Cardiovascular & Pulmonary Clinical Specialist (CCS)
CCS – CARDIOVASCULAR AND PULMONARY CLINICAL SPECIALIST |
EXAM QUESTIONS AND CORRECT ANSWERS | VERIFIED PHYSICAL
THERAPY SPECIALIST latest 2026/2027
Cardiovascular & Pulmonary Clinical Specialist (CCS)
1. Which chamber of the heart receives deoxygenated blood returning
from the systemic circulation?
A. Right atrium
B. Left atrium
C. Right ventricle
D. Left ventricle
ANSWER : A. Right atrium — The right atrium receives deoxygenated
blood via the superior and inferior vena cavae before it passes to the right
ventricle.
2. In most individuals, which coronary artery supplies the sinoatrial
(SA) node?
A. Left main coronary artery
B. Left anterior descending artery
C. Right coronary artery
D. Circumflex artery
ANSWER : C. Right coronary artery — The right coronary artery
supplies the SA node in approximately 55-60% of people; the remainder are
supplied via the circumflex branch of the left coronary artery.
Page 1 of 63
, Cardiovascular & Pulmonary Clinical Specialist (CCS)
3. The relationship between end-diastolic volume and stroke volume, in
which increased venous return stretches myocardial fibers to increase
contractile force, describes which principle?
A. Frank-Starling mechanism
B. Bainbridge reflex
C. Bohr effect
D. Laplace's law
ANSWER : A. Frank-Starling mechanism — The Frank-Starling
mechanism states that increased preload (stretch) increases the force of
ventricular contraction, matching cardiac output to venous return.
4. Which valve is located between the left atrium and left ventricle?
A. Aortic valve
B. Mitral (bicuspid) valve
C. Tricuspid valve
D. Pulmonic valve
ANSWER : B. Mitral (bicuspid) valve — The mitral valve, also called the
bicuspid valve, separates the left atrium from the left ventricle and has two
leaflets.
5. Closure of the mitral and tricuspid valves at the start of ventricular
systole produces which heart sound?
A. S4
B. S1
C. S2
D. S3
ANSWER : B. S1 — S1 ("lub") marks the onset of systole and the closure of
the atrioventricular (mitral and tricuspid) valves.
6. What is a normal resting left ventricular ejection fraction range?
A. 20-35%
B. 55-70%
C. 10-25%
D. 75-90%
ANSWER : B. 55-70% — A normal ejection fraction, the percentage of
end-diastolic blood volume ejected with each contraction, is generally 55-
70%.
Page 2 of 63
, Cardiovascular & Pulmonary Clinical Specialist (CCS)
7. Which layer of the heart wall contains the contractile cardiac muscle
tissue?
A. Endocardium
B. Epicardium
C. Pericardium
D. Myocardium
ANSWER : D. Myocardium — The myocardium is the thick, muscular
middle layer responsible for the heart's pumping contraction.
8. The coronary sinus empties venous blood from the majority of the
coronary circulation into which chamber?
A. Left atrium
B. Left ventricle
C. Right atrium
D. Right ventricle
ANSWER : C. Right atrium — The coronary sinus, located on the
posterior surface of the heart, drains most cardiac venous blood directly
into the right atrium.
9. Stimulation of which receptor type primarily increases heart rate
and myocardial contractility?
A. Alpha-1 adrenergic receptors
B. Beta-2 adrenergic receptors
C. Muscarinic M2 receptors
D. Beta-1 adrenergic receptors
ANSWER : D. Beta-1 adrenergic receptors — Beta-1 adrenergic
receptors, activated by sympathetic stimulation, increase heart rate
(chronotropy) and contractility (inotropy).
10. Cardiac output is calculated using which formula?
A. Heart rate x Ejection fraction
B. Heart rate x Stroke volume
C. Stroke volume / Heart rate
D. Mean arterial pressure / Systemic vascular resistance
ANSWER : B. Heart rate x Stroke volume — Cardiac output (L/min)
equals heart rate (beats/min) multiplied by stroke volume (L/beat).
Pulmonary Anatomy & Physiology
Page 3 of 63
, Cardiovascular & Pulmonary Clinical Specialist (CCS)
11. What is the primary muscle of inspiration at rest?
A. External intercostals
B. Sternocleidomastoid
C. Scalenes
D. Diaphragm
ANSWER : D. Diaphragm — The diaphragm performs approximately 70-
80% of the work of quiet inspiration by contracting and flattening to
increase thoracic volume.
12. Which anatomical structure closes over the trachea during
swallowing to prevent aspiration?
A. Epiglottis
B. Arytenoid cartilage
C. Uvula
D. Cricoid cartilage
ANSWER : A. Epiglottis — The epiglottis folds over the laryngeal inlet
during swallowing, directing food and liquid into the esophagus rather than
the airway.
13. Gas exchange between air and pulmonary capillary blood occurs
primarily at which structure?
A. Alveoli
B. Trachea
C. Bronchioles
D. Bronchi
ANSWER : A. Alveoli — The alveoli, thin-walled air sacs surrounded by
pulmonary capillaries, are the site of oxygen and carbon dioxide diffusion.
14. What is an approximate normal resting tidal volume in an adult?
A. 2500 mL
B. 150 mL
C. 1200 mL
D. 500 mL
ANSWER : D. 500 mL — Normal resting tidal volume is approximately
500 mL (about 5-7 mL/kg), of which roughly 150 mL occupies anatomic
dead space.
15. Which substance, produced by type II alveolar cells, reduces surface
tension and prevents alveolar collapse?
