Mcqs and Emqs
Mcqs and Emqs
Mcqs and Emqs
HUMAN
PHYSIOLOGY
6th edition
HUMAN
PHYSIOLOGY
with answers and
explanatory comments
6th edition
Ian C Roddie CBE, DSc, MD, FRCPI
Emeritus Professor of Physiology, The Queen's University of Belfast; former
Head of Medical Education, National Guard King Khalid Hospital, Jeddah,
Saudi Arabia
William FM Wallace BSc, MD, FRCP, FRCA, FCARCSI, FRCSEd
Emeritus Professor of Applied Physiology, The Queens University of Belfast;
former Consultant in Physiology, Belfast City Hospital, Belfast, N. Ireland
CONTENTS
vi
vii
Preface
How to use the book
1 Body fluids
MCQs
EMQs
1-57
58-67
1
21
MCQs
EMQs
68-126
127-138
33
53
MCQs
EMQs
139-187
188-194
63
79
MCQs
EMQs
195-249
250-260
87
107
MCQs
EMQs
261-330
331-340
115
139
MCQs
EMQs
341-384
385-394
149
163
MCQs
EMQs
395-434
435-444
171
185
MCQs
EMQs
445-501
502-512
193
211
MCQs
EMQs
513-567
568-576
219
237
MCQs
EMQs
577-639
640-649
245
265
MCQs
EMQs
650-686
687-691
273
287
MCQs
EMQs
692-708
709-714
291
325
2 CardiovascuIar system
3 Respiratory system
4 Alimentary system
5 Neuromuscular system
6 Special senses
7 Urinary system
8 Endocrine system
9 Reproductive system
12 Interpretative questions
Index
337
PREFACE
This book has now reached its sixth edition since it was first published over 30 years ago. Our
aim to base the questions on generally accepted aspects of physiology most relevant to clinical practice seems to have been fulfilled medical, dental and other health care students and
doctors in specialty training in countries around the world have told us of the books relevance
and usefulness.
We have tried to cover most of the concepts and knowledge typically asked for in physiology examinations and to concentrate on the core knowledge that is essential to pass them. We
believe that students who score consistently well in these questions know enough to face most
examinations in physiology with confidence. By concentrating on the area where yes/no
answers can be given to questions with reasonable certainty, we have had to exclude areas
where knowledge is as yet conjectural and speculative. We have tried to avoid excessive detail
in the way of facts and figures; those which are included are of value in medical practice. Both
conventional and SI units are generally quoted. Comments on the answers are given on the
reverse of each question. We hope that, with the comments, the book will provide a compact
revision tutor, encouraging understanding rather than rote learning.
For most questions the common five-branch MCQ format has been used. The stem and a
single branch constitute a statement to be judged True or False by the reader. Care has been
taken that the statements in any question are not mutually exclusive, so five independent decisions are required to answer each question. This system has the advantage of simplicity and
brevity over most other forms of multiple-choice question. In this edition, a further opportunity has been taken to prune and edit questions for greater compactness, clarity and precision
and to bring in new areas of knowledge which have emerged since the last edition went to
press. We have also tended to expand the comments in an effort to increase the clarity of our
explanations and so add to the educational value of the self-assessment exercise.
The book is divided into sections, each section containing questions related to one of the
main physiological systems of the body. They cover both basic and applied aspects of the subject. The applied questions are designed so that the answers may be deduced mainly by making
use of basic physiological knowledge and should provide a link with clinical practice. There is
also a section on sports and exercise physiology and one containing Interpretative questions
to provide practice in the interpretation of data, diagrams and figures. A new feature in this
edition is the addition of a number of Extended Matching Questions (EMQs) for each section of
the book. EMQs are an alternative form of multiple-choice question where answers have to be
selected from lists of options. They are becoming increasingly popular in undergraduate and
postgraduate examinations.
We thank colleagues for suggesting questions and all who commented on previous editions.
We continue to welcome such comments.
ICR
WFMW
September 2003
Answer, say, 20 questions (100 decisions), aiming to complete them in about 50 minutes.
In our experience of this type of question (one point tested in each Part), it is best for candidates to answer virtually all questions.
