Physiology- Barry

Question 1

Which of the following best explains the increased pulse wave velocity (PWV) observed in older adults?
A. Increased nitric oxide production
B. Decreased mean arterial pressure
C. Greater aortic compliance
D. Increased arterial stiffness
E. Enhanced endothelial function

Answer 1

D. Increased arterial stiffness

Question 2

What is a key consequence of early wave reflection in stiff arteries during late systole?
A. Improved coronary perfusion
B. Decreased myocardial oxygen demand
C. Increased central systolic blood pressure
D. Reduced flow turbulence
E. Decreased risk of atherogenesis

Answer 2

C. Increased central systolic blood pressure

Question 3

The Augmentation Index (AIx) is primarily a measure of:
A. Left ventricular ejection fraction
B. Arterial diameter
C. Wave reflection
D. Coronary artery blood flow
E. Pulse pressure variability

Answer 3

C. Wave reflection

Question 4

Why is it important to consider MAP when comparing arterial stiffness between two individuals?
A. MAP has no effect on stiffness measurements
B. Higher MAP artificially decreases PWV
C. MAP influences strain on aortic walls, affecting stiffness readings
D. Lower MAP always correlates with higher arterial stiffness
E. MAP only affects endothelial function, not arterial stiffness

Answer 4

C. MAP influences strain on aortic walls, affecting stiffness readings

Question 5

Which of the following best describes how diabetes contributes to increased cardiovascular risk?
A. Reduces PWV via hyperinsulinemia
B. Improves wave reflection and vascular compliance
C. Increases arterial stiffness and augmentation index
D. Decreases atherogenic potential via glucose control
E. Enhances buffering capacity of large arteries

Answer 5

C. Increases arterial stiffness and augmentation index

Question 6

Regular aerobic exercise reduces cardiovascular risk partly by:
A. Increasing fasting glucose levels
B. Increasing arterial stiffness
C. Reducing insulin sensitivity
D. Improving endothelial function and lowering PWV
E. Promoting subendocardial ischemia

Answer 6

D. Improving endothelial function and lowering PWV

Question 7

Which is NOT a likely effect of chronic physical inactivity on arterial health?
A. Increased arterial stiffness
B. Reduced glucose tolerance
C. Increased inflammatory biomarkers
D. Decreased augmentation index
E. Elevated cardiovascular risk

Answer 7

D. Decreased augmentation index

Question 8

What mechanism best explains increased microvascular damage in individuals with stiff arteries?
A. Enhanced nitric oxide signalling
B. Reduced pulsatile transmission
C. High pulsatile flow reaches microcirculation
D. Increased buffering by elastic arteries
E. Complete absence of wave reflection

Answer 8

C. High pulsatile flow reaches microcirculation

Question 9

How does nitric oxide influence arterial stiffness?
A. It increases vascular tone
B. It promotes wave reflection
C. It decreases arterial stiffness via vasodilation
D. It raises mean arterial pressure
E. It increases sympathetic activity

Answer 9

C. It decreases arterial stiffness via vasodilation

Question 10

Which of the following is characteristic of a healthy young arterial system during diastole?
A. Ventricular-vascular mismatch
B. Reduced coronary blood flow
C. Increased arterial stiffness
D. Efficient ventricular-vascular coupling
E. Decreased pulse pressure amplification

Answer 10

D. Efficient ventricular-vascular coupling

Question 11

Which tool is commonly used to assess both pulse wave velocity and augmentation index in clinical or research settings?
A. Doppler ultrasound
B. Electrocardiogram
C. Applanation tonometry (e.g., SphygmoCor)
D. Cardiac catheterisation
E. Holter monitor

Answer 11

C. Applanation tonometry (e.g., SphygmoCor)

Question 12

Increased arterial stiffness contributes to atherosclerosis mainly by:
A. Decreasing coronary perfusion
B. Reducing myocardial oxygen demand
C. Increasing turbulent blood flow and plaque rupture risk
D. Enhancing nitric oxide-mediated vasodilation
E. Promoting continuous laminar flow

Answer 12

C. Increasing turbulent blood flow and plaque rupture risk

Question 13

According to studies on young individuals, regular physical activity is associated with:
A. Increased PWV and AIx
B. Lower fasting glucose and lower PWV
C. Increased IMT and decreased arterial distensibility
D. Decreased nitric oxide bioavailability
E. Reduced endothelial function

Answer 13

B. Lower fasting glucose and lower PWV

Question 14

Insulin is thought to reduce arterial stiffness by:
A. Stimulating sympathetic nervous system activity
B. Increasing collagen breakdown in vessel walls
C. Enhancing nitric oxide production and endothelial function
D. Promoting smooth muscle proliferation
E. Decreasing baroreceptor sensitivity

Answer 14

C. Enhancing nitric oxide production and endothelial function

Question 15

Which of the following is considered a confounding factor when interpreting arterial stiffness measurements?
A. Exercise frequency only
B. Arterial calcium levels
C. Mean arterial pressure
D. Diastolic BP alone
E. Red blood cell count

Answer 15

C. Mean arterial pressure

Question 16

In younger individuals with compliant arteries, what beneficial effect is observed during diastole?
A. Reduced coronary perfusion
B. Early wave reflection
C. Enhanced coronary blood flow
D. Increased central systolic pressure
E. Ventricular-vascular uncoupling

