Cardiovascular System Practice Questions

Q: Which of the following is the most immediate cardiovascular response to acute stress?

Increased heart rate. ***Increased heart rate*** - The **sympathetic nervous system** is immediately activated during acute stress, leading to a rapid release of **catecholamines** (epinephrine and norepinephrine). - These hormones directly stimulate the heart, causing an almost instantaneous increase in its **rate and contractility**. *Decreased heart rate* - A decreased heart rate, or **bradycardia**, is characteristic of a **parasympathetic response**, which aims to conserve energy and promote rest. - This is the opposite of the "fight-or-flight" response seen in acute stress. *Release of cortisol* - **Cortisol** is a steroid hormone released by the adrenal cortex as part of the **hypothalamic-pituitary-adrenal (HPA) axis** response to stress. - While important in the stress response, its release and effects are **slower** and more sustained compared to the immediate cardiovascular changes mediated by the sympathetic nervous system. *Decreased blood pressure* - Acute stress typically causes an **increase in blood pressure** due to **vasoconstriction** and increased cardiac output. - A decrease in blood pressure (hypotension) would be an atypical and potentially dangerous response to acute stress, often indicative of shock or other severe conditions.

Q: By what percentage can cardiac output increase in a healthy adult during intense physical activity compared to resting levels?

300 - 400 %. ***300 - 400 %*** - In a healthy adult, **cardiac output** can increase remarkably during intense physical activity. - The heart can increase its output by **3 to 4 times** (or 300-400%) above resting levels during peak exertion. - At rest, cardiac output is approximately **5 L/min**, but during maximal exercise, it can reach **20-25 L/min** in well-conditioned individuals. - This represents the heart's **reserve capacity** to meet increased metabolic demands during exercise. *0 - 50 %* - This range represents a very **limited increase** in cardiac output and would be indicative of significant underlying cardiac impairment or **heart failure**. - A healthy individual would experience a much greater increase in cardiac output during intense activity than this small percentage. *50 - 100 %* - This range also suggests a **suboptimal cardiac response** for a healthy adult undergoing intense physical activity. - While some increase is present, it does not reflect the full capacity of a healthy cardiovascular system to adapt to extreme demands. *100 - 200 %* - While a 100-200% increase is substantial, it still **underestimates the maximal capacity** achievable in a healthy, well-conditioned individual during intense physical exertion. - The heart has a greater capacity for increasing its output to meet metabolic demands during peak exercise.

Q: When blood pressure falls below 40 mm Hg, which mechanism of regulation is working?

CNS ischemic reflex. ***CNS ischemic reflex*** - The **CNS ischemic reflex** is activated when blood pressure falls below 60 mmHg, with maximal activation below 40 mmHg, indicating severe ischemia in the brain's vasomotor center. - This reflex elicits an intense **sympathetic vasoconstriction** and cardiac stimulation to prioritize blood flow to the brain even at the expense of other organs. *Chemoreceptor response* - The chemoreceptor reflex is primarily activated by a decrease in **arterial pO2**, an increase in **pCO2**, or a decrease in **pH**. - While it can increase blood pressure, it is not the primary or most profound regulatory mechanism specifically triggered by extremely low blood pressure (below 40 mmHg) to prevent brain ischemia. *Baroreceptor response* - **Baroreceptors** are most sensitive to changes in blood pressure within the normal to moderately hypotensive range (e.g., 60-180 mmHg). - At very low pressures (below 40-50 mmHg), baroreceptors become **less sensitive** or "saturated," and their effectiveness in raising blood pressure significantly diminishes. *None of the options* - This option is incorrect because the **CNS ischemic reflex** specifically functions as a powerful, last-ditch mechanism to maintain cerebral blood flow during severe hypotension which is a life saving reflex during conditions like hemorrhage.

Q: Which of the following stimuli is primarily responsible for triggering the Bezold-Jarisch reflex?

Activation of cardiac C-fiber afferents. ***Activation of cardiac C-fiber afferents*** - The **Bezold-Jarisch reflex** is primarily triggered by stimulation of **cardiac mechanoreceptors and chemoreceptors** located in the ventricles, particularly the inferoposterior wall of the left ventricle. - These receptors have **unmyelinated vagal C-fiber afferents** that transmit signals to the medullary cardiovascular centers. - Activation of these afferents leads to the characteristic triad: **bradycardia, hypotension, and vasodilation** via increased parasympathetic activity and withdrawal of sympathetic tone. - Common triggers include vigorous ventricular contraction with decreased filling, certain drugs (veratridine), myocardial ischemia (especially inferior wall MI), and reperfusion. *Decreased venous return* - While **decreased venous return** creates the hemodynamic context (ventricular underfilling) that can lead to vigorous contraction of a relatively empty ventricle, it is not itself the *trigger* of the reflex. - The actual trigger is the activation of the ventricular receptors sensing this abnormal contraction pattern, which then signal via C-fiber afferents. - Decreased venous return alone, without receptor activation, would not produce the reflex. *Parasympathetic withdrawal* - **Parasympathetic withdrawal** would cause tachycardia and is opposite to the Bezold-Jarisch reflex, which involves **increased parasympathetic activity**. - This is a compensatory response seen in other reflexes like the baroreceptor reflex during hypotension. *Increased sympathetic stimulation* - **Increased sympathetic stimulation** produces tachycardia, increased contractility, and vasoconstriction—effects opposite to the Bezold-Jarisch reflex. - The reflex actually causes **sympathetic withdrawal** along with parasympathetic activation.