Score your answers by giving 1 for a correct response, 1 for an incorrect response and
0 for any omitted. It is suggested that this approach is in line with professional life when
many true/false decisions must be taken send the patient to hospital? Begin a certain
treatment? Carry out surgery urgently? The penalties for a wrong decision can be considerable!
As a very approximate guide, the following scale would apply to candidates who have not
spent time memorizing particular questions:
5060
6070
7090
90100
fair
good
excellent
outstanding
4. Range of options
Please note for the MCQs that all, some, or none of the branches in each question may be true.
Also, for the EMQs a given option may be used more than once, or not at all.
BODY FLUIDS
MCQs
Volume is greater.
Tonicity is lower.
Anions are mainly inorganic.
Sodium:potassium molar ratio is higher.
pH is lower.
7. Plasma bilirubin
A.
B.
C.
D.
E.
Is a steroid pigment.
Is converted to biliverdin in the liver.
Does not normally cross cerebral capillary walls.
Is freely ltered in the renal glomerulus.
Is sensitive to light.
MCQ
Questions 17
MCQ
Answers
1.
A.
B.
C.
False
False
True
D.
E.
True
False
False
False
False
False
False
True
True
True
False
True
D2O (heavy water) exchanges with water in all body fluid compartments.
Women carry relatively more fat than men and fat has a low water content.
ADH in the extracts inhibits water excretion by the kidneys.
It rises as fat stores are metabolized to provide energy.
70 per cent, the percentage in the lean body mass, is about the maximum per cent
possible.
False
True
False
True
False
True
False
True
False
True
True
True
False
True
False
False
False
True
False
True
2.
A.
B.
C.
D.
E.
3.
A.
B.
C.
D.
E.
4.
A.
B.
C.
D.
E.
5.
A.
B.
C.
D.
E.
6.
A.
B.
C.
D.
E.
7.
A.
B.
C.
D.
E.
Questions 813
A. Originate from precursor cells in lymph nodes.
B. Can increase in number when their parent cells are stimulated by factors released from
activated lymphocytes.
9. Erythrocytes
A.
B.
C.
D.
E.
13. Antibodies
A. Are protein molecules.
B. Are absent from the blood in early fetal life.
C. Are produced at a greater rate after a rst, than after a second, exposure to an antigen
six weeks later.
MCQ
8. Monocytes
MCQ
Answers
8.
A.
B.
False
True
C.
False
D.
E.
True
False
9.
A.
B.
C.
True
True
True
D.
E.
False
False
10.
A.
True
B.
C.
False
True
D.
E.
True
False
Its greater mass and lower molecular weight provide more osmotically active particles.
Only a small amount is ltered normally and this is reabsorbed by the tubules.
Blood pH is well above albumins isoelectric point so negative charges (COO)
predominate.
As carbamino protein (R-NH2 CO2 R-NH COOH).
It is a rst class protein containing essential and non-essential amino acids.
11.
A.
B.
True
True
C.
D.
E.
False
True
True
True
True
False
True
True
Due to the effects of tissue damage and serotonin on vascular smooth muscle.
This is the upper limit of the normal bleeding time.
Factor VIII increases clotting time, not bleeding time.
Warmth dilates skin blood vessels.
Intravascular pressure is reduced in an elevated limb.
A.
B.
True
True
C.
False
D.
E.
True
True
12.
A.
B.
C.
D.
E.
13.
Questions 1419
A.
B.
C.
D.
E.
15. Lymphocytes
A.
B.
C.
D.
E.
17. Blood
A. Makes up about 7 per cent of body weight.
B. Forms a higher percentage of body weight in fat than in thin people.
C. Volume can be calculated by multiplying plasma volume by the haematocrit (expressed
as a percentage).
MCQ
MCQ
Answers
14.
A.
B.
False
True
C.
D.
E.
False
False
True
15.
A.
B.
C.
D.
E.
False
True
True
False
True
A.
B.
False
True
C.
False
D.
E.
False
False
16.
17.
A.
B.
C.
True
False
False
D.
E.
True
True
18.
A.
B.
False
False
C.
D.
True
False
E.
True
True
False
True
False
False
19.
