Multiple Choice Question (MCQ)

Session 7
1. A 80-year-old man has a history of chest pains (angina) and periods
of confusion. He entered the clinic after several episodes of syncope
while hauling lumber. On physical examination, the physician noted a
murmur during systole, and his carotid artery pulse was weak and had a
delayed upstroke. The ECG indicated left axis deviation (due to
ventricular hypertrophy). Cardiac catheterization yielded the pressure
volume loop below (pink).
Which below is/are the most likely cause/s underlying the patients
fainting spells during heavy exertion?

A. Increased pulse pressure

B. Venodilation
C. Decreased TPR
D. Inability to increase cardiac output
E. A and B
F. B and C
G. C and D
2. The fetal circulation differs from the neonate circulation in different
respects. Which of the following is a feature of a healthy fetal
circulation?

A. The umbilical vein carries deoxygenated blood.

B. Blood traverses the foramen ovale in a right to left
direction.
C. The ductus arteriosus allows blood to flows from
the aorta to the pulmonary artery.
D. The fetal pulmonary circulation is a low resistance
circulation.
E. The ductus venosus carries blood between the
umbilical vein and the aorta.
3. A 42 yr old gentleman developed moderate hypertension two years
earlier and was very non compliant with his medication. At
presentation, he had basic investigations for his hypertension and they
were all normal. He now presents with a two day history of sudden
onset of severe headaches, vomiting, transient slurring of speech and
double vision. His B.P. is 210 /130 m.m. Hg. He is found to have
papilloedema (swelling of the optic nerve disc) and for the first time
proteinuria is detected.
Which of the below diagnosis is most likley?

A. Primary hyperaldosteronism - (Conns syndrome)

B. Malignant hypertension
C. Hyperthyroidism
D. Renal artery stenosis
E. Left ventricular hypertrophy
4. A 56 yr old female has had poorly controlled hypertension for the past 24
years. She presents with weakness, dyspnoea while walking on the level over
the last four months. The dyspnoea was worsening in recent days and lying
flat aggravated it. She noticed that swelling of her legs, which was present for
some months, had also worsened. Examination revealed an ill looking lady,
mildly dyspnoeic, B.P. was 148/ 100 mm Hg, pulse 100 / min, regular rhythm
and normal volume. Her JVP was elevated. Moderate degree of bilateral
pitting oedema was present. The apex beat was in the 6th LICS ant. axillary
line. Heart sounds were normal and no murmurs were audible. Crepitations
were present in mid and lower zones of lungs, bilaterally. Her liver was
enlarged 6 cms below the R. costal margin.
Which mechanism is most likely responsible for her symptoms?

A. Overproduction of angiotensin II
B. Decreased end diastolic volume
C. Decreased plasma volume
D. Upregulation of beta receptors
E. Hepatic decompensation
5. You are at a restaurant with a friend who orders a meal of lobster.
About five minutes into enjoying her meal she suddenly becomes
nauseated and complains of itching of her lips. She collapses to the
ground, where she is noted to have developed generalised hives and
has periorbital oedema and lip swelling. While awaiting the ambulance
and seeking some appropriate treatment for her, a check of her vital
signs reveals that her BP is 116/44 and she has a bounding pulse with
a rate of 110/min. She is noted to have warm extremities.
Which pathophysiological feature is present at the stage of this
patients presentation?

A. Obstruction to blood flow

B. Pump failure
C. Loss of blood
D. Significant endotoxins likely to have caused shock
E. Massive decrease in total peripheral resistance
likely to have occurred
6. A 24 yr old patient was brought by ambulance to the emergency
department with a stab wound to the right hypochondrial
abdominal region. The patient was restless with a BP of 96/82,
pulse of 128 /min. The pulse was low volume and the patient was
sweating with cold extremities.
The correct approach to treatment would be to

A. Improve his myocardial contractility by

giving dobutamine
B. Reduce his preload by giving nitrates
C. Control is heart rate with beta blockers
D. Increase his preload by giving isotonic
saline
E. Reduce his afterload by giving a calcium
channel blocker
7. A 35-year-old man was brought to the emergency department after
being involved in a motor vehicle accident in which he sustained a
severe loss of blood. On admission his BP was 80/40 mmHg and
despite all appropriate interventions, he died.
Which of the following is a major cause of death in severe
hemorrhagic shock?

A. Arrhythmias due to excessive sympathetic

activity
B. Massive fall in SVR due to underperfusion of
tissues
C. Bradycardia due to excessive parasympathetic
activation
D. Massive increase in mean arterial pressure
causing a cerebrovascular accident
Answers iMCQ 7 CVS Physiology
1.G

2. B

3. B

4. A

5. E

6. D

7. B