Page 4 of 63
CCS – CARDIOVASCULAR AND PULMONARY CLINICAL SPECIALIST |
EXAM QUESTIONS AND CORRECT ANSWERS | VERIFIED PHYSICAL
THERAPY SPECIALIST latest 2026/2027
Cardiovascular & Pulmonary Clinical Specialist (CCS)
1. Which chamber of the heart receives deoxygenated blood returning
from the systemic circulation?
A. Right atrium
B. Left atrium
C. Right ventricle
D. Left ventricle
ANSWER : A. Right atrium — The right atrium receives deoxygenated
blood via the superior and inferior vena cavae before it passes to the right
ventricle.
2. In most individuals, which coronary artery supplies the sinoatrial
(SA) node?
A. Left main coronary artery
B. Left anterior descending artery
C. Right coronary artery
D. Circumflex artery
ANSWER : C. Right coronary artery — The right coronary artery
supplies the SA node in approximately 55-60% of people; the remainder are
supplied via the circumflex branch of the left coronary artery.
Page 1 of 63
, Cardiovascular & Pulmonary Clinical Specialist (CCS)
3. The relationship between end-diastolic volume and stroke volume, in
which increased venous return stretches myocardial fibers to increase
contractile force, describes which principle?
A. Frank-Starling mechanism
B. Bainbridge reflex
C. Bohr effect
D. Laplace's law
ANSWER : A. Frank-Starling mechanism — The Frank-Starling
mechanism states that increased preload (stretch) increases the force of
ventricular contraction, matching cardiac output to venous return.
4. Which valve is located between the left atrium and left ventricle?
A. Aortic valve
B. Mitral (bicuspid) valve
C. Tricuspid valve
D. Pulmonic valve
ANSWER : B. Mitral (bicuspid) valve — The mitral valve, also called the
bicuspid valve, separates the left atrium from the left ventricle and has two
leaflets.
5. Closure of the mitral and tricuspid valves at the start of ventricular
systole produces which heart sound?
A. S4
B. S1
C. S2
D. S3
ANSWER : B. S1 — S1 ("lub") marks the onset of systole and the closure of
the atrioventricular (mitral and tricuspid) valves.
6. What is a normal resting left ventricular ejection fraction range?
A. 20-35%
B. 55-70%
C. 10-25%
D. 75-90%
ANSWER : B. 55-70% — A normal ejection fraction, the percentage of
end-diastolic blood volume ejected with each contraction, is generally 55-
70%.
Page 2 of 63
, Cardiovascular & Pulmonary Clinical Specialist (CCS)
7. Which layer of the heart wall contains the contractile cardiac muscle
tissue?
A. Endocardium
B. Epicardium
C. Pericardium
D. Myocardium
ANSWER : D. Myocardium — The myocardium is the thick, muscular
middle layer responsible for the heart's pumping contraction.
8. The coronary sinus empties venous blood from the majority of the
coronary circulation into which chamber?
A. Left atrium
B. Left ventricle
C. Right atrium
D. Right ventricle
ANSWER : C. Right atrium — The coronary sinus, located on the
posterior surface of the heart, drains most cardiac venous blood directly
into the right atrium.
9. Stimulation of which receptor type primarily increases heart rate
and myocardial contractility?
A. Alpha-1 adrenergic receptors
B. Beta-2 adrenergic receptors
C. Muscarinic M2 receptors
D. Beta-1 adrenergic receptors
ANSWER : D. Beta-1 adrenergic receptors — Beta-1 adrenergic
receptors, activated by sympathetic stimulation, increase heart rate
(chronotropy) and contractility (inotropy).
10. Cardiac output is calculated using which formula?
A. Heart rate x Ejection fraction
B. Heart rate x Stroke volume
C. Stroke volume / Heart rate
D. Mean arterial pressure / Systemic vascular resistance
ANSWER : B. Heart rate x Stroke volume — Cardiac output (L/min)
equals heart rate (beats/min) multiplied by stroke volume (L/beat).
Pulmonary Anatomy & Physiology
Page 3 of 63
, Cardiovascular & Pulmonary Clinical Specialist (CCS)
11. What is the primary muscle of inspiration at rest?
A. External intercostals
B. Sternocleidomastoid
C. Scalenes
D. Diaphragm
ANSWER : D. Diaphragm — The diaphragm performs approximately 70-
80% of the work of quiet inspiration by contracting and flattening to
increase thoracic volume.
12. Which anatomical structure closes over the trachea during
swallowing to prevent aspiration?
A. Epiglottis
B. Arytenoid cartilage
C. Uvula
D. Cricoid cartilage
ANSWER : A. Epiglottis — The epiglottis folds over the laryngeal inlet
during swallowing, directing food and liquid into the esophagus rather than
the airway.
13. Gas exchange between air and pulmonary capillary blood occurs
primarily at which structure?
A. Alveoli
B. Trachea
C. Bronchioles
D. Bronchi
ANSWER : A. Alveoli — The alveoli, thin-walled air sacs surrounded by
pulmonary capillaries, are the site of oxygen and carbon dioxide diffusion.
14. What is an approximate normal resting tidal volume in an adult?
A. 2500 mL
B. 150 mL
C. 1200 mL
D. 500 mL
ANSWER : D. 500 mL — Normal resting tidal volume is approximately
500 mL (about 5-7 mL/kg), of which roughly 150 mL occupies anatomic
dead space.
15. Which substance, produced by type II alveolar cells, reduces surface
tension and prevents alveolar collapse?
Page 4 of 63