A.
B.
C.
D.
E.
Questions 20-25
A.
B.
C.
D.
E.
Is an ultraltrate of plasma.
Is the main source of the brains nutrition.
Has the same pH as arterial blood.
Has a higher glucose concentration than has plasma.
Has a higher calcium concentration than has plasma.
22. Antigens
A. Are usually proteins or polypeptide molecules.
B. Can only be recognized by immune system cells previously exposed to that antigen.
C. Are normally absorbed from the gut via lymphatics and carried to mesenteric lymph
nodes.
Inactivation of heparin.
Inactivation of plasmin (brinolysin).
Calcium ions.
An adequate intake of vitamin K.
An adequate intake of vitamin C.
MCQ
20. The pH
MCQ
Answers
20.
A.
B.
C.
D.
E.
False
False
False
True
True
False
False
False
False
False
A.
B.
True
False
C.
False
D.
E.
True
True
False
False
True
True
False
False
False
True
True
False
A.
False
B.
C.
D.
E.
False
True
True
False
They form shortly after birth, possibly in response to A and B antigens carried
into the body by invading bacteria.
They cause agglutination (clumping) of A, B and AB cells.
Unlike Rh antibodies which have a smaller molecular size.
Around 1 000 000.
They are divalent and hence cause red cells to adhere to one another during
agglutination.
21.
A.
B.
C.
D.
E.
22.
23.
A.
B.
C.
D.
E.
24.
A.
B.
C.
D.
E.
25.
Questions 26-31
A.
B.
C.
D.
E.
Is effected by prothrombin.
Involves the disruption of certain peptide linkages by a proteolytic enzyme.
Is followed by polymerization of brin monomers.
Is inhibited by heparin.
Is reversed by plasmin (brinolysin).
litres of blood.
Bicarbonate is appropriate for patients being treated for cardiac and respiratory arrest.
Potassium-free fluids are appropriate for a patient with severe vomiting.
Isotonic glucose will expand both intracellular and extracellular fluid compartments.
Hypertonic saline will raise intracellular osmolality.
MCQ
26. Lymph
10
MCQ
Answers
26.
A.
True
B.
C.
False
True
D.
E.
False
True
Derived from plasma proteins leaked from capillaries into the tissues; it returns
these to the blood.
Lymph vessels are involved in the uptake and transport of absorbed fat.
Increased capillary pressure due to muscle vasodilatation increases tissue fluid
formation.
It contains lymphocytes derived from lymph nodes.
In addition, intrinsic rhythmic contractions in lymphatics help to propel lymph.
27.
A.
B.
C.
True
True
False
D.
E.
True
True
28.
A.
B.
C.
D.
E.
False
True
True
True
False
A.
B.
C.
D.
False
False
True
False
E.
True
Sucrose does not cross the cell membrane freely to equilibrate with ICF.
Sodium ions migrate easily from plasma to equilibrate with interstitial fluid.
Inulin crosses capillary walls freely but does not enter cells.
ICF volume is not measured directly; it is calculated by measuring ECF volume
and total body water and subtracting the former from the latter.
Radioactive K equilibrates with the body pool of non-radioactive K; both isotopes are treated similarly in the body.
29.
30.
A.
B.
C.
True
True
True
D.
E.
False
True
31.
A.
B.
False
True
C.
D.
E.
False
True
True
Some of the saline escapes from the circulation to the interstitial fluid.
It corrects the acidosis caused by accumulation of lactic acid and CO2 in the tissues.
Alimentary secretions are rich in potassium.
Glucose is metabolized, leaving the water to be distributed in both compartments.
Hypertonic extracellular fluid will draw water osmotically from the cells.
11
Questions 3237
A.
B.
C.
D.
E.
Cardiac output.
Incidence of vascular bruits.
2:3-diphosphoglycerate blood level.
Arterial PO2.
Capacity to raise oxygen consumption in exercise.
A to a group B person.
O to a group AB person.
A to a group O person.
A to a group AB person.
O Rh- negative to a group AB Rh-positive person.
MCQ
12
MCQ
Answers
32.
A.
B.
C.
True
True
True
D.
E.
True
False
33.
A.
