MD Part 1 Physiology MCQs 27

February 2011

40 MCQs

Multiple true false type MCQs

1. Oedema in the following situations is correctly matched with the relevant derangements in Starling forces of the capillary bed.

A. Nephrotic syndrome
B. C. D. E.

- decreased interstitial colloid osmotic pressure Congestive cardiac failure - increased capillary hydrostatic pressure Angio- oedema - increased capillary filtration coefficent Chronic lymphatic filariasis - decreased interstitial hydrostatic pressure Kwashiokor - decreased capillary colloid osmotic pressure

F T T F T

Starling forces

2.

The following haematological disorders are correctly matched with their pathophysiology

A. Pernicious anaemia B. Sideroblastic anaemia C. Sickle cell anaemia

- defective DNA synthesis - defective haem synthesis - defective cytoskeleton of the red cell D. Beta Thallasaemia major - defective globin chain synthesis E. Hereditary spherocytosis - defective red cell metabolism

T T F T T

Life story of the red cell

circulation

Release/ quality

Life span

Bone marrow

Tissue macrophage system

3.

A 70 year old man, who is on long term aspirin and clopidogrel for secondary prevention of IHD presents with severe melaena and haematochezia. UGIE reveals oesophageal varices. Ultra sound scan findings support cirrhosis of the liver. He is transfused 14 packs of red cell concentrate, several packs of platelets and FFP to restore the circulating volume. The transfusion takes place over 36 hours. Malaena stops on banding oesophageal varices but on the third day he starts to bleed from the IV puncture sites. In this patient, factors that are likely to contribute to bleeding from IV puncture sites include increased activity of tissue plasminogen activator (t-PA) increased activity of tissue thromboplastin (TPL) inhibition of cyclo-oxygenase decreased synthesis of factor VII inhibition of formation of platelet IIb IIIa complex
T T T T T

A. B. C. D. E.

4.

The following phases of the cardiac cycle is/are correctly paired with the waves/intervals/segments of the ECG

A. B. C. D. E.

Atrial systole Isovolumetric ventricular contraction Ventricular ejection Isovolumetric ventricular relaxation Ventricular filling

- P wave - R wave - ST segment - T wave - PR interval

T T T F F

5.

Which of the following increases the force of contraction of a cardiac muscle fibre for a given length?

A. B. C. D. E.

Epinephrine Digoxin Hypoxia Hypercarbia Acidaemia

T T T F F

Contractility, causes of change inChanges in contractility

INCREASE : Sympathetic nerves Catecholamines Digitalis Inotropic agents
Dopamine

Increase in contractility Stroke volume

Force-frequency relation

Decrease in contractility DECREASE : Parasympathetic nerves Hypoxia, Hypercapnia, Acidosis Pharmacological depressants Loss of myocardium Intrinsic depression

0
Ventricular End-diastolic volume

6.

Compounds that relax vascular smooth muscle include

A. B. C. D. E.

NO PGI2 Endothelin Angiotensin II Endothelial derived hyper-polarizing factor

T T F F T

7.

The following stimuli are correctly matched with the vascular response evoked cerebral vasodilatation - pulmonary vasoconstriction - pulmonary vasodilatation - cutaneous vasoconstriction - skeletal muscle vasoconstriction

A. B. C. D. E.

Hypercapnoea Hypoxaemia NO Epinephrine Hyperkalemia

T T T TF

PO2 PCO2 In alveoli

Reduced alveolar ventilation; excessive perfusion

Pulmonary arterioles Serving these alveoli constrict

Reduced alveolar ventilation; reduced perfusion

PO2 PCO2 In alveoli

Pulmonary arterioles Serving these alveoli dilate Enhanced alveolar ventilation; inadequate perfusion Enhanced alveolar ventilation; enhanced perfusion

8.

