Sample Exams

Exam Reviews

Physiology II - PB 3325
Course Director: Mrs. Kay Brashear

STUDY GUIDE Exam 1

The following study guide is designed to enhance the use of the lecture outlines provided. The study guide covers the major concepts discussed in lecture. A combination of lecture outline, lecture notes and the study guide will provide the most benefit. A copy of last trimester exams is located in the library. The exams may be copied. All exams are returned to students and many copies are floating freely. We do not use specific questions from old exams. Use of old exams should be restricted to looking at writing style, looking at the use of material from lecture, and to see how the major concepts covered in the course are presented. Old exams will also help assess level of testing.

Lecture Outline 1 Cardiac Cycle

1. Know how muscle spirals and the annulus fibrosis relate to cardiac function.
2. Know how an increase in heart rate affects the ratio systole/diastole. Which part of the cardiac cycle changes the most?
3. Know what causes atrial pressure waves “a”, “c” and “v”.   When do they occur during the cardiac cycle?
4. For each component of the cardiac cycle know the following:
            Position of valves
            Are there volume or pressure changes
            Are heart sounds associated with the phase
            Do any of the major components of the ECG correlate to the phase
5. Know the significance of the following:
            EDV = ESV + VR   (preload)
            ESV
            Stroke volume
            Ejection fraction
            Contractility – how does it affect stroke volume and ejection fraction?
6. Aortic pressure curve
            Know the location of diastolic pressure, systolic pressure, pulse pressure, and dicrotic
            notch or incisura on a diagram.
            What causes the aortic pressure curve? What causes the dicrotic notch?
            What is the role of the aorta in continuous blood flow and diastolic blood pressure?
7. What are the causes of S1, S2, S3 and S4?
8. What is external work? When is most EW used in the cardiac cycle?
9. What is Kinetic energy of work? When is kinetic energy used?
10. Pressure-Volume loop
            Area = EW
            Know where an increase in volume load would change the loop.
            Know where a change in a pressure load would affect the loop.
            Be able to label the loop.
            How do increases in the volume load (preload) and pressure load (afterload) affect
            cardiac work and oxygen usage?
11. Know the determinates of cardiac energy usage. See. IV on outline.
12. Know the difference between Intrinsic and Extrinsic regulation of the cardiac cycle.
13. Terminology:
        Inotropic chronotropic hypereffective
        Hypoeffective bradycardia tachycardia
14. Know how preload, afterload, heart rate and contractility affect myocardial function. (Outline III.)
15. Know the major effect of ions and temperature on heart function and the ECG.

Lecture Outline 2 Rhythmical Excitation of the Heart and Normal ECG

Rhythmical Excitation of the Heart

1. What is the function of the cardiac conduction system?

2. Know the anatomical components of the cardiac conduction system.

3. Know the function of the P cells and transitional cells in the S. A. node, internodal tracts or pathways, P cells and transitional cells in the A-V node, common bundle and the Purkinje fibers.

4. How does the cardiac conduction system control the cardiac cycle?

5. What is rhythmicity?

6. What components of the cardiac conduction system can spontaneously depolarize and what are their firing rates?

Normal ECG

1. Know the standard organization of the ECG. (time and voltage)
2. Know what factors affect the appearance of a waveform.
            a. direction of depolarization relative to the lead of axis
            b. muscle mass involved in depolarization or repolarization
            c. time factor
3. Know the characteristics, part of the heart, time and/or voltage for depolarization or repolarization.
            P wave
            P-R interval
            QRS complex
            J point
            S-T segment
            T wave
4. Know the characteristics of the Standard Limb Leads, Augmented Leads and Precordial Leads. ( type of leads and area of heart recorded)
5. What is Einthoven’s triangle? Einthoven’s Law? How can they be used?

Lecture Outline 3 Abnormal ECG

1. Know the definition of a vector.   How are vectors used?
2. Know the lead of axis for Standard Limb Leads I, II and III.
3. Be able to trace depolarization and repolarization in the ventricles.
4. What is the mean electrical axis?   What is the direction in degrees?
5. What is an axis deviation? What are the causes of left and right axis deviations?
6. What are the causes of high and low voltage ECGs?
7. What is the major cause of a wide QRS complex?
8. What is the major cause of a wide and bizarre QRS complex?
9. What is a current of injury? What part of the ECG is used to determine a current of injury?
10. What is the significance of the J point when diagnosing a current of injury of S-T segment shift?
11. What are the causes of a current of injury or S-T segment shift?
12. How does an ECG change from the time of immediate injury to recovery?
            S-T segment shift
            Significant Q wave
13. What is Angina Pectoris? What are the symptoms? Causes?
14. Know the abnormalities of the T wave.

ECG Case Studies

Be able to use the information from the chapters covering normal and abnormal ECGs to make a diagnosis. Examples are given below.

Example A
The following ECG information is available for a patient. What is your diagnosis?
P-R interval = 0.23 seconds
QRS complex = 0.08 seconds
S-T segment – 0.4 mv,
Mean electrical axis = +110 degrees

Example B
P-R interval = 0.18 seconds
QRS complex = 0.12 seconds
Mean electrical axis = -29 degrees
Voltage for the R wave is 2.8mv.

Example C
P-R interval = 0.08 seconds
QRS complex = 0.12 seconds, configuration is wide and bizarre
Mean electrical axis = -29 degrees

Answers:

Example A
     P-R interval = 0.23 seconds ---- slow conduction through A-V node
     S-T segment abnormal voltage – S-T segment shift or current of injury
     MEA show a right axis deviation

Right axis deviation combined with a segment shift indicates a left ventricular injury. The injury is also causing slow conduction through the A-V node

Example B

P-R interval is normal
QRS complex - abnormal time, no indication of abnormal configuation
S-T segment is normal
MEA indicates a left axis deviation

Left axis deviation coupled with the wide QRS would indicate left ventricular hypertrophy

Example C

P-R interval is normal
QRS Complex has an abnormal time and configuration
MEA indicates a left axis deviation

A left axis deviation coupled with a wide and bizarre QRS complex indicates a left bundle branch block

If you are having problems with the lecture material please come get help from the instructor.