False
B.
C.
False
False
D.
False
E.
True
It affects babies of Rh-negative mothers when the childs red cell membranes
carry the D antigen.
It occurs in Rh-positive babies.
The jaundice deepens rapidly after birth as bilirubin is no longer excreted by the
maternal liver.
This would be attacked by maternal Rh antibodies in the infants blood; Rhnegative blood is given.
These destroy fetal Rh-positive cells in the maternal circulation before such cells
can sensitize her to D antigen.
34.
A.
B.
C.
D.
E.
False
True
True
True
True
If
If
If
If
If
the
the
the
the
the
A.
B.
False
False
C.
False
D.
E.
False
True
True
False
False
False
False
True
False
True
False
False
35.
36.
A.
B.
C.
D.
E.
37.
A.
B.
C.
D.
E.
13
Questions 3843
A.
B.
C.
D.
E.
Metabolic acidosis.
Partly compensated respiratory alkalosis.
A reduced PCO2.
Chronic renal failure with a raised PCO2.
A history of persistent vomiting of gastric contents.
MCQ
14
MCQ
Answers
38.
A.
B.
True
True
C.
D.
E.
True
False
False
39.
A.
B.
C.
False
True
True
D.
True
E.
True
40.
A.
B.
C.
True
False
False
D.
E.
True
True
False
False
False
False
True
True
False
True
True
True
A.
B.
C.
False
True
True
D.
E.
False
True
41.
A.
B.
C.
D.
E.
42.
A.
B.
C.
D.
E.
43.
15
Questions 4449
A.
B.
C.
D.
E.
MCQ
16
MCQ
Answers
44.
A.
B.
C.
D.
False
False
True
True
E.
False
45.
A.
B.
C.
False
False
True
D.
True
E.
True
46.
A.
B.
True
False
C.
D.
E.
False
True
True
True
False
True
False
False
A.
B.
True
False
C.
True
D.
E.
True
False
Due to excessive reabsorption of water from the collecting ducts of the nephron.
Water is drawn into cells from the hypotonic extracellular fluid; water intoxication may occur.
People sweating heavily may replace their water, but not their salt, decit; they
tend to get muscle cramps unless they supplement their salt intake.
Sodium ions are responsible for nearly half of plasma osmolality.
The hypothalamic osmoreceptors responsible for thirst respond to hypertonicity,
not hypotonicity of the ECF.
47.
A.
B.
C.
D.
E.
48.
49.
A.
B.
C.
True
False
True
D.
E.
True
True
17
Questions 50-55
A.
B.
C.
D.
E.
MCQ
18
MCQ
Answers
50.
A.
True
B.
C.
D.
E.
False
False
False
True
Blood volume parallels body sodium levels; it expands with sodium retention and
shrinks with sodium depletion.
A reduced blood volume stimulates release of renin.
It is increased in sodium depletion due to an increased haematocrit.
If anything, ICF volume expands osmotically in sodium depletion.
Due to the loss of extracellular fluid in sodium depletion.
51.
A.
False
B.
C.
D.
E.
True
False
False
False
Blood volume is more reduced with sodium depletion; cardiovascular changes are
more pronounced.
Extracellular volume is a function of body sodium content.
It increases in both cases.
Hypertonicity is the main stimulus causing thirst.
Here also, hypertonicity is the main stimulus for ADH secretion.
52.
A.
B.
C.
D.
True
True
False
False
E.
False
53.
A.
True
B.
C.
D.
E.
True
True
False
True
Due to inability to excrete K ingested and released from cell breakdown in the
body.
Potassium is released from the damaged muscle bres.
Abnormal rhythms and heart failure may result.
Both hypo- and hyperkalaemia cause skeletal muscle weakness.
This facilitates entry of potassium into cells.
54.
A.
False
B.
C.
D.
E.
False
False
False
False
55.
A.
B.
C.
False
False
False
D.
E.
False
True
19
Questions 56-57
A. Normal (isotonic) saline increases the ECF more than the ICF volume.
B. 10 per cent dextrose provides sufcient energy for a sedentary adult for one day.
C. A suspension of lipids provides 23 times the energy of a suspension of carbohydrates
with the same concentration.