A healthy normovolaemic young adult is given an intravenous infusion of 2L of isotonic saline over 30 minutes. The cardiovascular regulatory mechanisms that will be initiated to maintain his blood pressure within normal limits include A. B. C. D. E. Increased discharge of aortic baroreceptors Excitation of the vagal innervations of the heart Decrease in the sympathetic discharge to the heart Arteriolar dilatation Decreased firing of atrial stretch receptors

T T T T F

9.

A 65 year old man complains of orthopnoea and paroxysmal nocturnal dyspnoea. On examination he has bilateral pitting ankle oedema, a pulse rate of 110 beats per minute, a blood pressure of 80/60 mmHg and an elevated jugular venous pressure. His apex beat is felt in the 6th intercostal space in the anterior axillary line. A third heart sound is heard at the apex. The physical signs are correctly matched with the pathophysiology.
A. B. C. D. E. Ankle oedema Tachycardia Decreased systolic blood pressure Elevated JVP Third heart sound T F F F T - activation of RAAM - increased stretch in the arterial baroreceptors - decreased afterload - increased right atrial contraction - increased ventricular filling

10. A. B. C. D. E.

Vital capacity measures the function of the respiratory pump. is about 6000 ml in a healthy adult. is measured with a peak flow meter is greater in trained athletes than in sedentary adults decreases when lying down from an erect position

T T F T T

11. A. B. C. D. E.

Diffusing capacity of lungs measures the integrity of the alveolo-capillary membrane is estimated using carbon dioxide needs to be corrected for the haemoglobin level decreases in alveolar oedema increases during isotonic exercise

T FT T T

12.

Oxygen- haemoglobin dissociation curve A. is steep when PO2 is between 80- 100 mmHg B. shows the relationship between haemoglobin content and oxygen content in blood C. assumes its shape because of tense- relaxed interconversion of haemoglobin D. shows that unloading of oxygen is facilitated when PO2 in blood is 50 mmHg E. is shifted to the left when 2,3 biphosphoglycerate levels are increased in blood

F F T T F

O2-Haemoglobin dissociation curve

P50

13.

The following conditions are paired correctly with the responses evoked by them
Condition Increased pH in body fluids Response

- increased respiratory rate Hyperinflation of lungs - bronchoconstriction Chronic hypoxia - increased erythropoiesis Isotonic exercise - pulmonary v asodilatation Reduction of blood supply to a lung segment - bronchodilatation in that segment

F T T T F

14.

Intra-pleural pressure becomes positive relative to the atmospheric pressure in A. B. C. D. E. quiet inspiration quiet expiration forced expiration Pneumothorax atelectasis

F F T T F

0 Intrapleural space 0 -2.5 mmHg IPP

AT REST

These forces just balance each other

Elastic recoil forces of the lung and chest wall are pulling in opposite directions, resulting in a negative pressure in the intrapleural space.

15. A. B. C. D. E.

Bronchial tone is the state of contraction of bronchial smooth muscle has a circadian rhythm when increased leads to turbulent air flow remains unchanged during a normal respiratory cycle is decreased with cholinergic stimulation of bronchial smooth muscle

T T T F F

Calibre of airways and resistance

Diameter 1
Airway resistance
Smooth muscle Submucosa Mucosa

Narrower the airway higher the resistance

Asthma Increased smooth muscle tone Oedema of the submucosal layer Obstruction of the lumen by secretions
d

16.

V/Q ratio in the lungs

A. is a determinant of arterial oxygenation B. changes with postural differences C. is independent of right ventricular output D. is influenced by the concentration of inhaled oxygen E. when increased is referred to as alveolar dead space

T T F T T

17.

