CVS 217 Qa

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CARDIOVASCULAR MODULE
CVS 217
Anatomy
BY
PROF. DR. HODA ELAASAR
PROFESSOR & HEAD OF ANATOMY DEPARTMENT

FACULTY OF MEDICINE - MTI
PROFESSOR OF ANATOMY
FACULTY OF MEDICINE - CAIRO UNIVERSITY
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Cardiovascular module
1. Pericardium:
a. Examine the boundaries of the transverse and oblique
sinuses of the pericardium.
b. Write on the dotted lines the marked features.
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1. The Heart:
a. Examine the shape, position, external features, borders
and surfaces of the heart.
b. Examine the internal structures of each chamber of the
heat.
c. Compare between right and left ventricle.
d. Detect the origin of the right and left coronary arteries
and their course and branches.
e. Detect the coronary sinus of the heart and its tributaries.
f. Write on the dotted lines the marked features.
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2. Large vessels of the thorax:
a. Detect the beginning and the level of bifurcation of the
pulmonary trunk.
b. Examine the beginning of the ascending, arch and
descending thoracic aorta and their branches.
c. Examine the level of union of the right and left
brachiocephalic veins to form the SVC and their
tributaries.
d. Write on the dotted lines the marked features.
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3. Large vessels of upper limb:
a. Trace the beginning, course and end of the axillary ,
brachial, radial and ulnar arteries and their branches.
b. Examine the important relations of the previous arteries.
c. Examine the site of the superficial and deep palmar
arches in the hand.
d. Trace the axillary, cephalic and basilic veins and their
termination.
e. Notice the median cubital vein and its deep relations.
f. Write on the dotted lines the marked features.
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4. Large vessels of lower limb:
a. Trace the beginning, course and end of the femoral,
popliteal posterior tibial, peroneal, anterior tibial and
dorsalis pedis arteries and their branches.
b. Examine the important relations and branches of the
previous arteries.
c. Trace the course of the long and short saphenous veins
and the accompanied nerves.
d. Trace the course of the femoral and popliteal veins and
their tributaries.
e. Write on the dotted lines the marked features.
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Self-Assessment Questions
A. Short assay questions:
1. Give the boundaries of th transverse sinus of the

pericardium.
2. Describe the boundaries of the oblique sinus of the

pericardium.
3. Mention the arterial and nerve supply of the fibrous

pericardium.
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4. What are the parts of the heart which form its sternocostal
and diaphragmatic surfaces.
5. Give the orifices of the right atrium.
6. Compare between the right and left ventricle.
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7. Give the origin and branches of the right coronary artery.
8. Determine the site of the coronary sinus and its tributaries.
9. Determine the location of the S.A. node and the A.V. node
and their arterial supply.
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10. Give the surface anatomy of the borders and valves of the
heart.
11. Give the areas of the heart supplied by the left coronary
artery.
12. Why blockage of one of the branches of the right coronary

artery may cause arrhythmias (irregularities in heart beat).
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13. Give the location and branches of the superficial cardiac
plexus.
14. Describe the beginning, course, end and branches of the

pulmonary trunk.
15. Mention the left anterior relation of the arch of aorta.
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16. Give the course and branches of the descending thoracic
aorta.
17. Determine the level of the beginning and termination of the

SVC and its tributaries.
18. Give the branches of the arteries sharing in the

anastomosis around scapula and its significance.
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19. Give the branches of the second part of the axillary artery.
20. Determine the beginning, course and termination of the

brachial artery.
21. Give the branches of the ulnar artery in the forearm
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22. Determine the branches of the arteries sharing in the
anastomosis around the elbow.
23. Describe the course and the arteries sharing in the

formation of the superficial palmar arch. Determine its
surface anatomy.
24. Give the beginning, course, tributaries and termination of

the axillary vein
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25. Give the beginning, course, branches and end of femoral
artery.
26. Mention the deep relations of the popliteal artery and its
branches.
27. Give the course and surface anatomy of the dorsalis

pedis artery.
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28. Give the course, tributaries and termination of the long
saphenous vein.
29. Give the location, afferents and efferents of the posterior

group of axillary lymph nodes.
30. Explain the stage of development of the interatrial septum

and the related congenital anomalies.
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31. Explain the congenital anomalies related to bulbus cordis.
32. Give the fate of the aortic arches.
33. Mention early changes in the circulation after birth.
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B. MCQs:
1. Regarding the fibrous pericardium, it is innervated by:
a. The cervical plexus
b. The vagus nerve
c. The phrenic nerve
d. The sympathetic chain
2. Regarding the function of the pericardium, one of the following
statements is correct:
a. The serous pericardium keeps the mouth of large vessels open.

b. The oblique sinus acts as a bursa behind the left atrium.
c. The oblique sinus allows distension of ascending aorta during
diastole.
d. The transverse sinus allows distension of oesophagus during
swallowing.
3. Regarding the nerve supply of the pericardium, choose the correct
answer:
a. Visceral layer of serous pericardium is supplied by the phrenic nerves

b. Fibrous pericardium is supplied by autonomic nerves
c. Fibrous pericardium is insensitive to pain of pericarditis
d. Parietal layer of serous pericardium is supplied by phrenic nerve
4. Regarding the transverse sinus of the pericardium, choose the correct
answer:
a. It is a passage between arterial and venous ends of the heart.
b. It is bounded in front by two atria.
c. It is bounded above and behind by the left pulmonary artery.
d. It is bounded below and behind by ascending aorta and pulmonary
trunk.
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5. Regarding the oblique sinus of the pericardium, one of the following
statements is correct:
a. It connects the right and left sides of the pericardial cavity

b. It is a blind recess between the right atrium and fibrous pericardium.
c. Below, the sinus is open into the pericardial cavity.
d. The entrance to the sinus is bounded by the S.V.C and the upper right
pulmonary vein.
6. Regarding the heart, choose the correct answer:
a. It lies in the middle mediastinum
b. Its base is formed by both atria mainly the right
c. Its apex is formed by both ventricles
d. Its right atrium receives four pulmonary veins
7. The inferior vena cava brings blood from the lower regions of the body
and empties into:
a. The right atrium
b. The left atrium
c. The left ventricle
d. The right ventricle
8. The atrio-ventricular groove of the heart lodges one of the following
vessels:
a. The anterior interventricular artery
b. The posterior interventricular artery
c. The right coronary artery
d. The right marginal artery
9. Regarding the conducting system of the heart, choose the correct
answer:
a. The S.A node is situated in the wall of the right atrium in front of the
opening of S.V.C
b. The S.A node is situated in the wall of the right atrium behind of the
opening of S.V.C
c. The S.A node is situated in the wall of right atrium in front of the
opening of I.V.C
d. The S.A node is situated in the wall of the right atrium behind of the
opening of I.V.C
10. Regarding the ascending aorta, choose the correct answer:
a. It begins opposite the 2nd left intercostal space
b. It begins opposite the 3rd left intercostal space
c. It begins opposite the 2nd right intercostal space
d. It begins opposite the 3rd right intercostal space
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11. Regarding the arch of aorta, choose the correct answer:
a. It begins at the 3rd right sternocostal junction
b. The right brachiocephalic vein runs along its upper border
c. The left brachiocephalic vein runs along its upper border
d. The left anterior aspect is related to the recurrent laryngeal nerve
12. Regarding the descending thoracic aorta, choose the correct answer:
a. It begins at the level of T12
b. It descends in the posterior mediastinum
c. It gives origin to the first posterior intercostal arteries
d. It gives the right bronchial artery directly
13. One of the following branches arises from ascending aorta:
a. Right coronary artery
b. Right common carotid artery
c. Right subclavian artery
d. Subcostal arteries
14. Regarding the beginning of arch of aorta, choose the correct answer:
a. It begins opposite the left 3rd intercostal space
b. It begins opposite the right 3rd intercostal space
c. It begins opposite the right 2nd sternocostal junction
d. It begins on the left side of the disc between T4-T5
15. One of the following branches arises from arch of aorta:
a. Posterior intercostal arteries
b. Right coronary artery
c. Left coronary artery
d. Left common carotid artery
16. Regarding the brachiocephalic veins, choose the correct answer:
a. They unite together to form the S.V.C behind the upper border of the
1st right costal cartilage
b. They unite together to form the S.V.C behind the lower border of the
1st right costal cartilage
c. They unite together to form the S.V.C behind the upper border of the
2nd right costal cartilage
d. They unite together to form the S.V.C behind the lower border of the
2nd right costal cartilage
17. Regarding the S.V.C, choose the correct answer:
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a. It measures about 2 inches
b. It measures about 3 inches
c. It measures about 4 inches
d. It measures about 5 inches
18. One of the following branches arises from the ulnar artery:
a. Common Interosseous artery.

b. Radial recurrent artery.
c. Anterior carpal artery.
d. Superficial palmar artery.
19. One of the followings is a branch of axillary artery:
a. Profunda brachii artery.
b. Subscapular artery.
c. Superior ulnar collateral.
d. Inferior ulnar collateral.
20. Regarding the ulnar artery, choose the correct answer:
a. It begins opposite the head of radius.
b. It ends by forming the deep palmar arch.
c. Its pulsation can be felt lateral to the flexor carpi ulnaris.
d. It gives the common interosseous artery.
21. Regarding the axillary artery, choose the correct answer:
a. It begins at the inner border of the first rib.
b. It ends at the lower border of the teres minor muscle.
c. It is divided into three parts by the pectoralis minor muscle.
d. Its third part is related medially to the median nerve.
22. Regarding the ulnar artery, one is correct:
a. It descends vertically on the medial side of the forearm lateral to the ulnar
nerve.
b. It enters the hand by passing deep to the flexor retinaculum.
c. It continues in the hand as the superficial palmar arch.
d. It supplies the thumb.
23. The following artery is a branch ulnar artery:
a. Radialis indicis.
b. Princeps pollicis.
c. Superficial palmar branch.
d. Anterior carpal artery.
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24. The following artery doesn't share in the anastomosis around the
elbow:
a. Radial recurrent artery.
b. Anterior circumflex humeral artery.
c. Anterior ulnar recurrent artery.
d. Posterior ulnar recurrent artery.
25. The radial artery in the anatomical snuff box passes on, choose the
correct bone(s):
a. Scaphoid.
b. Pisiform.
c. Trapezoid.
d. Capitate.
26. Branches of ulnar artery in the forearm, choose the correct answer:
a. Anterior ulnar recurrent.
b. Ulnar collateral artery.
c. Superficial palmar branch.
d. Nutrient branch to humerus.
27. Regarding the ulnar artery at the wrist and hand, mark the correct
answer:
a. Gives a deep palmar branch.
b. Gives radialis indicis artery.
c. Continues as anterior carpal arch.
d. Continues as deep palmar arch.
28. The subscapular artery, choose the correct answer:
a. Arises from the 2nd part of axillary artery.
b. Gives the posterior circumflex humeral artery.
c. Shares in anastomoses around surgical neck of humerus.
d. Gives circumflex scapular artery.
29. The brachial artery, choose the correct answer:
a. Starts at the distal border of teres major muscle.
b. Ends opposite the head of radius.
c. Descends on the medial side of the humerus.
d. It descends medial to ulnar nerve and bicipital aponeurosis.
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30. Profunda brachii artery, choose the correct answer:
a. Arises from third part of axillary artery.
b. Passes with the ulnar nerve in the spiral groove.
c. Descends between medial and long heads of triceps.
d. It supplies biceps brachii muscle.
31. Anastomosis around the lateral epicondyle of the elbow, choose the
correct answer:
a. Between brachial artery and both ulnar and radial arteries.
b. Anterior interosseous artery shares in the anastomosis.
c. Present on the front of the lateral epicondyle only.
d. Maintains free blood flow when the elbow is fully flexed.
32. Ligation of the posterior tibial artery at its origin would affect the
following branches:
a. Dorsalis pedis artery.
b. Lateral plantar artery.
c. Obturator artery.
d. Femoral artery.
33. Concerning the dorsalis pedis artery, choose the correct answer:
a. It is a continuation of the anterior tibial artery.
b. It enters the sole of the foot by passing between the two heads of the
second dorsal interosseouus muscle.
c. It can be palpated on the dorsum of the foot between the tendons of
tibialis anterior and the extensor hallucis brevis muscles.
d. It joins the medial plantar artery.
34. The peroneal artery is a branch of which artery:
a. Anterior tibial artery.
b. Popliteal artery.
c. Posterior tibial artery.
d. Arculate artery.
35. The arterial pulsation in the lower limb could be felt in:
a. Femoral artery just below and lateral to the pubic tubercle.
b. Popliteal artery when the knee joint is fully flexed.
c. Posterior tibial artery below and behind the lateral malleolus.
d. Dorsalis pedis artery on the dorsum of the foot.
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36. Regarding the veins of lower limb, choose the correct statement:
a. They are devoid of valves.
b. Small saphenous vein drains into great saphenous vein.
c. Femoral vein lies lateral to the femoral artery at the base of the femoral
triangle.
d. Great saphenous vein pierces cribriform fascia to enter femoral vein.
37. Regarding the veins of the lower limb, choose the correct answer:
a. Venae commitantes accompany the popliteal and femoral arteries.
b. The long saphenous vein ascends behind the medial malleolus.
c. Drainage of blood from deep veins is helped by contraction of the calf
muscles and arterial pulsation.
d. The perforating veins possess valves which direct the blood flow from
the deep to superficial veins.
38. Aortic arch IV forms the ……….on the right side of the embryo and
the ……….on the left.
a. Right subclavian artery, arch of aorta.