D. Isotonic (5 per cent) dextrose raises total body water by 15 per cent in the average
E.
adult.
An amino acid solution provides between 34 times the energy of a carbohydrate solution with the same concentration.
MCQ
20
MCQ
Answers
56.
A.
B.
C.
True
False
True
D.
True
E.
False
57.
A.
B.
C.
D.
False
False
False
True
E.
True
BODY FLUIDS
21
EMQs
EMQ Question 58
For each case of disordered haemostasis AE, select the most appropriate option from the following list of ndings.
1. Capillary abnormality.
2. Deciency of factor VIII.
3. Increased brinogen level.
4. Deciency of prothrombin.
5. Deciency of vitamin K.
6. Excessive heparin activity.
7. Massive blood transfusion.
8. Platelet count 90 109 per litre.
9
9. Platelet count 20 10 per litre.
A. A 15-year-old child is admitted to hospital with recent onset of widespread purpura
(pin-head areas of haemorrhage into the skin). Laboratory investigations reveal an
abnormality which accounts for the bleeding tendency.
B. A 50-year-old man is receiving anticoagulant therapy (warfarin, a vitamin K antagonist)
after heart valve replacement. He is admitted to hospital with haematuria (blood in the
urine) and his INR (international normalized ratio, a measure of the prothrombin clotting time in relation to the normal time) is found to be 4.2.
C. A 90-year-old women has blotchy purple areas about 5 cm diameter on her hands and
arms. They are not uncomfortable and she has no health complaints.
D. A 70-year-old man is operated on for aneurysm (swelling) of his aorta. Severe bleeding
requires infusion of forty units of blood. His recovery is complicated by a bleeding tendency and he is found to have a very low level of brinogen. His treatment includes
administration of heparin.
E. A 10-year-old child with no known medical problems has been admitted to hospital for
persistent bleeding after tooth extraction. Haemostasis had been achieved initially after
the extraction but subsequently prolonged oozing from the tooth socket began.
EMQ
Questions 5867
22
EMQ
Answers for 58
A.
B.
C.
D.
E.
Option 9
Platelet count 20 109 per litre. Widespread purpura is due to failure of
platelet plugging of capillaries and may be due to a low platelet count or to capillary
abnormality. An abnormal laboratory test to account for this would be a low platelet
count. Although both those given are below normal, only values below 2040 109 per
litre account for serious bleeding.
Option 4
Deciency of prothrombin. The action of warfarin, a vitamin K antagonist,
is to impair formation of several coagulation factors, notably prothrombin. There are a
number of cardiological indications for the use of warfarin, including heart valve replacement. The value quoted is above the usual recommended range and the prolonged prothrombin time due to a low level of prothrombin would account for the bleeding.
Option 1
Capillary abnormality. With advancing age, capillaries like tissues generally
become less resilient in the face of stress such as a relatively high internal pressure. This
leads randomly to patchy areas of bleeding such as those described. Apart from their
appearance they cause no problems.
Option 7
Massive blood transfusion. Massive blood transfusion may lead to widespread activation of the coagulation mechanism diffuse intravascular coagulopathy. This
in turn causes so much deposition of brin that the circulating brinogen level falls to
levels which result in a bleeding tendency. Paradoxically heparin, by preventing the
abnormal coagulation, allows the brinogen level to rise and can relieve the condition.
Option 2
Deciency of factor VIII. This condition (haemophilia) does not interfere
with initial haemostasis due to vascular closure, so the bleeding time is normal as in this
case. However, when the vascular spasm wears off, failure to clot is revealed as a persistent ooze of blood. Treatment is by supplying the missing factor VIII.
23
EMQ Question 59
1
2
3
4
5
6
pH
PO2
(kPa)
PCO2
(kPa)
HCO3
(mmol/l.)
7.15
7.4
7.25
7.55
7.55
7.2
16
14
9
10
11
25
3
5
8
3
7
9
11
25
32
20
32
32
A. A 60-year-old woman who suffers from long standing chronic bronchitis has just been
B.
C.
D.
E.
admitted to hospital because her condition deteriorated when she developed a chest
infection. No treatment had been given before the blood sample was taken.