Regarding elimination of CO2

A. Most of it is transported as carbamino compounds B. Chloride shift occurs in the red cells in venous blood C. A large partial pressure gradient is seen across the alveolocapillary membrane D. Release of O2 at tissue level increases the affinity of haemoglobin to CO2 E. Its solubility in biological membranes facilitates the process

F T F T T

Interstitial fluid CO2 CO2 CO2 (dissolved in plasma) CO2 + H2O H2CO3

Binds to plasma proteins

HCO3-

+ H+

CO2 Tissue cell

HCO3Chloride shift

Cl-

CO2
CO2

Fast CO2 + H2O H2CO3 Carbonic anhydrase

HCO3- + H+ ClHHb

CO2

CO2 + Hb = HbCO2 Carbaminohemoglobin

Red blood cell CO2

HbO2

O2 + Hb

O2 O2

Blood plasma O2 (dissolved in plasma)

Fused basal laminae

CO2 CO2 (dissolved in plasma) CO2 + H2O Slow H2CO3 HCO3+ H+

CO2

HCO3Reverse Chloride shift

ClCO2 Fast CO2 + H2O H2CO3 Carbonic anhydrase CO2 + Hb HbCO2 O2 + HHb H+ + HCO3Cl-

CO2 O2

Carbaminohemoglobin HbO2 + H+

Red blood cell

O2 O2 (dissolved in plasma)

Blood plasma

18.

Following are known to occur during moderate isotonic exercise.

A. B. C. D. E.

Increased uptake of glucose into skeletal muscle cells. Increased activity of the thoracic pump. Decrease in lymph flow. Accumulation of interstitial fluid in exercising muscles. Increased alveolar capillary oxygen gradient in lungs.

T T F T T

19.

A 24- year old medical student is studying for his final MBBS. He has had a clean record of health so far. He misses his dinner on the day before the medicine paper and stays up the whole night. Which of the following hormones will be present in excess amounts in his circulation, just before breakfast, the following morning?

A. B. C. D. E.

Growth hormone Insulin Norepinephrine Thyroxine Vasopressin

T F T F T

Endocrine regulation of carbohydrate metabolism

Starch Gut
Thyroid hormones Protein catabolism Lipid catabolism

Glucose

Glucocorticoids/GH/ Glucagon Thyroid hormones

catecholamines
Glucocorticoids/glucagon

GH/Glucocorticoids Blood
insulin

Tissues
insulin

Glycogen

20.

The following disorders are paired correctly with the tests that help in diagnosis

A. B. C. D. E.

Acromegaly - insulin hypoglycaemia test Hypopituitarism - glucose tolerance test Syndrome of inappropriate ADH secretion - water deprivation test Addisons disease - short synacthen test Cushings syndrome - dexamethasone suppression test

F F F T T

21. A. B. C. D. E.

Antidiuretic hormone secretion is stimulated by increased stretch of atrial baroreceptos primarily act on cytoplasmic receptors increases the number of aquaporins in the collecting ducts facilitates reabsorption of water in the proximal convoluted tubule when secreted in excess cause dilutional hyponatreamia

F F T F T

22.

A 25 year old woman complains of weight loss over the last 6 months. She feels unusually warm and sweaty all the time and complains of rising from a squatting position. On examination her hands are warm and moist and have fine tremors. Her pulse is irregularly irregular with a rate of approximately 120 beats per minute. She has proptosis and a palpable smooth goiter. Investigations show an increased FT4 with suppressed TSH. In this woman

A. weight loss is due to increased calorigenic action of thyroxine B. warmth in the hands is due to cutaneous vasodilatation C. increased heart rate is due to direct action of thyroxine on the SA node D. sweating is best treated by parasympathetic blockers. E. a high LDL level is an expected finding

T T T F F

23.

A 54 year old man complains of severe anorexia, nausea, generalized swelling and parasthesia of hands and feet. He has a serum calcium of 3.3 meq/L (4.3-5.3 meq/L). His GFR is 25 ml/ minute. Ultrasonically his kidneys are small with poor corticomedullary demarcation. He has not yet been prescribed calcium replacement therapy. In this person, the mechanisms leading to a low serum calcium level include decreased bone resorption decreased renal tubular absorption of calcium decreased gut absorption of calcium reduced excretion of phosphate by kidneys poor dietary intake of calcium

A. B. C. D. E.

F T T T T

24.