Q: All are true about baroreceptors, except?

Stimulated when BP decreases. ***Stimulated when BP decreases*** - Baroreceptors are **stretch receptors** located in the walls of the carotid sinus and aortic arch. - They are stimulated by an **increase in blood pressure (BP)**, which causes stretching of the arterial walls, not by a decrease. *Afferents are through sino-aortic nerves* - This statement is **true**. Afferent impulses from the carotid sinus baroreceptors travel via the **glossopharyngeal nerve (IX)**, and those from the aortic arch baroreceptors travel via the **vagus nerve (X)**. - These nerves collectively form the **sino-aortic nerves** that relay information to the brainstem. *Stimulation causes increased vagal discharge* - This statement is **true**. When baroreceptors are stimulated by **increased BP**, they send signals to the cardiovascular center in the medulla. - This leads to increased **parasympathetic (vagal) outflow** to the heart, causing a decrease in heart rate and contractility, and inhibition of sympathetic outflow. *Stimulate nucleus ambiguus* - This statement is **true**. The **nucleus ambiguus** is a brainstem nucleus that contains the cell bodies of preganglionic parasympathetic neurons that contribute to the vagus nerve. - Baroreceptor stimulation leads to activation of the nucleus ambiguus, thereby increasing **vagal output** to the heart.

Q: What is the critical closing pressure in the context of capillary physiology?

Pressure below which capillaries close. ***Pressure below which capillaries close*** - The **critical closing pressure** is the lowest pressure at which blood can flow through a capillary. - When the luminal pressure falls below this threshold, the capillary collapses due to **extrinsic tissue pressure** and intrinsic vascular tone. *Arterial pressure minus venous pressure* - This calculation represents the **arteriovenous pressure gradient**, which drives blood flow through a vascular bed. - It does not directly define the point at which capillaries collapse. *Capillary pressure minus venous pressure* - This difference primarily influences filtration and reabsorption of fluids across the capillary wall. - It is not directly related to the **critical closing pressure** of the capillaries. *None of the options* - This is incorrect as one of the provided options accurately defines the **critical closing pressure**.

Q: What is the role of gap junctions in cardiac muscle function?

Facilitate impulse transmission between cardiac myocytes. ***Facilitate impulse transmission between cardiac myocytes*** - **Gap junctions** are specialized channels between adjacent cells that allow for direct communication and rapid movement of **ions** and small molecules. - In cardiac muscle, they form an essential part of **intercalated discs**, enabling the heart to function as a **syncytium** by allowing electrical impulses to spread quickly from one myocyte to another. *Are not found in cardiac muscles* - This statement is incorrect; **gap junctions** are a defining feature of **cardiac muscle** and are crucial for its coordinated contraction. - They are located within the **intercalated discs** that connect individual cardiac muscle cells. *Are not found in smooth muscles* - This statement is incorrect; **gap junctions** are indeed found in **smooth muscle**, particularly in single-unit smooth muscle, where they contribute to synchronized contractions, such as in the **gastrointestinal tract**. - They allow for the rapid propagation of electrical signals, leading to coordinated muscle activity. *Have no significant role in cardiac muscle function* - This statement is incorrect; **gap junctions** play a critically significant role in cardiac muscle function by ensuring the **rapid and synchronized spread of electrical impulses**. - Without functional gap junctions, the heart would not be able to contract efficiently or effectively as a pump.

Q: What is the blood supply of the liver in ml/min/100g?

50-60 ml/min/100g. ***50-60 ml/min/100g*** - The liver receives a substantial blood supply, but when expressed per 100 grams of tissue, the value is around **50-60 mL/min/100g**. This demonstrates the organ's high metabolic demand. - This value represents the total blood flow from both the **hepatic artery** and the **portal vein** per unit weight of liver tissue. *1500-2000 ml/min/100g* - This value is extremely high and does not accurately represent the **blood flow per 100g of liver tissue**. Such a high flow rate would imply an unrealistic perfusion. - While the total blood flow to the liver is large, it's not at this magnitude when normalized to tissue weight. *1000-1500 ml/min/100g* - This range is closer to the **total blood flow to the entire liver** (1000-1800 ml/min), not the blood flow per 100 grams of tissue. - It's crucial to differentiate between total organ flow and flow density (per 100g). *250-300 ml/min/100g* - This value is significantly higher than the actual blood supply per 100g of liver tissue, suggesting an overestimation of the **perfusion density**. - While the liver is highly perfused, this rate is not physiologically accurate when normalized to the tissue weight.

