Module: Cardiovascular system (module 11) Name: Duration: Week:1 External feature of the heart 1.

The following are TRUE regarding the surfaces of the heart EXCEPT: A. It has sternocostal, posterior and diaphragmatic surface B. The base is directed posteriorly and the sternocostal surface is directed anteriorly C. The apex is directed forward, upward and to the left D. The lower border of the heart is formed by right ventricle and left ventricle (at the apex) 2. Choose the correct statement regarding sternocostal surface: iFormed by the 4 chamber mainly the left ventricle iiIt is bounded by 4 borders iiiAtrioventricular goove and anterior interventricular groove are present in this surface ivThe middle cardiac vein is present in the ant. interventricular goove A. I & II ONLY B. I, II, AND III C. II & III D. III AND IV 3. Choose the correct answer regarding the diaphragmatic surface of the heart: A. It is formed mainly by the left ventricle and rest on the diaphragm B. This surface rectangular in shape and formed mainly by the right ventricle C. Coronary sinus can be seen in the post. Interventricular groove D. The great cardiac vein together with ant. Interventricular artery are present here 4. Choose the correct statement: iThe left atrium is the least part contribute to the anterior surface of the heart iiMost of the left ventricle is anterior and the right ventricle is posterior iiiThe left ventricle and left auricle formed the left border of the heart ivThe left atrium formed the base of the heart A. I ONLY B. I, II AND III C. I, III AND IV D. III AND IV 5. Identify the four points indicated to the surface of the heart. Choose the correct one: A. Upper border of the left 3rd costal cartilage, 1 inch from the middle line B. Lower border of left 2nd costal cartilage, 2 inc from the middle line C. Right six intercostals space half inch from the middle line D. Left fifth intercostals space 3.5 inches from middle line

Internal features of heart. 6. Below are all about right atrium EXCEPT A. Separated from left atrium by interatrial septa B. Its posterior part receive venous blood from all part of body C. Contain smooth and rough part D. Its rough part is made of pectinate muscle 7. Below are all opening into right atrium I Superior vena cava II Inferior vena cava III Coronary sinus IV Anterior cardiac artery A. I, II, III B. II, III, IV C. I, III, IV D. All of the above True or False 8. Rough part left ventricle is named pulmonary infundibulum ( True / False ) 9. Inflow tract is always rough to act as brake for blood flow ( True / False ) 10. Moderator band prevent over distension of right ventricle ( True / False ) Histology of the Heart 11. Choose the false statement regarding the tunics of the heart wall: A. Endocardium is lined with an endothelial layer of flattened columnar cells B. Subendothelial layer of connective tissue unites the myocardium with the subendothelial layer C. Some cardiac myocytes have an endocrine secretory function as they secrete peptides D. Epicardium is covered externally by squamous epithelium (mesothelium) 12. All the following are true regarding the cardiac muscle except: A. Consists of long cylindrical fibers which branch extensively and join together B. Connected by straightly placed strands called the protoplasmic bridges C. Each fiber is composed of several long cuboidal cellular units joined by intercalated discs D. Each cell has a large, oval, central and single nucleus 13. Fine structures of cardiac muscle fibers are describes as the following except: A. Their sarcoplasm is more abundant and have much more numerous mitochondria B. Myofibrils are perfectly in register with one another hence fibers appear darkly striated C. Lipofuscin pigments may also present especially in old age D. In right atrium there is presence of spherical membrane-bounded secretory granules 14. Which is the false statement regarding T tubules and sarcoplasmic reticulum in cardiac muscle? A. T tubules are larger,more numerous and located at A-I junctions instead of Z-lines B. T tubules represent inward extensions of the extracellular space C. Terminal cisternae and triads are not present but instead they possess diads D. Corbular sarcoplasmic reticulum is the small saccules connected directly to the sarcolemma