Insulin facilitates the entry of following compounds to skeletal muscle cells. Amino acids Glucose Potassium Calcium Ketones

A. B. C. D. E.

T T T F T

25.

Pathophysiology of hyperglycaemia in insulin deficiency involves increased intestinal absorption of glucose increased renal tubular absorption of glucose decreased number of GLUT transporters in adipose tissue decreased number of GLUT transporters in skeletal muscle cells decreased activity of glucokinase in the hepatocytes

A. B. C. D. E.

F F T T T

Pool of GLUT 4

26.

The following measurements belong to an 18 year old individual. urine creatinine - 35 mg/dL Urine volume 3300 ml/ 24 hours Plasma creatinine-0.7 mg/dL Blood urea- high Haematocrit - normal Which of the following are true/false about this person?

A. B. C. D. E.

Renal plasma flow is calculated by above information GFR is calculated by above information He has diminished renal functions The investigations are consistent with volume depletion He is likely to have eaten a high protein meal soon before the investigations
F T F F T

GFR= UV/P
U=35 V=3300/24X60=2.29 P=0.7 35X 2.29/0.7=114.5

27. A. B. C. D. E.

Kidneys are target organs of following hormones Erythropoietin 1 25 DHCC Aldosterone Atrial natriuretic peptide Parathyroid hormone

F T T T T

28.

A 54 year old male is admitted to the medical casualty with dyspnoea and drowsiness. He has a history of diabetes mellitus and has suffered from polyuria and polydipsia in the recent few weeks. On examination his pulse is thread with a rate of 110 beats per minute. His blood pressure is 90/60 mmHg.

Investigation results are as follows.

RBS- 568 mg/dL Urinalysis - reducing substances +++ ketone bodies positive Which of the following findings are consistent with this patient?
A. B. C. D. E. Decreased Na reabsorption in the proximal convoluted tubule Decreased renal threshold for glucose increased secretion of angiotensin II Increased secretion of vasopressin Increased HCO3 in the extracellular fluid

T F T T F

29.

A 25 year old healthy female is deprived of water for 8 hours. Her hydration status was satisfactory prior to water deprivation. Her plasma and urine osmolality before and after water deprivation are shown below
Normal range(mosm/kg H2O)
Plasma osmololality Urine osmolality 280-295 50- 1400

Before deprivation
285 400

After deprivation
289 750

At the end of 8 hours A. Her ADH levels will be higher than normal B. Increased urine osmolality is due to increased aldosterone secretion C. Osmoreceptors in the hypothalamus are inhibited D. Urine output will be decreased E. Specific gravity of urine will be high.
T F F T T

30.

A 60 year old man suffered a massive bout of haematemesis. On admission to the hospital he is pale, restless, and has cold peripheries. The blood pressure is 90/60mmHg with a pulse rate of 120 per minute. An indwelling urinary catheter is inserted and 30 ml dark urine is collected. In this man,

A. GFR is reduced due to decreased renal plasma flow B. Urinary Na excretion is increased C. There is maximal vasopressin secretion D. ANP secretion is increased E. Thirst is stimulated via baro- receptors in blood vessels

T F T F T

Baro -

BP + VMC Sympathetic activation

Baro

Vagal stimulation -

hypothalamus

Adrenal medullary Catecholamine secretion

activation of RAAM

Vasopressin secretion

Increased HR & contractility

Peripheral vasoconstriction

Renal Na & H2O retention

Thirst

Normal values for questions 31 and 32.

PaO2- 85-100 mmHg PaCO2- 35-45 mmHg H+ concentration- 37-42 nanomol/L HCO3 concentration- 24-28 mmol/L

31.