Answer 16

C. Enhanced coronary blood flow

Question 17

What was a key cardiovascular finding from the UKPDS (United Kingdom Prospective Diabetes Study)?
A. Tight glycaemic control eliminated arterial stiffness
B. Physical activity was the most important intervention
C. Tight blood pressure control reduced microvascular complications more than glycaemic control
D. Augmentation index decreased with ageing
E. PWV measurements were irrelevant in diabetics

Answer 17

C. Tight blood pressure control reduced microvascular complications more than glycaemic control

Question 18

Which of the following is NOT a likely consequence of endothelial dysfunction?
A. Increased nitric oxide availability
B. Increased arterial stiffness
C. Enhanced wave reflection
D. Promoted atherogenesis
E. Impaired vasodilation

Answer 18

A. Increased nitric oxide availability

Question 19

Which statement best reflects the current theory about wave reflection and microcirculation protection?
A. All wave reflection should be eliminated in hypertensive patients
B. Reduced wave reflection improves buffering of pulsatile pressure
C. Increased wave reflection may prevent excessive pulsatile energy from reaching microvessels
D. High aPWV is protective when wave reflection is absent
E. Pulse wave amplification is irrelevant to microvascular damage

Answer 19

C. Increased wave reflection may prevent excessive pulsatile energy from reaching microvessels

Question 20

Which of the following is NOT a reported reason for conflicting literature on the effect of exercise on arterial stiffness?
A. Site of artery assessment
B. Type of exercise
C. Age of study cohorts
D. Methods of arterial stiffness measurement
E. Insulin formulation used in trials

Answer 20

E. Insulin formulation used in trials

Question 21

Which of the following is considered a structural contributor to vascular ageing?
A. Reduced nitric oxide release
B. Gender-specific endothelial signalling
C. Inflammation-mediated collagen deposition
D. Temporary vasoconstriction
E. Altered flow-mediated dilatation

Answer 21

C. Inflammation-mediated collagen deposition

Question 22

Flow-mediated dilatation (FMD) primarily assesses:
A. Coronary artery calcification
B. Microvascular resistance
C. Endothelial-dependent vasodilation
D. Arterial intima-media thickness
E. Aortic wall compliance

Answer 22

C. Endothelial-dependent vasodilation

Question 23

Which of the following best describes forearm plethysmography?
A. A method to assess arterial pulse pressure
B. A technique to image coronary arteries
C. A test for measuring microvascular blood flow and reactivity
D. An invasive procedure to measure cardiac output
E. A way to quantify left ventricular hypertrophy

Answer 23

C. A test for measuring microvascular blood flow and reactivity

Question 24

Which group shows increased arterial stiffness independent of other cardiovascular risk factors?
A. Individuals with low HDL
B. Individuals with impaired fasting glucose (IFG)
C. Patients on β-blockers
D. Those with elevated LDL alone
E. Smokers with normal BMI

Answer 24

B. Individuals with impaired fasting glucose (IFG)

Question 25

Pressure wave amplification refers to: A. The reduction of central pulse pressure with age B. Reflection of diastolic pressure waves from the microcirculation C. The difference between central and peripheral systolic pressures D. Increased diastolic runoff in older arteries E. Equalisation of arterial pressure throughout the vascular tree

Answer 25

C. The difference between central and peripheral systolic pressures

Question 26

Which combination is most likely to influence arterial stiffness? A. Ethnicity and smoking status B. BMI and LDL cholesterol C. Genetics, inflammation, and gender D. HDL levels and sodium intake E. Age and diastolic blood pressure alone

Answer 26

C. Genetics, inflammation, and gender

Question 27

Compared to healthy individuals, people with diabetes are more likely to develop: A. Only microvascular complications B. Only macrovascular complications C. Both macrovascular (e.g. MI) and microvascular (e.g. retinopathy) complications D. Neither type of complication if glucose is well-controlled E. Only peripheral vascular disease

Answer 27

C. Both macrovascular (e.g. MI) and microvascular (e.g. retinopathy) complications

Question 28

Nitric oxide (NO) and glyceryl trinitrate (GTN) improve arterial function by: A. Stimulating collagen synthesis B. Increasing AIx under all conditions C. Promoting vasodilation and reducing arterial stiffness D. Blocking sympathetic nerve activity E. Inhibiting endothelial nitric oxide synthase (eNOS)

Answer 28

C. Promoting vasodilation and reducing arterial stiffness

Question 29

Which principle does applanation tonometry rely on to measure arterial pressure waveforms? A. Laminar blood flow B. Magnetic resonance C. Flattening an artery against underlying structures D. Use of contrast dye E. Occlusion of arterial flow

Answer 29

C. Flattening an artery against underlying structures

Question 30

Why might reducing wave reflection in patients with already high aortic PWV be harmful to microcirculation? A. It reduces arterial compliance B. It increases pulse pressure transmission to microvessels C. It raises central systolic blood pressure D. It lowers myocardial oxygen delivery E. It causes compensatory bradycardia

Answer 30

B. It increases pulse pressure transmission to microvessels