b. Ductus arteriosus, pulmonary Artery
c. Arch of aorta, pulmonary Artery
d. Arch of aorta, ductus arteriosus
39. During fetal life, in which of the following structures is the percent
hemoglobin/oxygen saturation level of fetal blood the lowest?
a. Right Atrium
b. Inferior Vena Cava
c. Umbilical Vein
d. Descending Aorta
40. Regarding the development of the heart tubes, mark one correct
statement:
a. They develop in the cardiogenic field cranial to the buccopharyngeal

membrane.
b. They lie ventral to the mid gut after folding of the embryonic disc.
c. Their dorsal mesocardium persists and does not degenerate.
d. After folding, their cranial parts are embedded in the septum transversum.
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41. Regarding the development of the heart, mark one correct statement:
a. Ostium secundum lies between the lower free margin of the septum
primum and the endocardial cushions.
b. Ostium primum appears in the upper part of the septum primum.
c. Septum secundum is an incomplete septum.
d. Septum primum and septum secundum fuse together after birth.
42. Regarding the development of the atria, mark one correct statement:
a. The rough part of the definitive right atrium is derived from the
absorbed part of sinus venosus.
b. The smooth part of the definitive right atrium is derived from the
absorbed pulmonary veins.
c. Foramen secundum is located in the upper part of the septum primum.
d. Foramen ovale allows passage of blood from left atrium to right atrium.
a. The sinus venosus shares in the development of the left atrium.

b. The left common cardinal vein becomes the oblique vein of left atrium.
c. The right horn of sinus venosus gives rise to the coronary sinus.
d. The absorbed pulmonary veins forms the posterior wall of the right
atrium.
44. Regarding the development of the bulbus cordis, mark one correct
statement:
a. Its proximal third forms trabeculated part of the left ventricle.

b. Its distal third forms the pulmonary trunk and ascending aorta
c. Its middle third forms trabeculated part of the right ventricle.
d. After folding of the heart tubes, it lies dorsal to the atria.
a. The common atrioventricular opening is divided into two by the

endocardial cushions.
b. The primitive common atrium is divided by a spiral septum.
c. Ectopia cordis is an abnormal right position of the heart.
d. Extension from endocardial cushions gives the muscular part of the
interventricular septum.
46. One of the following anomalies is a component of Fallot’s tetralogy:
a. Atrial septal defect.

b. Aortic stenosis.
c. Patent ductus arteriosus.
d. Hypertrophy of right ventricle.
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47. Regarding the development of aortic arches, mark one correct
statement:
a. The definitive adult aortic arch develops from the third left arch.
b. The fourth arch disappears completely during development.
c. The pulmonary arteries grow out from the sixth arches.
d. The ductus arteriosus is the dorsal part of the right sixth arch.
48. Regarding the development ofarteries, mark one correct statement:
a. Each aortic arch arises from the aortic sac and terminates in the dorsal
aorta.
b. The maxillary artery is derived from the second arch.
c. The distal part of the right sixth aortic arch persist as ductus arteriosus.
d. The left fourth aortic arch forms the proximal segment of left subclavian
artery.
49. The common carotid artery develops from:
a. The umbilical artery.
b. The third aortic arch.
c. The first aortic arch.
d. The vitelline artery.
50. Regarding the development of the arterial system, mark one correct
statement:
a. Originally, there are six pairs of aortic arches.
b. The sixth arch disappears on both sides.
c. The right fourth arch forms part of the arch of aorta.
d. The subclavian artery is derived from the second aortic arch.
51. Regarding the development of the arteries, mark one correct
statement:
a. Postductal coarcitation of aorta is usually accompanied by patent
ductus arteriosus.
b. The second aortic arch forms the common carotid artery.
c. The left 7th cervical intersegmental artery forms the maxillary artery.
d. The external carotid artery arises as a bud from the 3rd aortic arch.
52. The annulus fossa ovalis is a remnant of the:
a. Truncal septum.
b. Septum secondum.
c. Septum primum.
d. Inter ventricular septum.
53. The fossa ovalis is a remnant of the:
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a. Truncal septum.
b. Septum primum.
c. Conus septum
d. Inter ventricular septum
C. Fill in the blank:
1. The axillary artery begins at the outer border of the …………… and
ends at the lower border of the ……………
2. The third part of the axillary artery gives the …… , …… and ……
arteries.
3. The anastomosis around the scapula is formed of ……, …… and ……
arteries.
4. The brachial artery begins at the lower border of ….. as the
continuation of …….
5. The brachial artery ends in the cubital fossa at the level of the neck
of the ……. by dividing into ….. and ….. arteries.
6. The anastomosis in front of the lateral epicondyle is formed of ……
and …….
7. The anastomosis in front of the medial epicondyle is formed of ……
and …….
8. The anastomosis behind the lateral epicondyle is formed of …… and
…….
9. The anastomosis behind the medial epicondyle is formed of ……,
…… and …….
10. The cephalic vein pierces the deep fascia at the……groove, then
pierces the …… fascia to end in the …… vein.
11. The basilic vein begins at the …..…..… side of the dorsal venous arch
of the hand. It unites with the………… at the lower border of teres
major to form …………….
12. The ulnar artery continues in the hand as the …...……palmar arch,
while the radial artery continues as the …………. palmar arch.
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13. The superficial palmar arch lies at the level of the ……….... border of
a fully stretched (extended) thumb. The deep palmar arch lies at the
level of the ………….. border of a fully stretched (extended) thumb.
14. The ulnar artery descends ……......... to the flexor retinaculum, while
the median nerve passes ……………. to the retinaculum.
15. The ulnar artery shares in the anastomosis around the elbow by
……….. and …………… while the radial artery shares in the
anastomosis around the elbow by ……………..
16. The femoral artery enters the thigh behind the inguinal ligament at a
point midway between the …………… and …………………
17. The dorsalis pedis artery lies between the tendons of ………………
and …………..
18. The popliteal artery begins at ……………. and ends at
…………………….
19. The femoral artery has 3 superficial branches: ………………………,
……………………… and ………………………
20. The femoral artery has 2 deep branches ……………………… and
………………………
21. Anterior tibial artery begins at ……………………… and ends at
………………………
22. Anterior and posterior tibial recurrent arteries are branches from
…………………. artery while the peroneal artery is a branch from
……………………… artery.
23. The pericardium of the heart is formed of two parts …………… and
………………
24. The sinuses of the serous pericardium are …………………… and
……………………
25. The interventricular septum is supplied by two arteries
…………………… and …………………
26. The right coronary artery arises from …………………… aortic sinus
while the left coronary artery arises from …………………… aortic
sinus.
27. The right coronary artery gives ……………………
and………………………
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28. The left coronary artery gives …………………… and
………………………
29. In 80% of individuals the AVN receives its arterial supply from
……………………………… while in 20 % the AVN receives its arterial
supply from …………………… artery.
30. The AV bundle passes within ………………………… and its arterial
supply arise from …………………………
31. The cusps of the mitral valve are…………………… and
……………………
32. The cusps of the tricuspid valve are…………………, ……………… and
…………………
33. the coronary sinus is ……………cm in length and opens in
……………… atrium.
34. the coronary sinus drains the following tributaries …………………,
………………… and …………………
35. In the fetal heart, the foramen ovale allows the passage of blood from
the ……………. to the……………
36. The right horn of the sinus venosus forms the ……………… while its
left horn forms the ……..........
37. The truncus arteriosus is divided by a spiral septum into …………
and …………..
38. Persistent atrioventricular canal is always accompanied by both
…………….. and ……………... septal defects.
39. The third aortic arch gives the ………….. artery and the proximal part
of the ……………. artery.
40. The right limb of the aortic sac forms the ………….. artery, while its
left limb forms part of the …………….
41. The right fourth aortic arch forms a part of the …………… artery,
while the left fourth aortic arch forms a part of the …………….
42. The oxygenated blood coming from the placenta is carried to the
fetus by the ………… while the deoxygenated blood from the fetus is
carried to the placenta by the ……………
Cross Matching Questions:
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1. Select from column (B) the branch of the artery in column (A):
Column A Column B
1- Radial artery a) Subscapular artery
2- Ulnar artery b) Suprascapular artery
3- Brachial artery c) Princeps pollicis
4- Axillary artery d) Superior ulnar collateral
5- Subclavian artery e) Common interosseous
2. Match the origin of the following arteries:
(A) (B)
1- Internal thoracic artery a- Descending aorta
2- Lower 3 anterior intercostals arteries b- Ascending aorta
3- Pericardiophrenic artery c- Muscuophrenic aretry
4- Coronary arteries d- Subclavian artery
5- Left bronchial artery e- Internal mammary artery
3. Match each of the following congenital anomalies of the heart in column

(A) with its cause in column (B):
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A B
1. Fallot’s tetralogy. A. Results from failure of fusion of the

bulbar cushions.
2. Persistent atrioventricular B. Results from anterior displacement
canal of the bulbar septum.
3. Transposition of the great C. Result from excessive resorption of
vessels. septum primum.
4. Atrial septal defect. D. Results from failure of fusion of the
atrioventricular endocardial
cushions
5. Persistent truncus D. Results from failure of the bulbar
arteriosus septum to follow its normal spiral
course.
4. Match the origin of the following arteries:
A B
1- Femoral artery a- Internal iliac artery
2- Superficial epigastric artery b- External iliac artery
3- Dorsalis pedis artery c- Posterior tibial artery
4- Peroneal artery d- Femoral artery
5- Medial circumflex femoral e- Anterior tibial artery
f- Profunda femoris artery
5. Match each of the following arteries in column (A) with its

embryological origin in column (B):
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A B
1. Common carotid artery. A. Arises from the first aortic arch.

2. Left subclavian artery. B. Arises from the second aortic arch.
3. Pulmonary artery. C. Arises from the third aortic arch.
4. Maxillary artery. D. Arises from the left seventh cervical
intersegmental artery.
5. Hyoid artery. E. Arises from the six aortic arch.
6. Regarding the fetal circulation, match each of the following structures

in column (A) with its suitable function in column (B):
A B
1. Foramen ovale. A. Shunts blood from the left pulmonary artery

to the arch of aorta.
2. Ductus arteriosus. B. Transmits deoxygenated blood from\the fetus
to the placenta.
3. Ductus venosus C. Transmits blood from the right to the left atria.
4. Umbilical vein. A. Transmits oxygenated blood from the left
branch of portal vein to the inferior vena cava
5. Umbilical arteries. A. Transmits oxygenated blood from the

placenta to the fetus.
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CVS 217
Histology
BY
PROF. DR. GHADA FAROUK MOHAMED

PROFESSOR & HEAD OF HISTOLOGY AND CELL BIOLOGY DEPARTMENT
PROFESSOR OF HISTOLOGY AND CELL BIOLOGY

FACULTY OF MEDICINE - ASU
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CARDIOVASCULAR MCQ
1. Aorta is:
a) An elastic artery
b) A muscular artery
c) A medium sized artery
d) An arteriole
2. In medium sized artery, adventitia contains the following EXCEPT:

a) Smooth muscles
b) Collagen fibers
c) Elastic fibers
d) Vasa vasora
3. Longitudinal muscle fibers are found in:

a) Femoral artery
b) Femoral vein
c) Common carotid artery
d) Inferior vena cava
4. Fenestrated elastic lamina is found in:

a) Blood capillaries
b) Femoral vein
c) Common carotid artery
d) Inferior vena cava
5. Prominent internal elastic lamina is found in:

a) Aorta
b) Femoral vein
c) Basilar artery
d) Superior vena cava
6. Tunica media matrix is synthesized by:

a) Fibroblasts
b) Smooth muscle cells
c) Endothelial cells
d) Pericytes
7. Tunica intima in a blood vessel is:

a) The thickest layer
b) Lined by simple cuboidal cells
c) Rich smooth muscle
d) Having elastic fibers occasionally
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8. A medium sized artery:
a) Has thick tunica media
b) Is rich in elastic fiber content
c) Contains longitudinal smooth muscle
d) Lacks vasa vasora
9. The intima of the medium sized vein:

a) Has internal elastic lamina
b) Contains elastic fibers
c) Is the thickest layer
d) Shows intimal folds
10. In inferior vena cava, tunica adventitia contains:

a) Circular smooth muscles
b) Elastic fibers
c) Longitudinal muscle fibers
d) All of the above
11. Continuous capillaries have:

a) Thin tunica media
b) Interrupted basement membrane
c) Fenestrated endothelial cells
d) Associated pericytes
12. Endothelial cells of continuous capillaries contain:

a) Pinocytotic vesicles
b) Prominent Golgi complex
c) Small pores
d) All of the above
13. Thickest layer in medium sized vein is the:

a) Tunica intima
b) Tunica media
c) Tunica adventitia
d) None of the above
14. In blood brain barrier, capillaries are:

a) Fenestrated with diaghragm
b) Fenestrated without diaghragm
c) Continuous with zonula occludens
d) Continuous with fascia occludens
46
15. Medium sized artery is characterized by
a) Collapsed lumen
b) External elastic lamina
c) Thick tunica adventitia
d) All of the above
16. Medium sized vein is characterized by:

a) Thick tunica media
b) Longitudinal muscle fibers
c) Elastic fibers
d) Collapsed lume
17. In Marfan syndrome which is characterized by improper deposition

of elastic fibers, which part of the cardiovascular system would be
mostly affected?
a) Middle cerebral artery
b) Basilar artery
c) Aorta
d) Superior vena cava
18. In H&E-stained section of the inferior vena cava, the characteristic
feature is the:
a) Well-developed internal elastic lamina
b) Fenestrated elastic membranes in the tunica media
c) Longitudinal smooth muscles in the tunica adventitia
d) Vasa vasora in the tunica intima
19. One of the following is a characteristic feature of blood sinusoid:
a) Discontinuous basal lamina
b) Non fenestrated endothelial cells
c) Narrow regular lumen
d) Well-developed internal elastic lamina
20. Endothelial cells of the blood capillaries of the brain:
a) Rest on a discontinuous basal lamina.
b) Have wide gaps between them.
c) Are fenestrated.
d) Contain pinocytotic vesicles.
21. The endothelium of the continuous capillaries is characterized by:
a) Being fenestrated
b) Contains numerous pinocytotic vesicles
c) Has discontinuous basement membrane
d) Cells are joined by gap junctions
47
22. The media of the femoral vein is characterized by having:
a) Internal elastic lamina
b) External elastic lamina
c) Smooth muscle fibers
d) Vasa vasorum
ANSWERS OF CVS MCQ
1 A
2 A
3 D
4 C
5 C
6 B
7 D
8 A
9 D
10 C
11 D
12 A
13 C
14 C
15 B
16 D
17 B
18 C
19 A
20 D
21 B
22 C
48
BLOOD VSCULAR SYSTEM
Compare the structural difference between elastic artery and muscular artery
Elastic artery Muscular artery

• Less apparent due to numerous
Internal elastic lamina • Apparent
elastic content in the wall
Elastic membranes • Numerous • Few
Smooth muscles • Few • Numerous
Nerve supply • Poor • Richly supplied by ANS
Compare the structural difference between medium sized artery and vein
Medium sized artery Medium sized vein

• thick • thin
Wall
• Present • Absent
Internal elastic lamina
• Absent • Present
Valves
• Thicker than adventitia • Thinner than adventitia
Tunica media
Elastic membranes
External elastic lamina
• Thinner than the media • Thicker than the media
Tunica adventitia
Compare the microscopic difference between continuous and fenestrated capillaries

U
Continuous capillaries Fenestrated capillaries
Endothelial cell form complete lining around the lumen Endothelial cell form an interrupted lining around the
lumen
Endothelial cells are not fenestrated The endothelial cells has fenestrae or pores
Endothelial cells are joined by zonula occludens Endothelial cells are joined by fascia occludens
The endothelial cells have few pinocytotic vesicles The endothelial cells has many pinocytotic vesicles
There are no clefts between the endothelial cells There are clefts between the endothelial cells
49
Describe the microscopic structure of the endothelial cell
Endothelial cells
U
 With LM:
- Single layer of flat cells.
2B
- Nucleus oval, flattened, central.