A 54 year old male is suffering from cardiac failure following a myocardial infarction. He is breathless and mildly cyanotic on examination. His arterial blood gas analysis reveals a pH of 7.2, HCO3 concentration of 14 mmol/L, PCO2 of 32 mmHg and PO2 of 65 mmHg. In this patient

A. the actual H+ concentration is likely to be 20 nanomol/L B. the primary acid base disorder is in the respiratory system C. urine is likely to have a decreased HCO3/H+ ratio D. renal acid excretion is facilitated by the current PCO2 level. E. arterial oxygen saturation is likely to be 95%.

F F T F F

32.

A 30 year old healthy male goes on a mountain climbing expedition in the Himalayas. He reaches the first camp at 3000 meters and spends two days there. On the second day he is found to have a respiratory rate of 34 breaths/ minute and complains of faintness. This person is likely to have

A. a plasma pH of > 7.4 B. a PCO2 of 45 mmHg C. bicarbonaturia D. an increased anion gap E. cerebral vasodilatation

T F T F F

33.

Stimulants of Gastric acid secretion include A. stretching of the stomach wall B. presence of a high protein content in the stomach C. Helicobacter pylori infection of the stomach D. presence of a high fat content in the duodenum E. hypoglycaemia

T T F F T

34.

A 32 year old man was found to have a serum bilirubin of 5 mg/dL on a routine medical check. All the other liver biochemistry and physical examination is normal. His reticulocyte count is within normal limits. His hyperbilirubinaemia is likely to be due to

A. decreased UDP glucuronyl transferase activity. B. decreased uptake of bilirubin into liver cells. C. impaired secretion of bile in to the biliary canaliculi. D. increased breakdown of red cells. E. intrahepatic bile duct obstruction.

T T F F F

Red cell production and breakdown

Destruction in reticuloendothelial system

Matured red cell Life span 120 days

Globin

Reutilized

Fe

Haem Iron Reutilized

C Transport in plasma bound to albumin Bilirubin glucuronide Gut Stercobilinogen

Bilirubin

Enterohepatic Circulation of urobilinogen

Urobilinogen Urinary urobilinogen

Bile pigments
RBC
breakdown

Hb

Hb
Heam Globin

Hepatocyte Bilirubin + 2UDPGA

Porphyrin Fe++ Biliverdin Circulation Bilirubin

glucuronyl transferase
Bilirubin diglucuronide

Bilirubin +albumin
RES cell eg. Kupffer cells of liver

Excreted in bile

35.

Following GI hormones and their actions are correctly paired.

stimulation of mucosal growth of the stomach stimulation of pancreatic juice secretion relaxation of the gall bladder inhibition of gastric acid secretion secretion of electrolytes from the small intestine

A. Gastrin

B. Secretin
C. Cholecystokinin-Pancreozymin D. Somatostatin

E. Vasoactive Intestinal Polypeptide -

T T F T T

36.

The following structures are depolarized due to opening of Voltage gated Na channels. Visceral smooth muscle Motor nerves Skeletal muscle Cardiac muscle Cardiac pace maker tissue

A. B. C. D. E.

F T T T F

37. A. B. C. D. E.

A myelinated nerve evokes a local response with a sub-threshold stimulus has sodium channels distributed evenly along its length is refractory to stimulation during the spike potential is susceptible to conduction block with hypoxia does not regenerate after damage

T F T T F

38. A. B. C. D. E.

Regarding the stretch reflex Muscle spindle is the receptor. The excitatory pathway is polysynaptic. The main efferents are motor neurons. Motor cortex has inhibitory inputs to the stretch reflex. Basal ganglia facilitate the stretch reflex.

F F T T T

Dorsal root ganglion

interneuron releasing glycine Motor Neuron of Protagonist muscle

Motor neuron of Antagonist muscle

Protagonist muscle

Ventral root Antagonist muscle

39.

Withdrawal reflex

A. is prepotent. B. is monosynaptic. C. occurs as a result of contractions of ipsilateral extensor muscles. D. removes the limbs from harmful stimuli. E. is accompanied with a crossed extensor response.

T F F T T

40.

