{"id":413,"date":"2023-08-02T18:46:00","date_gmt":"2023-08-02T18:46:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=413"},"modified":"2026-02-20T17:03:31","modified_gmt":"2026-02-21T01:03:31","slug":"usmle-step-1-question-of-the-day-frank-starling-curve","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Frank-Starling Curve"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\">A patient\u2019s resting <strong>Frank-Starling curve<\/strong> is shown below and denoted as Curve 1.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following scenarios would cause the patient\u2019s Frank-Starling curve to more closely resemble that denoted by Curve 2?<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"642\" height=\"778\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/32.png\" alt=\"A chart demonstrating the Frank-Starling curve and how certain scenarios can alter its shape in patient's cardiovascular health in relationship to strokes.\" class=\"wp-image-415\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/32.png 642w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/32.png?resize=248,300 248w\" sizes=\"auto, (max-width: 642px) 100vw, 642px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Heart failure<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Propranolol administration<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Dilated cardiomyopathy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Dobutamine administration<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Myocardial infarction<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Dobutamine administration<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the main explanation, let&#8217;s look at the explanations for the incorrect answers. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Heart failure<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Heart failure would result in <strong>reduced cardiac contractility<\/strong>, which would shift the curve downwards and to the right. In contrast, this question is looking for a factor that would shift the curve upwards and to the left.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Propranolol administration<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Propranolol is a \u03b2-blocker that <strong>reduces cardiac contractility<\/strong>, which shifts the curve downwards and to the right. In contrast, this question is looking for a factor that would shift the curve upwards and to the left.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Dilated cardiomyopathy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Dilated cardiomyopathy is a condition wherein the <strong>heart becomes enlarged<\/strong> and cannot pump blood effectively. The condition would result in <strong>reduced cardiac contractility<\/strong>, which would shift the curve downwards and to the right. In contrast, this question is looking for a factor that would shift the curve upwards and to the left.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Myocardial infarction<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;A myocardial infarction can lead to <strong>cardiac tissue injury <\/strong>and <strong>death<\/strong>. These changes would likely result in <strong>reduced cardiac contractility<\/strong> and cause the Frank-Starling curve to shift downwards and to the right.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The&nbsp;<strong><\/strong><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Frank-Starling_relationship\" target=\"_blank\" rel=\"noreferrer noopener\">Frank-Starling mechanism<\/a><\/strong><strong><\/strong>&nbsp;describes the relation between end-diastolic volume (EDV) and stroke volume (SV).&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"margin: 0px;padding: 0px\">Factors that&nbsp;<strong>increase cardiac contractility<\/strong>, also known as inotropy, cause the curve to shift&nbsp;<strong>upward<\/strong>s and to the&nbsp;<strong>left<\/strong>. Examples of such factors include exercise, increased catecholamine release (e.g., fight-or-flight response), and inotropic medications (e.g., dobutamine, milrinone, and digoxin).&nbsp; <\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In contrast, factors that&nbsp;<strong>decrease cardiac contractility<\/strong>&nbsp;will cause the curve to shift downwards and to the right. Examples of such factors include <strong>heart failure<\/strong>, loss of functional myocardium (e.g. <strong>myocardial infarction<\/strong>), <strong>dilated cardiomyopathy<\/strong>, and medications that decrease inotropy (e.g., <strong>\u03b2-blockers, calcium channel blockers<\/strong>).<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"588\" height=\"338\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/33.png\" alt=\"Frank-Starling Relationship\nPositive inotropic effect\n* Increase in strength of contraction and stroke volume\n* e.g., sympathetic nervous systems or digoxin\nNegative Inotropic Effect\n* Decrease in strength of contraction and stroke volume\n* e.g., beta blockers\" class=\"wp-image-416\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/33.png 588w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/33.png?resize=300,172 300w\" sizes=\"auto, (max-width: 588px) 100vw, 588px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The&nbsp;<strong>Frank-Starling mechanism<\/strong>&nbsp;describes the relation between end-diastolic volume and stroke volume. Factors that&nbsp;<strong>increase cardiac contractility<\/strong>&nbsp;will lead to an&nbsp;<strong>upward<\/strong>&nbsp;and&nbsp;<strong>leftward<\/strong>&nbsp;shift of the curve. In contrast, factors that&nbsp;<strong>decrease cardiac contractility<\/strong>&nbsp;will lead to a&nbsp;<strong>downward<\/strong>&nbsp;and&nbsp;<strong>rightward<\/strong>&nbsp;shift of the curve.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic? <span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video: <\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Frank-Starling_relationship\"><strong>Frank-Starling relationship<\/strong><\/a><\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><a href=\"https:\/\/www.osmosis.org\/blog\/all-your-usmle-step-1-questions-answered-the-osmosis-ultimate-guide\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/35.png\" alt=\"The ultimate guide to the USMLE step 1: Everything you need to know CTA to guide\" class=\"wp-image-417\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/35.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/35.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><figcaption class=\"wp-element-caption\"><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.&nbsp;<\/sub><\/em><\/figcaption><\/figure>\n\n\n\n<p class=\"has-text-align-left wp-block-paragraph\"><em>Want more <strong>USMLE\u00ae Step 1 practice questions<\/strong>? Try <strong>Osmosis from Elsevier<\/strong> today! Get your\u00a0<em><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a><\/em>\u00a0and find out why millions of current and future <strong>clinicians and caregivers love learning by Osmosis<\/strong>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Learn how various physiological and pharmacological factors shift the Frank-Starling curve, impacting cardiac output and patient hemodynamics.<\/p>\n","protected":false},"author":202,"featured_media":414,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,20,16,1369,44],"tags":[195,196,199,197,157,84,186,200,198,194],"class_list":["post-413","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-step-1-questions","category-step-1","tag-cardiology","tag-cardiovascular-physiology","tag-clinical-scenarios","tag-exam-prep-tips","tag-heart-health","tag-medical-education","tag-medical-exams","tag-medical-knowledge","tag-student-resources","tag-usmle-questions"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Frank-Starling Curve - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Frank-Starling Curve - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Learn how various physiological and pharmacological factors shift the Frank-Starling curve, impacting cardiac output and patient hemodynamics.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2023-08-02T18:46:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-02-21T01:03:31+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/5.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Marina Horiates Kerekes, MD &amp; Team\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; Team\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/c7e60a94ecf3ec6e6cfe4855957afafc\"},\"headline\":\"USMLE\u00ae Step 1 Question of the Day: Frank-Starling Curve\",\"datePublished\":\"2023-08-02T18:46:00+00:00\",\"dateModified\":\"2026-02-21T01:03:31+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve\"},\"wordCount\":539,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/5.webp\",\"keywords\":[\"cardiology\",\"cardiovascular physiology\",\"clinical scenarios\",\"exam prep tips\",\"heart health\",\"medical education\",\"medical exams\",\"medical knowledge\",\"student resources\",\"USMLE questions\"],\"articleSection\":[\"Allopathic Medicine (MD)\",\"Exam Prep\",\"Osteopathic Medicine (DO)\",\"USMLE Step 1\",\"USMLE\u00ae Step 1\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve\",\"url\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-frank-starling-curve\",\"name\":\"USMLE\u00ae Step 1 Question of the Day: Frank-Starling Curve - 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