3B
- Rest on basement membrane.

4B
- The basement membrane splits to enclose pericytes.

5B
 With EM:
6B
- Perinuclear few organelles.

7B
- Intermediate filaments (desmin and vimentin) → supportive.

8B
- The cells are held together by tight junctions "fascia occludens" with intercellular
9B
clefts inbetween.
- Many pinocytotic pits and vesicles.
10B
- The vesicles may be interconnected together forming tubular channels →

1B
bidirectional exchange→ Transcytosis.

 Functions:
- Exchange of O2 and nutrients.
- Converting inactive angiotensin I to active angiotensin II
- Inactivating various substances as bradykinin.
- Release of prostacyclin, which is a potent vasodilator and inhibitor of platelets aggregation.
- Synthesis of type II, IV and V collagen fibers, laminin and extracellular matrix.
- Production of growth factors e.g. vascular endothelial growth factors.
Describe the microscopic structure of the pericyte

Pericytes
- Origin: UMC
- Site: it surrounds the endothelial cells
o Branched cell
o Have their own basement membrane.
o Cytoplasmic processes wrap around endothelial cells.
o Has gap junction with the endothelial cells
o Contain microtubules & actin → support
o Function:
- Contractile → regulate blood flow
- Stem cells for, endothelial cells & smooth muscles
Compare between blood capillary and blood sinusoid
Blood capillary Blood sinusoid
Lumen Small regular lumen Wide irregular lumen
Endothelial cells Continuous or fenestrated Always fenestrated
Basement membrane Continuous Discontinuous
Cell junction Zonula or fascia occludens Fascia occludens
Intercellular clefts No or narrow clefts Wide gaps
Associated cells Pericytes Macrophage
50
Give reasons for:
1. Presence of fenestrae or holes in the elastic membrane of the arterial wall
To permit passage of nutrients to the wall of the artery
2. Presence of longitudinal muscle in the adventitia of IVC
To support the wall of the IVC
3. Capillaries are responsible for transport of nutrient to the tissues
As they are formed of only endothelial cells which have the following means of transport:
o Diffusion
o Intercellular clefts
o Pinocytosis
o Transcytosis
o Fenetestra in fenestrated capillaries
o Diapedesis
4. Abundance of elastic membrane in the wall of elastic arteries
o Minimizing fluctuations in blood pressure during systole & diastole.
o Acts as a secondary pump
5. Abundance of smooth muscles in the wall of muscular arteries
 Control the blood flow to different parts of the body.
0B
 The thick muscular media is supplied and under the control of ANS
1B
6. Presence of valves in the venous wall

They are provided with valves in order to maintain the direction of blood flow towards the heart.
7. Presence of A-V connection shunts
Function of A-V shunts:
a. Thermoregulation.
b. Regulation of venous return, blood pressure and physiological processes as erection.
c. Regulation of blood supply to different organs.
51
CVS 217
Physiology
BY
PROF. DR. MAGED HAROUN

PROFESSOR & HEAD OF PHYSIOLOGY DEPARTMENT
PROFESSOR OF PHYSIOLOGY
52
53
Cardiovascular
1) Concerning the cardiac muscle:
a. Is striated
b. Has myosin but not actin filaments
c. Have intercalated discs inside the muscle fiber
d. All the above are correct
2) The cardiac muscle is characterized by all the following, except:

a. The low electric resistance of the membrane at the intercalated discs
b. When one ventricular muscle fiber is stimulated all muscle contract
maximally
c. In acts as a functional syncytium
d. Its fibers are larger and thicker than in skeletal muscle
3) Which of the following is not a part of the specialized self-excitable

conductive system of the heart?
a) SA node
b) AV node
c) Papillary muscle
d) Bundle of His
4) The slowest conducting velocity occurs in:

a. Atrial muscles
b. AV node
c. Purkinje fibers
d. Ventricular muscles
5) The SAN is the heart's normal pacemaker because:

a) It has the fastest rate of rhythmicity.
b) It has both sympathetic and parasympathetic innervations.
c) It lies in the right atrium.
d) Activation of K+ channels occur more rapidly in this region than
elsewhere in the heart.
54
6) Sino-atrial node:
a) is present in the left ventricle
b) is the normal pace-maker of the heart.
c) activity is increased by vagal stimulation,
d) activity is increased by cooling.
7) Regarding the action potential of the ventricular cardiac muscle:

a) RMP equals-70mV.
b) plateau phase is due to Na+- Ca+ influx and K+ efflux.
c) repolarization is due to K+ influx.
d) refractory period duration is shorter than that of the skeletal muscle.
8) In the action potential of the cardiac muscle, the plateau:

a. Is the cause of tetanus in cardiac muscle
b. Results form increase CL permeability
c. Is longer in the nodal cells
d. None of the above
9) At which phase of ventricular action potential, the calcium

permeability is increased:
a. Depolarization
b. Rapid small repolarization
c. Plateau
d. Rapid large repolarization
10) Why can't tetany of the heart occur?

a. There are no distinct motor units in the heart.
b. There is inadequate oxygen supply via the coronary circulation lo
metabolically support sustained contraction.
c. The refractory period in cardiac muscle lasts almost as long as the
duration of contraction.
d. The heart, contracts with maximal force every beat so it is impossible to
increase the strength of cardiac contraction
55
11) The function of the AV node is to:
a- Excite the left and right atrium
b- Prevent the atria and ventricles from contracting simultaneously
c- Repolarize the heart after systole.
d- None of the above
12) Propagation of the action potential through the heart is slowest in

the:
a) atrial muscle.,
b) AV node.
c) Purkinje fibers.
d) ventricular muscle.
13) Which of the following is not a method of removing cytosolic Ca

following contraction of cardiac muscle:
a- Na-Ca exchanger transports Ca3f out of the cells
b- ATP-dependent sarcolemma Ca pump removing Ca +out of the cell
c- Ca diffuses passively out of the cells via calcium channels
d- ATP-dependent SR Ca2+ pump removing Ca2+ into SR
14) SA node cells are characterized by the following, except:

a) Their membrane potential is unstable
b) Innervated by the vagus
c) Unable to generate impulses when completely denervated
d) Connected to the AV node by internodal fibers
15) Prepotential:
a) is present in ordinary ventricular muscle fibre.
b) is due to increased permeability to K+
c) slope is decreased by sympathetic stimulation
d) is essential for the rhythmicity
16) Rhythmicity is increased by:

a) Vagal stimulation which increases the slope of prepotential
56
b) Catecholamines due to decrease in the permeability of SA node to K+
c) Excess extracellular calcium
d) Digitalis which increases K+ permeability
17) Sympathetic stimulation has the following effect(s) on heart:

a. Increased heart rate
b. Increased cardiac output
c. Increased contractility
d. All the above
18) The effect of parasympathetic NS on the heart is:

a- Slowing of the heart
b- Increased activity of the SAN
c- Increased activity of the AVN
d- Increased conduction velocity through bundle of His
19) Stroke volume is increased by which of the following?

a- An increase in venous capacity due to venous dilation.
b- A decrease in the extracellular Ca2+
c- Increased arterial blood pressure
d- An increase in the preload
20) The following data are obtained from a patient: The end diastolic
volume 130 ml, the end systolic volume 70 ml and the cardiac output
4800ml/min. From these data, one can determine that heart rate
equals:
a- 70 beat/minute
b- 80 beat/minute
c- 90 beat/minute
d-100 beat/minute
21) Cardiac output is equal to:

a. Diastolic BP + 1/3 (Systolic BP - diastolic BP)
b. Heart rate x stroke volume
57
c. End diastolic volume - end systolic volume
d. (End diastolic volume - stroke volume) x heart rate
22) Starling's law of the heart:

a) Does not operate in the failing heart
b) Does not operate during exercise
c) Explains the increase in heart rate produced by exercise
d) Explains the increase in cardiac output that occurs when venous return
is increased
23) The cardiac output:

a) of left ventricle is more than that of the right ventricle.
b) is increased during standing from supine position.
c) is not affect by the respiratory pump.
d) increased during sympathetic stimulation.
24) Cardiac output:

a) is the volume of blood ejected from each ventricle per minute.
b) play a minor role in determining the systolic blood pressure.
c) increases when the person stands up from a sitting position
d) does not change when the heart rate changes.
25) The cardiac output can increase up to 40 L/min. during exercise

because all of the following, EXCEPT:
a) increased heart rate due to increased sympathetic stimulation.
b) increased in venous return due to greater muscle pump.
c) increased in the total peripheral resistance.
d) increased force of myocardial contraction.
26) Cardiac output is increased during:

a) sympathetic stimulation.
b) increased venous return.
c) exercise
d) all the above.
58
27) The cardiac output increases:
a) With an increase in HR (>220 beats/min)
b) In hypovolemic shock
c) Due to stimulation of parasympathetic
d) None of the above is correct
28) Which of the following causes a decrease in stroke volume?

a) Stimulation of the sympathetic
b) Venoconstriction
c) Stimulation of the baroreceptors
d) Inhibition of the baroreceptors
29) The diastolic blood pressure will increase:

a) With any increase in arteriolar diameter
b) In cases of anemia
c) In cases of increased total peripheral resistance
d) Markedly with any increase in stroke volume
30) If the systolic and diastolic blood pressure are 140 mmHg and 80
mmHg respectively. The mean arterial blood pressure will be:
a) 20 mmHg
b) 100 mmHg
c) 160 mmHg
d) 60 mmHg
31) Afferent discharge from arterial baroreceptors:

a) Increase rate and depth of respiration
b) Are responsible for vasoconstriction during hypoxia
c) Are carried by sympathetic nerves
d) Inhibit the pressor area
32) The mean arterial blood pressure:

a) is the average pressure throughout the cardiac cycle.
59
b) is calculated as the diastolic pressure plus 1/3 the systolic blood
pressure.
c) is equal to the cardiac output plus the total peripheral resistance.
d) is higher in women than in men under 50 years.
33) Baroreceptors:
a- Are a type of stretch receptors
b- Are located in the aortic and carotid bodies
c- Control the mean arterial pressure from week to week
d- Produce sensory signals which stimulate the vasomotor center and
vagus nucleus in the medulla
34) The difference between the systolic and the diastolic pressures is
known as the:
a- Blood Pressure
b- Pulse Pressure
c- Mean Arterial Pressure
d- End-ventricular Pressure
35) Which of the following is the correct formula for mean arterial
blood pressure:
a- MAP = COP X SV
b- MAP = COP X HR
c- MAP = HR X SV X TPR
d- MAP = HR X TPR
36) Hypovolemic shock is characterized by all the following, except:

a- Low blood pressure
b- Slow pulse rate.
c- Cold, pale and sweaty skin.
d- Rapid respiration
37) During anaphylactic shock, release of which substance causes

vasodilatation and increased capillary permeability:
60
a- Histamine
b- Bradykinin
c- Nitric oxide
d- Atrial natriuretic peptide
38) The secretion of the following hormones is increased during

hemorrhagic shock, except:
a- Catecholamines
b- Atrial natriuretic peptide.
c- Aldosterone.
d- Erythropoietin.
39) Low resistance shock:

a- Occurs when the size of the vascular system is increased by
vasodilatation of arterioles and capillaries.
b- Is characterized by an increase of the venous return,
c- Skin is cold and pale in septic shock.
d- Is characterized by decreased blood volume
40) In hypovolemic shock, the following receptors are stimulated,

except:
a- Baroreceptors in the carotid sinus and aortic arch
b- Peripheral chemoreceptors in the aortic and carotid bodies:
c- Atrial stretch receptors.
d- Central chemoreceptors in the medulla
41) The following hormones increase as compensatory mechanisms

after hemorrhage, except:
a) Antidiuretic hormone
b) Atrial natriuretic peptide
c) Cortisol hormone
d) Epinephrine
61
42) A functional syncytium of the cardiac muscles means that they:
a. Are striated.
b. Are involuntary.
c. Have a short refractory period.
d. Work as a unit mechanically and electrically
43) Which of the following is not true about parasympathetic supply to