Sensory receptors

A. are sensory nerve endings B. produce generator potentials proportionate to the strength of the stimulus C. are found more concentrated in the viscera than the soma D. can transform chemical energy in to action potentials E. have a low threshold for their adequate stimuli

T T F T T

Best response MCQS Select the best answer.

1.

A 22 year old previously healthy young woman was found to be hyperventilating on admission to the hospital. She complained of dizziness and pins and needles in her hands and feet. On examination she had carpal spasms. Rest of the system examination was unremarkable. Which of the following biochemical profile matches her clinical profile?
A. Both serum ionized calcium and free hydrogen levels will be increased B. Both serum ionized calcium and free hydrogen levels will be decreased C. Both serum ionized calcium and free hydrogen levels will be normal D. Serum ionized calcium will be increased and free Hydrogen ions will be decreased E. Serum ionized calcium will be decreased and free Hydrogen ions will be increased
B

2.

A 35 year old female tea estate worker from Talawakelle is admitted to the rural hospital with fever, productive cough with rusty sputum and difficulty in breathing. She has left sided pleuritic pain. On examination she has a respiratory rate of 30 breaths/ minute, reduced chest expansion on the left side, dull percussion note and crepitations in the left lower zone. She is mildly pale but not cyanotic. The investigations reveal a haemoglobin content of 10 g/dL, a white cell count of 17000/mm3 with a differential neutrophil leucocytosis and an ESR of 78 mm in the first hour. On the second day following admission her respiratory symptoms worsen and she becomes restless. The attending medical officer suspects severe tissue hypoxia and plans to transfer her to a provincial hospital for specialized management. The most likely reason for suspected tissue hypoxia here is A. B. C. D. E. severe ventilation perfusion imbalance respiratory muscle fatigue a combination of ventilation perfusion imbalance and respiratory muscle fatigue decreased concentration of inhaled oxygen decreased cellular cytochrome oxidase level activity C

3.

A 30 year old woman presents with drooping of eyelids and diplopia for 3 months. She notes that symptoms worsen towards the end of the day. EMG shows decremental potentials during repetitive stimulation and is otherwise normal. Mediastinal magnetic resonance imaging confirms thymic hyperplasia. The most probable reason for the symptoms in this woman is A. post- synaptic inhibition of ligand gated Na+- K+ channels B. decreased quantal release of acetylcholine from the pre synaptic end C. pre- synaptic inhibition of voltage gated Ca channels D. a raised level of acetylcholine esterase in the synaptic cleft E. decreased conduction velocity of motor nerves
A

EVENTS AT NERVE ENDING

+ + ++++++++ - ----------Axon

- Ca +
Ach
Ach

Ca Ca

Ca

Ach

----------- - +++++++++ +
Ca -- Calcium ions

Ca
Ach Ach

Synaptic cleft

Ach --vesicles containing Acetylcholine

Events at motor end plate

++++++++
+++
sarcolemma

K+

-----

--Motor end plate

-- Acetylcholine receptor

Na+ Na+

+++

-- Acetylcholine molecule

Ligand- gated channel

4.

A 40 year old man presents with changing facial appearance, weight gain, and difficulty in getting up from a squat, polyuria and polydipsia. He has a history of unsupervised treatment for severe chronic asthma. Examination and investigations reveal abdominal obesity, proximal muscle weakness, a raised blood pressure and hyperglycaemia. In this patient, which of the following is not a component of the pathophysiology of raised blood pressure? A. B. C. D. E. Permissive action of glucocorticoids on catecholamines Increased sodium and water retention Direct action of glucocorticoids on blood vessels Direct action of angiotensin II on blood vessels Compromised renal blood supply

Further reading:

Review of Medical Physiology WF Ganong 22nd edition Textbook of Medical Physiology Guyton & Hall Kumar and Clarks Clinical Medicine 7th edition

Acknowledgements
Dr. Suresh Dissanayake Dr. Dilshani Dissanayake Mrs. Nadeesha Keragala All of department of Physiology, Colombo