A 50-year-old man with long-standing chronic bronchitis has been in hospital for several days for treatment of an exacerbation. He is receiving oxygen therapy but his condition is deteriorating.
A 50-year-old woman with long-standing renal disease has been admitted with deterioration of her condition, including marked drowsiness. She is noticed to be hyperventilating.
A 25-year-old man is taking part in a mountain climbing expedition in the Himalayas
and the medical ofcer of the team is carrying out physiological measurements. The
subject has been through the usual protocol for acclimatization to high altitude.
A 30-year-old man has been admitted to hospital suffering from abdominal pain and
general malaise. He has long-standing upper abdominal pain for which he has been
treating himself for some years with quite large amounts of sodium bicarbonate which
rapidly relieves the pain. He has begun to get muscle spasms in his hands and feet.
EMQ
For each case of disturbed acidbase balance AE, select the most appropriate option from the
following list of results of arterial blood analysis.
24
EMQ
Answers for 59
A.
B.
C.
D.
E.
Option 3
This patient has features suggesting respiratory failure drowsiness and
cyanosis in someone with chronic obstructive airways disease. So we are looking for signs
of a respiratory acidosis low pH due to high carbon dioxide levels and a reduced oxygen
level to account for the cyanosis. Only Option 3 has these three features. In someone with
a long-standing respiratory acidosis the bicarbonate is usually raised as in this case (for
comparison, results in Option 2 are all average normal).
Option 6
This patient is very similar to the one above except that he has been receiving oxygen therapy for his hypoxic hypoxia. Deterioration on oxygen suggests the possibility that complete relief of the hypoxia has resulted in respiratory depression with a
rising carbon dioxide level and worsening respiratory acidosis. Results in Option 6 conrm
this with the very high oxygen pressure which can be produced by breathing oxygen
together with a high carbon dioxide level and a dangerously low pH. Correct therapy is to
give controlled oxygen at, for example, 2428 per cent and monitor the blood gases so
that the oxygen level is above dangerous levels but the carbon dioxide does not rise dangerously.
Option 1
This patient has the symptoms of severe renal failure, a condition which
leads to a non-respiratory (or metabolic) acidosis. This is conrmed by the very low bicarbonate level and the very low pH. Such a condition leads to respiratory compensation by
hyperventilation to lower the carbon dioxide level as shown. The hyperventilation also
raises the oxygen level towards that in the atmosphere.
Option 4
High altitudes lead to hyperventilation triggered by the carotid bodies in
response to hypoxic hypoxia. The hyperventilation improves the oxygen level (which is
still below that at sea level) but produces a respiratory alkalosis due to washout of carbon
dioxide. With acclimatization the kidney responds by lowering the bicarbonate level by
reducing tubular secretion of the now scarce hydrogen ions.
Option 5
This is now a rather rare cause of metabolic alkalosis ingestion of large
amounts of sodium bicarbonate which relieves ulcer pain by temporarily buffering the
gastric acid. However the bicarbonate is absorbed and can lead to a metabolic alkalosis.
Alkalosis increases the binding of available calcium ions in the blood by plasma proteins
and can lead to tetany, which usually starts in adults with carpo-pedal spasm. Metabolic
alkalosis is compensated by depression of respiration, allowing the carbon dioxide level
to rise and balance the increased bicarbonate level. The oxygen pressure tends to fall with
the hypoventilation.
25
EMQ Question 60
EMQ
For each case of fluid balance disturbance AE, select the most appropriate option from the
following list.
1. Increased total body water.
2. Decreased total body water.
3. Increased extracellular fluid.
4. Decreased extracellular fluid.
5. Increased interstitial fluid.
6. Decreased interstitial fluid.
7. Increased blood volume.
8. Decreased blood volume.
9. Increased plasma volume.
10. Decreased plasma volume.
A. A 20-year-old mentally disturbed patient has refused all food and drink for several
days. Urine volume has fallen to around 100 ml in ve hours. Plasma osmolality has
risen to 320 mosmol per litre (previously 290 mosmol per litre).