the heart?
a- It affects muscarinic receptors
b- It decreases the heart rate via an action on SA node
c- It decreases conduction velocity of AV node
d- It can be blocked by beta blockers as propranolol
44) The slowest conducting velocity occurs in:

a- Atrial muscles
b- AV node
c- Purkinje fibers
d- Ventricular muscles
45) The correct pathway of impulses through the conducting system of

the heart is:
a- SA node, AV node, AV bundle, bundle branches, Purkinje fibers
b- AV node, AV bundle, Purkinje fibers, bundle branches, SA node
c- Purkinje fibers, AV node, bundle branches, SA node, AV bundle
d- SA node, AV node, Purkinje fibers, bundle branches, AV bundle
46) If there is a blockage between the AV node and the AV bundle,

how will this affect the appearance of the ECG?
a- PR interval would be smaller
b- QRS interval would be shorter
c- There would be more P waves than QRS complexes
d- There would be more QRS complexes than P waves
47) The SAN is the heart's normal pacemaker because:
62
a. It has the fastest rate of rhythmicity.
b. It has both sympathetic and parasympathetic innervations.
c. It lies in the right atrium.
d. Activation of K+ channels occurs more rapidly in this region
48) In the action potential of the cardiac muscle, the plateau:

a- Is the cause of tetanus in cardiac muscle
b- Results form increase CL permeability
c- Is longer in the nodal eels
d- None of the above
49) Regarding the cardiac myocytes, a decrease of K concentration in

extracellular fluid results in:
a) an increase of RMP.
b) a decreases of excitability
c) an increase of excitability.
d) increased activity of Na -K pump.
50) With respect to action potential in the SA node;

a- The resting membrane potential is more negative than for non-
conducting cardiac muscle
b- Depolarization is caused by activation of fast voltage gated sodium
channels
c- There is dependence on vagal nerve stimulation for the generation of
action potentials
d- Repolarization is caused by increased potassium permeability
51) With respect to the conducting system of the heart:

a- The refractory period of the atrioventricular node is shorter than for
normal cardiac muscle fibers
b- The sinoatrial node has an intrinsic rhythmic rate of 40-60 per minute
c- The atrioventricular node is the natural pacemaker
d- The Purkinje fibers have an intrinsic rhythmic rate of 15-40 per minute
63
52) Myocardial contractility is increased by all of the following,
except:
a- Catecholamines
b- An increase in heart rate
c- An increase in end diastolic volume
d- An increase in parasympathetic nervous system activity
53) The left ventricle has a thicker wall than the right because:
a- It has to eject a greater stroke volume
b- It has to eject blood with lower velocity
c- It has to eject blood through narrower valve
d- It has to do more work against high pressure
54) Which of the following is correct?

a- The SAN is the pacemaker of the heart
b- The AVN is the pacemaker of the heart
c- Normal HR is 72 beats/second
d- In second degree AV block the impulse is blocked in the SAN
55) Digitalis has positive inotropic effect through following

mechanism:
a- An increase of intracellular cAMP
b- Activation of voltage-gated calcium channels
c- Inhibition of Na+-K+ pump in the cardiac muscle
d- Inhibition of ATP-dependent Ca2+ pump in the sarcoplasmic reticulum
56) The Purkinje tissue cells in the heart are characterized by all of
the following, except:
a- Are responsible for short duration of QRS
b- Are the more rapid conductor in the heart
c- Lead to excitation of the base before the apex of the heart
d- Are larger than ventricular myocardial cells
64
57) Which of the following is not a method of removing cytosolic Ca
following contraction of cardiac muscle:
a- Na-Ca exchanger transports Ca3f out of the cells
b- ATP-dependent sarcolemma Ca pump removing Ca +out of the cell
c- Ca diffuses passively out of the cells via calcium channels
d- ATP-dependent sarcoplasmic reticulum Ca2+ pump removing Ca2+ into SR
58) Sympathetic stimulation has the following effect(s) on the heart:

a. Increased heart rate
b. Increased cardiac output
c. Increased contractility
d. All the above
59) The low-resistance pathways between myocardial cells that allow

for the spread of action potentials are the:
a- Gap junctions
b- T-tubules
c- Sarcoplasmic reticulum
d- Intercalated disks
60) Digitalis is a positive inotropic agent refers to:

a- Decreased stroke volume
b- Decreased EDV
c- Increased contractility of the heart
d- Movement of blood elements related to a change in chemical gradient
61) The effect of parasympathetic NS on the heart is:

a- Slowing of the heart
b- Increased activity of the SAN
c- Increased activity of the AVN
d- Increased conduction velocity through bundle of His
62) Which of the ion channels is responsible for the inward current of
plateau phase of the cardiac action potential:
65
a- Cl- channels
b- K+ channels
c- Na+ channels
d- L-type Ca3+ channels
63) As regards vulnerable period:

a- it coincides with the relative refractory period.
b- it coincides with the first half of diastole
c- excitability of the cardiac muscle is. subnormal
d- Stimulation of the heart during this period may produce ventricular
fibrillation.
64) Prepotential:
a- Is present in ordinary ventricular muscle fiber
b- Is due to increased permeability to K+
c- Slope is decreased by sympathetic stimulation
d- Is essential for the rhythmicity
65) Concerning L-type Ca2+ channels in cardiac muscle fibers, all the
following is true, except:
a- Are voltage-gated channels.
b- Are opened during the plateau,
c- Conduct outward current.
d- Are inactivated very slowly.
66) During isovolumetric ventricular contraction:

a. Rapid filling of the ventricles occurs,
b. No blood enters or leave the ventricles.
c. The maximum volume of blood is ejected,
d. The maximum rate of ejection occurs,
67) During the cardiac cycle:

a- Pressure in the left ventricle must rise above 120 mmHg to cause
opening of the aortic valve
66
b- The period of rapid ejection occupies the first 70% of ventricular
ejection time
c- The normal PR interval is about 0.16s
d- The QT interval is the duration of ventricular relaxation
68) The opening of the AV-valves occurs at about the same time in the
cardiac cycle as the:
a- Beginning of diastole
b- Beginning of systole
c- End of isovolumetric contraction
d- First heart sound
69) The reason the T wave has the same direction as the R wave is:
a- Atrial wall repolarizes in the same direction it depolarizes
b- Atrial wall repolarizes in the opposite direction it depolarizes
c- Ventricular wall repolarizes in the same direction it depolarizes
d- Ventricular wall repolarizes in the opposite direction it depolarizes
70) Concerning ECG:

a- Atrial contraction occurs during ST segment
b- The P wave of the electrocardiogram represents atrial depolarization
c- The QRS complex represents ventricular repolarization
d- The T wave represents ventricular depolarization
71) Concerning the ECG which of the following is correct?

a) P wave represents atrial depolarization
b) P wave represents atrial repolarization
c) QRS complex represents ventricular repolarization
d) T wave represents ventricular depolarization
72) On a normal ECG, a wave for repolarization of the atria is not

recorded. Why?
a- The leads are not placed in a position to pick It up
b- No repolarization of the atria occurs normally
67
c- It occurs simultaneously with ventricular depolarization and is masked
by the QRS complex
d- It does not travel through body fluids e- It is too small to be picked up
by external recording electrode
73) Repolarization of the ventricle(s) is the:

a) P-wave.
b) QRS complex
c) T wave
d) none of the above.
74) P-wave of the ECG is associated with:

a) atrial repolarization.
b) blood flow into the aorta
c) atrial depolarization.
75) The PR interval of the ECG corresponds to:

a- Ventricular repolarization
b- Repolarization of the AV node and the AV bundle
c- Atrial depolarization and the AV nodal conduction
d- Conduction through the SA node
76) In the ECG, all the following are correct, except:

a) T wave is due to repolarization of the ventricle
b) QRS complex follows the onset of ventricular contraction
c) Q-T interval corresponds with ventricular action potential
d) S-T segment coincides with plateau phase of action potential
77) The electrocardiogram: All correct, except;

a) Shows a positive P wave represent atrial depolarization
b) Shows an isoelectric S-T segment
c) Has a normal positive T wave due to ventricular repolarization
d) Shows P-R interval with duration of 0.44 seconds
68
78) The diagnosis of a first-degree heart block is made if:
a. The PR interval of the ECG is increased
b. The P wave of the ECG is never followed by a QRS complex
c. The P wave of the ECG is sometimes followed by a QRS complex
d. The T wave of the ECG is inverted
79) The closure of the AV-valves occurs at about the same time in the
cardiac cycle as the:
a- Beginning of diastole
b- End of isovolumetric relaxation
c- First heart sound
d- Second heart sound
80) During ventricular ejection phase:

a- The atria are contracting
b- The AV valves are closed
c- The pressure inside the ventricles is less than inside the atria
d- The semilunar valves are closed
81) Aortic pressure is highest:

a) At the end of reduced ejection phase
b) At the end of rapid ejection phase
c) At the end of diastole
d) At the onset of diastole
82) The ventricular systole occupies the following, except:

a) Isometric contraction phase
b) Isometric relaxation phase
c) Rapid ejection phase
d) Reduced ejection phase
83) The protodiastolic phase:

a) Lasts 0.04 sec
69
b) Is the end of ventricular systole
c) Ends by closure of the mitral valve
d) None of the above
84) During isovolumetric contraction phase:

a. The aortic valve is opened
b. The AV valves are opened
c. The pressure inside the ventricles is less than the atria
d. The ventricular volume is constant
85) During atrial systole:

a) Second heart sound occurs
b) Fourth heart sound occurs
c) First heart sound occurs
d) 100% of the ventricular filling occurs
86) Which of the following is associated with the first heart sound?
a- Rushing of the blood into the ventricles due to atrial contraction
b- Closing of the A-V valves
c- Closing of the pulmonary valve
d- Opening of the AV valves
87) During isovolumic relaxation:

a) Blood flows from the LA into the LV
b) The mitral valve is open
c) The mitral valve is closed
d) The a wave occurs
88) Which of the following is correct?

a) c wave is due to atrial relaxation
b) a wave is due to atrial relaxation
c) a wave is due to atrial systole
d) c wave is due to atrial contraction
70
89) During the isovolumetric contraction phase:
a) A-V valves are closed but semilunar valves are open
b) A-V valves are open but semilunar valves are closed
c) A-V and semilunar valves are closed
d) Both A-V and semilunar valves are open
90) Normal cardiac cycle duration is:

a) 0.3 sec,
b) 0.5 sec.
c) 0.8 sec.
d) 0.1 sec.
91) The "a" wave of the jugular venous pulse tracing is caused by:
a) ventricular systole.
b) blood flow into the pulmonary veins
c) atrial systole
92) Regarding ventricular filling:

a) depends mainly only contraction of atria
b) begins during isometric relaxation phase of cardiac cycle
c) gives rise to second heart sound
d) is mainly due to pressure difference between atria and ventricles.
93) The dicrotic notch on the aortic pressure curve is caused by:
a) Closure of the mitral valve
b) Closure of the tricuspid valve
c) Closure of the aortic valve
d) Closure of the pulmonary valve
94) Normal splitting of the second heart sound is increased during

inspiration because:
a) The heart rate is decreased
b) The closing of the pulmonary valve is delayed
71
c) The closing of the aortic value is delayed
d) The stroke volume of the left ventricle is increased
95) If the end-diastolic volume is increased:

a- The stroke volume would be increased
b- The cardiac output would be decreased
c- The force of cardiac contraction would be decreased
d- The heart rate would be increased
96) Myocardial contractility is best correlated with the intracellular

concentration of:
a) Na+
b) K+
c) Ca++
d) Cl
97) Contractility of the cardiac muscle can be increased by:

a. Decreasing the end diastolic volume
b. Decrease the extracellular calcium
c. Decrease blood pressure
d. Mild alkalosis
98) In a resting adult, the ventricular ejection fraction is:

a- 20%
b- 30%
c- 40%
d- 60%
99) Negative inotropics include the following, except:

a) Insufficient coronary flow (ischemia)
b) Acidosis
c) Acetylcholine
d) Glucagon
72
100) The strength of contraction of left ventricular muscle increases
when:
a) End diastolic volume rises
b) Serum potassium level rise
c) Blood calcium level falls
d) The initial length decreased
101) Stroke volume is increased by which of the following?

