Basic Sciences in Cardiology

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Question 1 of 20

1. Question

The plateau phase (phase 2) of the ventricular myocyte action potential is principally maintained by which of the following?

Balance between inward L-type calcium current and outward delayed rectifier potassium current
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Rapid influx of sodium through fast voltage-gated sodium channels
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Inward funny current (If) carried by HCN channels
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Efflux of chloride through calcium-activated chloride channels
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Sodium influx through the sodium-calcium exchanger operating in reverse mode
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Question 2 of 20

2. Question

The cellular basis of the Frank-Starling relationship, whereby increased ventricular preload augments stroke volume, is best explained by which of the following?

Length-dependent increase in myofilament calcium sensitivity
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Increased sympathetic catecholamine release with stretch
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Reduced afterload permitting greater fibre shortening
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Enhanced sarcoplasmic reticulum calcium reuptake
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Increased heart rate through the Bainbridge reflex
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Question 3 of 20

3. Question

B-type natriuretic peptide (BNP) is released predominantly from which structure in response to which primary stimulus?

Ventricular myocytes in response to ventricular wall stretch
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Atrial myocytes in response to atrial pressure
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Vascular endothelium in response to shear stress
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Renal juxtaglomerular cells in response to sodium load
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Hypothalamic neurons in response to plasma osmolality
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Question 4 of 20

4. Question

Occlusion of the left circumflex coronary artery in a right-dominant circulation most typically produces ischaemia in which region and corresponding ECG leads?

Lateral wall of the left ventricle; leads I, aVL, V5-V6
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Anterior left ventricle and septum; leads V1-V4
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Inferior wall; leads II, III, aVF
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Right ventricle; right-sided leads V3R-V4R
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Posterior interventricular septum; leads V7-V9
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Question 5 of 20

5. Question

In severe aortic stenosis, which pulse and pressure finding is most characteristic?

Narrow pulse pressure with a slow-rising, low-volume pulse
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Wide pulse pressure with a collapsing pulse
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Pulsus bisferiens with normal pulse pressure
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Pulsus paradoxus exceeding 20 mmHg
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Water-hammer pulse with bounding character
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Question 6 of 20

6. Question

Digoxin exerts its positive inotropic effect through which primary molecular action?

Inhibition of the sarcolemmal sodium-potassium ATPase, secondarily raising intracellular calcium
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Direct agonism at cardiac beta-1 adrenergic receptors
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Increasing intracellular cyclic AMP by phosphodiesterase inhibition
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Blockade of L-type calcium channels in the AV node
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Enhancement of sarcoplasmic reticulum calcium ATPase activity
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Question 7 of 20

7. Question

Torsades de pointes is most directly precipitated by which electrophysiological abnormality?

Early afterdepolarisations during prolonged repolarisation
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Delayed afterdepolarisations from intracellular calcium overload
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Enhanced automaticity of the sinoatrial node
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Accessory pathway re-entry
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Complete atrioventricular dissociation
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Question 8 of 20

8. Question

In the diagnosis of acute myocardial infarction using high-sensitivity cardiac troponin, which statement is most accurate?

Serial measurement demonstrating a rising or falling pattern is required to distinguish acute myocardial injury from chronic elevation
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Troponin levels peak within one hour of symptom onset
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A single normal value at presentation reliably excludes infarction
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Troponin is entirely specific for atherothrombotic myocardial infarction
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Creatine kinase-MB is more sensitive than high-sensitivity troponin
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Question 9 of 20

9. Question

Which haemodynamic feature most reliably distinguishes constrictive pericarditis from restrictive cardiomyopathy?

Ventricular interdependence with discordant respiratory variation in ventricular pressures
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Elevated jugular venous pressure
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Prominent y-descent in the jugular venous waveform
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Kussmaul's sign
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Equalisation of diastolic pressures across all chambers
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Question 10 of 20

10. Question

The earliest histological lesion of atherosclerosis, the fatty streak, is characterised by which cellular event?

Subendothelial accumulation of lipid-laden macrophage foam cells
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Medial smooth muscle calcification
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Fibrous cap formation with a necrotic core
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Intraplaque haemorrhage from neovascularisation
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Adventitial lymphocytic infiltration
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Question 11 of 20

11. Question

Spontaneous diastolic depolarisation (phase 4) in sinoatrial nodal cells is primarily generated by which current?

Funny current (If)
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Fast inward sodium current
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Delayed rectifier potassium efflux
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Inward rectifier potassium current
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Chloride efflux through CFTR channels
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Question 12 of 20

12. Question

The characteristic dynamic left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy is worsened by which manoeuvre?

Valsalva manoeuvre
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Squatting
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Passive leg raise
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Hand-grip isometric exercise
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Administration of intravenous fluids
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Question 13 of 20

13. Question

Angiotensin II raises blood pressure through which combination of effects?

Arteriolar vasoconstriction, aldosterone release and stimulation of thirst
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Arteriolar vasodilation and natriuresis
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Inhibition of ADH release and diuresis
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Reduction of sympathetic outflow and bradycardia
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Direct inhibition of proximal tubular sodium reabsorption
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Question 14 of 20

14. Question

A widened pulse pressure is most characteristically associated with which condition?

Chronic severe aortic regurgitation
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Aortic stenosis
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Cardiac tamponade
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Mitral stenosis
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Hypovolaemic shock
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Question 15 of 20

15. Question

According to Poiseuille’s law, halving the radius of an arteriole (all else being constant) changes resistance to flow by which factor?

Increases resistance sixteen-fold
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Doubles resistance
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Quadruples resistance
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Increases resistance eight-fold
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Halves resistance
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Question 16 of 20

16. Question

The pathophysiological hallmark of Eisenmenger syndrome, arising from an uncorrected large left-to-right shunt, is which of the following?

Progressive pulmonary vascular disease causing shunt reversal to right-to-left with cyanosis
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Left ventricular volume overload with preserved oxygen saturation
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Reversible pulmonary vasoconstriction relieved by oxygen
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Isolated left atrial enlargement without pulmonary hypertension
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Systemic hypertension with left ventricular hypertrophy
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Question 17 of 20

17. Question

Statins reduce plasma LDL cholesterol predominantly through which mechanism?

Inhibition of HMG-CoA reductase leading to upregulation of hepatic LDL receptors
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Direct binding and sequestration of intestinal bile acids
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Inhibition of intestinal cholesterol absorption via NPC1L1
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Activation of lipoprotein lipase
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Inhibition of PCSK9
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Question 18 of 20

18. Question

Complete (third-degree) atrioventricular block is defined electrocardiographically by which finding?

Complete atrioventricular dissociation with independent atrial and ventricular rates
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Progressive PR prolongation until a beat is dropped
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Fixed PR prolongation greater than 200 milliseconds with 1:1 conduction
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Intermittent dropped beats without PR prolongation
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A widened QRS with a normal PR interval
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Question 19 of 20

19. Question

Pulsus paradoxus in cardiac tamponade is best explained by which mechanism?

Exaggerated inspiratory increase in right ventricular filling causing leftward septal shift and reduced left ventricular output
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Fixed reduction in stroke volume independent of respiration
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Loss of atrial contribution to ventricular filling
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Aortic valve regurgitation during inspiration
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Inspiratory increase in systemic vascular resistance
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Question 20 of 20

20. Question

Which of the following changes would most increase myocardial oxygen demand?

Increased wall tension from elevated afterload combined with tachycardia
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Reduced heart rate with a beta-blocker
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Coronary vasodilation with nitrates
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Reduced preload with venodilation
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Improved diastolic perfusion pressure
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Basic Sciences in Cardiology

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