B. A 50-year-old man has suffered from vomiting and diarrhoea for several days. His
peripheries are cold and he has a heart rate of 120 per minute and an arterial blood
pressure of 90/65.
C. A 50-year-old woman is suffering from weakness and mild confusion. She is found to
have a plasma sodium level of 125 mmol/litre (normal about 140 mmol/litre) and has a
raised level of vasopressin (antidiuretic hormone).
D. An 80-year-old woman has been admitted to hospital after vomiting blood. Following
transfusion of several pints of blood she has become breathless and is found to have an
increased jugular venous pressure.
E. A 40-year-old man has been admitted to hospital with full thickness burns of 40 per
cent of his body surface. Next day his blood pressure has fallen. A blood test shows a
haematocrit of 54 per cent.
26
EMQ
Answers for 60
A.
B.
C.
D.
E.
Option 2
Decreased total body water. In the absence of any water intake, a person
loses a minimum of around 1500 ml per day (500 ml insensible loss from the lungs,
500 ml insensible loss from the skin and 500 ml as the minimum amount of water which
can dissolve excreted solid waste products in the urine). A urine volume of 100 ml in ve
hours conrms this condition. After several days there will be a water decit of around
four to ve litres or 10 per cent of total body water, so the osmolality has risen by about
10 per cent. The water decit is distributed between intracellular and extracellular fluid
and oral water would correct the decit.
Option 4
Decreased extracellular fluid. The patient has lost a considerable volume of
intestinal secretions. This fluid is isotonic and rich in sodium and chloride, the main extracellular ions. His main depletion is of extracellular fluid and this is conrmed by signs of
severe peripheral circulatory failure evidenced by a low arterial blood pressure despite
vasoconstriction (cold peripheries) and a rapid heart rate. He urgently needs replenishment
of his extracellular fluid by intravenous infusion of isotonic (normal) saline. Although
Option 8 accounts for the peripheral circulatory failure, Option 4 is more appropriate as it
includes the underlying mechanism and points to the appropriate treatment.
Option l
Increased total body water. Inappropriately raised secretion of antidiuretic
hormone causes excessive reabsorption of water as fluid passes through the collecting
ducts. This dilutes all body fluids as indicated by the low sodium level (osmolality would
be correspondingly reduced). The waterlogging of the body cells impairs function and this
effect in the brain is manifested by confusion. Restricted water intake would improve the
condition.
Option 7
Increased blood volume. Replacement of blood loss is urgent in the elderly,
but over-transfusion can increase the blood volume above normal. In the elderly there is
an increased risk of heart failure and increasing the blood volume can precipitate this so
that the heart cannot adequately clear the venous return. The lling pressure of the two
sides of the heart increases, causing pulmonary oedema and breathlessness plus increased
systemic venous pressure. Diuretic therapy would reduce blood volume by causing excretion of salt and water, thereby lowering extracellular fluid volume.
Option 10 Decreased plasma volume. By damaging capillaries, burns cause increased
loss of fluid and proteins from the circulation. In addition large amounts of interstitial
fluid are lost through the damaged skin. Both effects lower plasma volume, raising the
haematocrit. Low blood volume can lead to peripheral circulatory failure. The standard
treatment is to infuse large quantities of normal saline, in proportion to the area of seriously burnt skin.
27
EMQ Question 61
EMQ Question 62
For each case of anaemia AE, select the most appropriate option from the following list.
1. Iron deciency anaemia.
2. Pernicious anaemia.
3. Microcytic anaemia.
4. Macrocytic anaemia.
5. Normocytic anaemia.
6. Bone marrow disease.
7. Compensatory rise in cardiac output. 8. Decreased blood viscosity.
9. Haemolytic anaemia.
10. Increased bone marrow activity.
A. Normal under the microscope. The mean red cell volume is normal at 90 cubic microns.
B. A patient with long-standing indigestion has noticed increasing lack of energy and tiredness when walking uphill. On questioning he has noticed that the bowel motions are
unusually dark from time to time. Due to the indigestion the patient takes a bland diet
without much meat or vegetables.
C. A patient with a blood haemoglobin concentration of 60 grams per litre complains of
recent palpitations (an abnormal awareness of the heart beat, often rather fast). When at
rest, the pulse is 110 per minute and the blood pressure 140/60 mmHg.