a- An increase in venous capacity due to venous dilation.
b- A decrease in the extracellular Ca2+
c- Increased arterial blood pressure
d- An increase in the preload
102) Cardiac output is equal to:

a. Diastolic BP + 1/3 (Systolic BP - diastolic BP)
b. Heart rate x stroke volume
c. End diastolic volume - end systolic volume
d. (End diastolic volume - stroke volume) x heart rate
103) Which of the following leads to an increase in the force of

contraction (heterometric auto-regulation):
a) An increase in resting fiber length
b) An increase in diastolic fiber length
c) An increase in EDV
d) All of the above are correct
104) Regarding cardiac index the following is true, except:

a- It is the cardiac output per square meter of body surface area.
b- It is about 5 liters/min in healthy adult.
c- It is related to height and weight of the person.
d- It depends upon contractility of the ventricles.
105) If the systolic blood pressure is 120 mmHg and the pulse
pressure equals 30 mm Hg, the mean arterial blood pressure would be:
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a- 100 mmHg
b- 90 mmHg
c- 80 mmHg
d- 70 mmHg
106) All about the preload is true, except:

a- Increases during exercise
b- Is mainly dependent on venous return
c- Tends to reduce the force of cardiac contraction as preload increases
under normal conditions
d- Is more important in determining cardiac output than is afterload
107) If the EDV is increased (within limits):

a- COP would be decreased
b- The force of cardiac contraction would be decreased
c- The output of right ventricle would exceed the output of left ventricle
d- The stroke volume would be increased
108) Cardiac output is reduced:

a) By increasing the end-diastolic volume
b) By cutting the sympathetic nerve supply to the heart
c) As a result of reduced pressure in the carotid sinus
d) During sleep
109) The cardiac output increases:

a) With an increase in HR (>220 beats/min)
b) In hypovolemic shock
c) Due to stimulation of parasympathetic
d) None of the above is correct
110) Which of the following causes a decrease in stroke volume?
a) Stimulation of the sympathetic
b) Venoconstriction
c) Stimulation of the baroreceptors
d) Inhibition of the baroreceptors
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111) Which of the following will not Increase stroke volume?
a. Increased end-diastolic volume
b. Increased contractility of the heart
c. Increased end-systolic volume
d. Increased stretch of the cardiac muscle fibers during ventricular filling

a) With any increase in arteriolar diameter
c) In cases of increased total peripheral resistance
d) Markedly with any increase in stroke volume
113) All of the following produce vasodilatation, except:

a) Nitric oxide (NO)
b) Sympathetic supply to skeletal muscles
c) Systemic hypercapnia and hypoxia
d) Decreased local temperature
114) Stimulation of carotid bodies causes:

a- Decrease in depth of respiration
b- Decreased discharge in the IX cranial nerve
c- Increased discharge in the X cranial nerve
d- Stimulation of respiratory center
115) Cardiac reserve:

a) mechanism involves an increase of ESV.
b) equals the difference between maximal heart rate during exercise and
resting heart rate.
c) in a well-trained athlete may reach up to 600%.
d) eccentric hypertrophy occurs in pressure overload
116) Arterial blood pressure may be increased by:

a- Decreased sympathetic lone
b- Venodilation
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c- Decreased parasympathetic tone
d- Decreased antidiuretic hormone release

a) Markedly with an increase in stroke volume
c) With an increase in arteriolar diameter
d) With tachycardia
118) The mean arterial blood pressure:

a) is the average pressure throughout the cardiac cycle.
b) is calculated as diastolic pressure plus 1/3 the systolic blood pressure.
c) is equal to the cardiac output plus the total peripheral resistance.
d) is higher in women than in men under 50 years.

a) with any increase in arteriolar diameter.
b) in case of anemia.
c) in cases of increased total peripheral resistance.
d) markedly with any increase in stroke volume.
120) Regarding blood pressure:

a) it is increased when baroreceptors are stimulated.
b) it is reduced when the vasomotor centre is stimulated.
c) renin-angiotensin system increases the blood pressure.
d) increased ADH decreases ABP.
121) The ABP is increased by all, EXCEPT:

a) increasing the muscle pump.
b) sympathetic stimulation
c) decrease in the heart rate
d) increased adrenaline level in the blood.
122) Vaso-constriction of arterioles is produced by:
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a) nitric oxide (NO)
b) endothelin-1.
c) increased sympathetic discharge to skeletal muscle.
d) increased local temperature.
123) Concerning blood flow:

a) F = ÅP/R
b) Decreases when the resistance decreases
c) Increases when the resistance increases
d) Increases due to arteriolar constriction
124) Mean systemic filling pressure is decreased by:

a- Norepinephrine administration
b- Increased blood volume
c- Increased sympathetic stimulation
d- Increased venous capacitance
125) Vascular resistance is most markedly affected by:

a- Vessel lumen diameter
b- Vessel cross-sectional area
c- Blood viscosity
d- Vessel length
126) Endothelins have the following functions, except:

a) Have negative inotropic effect
b) Have strong coronary vasoconstrictor
c) Have stimulatory effect on aldosterone release
d) Decrease renal blood flow
127) All about the bulk flow across the capillaries is true except:
a) A passive process
b) The mechanism by which the plasma proteins pass to interstitial fluid
c) Increased by arteriolar dilatation
d) Decreased if the interstitial hydrostatic pressure increases
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128) All about net capillary filtration is correct, Except:
a- Increases when the plasma protein concentration is increased
b- Increases as capillary pressure increases
c- Increases as the capillary permeability to protein increases
d- Is more likely to occur at arteriolar than the venular end of a capillary
129) The causes of edema include all of the following, except:

a. Reduced concentration of plasma proteins
b. Increased permeability of capillary walls
c. Increased venous pressure
d. Vasoconstriction
130) An increase in capillary hydrostatic pressure can be caused by:

a) An increase in arteriolar resistance
b) A decrease in venous resistance
c) A decrease in venous pressure
d) An increase in venous pressure
131) The capillary blood pressure:

a) Increases with venous dilatation
b) At the venular end it enhances fluid filtration
c) Is higher in lower limb capillaries in the erect position
d) Decrease with arteriolar dilatation
132) A patient has a renal disease that produced albuminuria. Which

of the following is likely to occur?
a- Decrease in the interstitial fluid hydrostatic pressure
b- Increase in the capillary hydrostatic pressure
c- Increase in lymph flow
d- Increase in plasma oncotic pressure
133) Which of the following causes an increase in venous return?

a) Venodilation
b) Exercise
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c) Inhibition of the sympathetic
d) Hemorrhage
134) A sudden change in body position from supine to standing causes

all the following reflexes, except:
a) Tachycardia
b) Constriction of the skeletal muscle arterioles
c) Constriction of the cerebral arterioles
d) Venoconstriction
135) Which of the following is greater in veins than arteries?

a- Resistance
b- Wall thickness
c- Compliance
d- More richly innervated
136) An ACE inhibitor would be expected to cause a:

a- Decrease in systemic BP
b- Decrease in plasma angiotensin II
c- Decrease in plasma aldosterone
d- All of the above
137) Veins:
a- Have a sympathetic vasoconstrictor innervation
b- Respond to distension by contraction of their smooth muscles
c- Are considered a high-pressure system
d- Contain 15% of the total blood volume at rest
138) Central venous pressure is increased by:

a) increasing venous compliance
b) decreasing blood volume
c) decreasing heart rate
d) increasing total peripheral resistance
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139) Venous return to the right atrium is increased by all the
following, EXCEPT:
a) increased cardiac sympathetic tone.
b) increased minute ventilation.
c) increased venous tone.
d) deep expiration with closed glottis.
140) Which statement is true regarding lymphatic circulation?

a- Lymph contains proteins more than plasma
b- Lymph flows in otic direction only from the heart to the interstitial fluid
c- Lymph contains clotting factors and clots on standing
d- Lymph transports the absorbed carbohydrates from the intestine
circulation
141) Select the correct statement about veins:

a. Their walls are highly muscular.
b. Their walls consist of one layer of cells.
c. There are only about forty large ones in the body.
d. They serve as a blood reservoir.
142) The largest total cross-sectional area is found in the:

a. Aorta.
b. Arteriole
c. Capillaries
d. Venules.
143) With regards to the coronary circulation:

a) coronary blood flow is about 150 ml/min during rest.
b) the left coronary artery has bigger flow in about 50% of individuals.
c) many communications exist between left and right coronary vessels.
d) β-adrenergic stimulation produces coronary vasodilatation.
144) Concerning the coronary blood flow, the following are true,
EXCEPT:
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a) it is about 225-250 ml/min.
b) it can increase 4 folds during strenuous exercise.
c) the right coronary artery supplies right ventricle and posterior part of
the left ventricle.
d) flow is equal in right and left coronary arteries in 50% of individuals.
145) Coronary blood flow is maximum during:

a) isometric contraction phase of the heart
b) isometric relaxation phase of the heart
c) during maximum ejection phase
d) during slow ejection phase
146) The left coronary flow:

a- Does not exhibit reactive hyperemia
b- Is independent of the oxygen needs of the myocardium
c- Is the same as the right coronary flow
d- Maximum in early diastole
147) The highest coronary blood flow would occur:

a) At beginning of diastole
b) When the aortic pressure is highest
c) When the aortic blood flow is highest
d) When the ventricular pressure is highest
148) With regards to the coronary circulation:

a) Coronary blood flow is about 150 ml/min during rest
b) The left coronary artery has bigger flow in about 50% of individuals
c) Many communications exist between left and right coronary vessels
d) β-adrenergic stimulation produces coronary vasodilatation
149) The coronary blood flow:

a- Is about 500 ml/min at rest
b- Increases in the endocardium during systole
c- Decreases by adenosine
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d- Is auto- regulated
150) During anaphylactic shock, release of which substance causes

vasodilatation and increased capillary permeability:
a- Histamine
b- Bradykinin
c- Nitric oxide
d- Atrial natriuretic peptide
151) The following hormones increase as compensatory mechanisms

after hemorrhage, except:
a) Antidiuretic hormone
b) Atrial natriuretic peptide
c) Cortisol hormone
d) Epinephrine
152) Concerning hypovolemic shock:

a) The extremities are warm
b) Baroreceptors are stimulated
c) Urine volume remains unchanged
d) Sympathetic tone is decreased
153) The secretion of the following hormones is increased during

hemorrhagic shock, except:
a- Catecholamines
b- Atrial natriuretic peptide.
c- Aldosterone.
d- Erythropoietin.
154) Low resistance shock:

a- Occurs when the size of the vascular system is increased by
vasodilatation of arterioles and capillaries.
b- Is characterized by an increase of the venous return,
c- Skin is cold and pale in septic shock.
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d- Is characterized by decreased blood volume
155) Functions of the blood-brain barrier include all the following,

EXCEPT:
a) Maintenance of the constancy of the internal environment of the
neurons in the CNS.
b) Prevent escape of neurotransmitters into the general circulation.
c) Help to keep the brain K+ concentration.
d) Protection of the brain from endogenous toxins in the blood.
156) Cerebral blood flow:

a) is almost constant when the arterial blood pressure is in the range of 80-
160 mmHg.
b) is about 750 ml/min at rest.
c) is controlled mainly by sympathetic innervations.
d) decreases when there is a high arterial PCO2.
157) In irreversible hemorrhagic shock, the following occurs:

a- increased capillary permeability
b- Dilation of veins
c- Tissue alkalosis
d- Increased urine output
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CARDIOVASCULAR
Key Answers of MCQ
No Answer No Answer No. Answer No. Answer No. Answer
1 A 25 C 49 C 73 C 97 C
2 D 26 D 50 D 74 C 98 D
3 C 27 D 51 D 75 C 99 D
4 B 28 C 52 D 76 B 100 A
5 A 29 C 53 D 77 D 101 D
6 B 30 B 54 A 78 A 102 B
7 B 31 D 55 C 79 C 103 D
8 B 32 A 56 C 80 B 104 B
9 C 33 A 57 C 81 B 105 A
10 C 34 B 58 D 82 B 106 C
11 B 35 C 59 A 83 A 107 D
12 B 36 B 60 C 84 D 108 D
13 C 37 A 61 A 85 B 109 D
14 C 38 B 62 D 86 B 110 C
15 D 39 A 63 D 87 C 111 C
16 B 40 D 64 D 88 C 112 C
17 D 41 B 65 C 89 C 113 D
18 A 42 D 66 B 90 C 114 D
19 D 43 D 67 C 91 C 115 C
20 B 44 B 68 A 92 D 116 C
21 B 45 A 69 D 93 C 117 D
22 D 46 C 70 B 94 B 118 A
23 D 47 A 71 A 95 A 119 C
84
24 A 48 d 72 C 96 c 120 C
121 C 129 B 137 A 145 B 153 B
122 B 130 D 138 C 146 D 154 A
123 A 131 C 139 D 147 A 155 C
124 D 132 C 140 C 148 D 156 B
125 A 133 B 141 D 149 D 157 A
126 A 134 B 142 C 150 A
127 B 135 C 143 D 151 B
128 A 136 D 144 D 152 B
85
CVS 217
Medical Biochemistry
BY
PROF. DR. MARWA MATBOLI SAYED
PROFESSOR & HEAD OF BIOCHEMISTRY DEPARTMENT

PROFESSOR OF BIOCHEMISTRY
86
87
Cardiovascular Module :Metabolism of
cardiovascular system MCQ
Quiz on Energy Supply to heart muscles

1. The main source of energy supply to the heart under aerobic conditions
is:
A. Glucose
B. Lactate
C. Fatty acids
D. Ketone bodies
2. Thiamine is an important coenzyme for the following:
a) Fatty acid metabolism
b) Carbohydrate metabolism
c) Protein metabolism
d) All of the above
Quiz on Biomarkers for Acute Myocardial Infarction (acute coronary syndrome

(ACS).
1. The isoenzymes of lactate dehydrogenase
a-can be a monomer or a tetramer
B- present only in heart
c-exits in five forms, depending upon the content of M and H units
88
d- It is used for early diagnosis of myocardial infraction
QUIZ on fatty acid synthesis

1. The rate limiting enzyme in fatty acid synthesis is:
a. ketoacyl synthase d. Malonyl transacylase.
b. Thiokinase e. Pyruvate dehydrogenase
c. Acetyl COA carboxylase
2. Transport of acetyl COA across the mitochondrial membrane requires:
a. Citrate shuttle d. Acyl COA shuttle
b. Malate shuttle e. Glycerol 3 Phosphate shuttle
c. Carnitine shuttle
3. Which of the following is not required in the synthesis of fatty acids?
a. Acetyl-CoA d. Malonyl-CoA
b. Biotin e. NADH
c. HCO3 – (CO2 )
4. Which of these can be synthesized by plants but not by humans?
A) Linoleate [18:2( 9,12)] D) Pyruvate
B) Palmitate (16:0) E) Stearate (18:0)
C) Phosphatidylcholine
5.Explain briefly why we require fats
in our diets.
1
89
2. Which of the following cardiac biomarkers is recommended to evaluate
patients with suspected acute MI?
A. Troponin I
B. LDH (lactate dehydrogenase)
C. Creatine kinase
D. Myoglobin
Quiz on Triglycerides Metabolism
1. Adipose tissue lacks

A- Hormone-sensitive lipase.
B- Glycerol kinase.
C- cAMP-dependent protein kinase.
D- Glycerol-3-phosphate dehydrogenase.
E- Acetyl COA Carboxylase.
2. Which of the following statements about triacylglycerol is correct?
A- Triacylglycerol is carried in the blood bound to albumin.
B- Triacylglycerol is stored in all cells.
C- Triacylglycerol is oxidized to glycerol and fatty acids.
D- Triacylglycerol is hydrolyzed to glycerol and fatty acids.
3. Which of the following has the opposite effect of insulin?

a. Somatotropin
b. Glucagon
c. Oxytocin
d. Vasopressin
e. Testosterone
4. Which of the following enzymes is the rate determining enzyme in lipolysis?