Q: In a healthy person, arterial baroreceptor activity is seen at what stage of the cardiac cycle?

Both. ***Both*** - Baroreceptors respond to changes in **arterial pressure**, which fluctuates throughout both systole and diastole. - The baroreflex mechanism is continuously active, monitoring and adjusting blood pressure through changes in **heart rate**, **contractility**, and **vascular resistance** during both phases of the cardiac cycle. *Systole* - While baroreceptors are active during systole due to the **rise in arterial pressure**, they are not exclusively active during this phase. - Their primary role is to detect and respond to the **peak pressure** changes that occur during **ejection**, but their activity extends beyond this. *Diastole* - Baroreceptors continue to fire during diastole, albeit at a lower rate, as blood pressure falls; however, their activity is not limited to this phase alone. - They monitor the **decline in pressure** to help regulate the overall mean arterial pressure, not just the trough. *None of the options* - This option is incorrect because arterial baroreceptors are indeed active and crucial for blood pressure regulation throughout the entire cardiac cycle, encompassing both systole and diastole. - Their continuous monitoring is essential for maintaining **hemodynamic stability**.

Q: What is the normal cerebral blood flow in milliliters per minute for a healthy adult?

750 ml/min. ***750 ml/min*** - The brain receives approximately **15% of the cardiac output**, which for an average adult with a cardiac output of 5 L/min (5000 ml/min) translates to about **750 ml/min**. - This flow rate is essential to meet the high metabolic demands of the brain, which consumes about **20% of the body's total oxygen**. - For reference, this corresponds to approximately **50-55 ml/100g/min** when normalized to brain tissue weight. *55 ml/min* - This value represents the **cerebral blood flow per 100 grams of brain tissue** (50-55 ml/100g/min), not the **total cerebral blood flow**. - As a total flow value, 55 ml/min would be severely **inadequate** for the entire brain (~1400g) and would lead to immediate **ischemia** and neurological dysfunction. *150 ml/min* - While higher than 55 ml/min, this rate is still **grossly insufficient** to maintain the metabolic needs of the entire adult brain. - Such a low total flow would result in widespread **cerebral hypoperfusion** and severe neurological deficits. *1000 ml/min* - Although the brain has significant blood flow, 1000 ml/min is generally **higher than the normal average** for a healthy adult at rest. - The normal range is typically **750-800 ml/min**; sustained flow at 1000 ml/min might be seen in hyperemia or certain physiological states but is not the typical baseline.

Question 1

Which of the following is the most immediate cardiovascular response to acute stress?

Accepted Answer

Increased heart rate

Answer

Decreased heart rate

Answer

Release of cortisol

Answer

Decreased blood pressure

Question 2

By what percentage can cardiac output increase in a healthy adult during intense physical activity compared to resting levels?

Accepted Answer

300 - 400 %

Answer

0 - 50 %

Answer

50 - 100 %

Answer

100 - 200 %

Question 3

When blood pressure falls below 40 mm Hg, which mechanism of regulation is working?

Accepted Answer

CNS ischemic reflex

Answer

Chemoreceptor response

Answer

Baroreceptor response

Answer

None of the options

Question 4

Which of the following stimuli is primarily responsible for triggering the Bezold-Jarisch reflex?

Accepted Answer

Activation of cardiac C-fiber afferents

Answer

Parasympathetic withdrawal

Answer

Decreased venous return

Answer

Increased sympathetic stimulation

Question 5

All are true about baroreceptors, except?

Accepted Answer

Stimulated when BP decreases

Answer

Stimulation causes increased vagal discharge

Answer

Stimulate nucleus ambiguus

Answer

Afferents are through sino-aortic nerves

Question 6

What is the critical closing pressure in the context of capillary physiology?

Accepted Answer

Pressure below which capillaries close

Answer

Arterial pressure minus venous pressure

Answer

Capillary pressure minus venous pressure

Answer

None of the options

Question 7

What is the role of gap junctions in cardiac muscle function?

Accepted Answer

Facilitate impulse transmission between cardiac myocytes

Answer

Are not found in cardiac muscles

Answer

Are not found in smooth muscles

Answer

Have no significant role in cardiac muscle function

Question 8

What is the blood supply of the liver in ml/min/100g?

Accepted Answer

50-60 ml/min/100g

Answer

1500-2000 ml/min/100g

Answer

1000-1500 ml/min/100g

Answer

250-300 ml/min/100g

Question 9

In a healthy person, arterial baroreceptor activity is seen at what stage of the cardiac cycle?

Accepted Answer

Both

Answer

None of the options

Answer

Diastole

Answer

Systole

Question 10

What is the normal cerebral blood flow in milliliters per minute for a healthy adult?

Accepted Answer

750 ml/min

Answer

55 ml/min

Answer

150 ml/min

Answer

1000 ml/min

Cardiovascular System — MCQs

Cardiovascular System — MCQs

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