15. Purkinje muscle fibers are all the following except: A. Modified cardiac muscle fibers in interventricular septum B. Specialized to conduct cardiac impulse four and half times faster than typical cardiac muscle C. Shorter, larger, paler with more myofibrils limited to the periphery D. Contain more sarcoplasm and their nuclei are more rounded PROPERTIES OF THE HEART (1) 16. What is the definition of rythmicity? A. The ability of the cardiac muscles to generate action potential spontaneously and regularly B. The ability of the cardiac muscles to be excited by adequate stimuli and respond by generating an action potential followed by contraction C. The ability of the cardiac muscles to transmit excitation waves that originate from SA node to all parts of the heart D. The ability of the cardiac muscle to convert chemical energy into mechanical form of energy 17. All the following is the channels that present in cardiac muscle action potential EXCEPT A. Voltage-gated K+ channel B. Funny leaking Na+ channel C. L-type Ca2+ channel D. Voltage-gated Na+ channel 18. Which of the following is FALSE? A. Slow response action potential depolarized by Na+ influx only B. Fast action potential depolarized by Na+ influx C. Prepotential has no phase 1 and 2 D. Plateau phase due to slow but prolong Ca2+ influx that opposed K+ efflux True or False 19. In resting state; all channels are closed. (TRUE / FALSE) 20. Migration of Ca2+ ions from non-contractile cardiac muscle to contractile cardiac muscle caused opening of voltage-gated Na+ channels leading to rapid depolarization of contractile cardiac muscle. (TRUE / FALSE) Blood supply of the heart 21. Where is the beginning of right coronary artery? A. Left posterior aortic sinus of ascending aorta B. Anterior aortic sinus of ascending aorta C. Right posterior aortic sinus of ascending aorta D. Posterior aortic sinus of ascending aorta 22. Which of the following is the branch of right coronary artery? A. Anterior interventricular artery B. Circumflex artery C. Posterior interventricular artery D. pulmonary artery

23. Where is the beginning of left coronary artery? A. Left posterior aortic sinus of ascending aorta B. Anterior aortic sinus of ascending aorta C. Right posterior aortic sinus of ascending aorta D. Posterior aortic sinus of ascending aorta 24. Which of the following is the branch of left coronary artery? A. Pulmonary artery B. Posterior interventricular artery C. Anterior interventricular artery D. Right marginal branch 25. All the vein are drained into coronary sinus except? A. Small cardiac vein B. Great cardiac vein C. Middle cardiac vein D. Anterior cardiac vein 26. Choose the correct statement regarding tunica adventitia in large elastic artery A. Contains many blood vessels B. It is not evident C. Contains elastic, collagenous and some smooth muscle fiber D. It is a thin coat that makes 20% of the thickness of the wall True and false: Regarding to arch of aorta; 27. It begins at the left upper side of sternum (true/false) 28. One of the b ranches of brachiocephalic trunk is left subclavian artery (true/false) 29. Ascending aorta is the common site for aneurysm(true/false) Regarding descending aorta; 30. It is related posteriorly to thoracic duct and azygos vein Mediastinum 31. The following are the contents of superior mediastinum EXCEPT: A. Oesophagus B. Thoracic duct C. Thymus gland D. Trachea 32. The ascending aorta arise from the left ventricle, will terminate at A. 3rd left intercostal space B. 3rd right costal cartilage C. 2nd right costal cartilage D. 2nd right intercostal space

33. Which of the following forming the inferior relation with arch of the aorta? I. Deep cardiac plexus II. Left recurrent laryngeal nerve III. Ligamentum arteriosum IV. Bifurcation of pulmonary trunk A. B. C. D. I, II and III I, II and IV I, III and IV II, III and IV 34. Following are the parietal branches of descending aorta: Subcostal artery Phrenic branch Posterior intercoastal artery Mediastinal branch I, II and III I,II and IV I,IIII and IV II, III and IV

I. II. III. IV. A. B. C. D.

35. Which of the following is false regarding the structure related to descending aorta : A. Thoracic duct : right to it B. Right lung : Left to it C. Oesophagus : Anterior to it D. Anterior longitudinal ligament : Posterior to it 36. The following are true regarding effect of changes in extracellular ion concentration on cardiac properties EXCEPT A. Hypokalemia decreases cell excitability B. Hyperkalemia increases cell excitability C. The type of action potential is of slow type in hyperkalemia D. Activation of calcium and potassium channels increases excitability 37. The following statements are true EXCEPT A. Excessive increase in extracellular calcium causes cessation of relaxation B. Calcium rigors occur in increased extracellular calcium level C. More binding sites are uncovered which increases force of contraction in high level of extracellular calcium D. Release of intracellular calcium from sarcoplasmic reticulum is augmented by diminishing extracellular calcium