A. Hormone Sensitive Lipase
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90
B. Adipose Tissue Sensitive Lipase
C. Monoglyceride lipase
5. Which of the following will induce lipolysis?

A. High insulin/Low epinephrine
B. High insulin/High epinephrine
C. Low insulin/High epinephrine
D. Low insulin/Low epinephrine
Quiz on Cholesterol and lipoprotein metabolism

1. The enzyme of cholesterol biosynthesis is:
A. HMG CoA synthetase
B. mevalonate dehydrogenase
C. HMG CoA lyase
D. HMG CoA reductase
E. LCAT
2. HMG- CoA reductase enzyme:
A. Is active when it is phosphorylated
B. Needs 2 NADPH+H as it consumes four hydrogen atoms
C. Is the key regulatory enzyme for ketogenesis
D. Present mainly in mitochondria
E. May be affected by chylomicrons
3. Hypercholesterolaemia are commonly associated with:
a- Thyrotoxicosis
b- Obstructive jaundice
c- Infective hepatitis
d- Glycogen storage diseases
e- Low fat diet
4. Degradation of one molecule of cholesterol will release :
a. 13 acetyl CoA molecules
b. 12 acetyl CoA molecules
c. 11 acetyl CoA molecules
d. no acetyl CoA
e. 10 acetyl CoA molecules
5. Primary bile acids are characterized by one of the following:
A) Hydroxylated at C7
B) Synthesized in intestine
C) Can’t be conjugated with glycine and taurine.
1
91
D) Have no role in lipid absorption
E) Consists of 27 carbon atoms
6. The key enzyme of bile acids synthesis is :
A. HMG-CoA reductase
B. HMG-CoA lyase
C. 7-α hydroxylase
D. Thiokinsae enzyme
E. ACAT
7. For the synthesis of bile acids we need the following vitamin:
A. Vitamin A
B. Vitamin C
C. Vitamin E
D. Vitamin D
E. Vitamin B
8. As regards the secondary bile acids it is NOT :

A. Synthesized in the intestine
B. Deconjugated from glycine and taurine
C. 7-α hydroxylated
D. Reabsorbed via enterohepatic circulation.
E. Have a role in lipid metabolism
9. Chylomicrons are responsible for the transport of :
a. Exogenous TAG
b. Endogenous TAG
c. Endogenous cholesterol
d. Endogenous phospholipids
e. Endogenous cholesterol and phospholipids
10.In post-prandial hyperlipaemia which of the following will be responsible for the
characteristic milky plasma?
a- phospholipids
b- Chylomicrons
c- B-lipoproteins
d- Cholesterol
e. LDL
1
92
11.Reverse cholesterol transport is helped by:
a. LDL
b. LCAT
c. IDL
d. Chylomicrons
E. ACAT
12.The substrate for LCAT enzyme is:
A. any phospholipids molecule of HDL

B. phosphatidyl serine of HDL
C. phosphatidylcholine of HDL
D. phosphatidylcholine of peripheral cells
E. phosphatidylinositol of HDL
13.LDL is the main carrier of cholesterol ester.

A. True
B. False
14.HDL lipoprotein:
a. Provides a vehicle for distribution of cholesterol to peripheral tissues.
b. Helps in mobilization of cholesterol from peripheral tissues.
c. Contains more TAG than other types.
d. Helps in mobilization of cholesterol from liver.
e. Needs ACAT for its activity.
15.Lipoproteins with high TAG content have a high density.
A. True
B. False
16.LCAT is activated by Apo C1, on HDL:

A. True
B. False
17.All apolipoproteins are specific for each lipoprotein.
A. True
B. False
18.Lipoprotein lipase is a free blood enzyme.
A. True
2
93
B. False
19.VLDL:
a. has the same density as chylomicrons.
b. contains B-48 as its major apolipopprotein.
c. transports exogenous (dietary) lipids.
d. its major lipid is triglyceride.
e. has the same density as LDL.
20.Lipoprotein lipase:
a- is present in the coat of VLDL and chylomicrons.
b- is induced by insulin in adipose tissues.
c- has a role in reverse cholesterol transport.
d- is induced by insulin in muscle.
e- is activated by apo B48.
21.LCAT enzyme is important for:

a. de novo synthesis of cholesterol
b. reverse cholesterol transport
c. uptake of cholesterol by peripheral cells
d. distribution of cholesterol via LDL
e. de novo synthesis of TAG
22.The oxidized LDL triggers the process of atherosclerosis. Which of the following
structures are components of LDL:
a) ApoB 48
b) ApoB 100
c) Apo C
d) Apo E
e) Apo A
23.Apoprotein A is formed by liver while Apo B48 is exclusively synthesized

by intestine.
A. True
B. False
24.A deficiency of apoprotein C results in:
a. over production of endogenous triglycerides in the liver and secreted as VLDL.
b. deficiency of lipoprotein lipase.
c. inactivation of lipoprotein lipase
d. over production of triglycerides synthesized in adipose tissue.
e. inactivation of hormone sensitive lipase.
3
94
25.The term "bad cholesterol" is referred to:
a. stored cholesteryl esters
b. cholesterol content of LDL
c. cholesterol content of HDL
d. membrane cholesterol content
e. coprastanol
26.The characteristic apoprotein of chylomicrons is:
a. A1
b. A4
c. B100
d. B48
e. C1
27.A 34- year old female has been diagnosed as type IIa hyperlipidemia, which of
the following lipoproteins is elevated in such disorder?
a) VLDL
b) Chylomicrons
c) LDL
d) HDL
e) All of above
28.Type I hyperlipoproteinemia is caused by:
a. hormone sensitive lipase deficiency
b. pancreatic lipase deficiency
c. lipoprotein lipase deficiency
d. apo B-48 deficiency
e. apoE deficiency
29.In Tangier disease, which kind of lipoprotein is deficient:
a) LDL
b) VLDL
c) HDL
d) Chylomicrons
e) Free fatty acid
30.All the following represent risk factors for atherosclerosis except:
1- Hypercholesterolemia.
2- Hyperthyrodism
3- Diabetes mellitus
4- Coffee drinking
5- Cigarette smoking
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95
31.Premenopausal women are at higher risk for atherosclerosis than
postmenopausal women
a) True
b) False
32.Cholestyramine is used in treatment of hypercholesterolemia as it:

A. Inhibits HMG-CoA reductase
B. Converts cholesterol to CE
C. Binds to bile acids preventing their reabsorption.
D. Oxides cholesterol to CO2 and H2O
E. increases solubility of cholesterol
5
96
Quiz on energy supply
1 C
Quiz on biomarkers of acute MI
1 C
2 A
fatty acid synthesis
1 c
2 a
3 e
4 a
Quiz on triglycerides
1 B
2 D
3 B
4 A
5 C
Quiz on cholesterol
1 D
2 B
3 B
4 D
5 A
6 C
7 B
8 C
9 A
10 B
11 B
12 C
13 A
14 B
15 B
16 B
17 B
18 B
19 D
20 D
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97
21 B
22 B
23 A
24 C
25 B
26 D
27 C
28 C
29 C
30 B
31 B
32 C
98
CVS 217
Medical Microbiology and Immunology
BY
ASSISST. PROF. DR. NAGWA MAHMOUD
ASSISST. PROFESSOR & HEAD OF MEDICAL MEICROBIOLOGY & IMMUNOLOGY

DEPARTMENT
ASSISST. PROFESSOR OF MEDICAL MICROBIOLOGY & IMMUNOLOGY

99
Theoretical Revision on Cardiovascular System
Pancarditis
1-A 70-year-old woman presented with shortness of breath and fever390 C. on
auscultation a diastolic murmur was heard. History revealed a cardiac valve
replacement five years earlier. 3 consecutive blood cultures taken during febrile
periods revealed catalase-positive and coagulase-negative Gram positive cocci.
Which of the following organisms is the most likely cause of this infection?
a) Staphylococcus epidermidis.
b) Enterococcus faecalis.
c) Staphylococcus aureus.
d) Staphylococcus saprophyticus.
2- A 22-year-old man presented with high grade fever and fatigue for the past 3
days. On examination, a new diastolic murmur was detected. Blood culture
revealed beta hemolytic, coagulase positive Gram positive cocci. Which one of the
following is the MOST likely causative organism of this infection?
a) Staphylococcus epidermidis.
b) Staphylococcus aureus.
c) Viridans streptococci.
d)Streptococcus pyogenes.
3- A 43-year-old man is presented to the emergency department with fever, chest
pain, and shortness of breath after mild exertion. He reports a flulike illness 2
weeks previously. A biopsy was taken after the patient began to show signs of
heart failure, revealed mononuclear infiltration in the myocardial tissue. PCR assay
identified a viral cause. What is the most likely etiological agent causing this
patient’s condition?
a) Adenovirus.
b) Parainfluenza virus.
c) Measles virus.
d) Coxsackievirus B.
Bacteremia, Sepsis &Toxemia

1-A 55-year-old woman on chemotherapy for lymphoma via intravenous catheter.
She suddenly developed fever, chills and hypotension. a blood culture was done
that reported growth of Escherichia coli. Which of the following bacterial
structures is the most likely responsible for fever and hypotension in this
patient?
a) Pili.
b) Lipopolysaccharide.
c) Capsule.
d) Coagulase.
2-Which one of the following BEST describes the mode of action of endotoxin?
a) Degrades lecithin in cell membranes.
b) Inactivates elongation factor-2.
c) Blocks release of acetylcholine.
d) Causes release of tumor necrosis factor.
100
Human Immunodeficiency Virus (HIV)
1-Which one of the following is the most accurate regarding the replication of
HIV?
a) The protease cleaves cellular ribosomal proteins inhibiting protein synthesis.
b) Integrase enzyme integrates copies of viral genome into the progeny virions.
c) Reverse transcriptase transcribes the genome RNA into double-stranded DNA.
d) p24 protein interacts with the CD4 protein on the cell surface.
2-To design a vaccine against HIV infection that prevent the attachment of the
virus to helper T lymphocytes. Which of the following molecules in the virus
might best be targeted in the prepared vaccine?
a) gp41.
b) p17.
c) p24.
d) gp120.
3-An HIV-positive patient with a drop in his CD4 T-cell count from 240 to 50/μL
presented with dry cough, low-grade fever and shortness of breath. On
examination, his temperature was 38.5°C. Pulmonary examination revealed
decreased breath sounds and rhonchi in all fields. A chest x-ray showed a bilateral
interstitial infiltrate with a “ground-glass” appearance. microscopic examination of
bronchial alveolar lavage revealed cysts. Which of the following is the most likely
stage of this patient’s HIV disease?
a) Acute stage.
b) Middle latent stage.
c) Late stage (AIDS).
d) Stage unknown.
4-Which one of the following is the most accurate regarding the laboratory
diagnosis of HIV?
a) The initial screening for antibodies is done by the complement fixation test.
b) A confirmatory Western blot assay should be performed after a positive screening
test.
c) Viral load is the amount of virus produced by patient’s CD4 T lymphocytes in cell
culture.
d) After infection, Antibodies can be detected before the PCR can detect the nucleic
acids.
5-Which one of the following is the most accurate regarding the mode of action of
antiretroviral drugs?
a) Maraviroc acts by inhibiting the reverse transcriptase in the virion.
b) Zidovudine is a nucleoside analog that inhibits mRNA synthesis of HIV.
c) Lamivudine inhibits the growing polypeptide chain by causing misreading of mRNA.
d) Raltegravir inhibits the integration of HIV DNA into host cell DNA.
101
Epstein–Barr virus, Cytomegalovirus &Parvovirus B19
1-Which one of the following is the most accurate regarding the pathogenesis of
infectious mononucleosis?
a) The infection starts in the skin and then spreads to the blood.
b) The atypical lymphocytes in the blood of patients are EBV-infected T helper
cells.
c) The viral DNA is integrated into cellular DNA of latently infected cells.
d) EBV enters the latent state primarily in B lymphocytes.
2-An 18-year-old female presented with fever, sore throat, fatigue, and myalgia.
Physical examination revealed enlarged tonsils and cervical lymphadenopathy.
patient’s peripheral blood showed atypical lymphocytes and negative Monospot
test. Which of the following organisms is the most likely cause of this condition?
a) Epstein-Barr virus.
b) Cytomegalovirus.
c) Adenovirus.
d) Influenza virus.
3-A 5-year-old male is presented with fever and a new skin rash. On examination,
temperature is 38.2°C, His cheeks appear as if they had been slapped with
erythematous, maculopapular rash on his extremities. Which of the following is the
most likely diagnosis of this patient’s condition?
a) Erythema infectiosum.
b) Scarlet fever.
c) Roseola infantum.
d) Hand-foot-and-mouth disease.
4- Which of the following is a target cell for infection by parvovirus B19?
a) Blood monocytes.
b) Erythroblasts.
c) B lymphocytes
d) CD4 T lymphocytes.
5-A 17-year-old female presented with sore throat and fever 390C. On examination,
enlarged tonsils with cervical adenopathy and splenomegaly, patient’s blood
smear showed atypical lymphocytes and a positive Monospot test. Which of the
following organisms is the most likely cause of this infection?
a) Cytomegalovirus.
b) Adenovirus.
c) Influenza virus.
d) Epstein-Barr virus.
Viruses causing Hemorrhagic Fever
1- Which of the following viruses is associated with hemorrhagic fever?
a) Yellow fever virus.
b) Coxsackie virus.
c) Echo virus.
d) West Nile virus.
102
2-Which of the following best describes the pathogenesis of dengue hemorrhagic
fever?
a) Allergy to Aedes mosquito bites.
b) Immune-complex hypersensitivity.
c) Increased release of dengue hemolysins.
d) Previous immunity to a different serotype of dengue virus.
3-Which one of the following best describes the mode of transmission of Ebola
virus?
a) Contact with patient’s blood and body fluids.
b) Bite of Aedes mosquito.
c) Inhalation of aerosols of rodent’s feces and urine.
d) Ingestion of contamination of food or water with mice urine.
4- Which of the following best describes the genome of Hantavirus?
a) Segmented, single stranded, positive sense RNA.
b) Non-segmented, single stranded, positive sense RNA.
c) Double stranded RNA genome.
d) Segmented, single stranded, negative sense RNA.
Relevant zoonotic diseases

1-A farmer rearing cattle, presented with fever rising and falling for the past 4
weeks. On examination, enlarged lymph nodes and hepatomegaly. Which of the
following bacteria is the most likely cause of this infection?
a) Brucella melitensis.
b) Brucella suis.
c) Francisella tularensis.
d) Brucella abortus.
2-Which one of the following best describes the mode of transmission of plague
to humans?
a) Exposure to water contaminated with rodents’ urine.
b) Ingestion of food contaminated with rodent feces.
c) Flea bite that was infesting the infected rodent.
d) Transmitted from rodents to humans by tick bites.
3-An outbreak of pneumonic plague occurs in the Republic of the Congo. Which
of the following is the most likely mode of transmission of this form of plague?
a) Direct skin contact with buboes.
b) Ingestion of contaminated water.
c) Bite of infected tick.
d) Inhalation of respiratory droplets.
4-Which one of the following is the main reservoir of Lyme disease?
a) Mice.
b) Cattles.
c) Rabbit.
d) Pigs.
103
5-A 9-year-old boy presents with a migratory rash with central clearing on the
back of his neck. The child had recently been on vacation with his family and had
gone hiking. The child’s pediatrician observes the rash and suspects erythema
migrans. Which of the following is the most likely causative organism of this
infection?
a) Borrelia recurrentis.
b) Borrelia burgdorferi.
c) Borrelia hermsii.
d) Borrelia miyamotoi.
6-A 20-year-old man presented with fever and an erythematous macular rash on
the right arm for the past 4 days. He reported hiking recently. You suspect the
rash is erythema migrans. Which one of the following is the best approach to
confirm your clinical diagnosis of this patient?
a) Beta hemolytic colonies on blood agar.
b) Agglutination reaction with capsular polysaccharide of the organism.
c) Direct demonstration of the organism in stained smears of peripheral blood.
d) Detect IgM antibodies in an ELISA assay.
Autoimmune disease
1. Regarding immunologic tolerance, which one of the following is the most
accurate?
a) Clonal deletion occurs with T cells but not with B cells.
b) Tolerance to self-antigens occurs by negative selection of immature T cells in the
thymus.
c) The presence of B7 on the surface of the antigen-presenting cell is one of the
essential steps required to establish tolerance.
d) Tolerance is easier to establish in adults than in newborns.
2. In which one of the following autoimmune diseases, antibodies is formed

against DNA?
a) Myasthenia gravis.
b) Rheumatic fever.
c) Systemic lupus erythematosus.
d) Rheumatoid arthritis.
3. In which one of the following autoimmune diseases, antibodies is formed

against human against IgG?
a) Rheumatoid arthritis.
b) Myasthenia gravis.
c) Rheumatic fever.
d) Systemic lupus erythematosus.
104
4.Regarding the pathogenesis of autoimmune diseases, which one of the
following is the most accurate?
a) In myasthenia gravis, antibodies are formed against acetylcholine at the
neuromuscular junction.
b) In Goodpasture’s syndrome, antibodies are formed against the synovial
membrane in the large weight-bearing joints.
c) In autoimmune hemolytic anemia, the red cells are destroyed by tumor necrosis
factor produced by activated macrophages.
d) In Graves’ disease, antibodies bind to the receptor for thyroid stimulating
hormone, which stimulates the thyroid to produce excess thyroxine.
5.Which of the following autoimmune diseases is a systemic disease?

a) Myasthenia gravis.
b) Gravis’ disease.
c) Systemic lupus erythematosus.
d) Type I diabetes mellitus.
105
Model answer of theoretical revision on Cardiovascular system
Pancarditis Relevant zoonotic diseases

Question Answer
Question Answer
1 A
1 D
2 B
2 C
3 D
3 D
4 A
Bacteremia, Sepsis &Toxemia 5 B
6 D
Question Answer
1 B
2 D
Human Immunodeficiency Virus Autoimmune disease

Question Answer Question Answer
1 C 1 B
2 D 2 C
3 C 3 A
4 B 4 D
5 D 5 C
Epstein–Barr virus, Cytomegalovirus &Parvovirus B19
Question Answer
1 D
2 B
3 A
4 B
5 D
Viruses causing Hemorrhagic Fever
Question Answer
1 A
2 D
3 A
4 D
106
CASE Study Activity
I.A 15-year old boy with congenital heart disease presented with fever, fatigue and
night sweats for 2 weeks after tooth extraction. On examination, his temperature is
38.5°C and a new loud systolic murmur heard over the heart. Blood cultures grew
optochin resistant, alpha hemolytic, Gram-positive cocci in chains.
1.What is your provisional diagnosis of this boy’s presentation?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
2.What is the most likely causative organism of this boy’s condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
3. Mention the predisposing factors in this patient.
………………………………………………………………………………………………………
………………………………………………………………………………………………………
4. What is the BEST approach for prevention of infection caused by the etiologic
agent in this boy’s condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
II. A well-known HIV-positive patient with CD4 T-cell count 150/μL presented with
multiple dark purple nodular lesions on his sole and oral cavity. On examination
these lesions are firm on palpation and several of them appear to be growing
together into larger confluent plaques. A biopsy specimen from one of the lesions
revealed neoplastic cells.
1.What is your provisional diagnosis of this patient’s presentation?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
2.What is the most likely etiologic agent of this patient’s condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
3. Mention the clinical stage of this patient’s HIV disease?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
4. What is the cell of origin of the neoplastic cells examined by biopsy specimen?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
107
III. A 25-year-old male presented with sore throat anorexia, fatigue and fever. On
examination, his temperature is 38.50C with enlarged tonsils, cervical
lymphadenopathy, and enlarged spleen was palpable on abdominal examination.
Patient’s peripheral blood smear showed atypical lymphocytes and a positive
Monospot test.
What is your provisional diagnosis of this patient’s presentation?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
2.What is the most likely etiologic agent of this patient’s condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
3.What is the target cell for infection by the etiologic agent of this patient’s
condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
4. Infection with the etiologic agent is associated with certain malignancies,
Mention these malignancies.
………………………………………………………………………………………………………
………………………………………………………………………………………………………
108
Practical Work Sheets
CASE 1
A 20- year-old drug addict presented with fever of 390C and fatigue of 4 days
duration. On auscultation a heart murmur was heard. Microbiological culture
results revealed beta hemolytic, coagulase positive Gram-positive cocci in
clusters.
1.What is your clinical diagnosis of this patient’s condition?
……………………………………………………………………………………………….
……………………………………………………………………………………………….
2.What is the appropriate specimen to be collected from this patient?
……………………………………………………………………………………………….
……………………………………………………………………………………………….
3. Mention the MOST likely etiologic agent of this patient’s condition.
……………………………………………………………………………………………….
……………………………………………………………………………………………….
4.Mention the expected result and the importance of performing catalase test for
the causative organism.
……………………………………………………………………………………………….
……………………………………………………………………………………………….
109
CASE 2
A 45-year-old man with mitral valve replacement two years ago presented with
fever 38.5°C and fatigue 3 weeks after tooth extraction. On heart auscultation a
murmur was heard. Microbiological culture results revealed alpha hemolytic,
Gram-positive cocci in chains.
1.What is your clinical diagnosis of this patient’s condition?
……………………………………………………………………………………………….
……………………………………………………………………………………………….
2. Optochin sensitivity test was performed. What is the expected result of this test
according to the MOST likely causative organism?
……………………………………………………………………………………………….
……………………………………………………………………………………………….
3. Mention the MOST likely etiologic agent of this patient’s condition.
……………………………………………………………………………………………….
……………………………………………………………………………………………….
110
References
-Review of Medical Microbiology and Immunology (2022) Warren L, 17th edition by
McGraw- Hill Education.
-Microbiology: an introduction (2013) Gerard J. Tortora, Berdell R. Funke, Christine

L. Case, 11th Edition, Pearson Education
-Jawetz, Melnick, & Adelberg’s Medical Microbiology (2019) Riedel S, Morse SA,
Mietzner TA, Miller S, 28th edition by McGraw-Hill Education.
-Case files Microbiology (2015) Toy EC, Debord CR, Wagner A, Mackenzie C, Pillai
AS, Kettering JD, 3rd edition by McGraw-Hill Education.
- Lippincott’s illustrated Q&A review of microbiology and immunology (2010)

Buxton B A, Lauritz A. Jensen and Randal K. Gregg. 1st edition by Lippincott Williams &
Wilkins. Microbiology.
-Sherris Medical microbiology (2014) Kenneth J. Ryan, C. George Ray, Nafees

Ahmad, W. Lawrence Drew, Michael Lagunoff, Paul Pottinger, L. Barth Reller, Charles
R. Sterling. 6th edition, McGraw-Hill Education.
-Mims’ medical microbiology (2013) Goering RV, Dockrell MH, Zuckerman M,

Chiodini PL, Roitt MI, 5th edition, Elsevier.
-Basic immunology: functions and disorders of the immune system (2011) Abbas
AK and Litchman AH, 3rd edition by Elsevier, Inc.
-Cellular and molecular immunology (2018) Abbas AK, Litchman AH and Pillai S, 9th
edition by Elsevier, Inc.
- https://www.cdc.gov/vhf/index.html
- https://www.cdc.gov/vhf/rvf/index.html
- https://www.who.int/news-room/fact-sheets/detail/rift-valley-fever
111
CVS 217
Pathology
BY
PROF. DR. HALA KHEIDR
PROFESSOR & HEAD OF PATHOLOGY DEPARTMENT

PROFESSOR OF PATHOLOGY
112
113
1. Acute rheumatic fever classically develops in children 1 to 4 weeks after
a group A β-hemolytic streptococcal infection of the
a. Aorta
b. Heart
c. Lungs
d. Pharynx
e. Tongue
2. One of the followings is the most common primary tumor of the

heart in adults and usually located in the left atrium
a. Chordoma
b. Rhabdomyoma
c. Leiomyoma
d. Myxoma
3. Regarding chronic phase of rheumatic fever, it is associated with one

of the followings
a. Fleeting arthritis
b. Chorea
c. Subcutaneous nodules
d. Carditis
4. A male banker patient 45 years old presented by chest precordial

pain that occurs at rest and unrelated to physical activity . He is
suffering from which type of ischaemic heart disease?
a. Stable angina
b. Prinzmetal angina
c. Crescendo angina
d. Chronic ischaemic heart disease
5. A male patient 50 years old hypertensive and heavy cigarette

smokers is admitted to intensive care unit presenting by severe chest
pain, nausea , vomiting and dyspnea with laboratory elevated
creatine kinase. Angiography revealed complete occlusion of the left
114
circumflex artery what is the area of the myocardium which is
affected by infarction ?
a. Anterior wall of left ventricle
b. Anterior portion of interventricular septum
c. Apex
d. Lateral wall of left ventricle
6. The most common complication of rheumatic heart disease is

a. Mitral stenosis
b. Aortic stenosis
c. Aortic incompetence
d. Mitral incompetence
7. Which of the following statements is true about rheumatic fever:

a. It follows staphylococcal infection
b. It most commonly starts about the age of 35 years
c. It may involve extracardiac sites as brain and lungs causing chronic
damage.
d. The characteristic myocardial lesions are Aschoff bodies composed
of macrophages, lymphocytes and plasma cells
8. Which of the following conditions is not a complication of

rheumatic fever:
a. Mitral stenosis.
b. Subacute infective endocarditis.
c. Aortic incompetence.
d. Perforation of the cusps.
9. The most common primary cardiac tumor in children is

a. Angiosarcoma.
b. Rhabdomyoma.
c. Papillary fibroelastoma.
d. Rhabdomyosarcoma.
e. Lipoma.
115
10. Chylous pericardial effusion is caused by:
a. Generalized edema.
b. Bacterial infection.
c. Lymphatic obstruction.
d. Viral infection.
e. Tuberculous infection.
11.Caseous pericarditis is caused by:

a. Generalized edema.
b. Bacterial infection.
c. Lymphatic obstruction.
d. Tuberculous infection.
12.Obliteration of pericardial sac by dense fibrosis encasing the heart:

a. Adhesive mediastinopericarditis.
b. Constrictive pericarditis.
c. Hemorrhagic pericarditis.
d. Suppurative pericarditis.
e. Caseous pericarditis.
13. Rheumatic fever is a common cause for:

a. Serofibrinous pericarditis.
b. Suppurative pericarditis.
c. Caseous pericarditis.
d. Hemopericardium.
e. Chylous pericardial effusion.
14. Which of the followings isThe most common type of cardiomyopathy :

a. Restrictive cardiomyopathy.
b. Viral myocarditis.
c. Dilated cardiomyopathy.
d. Hypertrophic cardiomyopathy.
15.Which of the following is a feature of subacute infective endocarditis:

a. It is caused by highly virulent organism.
b. If affects normally structured valve.
116
c. It may lead to pyemia.
d. It may be complicated by mycotic aneurysms
16.Which of the following is a feature of acute infective endocarditis:

a. Is caused by streptococcal low virulent infection.
b. Affects previously injured valve.
c. Is associated with low mortality rate.
d. The affected cusps are commonly perforated.
17- What is the commonest type of congenital heart disease
a. Ventricular septal defect
b. Fallot’s tetralogy
c. Fallot’s triology
d. Coarctation of the aorta
18- Which is true regarding polyarteritis nodosa
a- Females are commonly affected than males
b- Presented by exaggerated response to cold
c- It has a good remission rate with corticosteroids
d- It affects large vessels
117
CVS 217
Pharmacology
BY
PROF. DR. HISHAM ALSHEKHEPY
PROFESSOR & HEAD OF PHARMACOLOGY DEPARTMENT