38. Choose the FALSE statement I) Frank-Starling law of the heart demonstrates one of the protective mechanism of heart in circulatory system II) Heart pumps all blood that comes to it with excessive stasis of blood in the veins III) Overstretched elastic fibers may cause excessive stasis of blood in the veins IV) The non-innervated cardiac pumping is based on the intrinsic ability of heart to adapt to changing venous blood returned to it A. I & II B. II C. III D. IV 39. The following are true EXCEPT I) During isometric contraction, the myocardial fibers contract without shortening II) Tension developed in the chambers increases during isotonic contraction III) High pressure inside the heart open the cardiac valves IV) Volume of heart decreases in isometric contraction A. I & II B. II & III C. II & IV D. III & IV 40. Choose the FALSE statement A. Purkinje fibers conducts impulse with the highest speed B. A-V nodal delay is important to make sure the complete emptying of atria before ventricular contraction starts C. Tetanus is prevented by the long absolute refractory period of the cardiac muscle D. The idioventricular rhythm has the highest rhythmicity MEDIASTINUM (2) 41. Which of the following statement is false about the mediastinum? A. It lies between the two lungs B. It can be divided in to superior and inferior mediastinum by an imaginary line passing between the sternal angle anteriorly and the third thoracic vertebrae posteriorly C. It is the middle region in the thoracic cavity D. The inferior mediastinum can be subdivided into anterior, middle and posterior mediastinum 42. All of the following structures are the contents of superior mediastinum except A. Lymph nodes B. Phrenic nerve C. Thoracic duct D. Arch of the aorta and its branches 43. All of the following answers are true about the ascending aorta except A. It terminate at the second right costal cartilage B. The left coronary artery arises from the right posterior aortic sinus C. It arises from the left ventricle, at the level of third left intercostal space D. It has three sinuses, anterior, left posterior and right posterior

44. Which of the following is true about the descending aorta? A. It begin at the level of the second thoracic vertebra B. It terminate at the level of twelve cervical vertebra C. It is related on the right side by the thoracic duct and azygos vein D. It gives visceral branches only 45. All of the following statement is true about the arch of the aorta except A. It begin at the right border of the sternum, at the level of second costal cartilage B. Its branches are the brachiocephalic trunk, left common carotid artery and left subclavian artery C. It lies in its entire course within the superior mediastinum D. It end at the left side of the upper border of the fourth thoracic vertebra PHYSIOLOGY: ECG (1) 46. All the following pairs are correct EXCEPT A. Recorder = electrodes B. Record = lead C. Leads = electrical pictures D. 12 leads = record 47. Normal ECG composed all the following waves EXCEPT A. P wave B. Q wave C. T wave D. S wave E. W wave 48. Which of the following pair of sites involved in Einthovens triangle (Bipolar Limb Leads)? ILeft arm + Right arm IILeft leg + Right arm IIILeft leg + Left arm IVRight leg + Right arm VRight leg + Left arm A. B. C. D. I, II and III I, II and IV III, IV and V I, III and IV

49. Which of the following is CORECT regarding unipolar leads? A. It involves only chest leads B. It has indifference electrode that stays at zero potential C. Unipolar chest leads is augmented but no configuration change D. aVR is inverted due to its left side position E. In V1 the QRS recordings of the normal heart are mainly positive

50. Choose the CORRECT statements below. IIf depolarization wave travelling towards the electrodes, a positive wave is recorded IIIf repolarization wave travelling towards the electrodes, a negative wave is recorded IIIIf repolarization wave travelling away from electrodes, a positive wave is recorded IVIf depolarization wave travelling away from electrodes, a negative wave is recorded VWhen there is complete polarization or depolarization no potential is recorded A. B. C. D. E. I, III and IV II, III and IV I, II, III and IV I, II, III, IV and V II, III, IV and V

ECG 2 51. Which of the following is CORRECT regarding P wave? I. Has duration of 0.1s II. Has amplitude of 0.1-0.3mV III. In atrial hypertrophy, P wave is large. IV. It starts synchronously with atrial contraction A. I and II B. II and III C. I,III and IV D. I,II and III 52. Choose the CORRECT statement. A. Q wave is the first negative wave caused by depolarization of left ventricle. B. R wave is produced by depolarization wave, directed downward and to the right. C. S wave is produced by depolarization of first segment of myocardium. D. In muscular exercise, duration of QRS complex is prolonged. 53. T wave is flattened in A. Ventricular septal defect B. Old age C. Myocardial ischemia D. Ventricular hypertrophy 54. Which of the following is WRONG regarding PR interval? A. Represent atrial depolarization and conduction through SA node and AV node. B. Normal duration is 0.12-0.2s. C. Impaired conduction from atrium to ventricle can prolong its interval. D. Prolonged interval indicates 1st degree heart block. 55. Q-T interval is shortened in A. Hypocalcemia B. Hypokalemia C. Hypercalcemia D. Hyperkalemia

56. Azygos system connected the : A. Pulmonary trunk and superior vena cava B. Superior vena cava and inferior hemiazygos vein C. Superior vena cava and inferior vena cava D. Inferior vena cava and pulmonary veins 57. Superior vena cava is formed by the union of : A. Right brachiocephalic vein and internal jugular vein B. Right and left brachiocephalic vein C. Subclavian vein and internal jugular vein D. None of above 58. The following correct about azygos vein EXCEPT: A. It is posterior to oesophagus B. It starts in abdomen from the back SVC C. It gives superior and inferior hemiazygos vein D. It enters the thorax through the aortic opening 59. IVC pierced the diaphragm at the level of : A. ribs 8 B. T12 C. T6 D. T8 60. The following are tributaries of azygos vein : I. Highest intercostal vein II. Hemiazygos vein III. Acessory hemiazygos vein IV. Second and third left posterior intercostal veins A. I AND II B. II AND III C. III AND IV D. II AND IV Histology of Blood Vessels 61. Arteries are classified according to their size into: I large arteries II medium arteries III arterioles IV capillaries A B C D I, II and III I, II and IV I, lll and IV ll, lll and lV

62. Tunica intima of the conducting arteries have the following structure except: A. Simple squamous epithelium B. Loose fibroelastic connective tissue C. Smooth muscle fiber D. NONE OF THESE ABOVE 63. The following statement about the tunica media of the distributing arteries are CORRECT except: A. Consist of circular oriented smooth muscle layers B. Makes 50% of the thickness of the wall C. Absent of elastic fiber between the smooth muscle fiber layer D. Smooth muscle fiber is more than that in large arteries 64. The following statement are correct regarding the medium sized arteries except: A. The percentage of tunica media and tunica adventitia is the same. B. Vasa vasorum is absent in the tunica adventitia C. The tunica intima has well developed internal elastic lamina D. There are definite external elastic lamina in between the tunica media and tunica adventitia.

Answer: 1.D(pg.3) 2.C(pg.3) 3.A(pg.4) 4.C(pg.5) 5.D(pg.13) 6.B 7.A 8.False 9.True 10.False 11.A(pg.59) 12.C(pg.60) 13.B(pg.61) 14.A(pg.61) 15.C(pg.64) 16.A 17.B 18.A 19.False 20.True 21.B 22.C 23.D 24.B 25.D 26.D(pg.68) 27.False 28.False 29.True 30.False 31.C 32.C 33.D 34.A 35.B 36.B 37.D 38.B 39.C 40.D 41.B(pg.30) 42.A(pg.30) 43.B(pg.31) 44.C(pg.33) 45.D(pg.32) 46.B(pg.92) 47.E(pg.92) 48.A(pg.94) 49.B(pg.94) 50.D(pg.93) 51.D(pg.96) 52.D(pg.97) 53.B(pg.97) 54.A(pg.98) 55.C(pg.98) 56.A 57.B 58.B 59.D 60.B 61.A(pg.65) 62.D(pg.66) 63.C(pg.67) 64.B(pg.67)