PROFESSOR OF PHARMACOLOGY
118
Pharmacology
MCQ CVS
1-Spironolactone is:
a- A loop diuretic
b- A thiazide diuretic
c- An antiarrhythmic drug
d- A potassium sparing diuretic
2-Thiazide diuretics produce all of the following actions except:

a- Hypotension
b- Uricosuric action
c- Hyperglycemia
d- Decreased excretion of calcium
3-Which of the following is correct as regards frusemide:

a- Is a weaker diuretic than thiazide
b- Causes hypercalcemia
c- Reduces urine volume in diabetes insipidus
d- Can produce hypokalemia
4-Thiazide diuretics can produce the following side effects except:

a- Hypokalemia
b- Hypocalcemia
c- Hyperglycemia
d- Hyperuricemia
5-The following diuretic is used IV in treatment of acute pulmonary edema:

a- Hydrochlorothiazide
b- Trimetrene
c- Furosemide
d- Acetazolamide
6-Thiazide diuretics are useful in treatment of which of the following:

a- Hypotension
b- Chronic heart failure
c- Angina pectoris
d- Cardiac arrhythmia
7- Each of the following diuretics is paired with an appropriate use EXCEPT:

a- Hydrochlorothiazide - acute renal failure
b- Triamterene - hypokalemia induced by thiazides
c- Spironolactone - hyperaldosteronism
d- Acetazolamide - glaucoma
119
8-Concomitant administration of furosemide with the following agent can induce severe
ototoxicity:
a- Captopril
b- Propranolol
c- Acetazolamide
d- Gentamicin
9-The following diuretics cause hyperkalemia except:

a- Triamterene
b- Spironolactone
c- Hydrochlorothiazide
d- Amiloride
10-The diuretic preferred in cases of acute renal failure is:

a- Thiazide diuretic
b- Frusemide
c- Spironolactone
d- Mannitol
11-Gynecomastia and hyperkalemia in males are side effects of:

a- Thiazide diuretic
b- Frusemide
c- Spironolactone
d- Mannitol
12-Drugs used for urine Acidification:

a- Ammonium chloride
b- Sodium bicarbonate
c- Pyridoxine
d- A & B
13-Mechanism of action of acetazolamide is:

a- Through osmotic effects
b- Inhibition of carbonic anhydrase enzyme.
c- Interaction with hormonal receptors
d- Blockade of Na+ channels
14-Potassium supplementation is contraindicated in patients using the following diuretics:

a- Chlorthalidone
b- Hydrochlorothiazide
c- Furosemide
d- Triamterene
15-All the following agents belong to cardiac glycosides EXCEPT:

a. Digoxin
b. Ouabain
c. Amrinone
d. Digitoxin
120
16-Sugar molecules in the structure of glycosides influence:
a. Cardiotonic action
b. Pharmacokinetic properties
c. Toxic properties
d. All the above
17-All the following statements regarding cardiac glycosides are true EXCEPT:
a. They inhibit Na+/K+-ATPase, so increase intracellular Ca++ in myocardial cells
b. They cause a decrease in vagal tone
c. Children tolerate higher doses of digitalis than do adults
d. The most frequent cause of digitalis intoxication is concurrent administration of
diuretics that deplete K+
18-Digoxin is thought to increase intracellular concentrations of calcium in myocardial cells

by indirectly slowing the action of the sodium-calcium exchanger. This consideration is:
a. True
b. False
19-The cardiac manifestation of glycosides intoxication is:

a. Atrioventricular junctional rhythm
b. Second-degree atrioventricular blockade
c. Ventricular tachycardia
d. All the above
20-For digitalis-induced arrhythmias the following drug is favored:

a. Verapamil
b. Amiodarone
c. Lidocaine
d. Propranolol
21-All of the following statements regarding cardiac glycoside-induced ventricular

tachyarrhythmia are true EXCEPT:
a. Lidocaine is a drug of choice in treatment
b. Fab fragment should be used in life-threatening cases
c. They occur more frequently in patients with hyperkalemia than in those with
hypokalemia
d. They are more likely to occur in patients with a severely damaged heart
22- This drug is a selective beta-1 agonist:

a. Digoxin
b. Dobutamine
c. Amrinone
d. Dopamine
23-This drug acts by inhibiting type III cyclic nucleotide phosphodiesterase:

a. Amiodarone
b. Milrinone
c. Propranolol
d. Enalapril
121
24-All the following drugs are used in the treatment of severe congestive heart failure
EXCEPT:
a. Verapamil
b. Digoxin
c. Dobutamine
d. Dopamine
25-All the following statements concerning angiotensin converting enzyme (ACE)

inhibitors are true EXCEPT:
a. They act by inhibiting the ability of renin to convert angiotensinogen to angiotensin
I.
b. Enalapril is a prodrug that is converted to an active metabolite
c. They reduce secretion of aldosterone
d. They can produce hyperkalemia in combination with a potassium-sparing diuretic
26-All the following statements concerning the use of angiotensin-converting enzyme

(ACE) inhibitors in the treatment of heart failure are true EXCEPT:
a. They improve hemodynamics by decreasing afterload
b. They can increase plasma cholesterol levels
c. They may slow the progression of heart failure by preventing myocardial and
vascular remodeling
d. They are effective first-line agents in the treatment of chronic heart failure
27-All these drug groups useful in angina both decrease myocardial oxygen requirement
(by decreasing the determinations of oxygen demand) and increase myocardial oxygen
delivery (by reversing coronary arterial spasm), EXCEPT:
a. Nitrates and nitrite drugs (Nitroglycerin, Isosorbide dinitrate)
b. Calcium channel blockers (Nifedipine, Nimodipine)
c. Beta-adrenoceptor-blocking drugs (Atenolol, Metoprolol)
d. Potassium channel openers (Minoxidil)
28-This drug group useful in angina increase myocardial oxygen delivery (by reversing
coronary arterial spasm) and does not decrease myocardial oxygen requirement (by
decreasing the determinations of oxygen demand):
a. Beta-adrenoceptor-blocking drugs (Atenolol, Metoprolol):
b. Myotropic coronary dilators (Dipyridamole)
c. Calcium channel blockers (Nifedipine, Nimodipine)
d. Potassium channel openers (Minoxidil)
29-Which of the following nitrates and nitrite drugs is used for prevention of angina attack?
a. Nitroglycerin, 2% ointment
b. Nitroglycerin, oral sustained release tablet
c. Isosorbide mononitrate
d. All of the above
30-Duration of nitroglycerin action (sublingual) is:

a. 10-30 minutes
b. 6-8 hours
c. 3-5 minutes
d. 1.5-2 hours
122
31-Side effect of nitrates and nitrite drugs are, EXCEPT:
a. Orthostatic hypotension, tachycardia
b. Ototoxic effect
c. Throbbing headache
d. Tolerance
32-One of the following statements concerning mechanism of calcium channel blockers’

action are wrong:
a. Therapeutically active agents in this group are capable of releasing nitric oxide (NO)
in vascular smooth muscle target tissues
b. Calcium channel blockers bind to L-type calcium channel sites
c. Calcium channel blockers useful in angina decrease myocardial oxygen requirement
d. Calcium channel blockers decrease transmembrane calcium current associated in
smooth muscle with long-lasting relaxation and in a cardiac muscle with a reduction
in contractility
33-Which of the following cardiovascular system effects refers to a calcium channel

blocker?
a. The reduction of peripheral vascular resistance
b. The reduction of cardiac contractility and, in some cases, cardiac output
c. Relief of coronary artery spasm
d. All of the above
34-Which of the following antianginal agents is a beta-adrenoceptor-blocking drug:

a. Dipyridamole
b. Isosorbide dinitrate.
c. Atenolol
d. Alinidine
35- Which of the following statements concerning Dipyridamole is true?

a. Dipyridamole is an agent that blocks the reabsorption and breakdown of adenosine
that results in an increase of endogenous adenosine and vasodilatation
b. The drug causes relative hypoperfusion of myocardial regions served by coronary
arteries with hemodynamically significant stenosis
c. Dipyridamole is a platelet aggregation inhibitor
d. All of the above
36- Which of the following antianginal agents is a potassium channel opener:

a. Dipyridamole
b. Isosorbide dinitrate
c. Atenolol
d. Minoxidil
37-This drug reduces blood pressure by acting on vasomotor centers in the CNS:
a. Labetalol
b. Clonidine
c. Enalapril
d. Nifedipine
123
38- All the following are central acting antihypertensive drugs EXCEPT:
a. Methyldopa
b. Clonidine
c. Moxonidine
d. Minoxidil
39-Which one of the following drugs is sympatholytic drug:

a. Labetalol
b. Prazosin
c. Guanethidine
d. Clonidine
40-This drug blocks alpha-1 adrenergic receptors:

a. Prazosin
b. Clonidine
c. Enalapril
d. Nifedipine
41-This drug activates alpha-2 adrenergic receptors:

a. Labetalol
b. Phentolamine
c. Clonidine
d. Enalapril
42-This drug is an inhibitor of renin synthesis:

a. Propranolol
b. Enalapril
c. Diazoxide
d. Losartan
43-This drug is a non-peptide angiotensin II receptor antagonist:

a. Clonidine
b. Captopril
c. Losartan
d. Diazoxide
44-This drug is a potassium channel activator:

a. Nifedipine
b. Saralasin
c. Diazoxide
d. Losartan
45-This drug is a Class IA antiarrhythmic drug:

a. Sotalol
b. Propranolol
c. Verapamil
d. Quinidine
124
46-This drug is a Class IC antiarrhythmic drug:
a. Flecainide
b. Sotalol
c. Lidocaine
d. Verapamil
47-This drug is a Class IC antiarrhythmic drug:

a. Flecainide
b. Sotalol
c. Lidocaine
d. Verapamil
48- This drug is a Class II antiarrhythmic drug:

a. Flecainide
b. Propranolol
c. Lidocaine
d. Verapamil
49-This drug is a Class III antiarrhythmic drug:

a. Flecainide
b. Sotalol
c. Lidocaine
d. Verapamil
50-This drug is used in treating supraventricular tachycardias:

a. Digoxin
b. Dobutamine
c. Amrinone
d. Dopamine
C.V.S. Key Answers
1 D 21 C 41 C
2 B 22 B 42 A
3 D 23 B 43 C
4 B 24 A 44 C
5 C 25 A 45 D
6 B 26 B 46 C
7 A 27 C 47 A
8 D 28 B 48 B
9 C 29 D 49 B
10 B 30 A 50 A
11 C 31 B
12 A 32 A
13 B 33 D
14 D 34 C
15 C 35 D
16 16 36 D
17 B 37 B
18 A 38 D
19 D 39 C
20 C 40 A
125

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1

PROF. DR. HODA ELAASAR

PROFESSOR & HEAD OF ANATOMY DEPARTMENT

1. Give the boundaries of th transverse sinus of the

2. Describe the boundaries of the oblique sinus of the

3. Mention the arterial and nerve supply of the fibrous

5. Give the orifices of the right atrium.

6. Compare between the right and left ventricle.

8. Determine the site of the coronary sinus and its tributaries.

12. Why blockage of one of the branches of the right coronary

14. Describe the beginning, course, end and branches of the

15. Mention the left anterior relation of the arch of aorta.

17. Determine the level of the beginning and termination of the

18. Give the branches of the arteries sharing in the

20. Determine the beginning, course and termination of the

21. Give the branches of the ulnar artery in the forearm

23. Describe the course and the arteries sharing in the

24. Give the beginning, course, tributaries and termination of

27. Give the course and surface anatomy of the dorsalis

29. Give the location, afferents and efferents of the posterior

30. Explain the stage of development of the interatrial septum

32. Give the fate of the aortic arches.

33. Mention early changes in the circulation after birth.

a. The serous pericardium keeps the mouth of large vessels open.

a. Visceral layer of serous pericardium is supplied by the phrenic nerves

a. It connects the right and left sides of the pericardial cavity

17. Regarding the S.V.C, choose the correct answer:

a. Common Interosseous artery.

a. Right subclavian artery, arch of aorta.

a. They develop in the cardiogenic field cranial to the buccopharyngeal

a. The sinus venosus shares in the development of the left atrium.

a. Its proximal third forms trabeculated part of the left ventricle.

a. The common atrioventricular opening is divided into two by the

46. One of the following anomalies is a component of Fallot’s tetralogy:

a. Atrial septal defect.

C. Fill in the blank:

Cross Matching Questions:

1- Radial artery a) Subscapular artery

2- Ulnar artery b) Suprascapular artery

3- Brachial artery c) Princeps pollicis

4- Axillary artery d) Superior ulnar collateral

5- Subclavian artery e) Common interosseous

2. Match the origin of the following arteries:

1- Internal thoracic artery a- Descending aorta

2- Lower 3 anterior intercostals arteries b- Ascending aorta

3- Pericardiophrenic artery c- Muscuophrenic aretry

4- Coronary arteries d- Subclavian artery

5- Left bronchial artery e- Internal mammary artery

3. Match each of the following congenital anomalies of the heart in column

1. Fallot’s tetralogy. A. Results from failure of fusion of the

4. Match the origin of the following arteries:

1- Femoral artery a- Internal iliac artery

2- Superficial epigastric artery b- External iliac artery

3- Dorsalis pedis artery c- Posterior tibial artery

4- Peroneal artery d- Femoral artery

5- Medial circumflex femoral e- Anterior tibial artery

f- Profunda femoris artery

5. Match each of the following arteries in column (A) with its

1. Common carotid artery. A. Arises from the first aortic arch.