D. A woman of 75 has noticed unusual lack of energy recently and feels she is paler than
usual. Her haemoglobin level is 110 grams per litre and the red cell count is depressed
beyond that expected with the fall in haemoglobin. The circulating level of vitamin B12
is very low, but the folate level is normal.
E. A patient with moderate anaemia is found to have a bruit (abnormal murmur) when a
stethoscope is used to listen over each of the carotid arteries in the neck. The doctor is
inclined to attribute the murmur to a physical effect of the anaemia on the blood rather
than to an abnormality of the carotid arteries.
EMQ
For each blood transfusion problem AE, select the most appropriate option from the following list.
1. ABO incompatibility.
2. Rhesus incompatibility.
3. Major incompatibility.
4. Minor incompatibility.
5. Multiple repeated transfusions.
6. Massive blood transfusion.
7. Use of stored blood.
8. Use of fresh blood.
A. A patient has been given three units of blood during a surgical operation. Just after the
operation the patient is at risk of inadequate tissue oxygenation despite satisfactory
arterial blood pressure, haemoglobin and arterial blood oxygen saturation levels.
B. A patient has been given two units of blood on the day before a planned surgical operation. Towards the end of the transfusion the patient was noted to have mild fever, and
the next morning slight jaundice was noted in the conjunctivae.
C. A patient admitted with vomiting of blood shows signs of circulatory failure and is
given a unit of blood quite rapidly. As the transfusion is nearly completed it is discovered that there has been confusion between two patients with exactly the same rst and
second names and the patient with the transfusion appears much more unwell than at
the start of the transfusion. In fact the group B patient was given group A blood.
D. During emergency surgery for a dissected aortic aneurysm, a condition notorious for
severe bleeding during operation, a patient is transfused with 20 units of blood. Despite
restoration of a normal blood volume this patient is at risk of hypothermia, tissue
hypoxia and coagulation problems.
E. A patient with failure of bone marrow function causing aplastic anaemia is admitted for
transfusion as the haemoglobin level has fallen to an unacceptable level. The blood
bank report difculty in nding suitable red cells due to problems with some of the
minor blood groups, M and Kell.
28
EMQ
Answers for 61
A.
B.
C.
D.
E.
Option 7
Use of stored blood. This blood has the characteristic property of stored
blood a low level of 2:3-DPG. Hence the blood oxygen dissociation curve is shifted to
the left, and the blood does not give up adequate oxygen at tissue oxygen tensions.
Option 4
Minor incompatibility. There has been a mild antibody rejection of the
donor red cells. A relatively small number of these have been broken down (lysed) to
release bilirubin which causes the jaundice. The immune response also releases products,
including interleukin-1, which cause the fever.
Option 3
Major incompatibility. This type of mistake carries a high risk of death
because the recipients naturally occurring anti-A antibody (agglutinin) rapidly destroys
the transfused group A red cells, releasing huge amounts of deadly toxins.
Option 6
Massive blood transfusion. A massive blood transfusion is dened as one
where the volume of blood transfused equals or exceeds the patients original blood
volume. Stored blood carries the problem mentioned in (A) but because large volumes of
blood must be given very rapidly there is not time to heat them to body temperature from
their initial low temperature, so the patients core temperature drops (hypothermia). This
compounds the shift in the blood oxygen dissociation curve and also slows the coagulation reactions.
Option 5
Multiple repeated transfusions. Such patients require regular blood transfusions on repeated occasions, so their immune system builds up antibodies to minor
blood group antigens such as M, N, Kell and Duffy.
Answers for 62
A.
B.
C.
D.
E.
Option 5
Normocytic anaemia. The haemoglobin concentration is about half normal,
indicating moderate anaemia. Since the red cells look normal and mean cell volume is also
normal this is a normocytic anaemia. It could be due to bone marrow disease, lack of
erythropoietin or other chronic disease.
Option 1
Iron deciency anaemia. This patient has symptoms of anaemia, along with
a suggestion of repeated bleeding into the bowel and a diet likely to be low in iron. The
most likely explanation is anaemia due to iron deciency. This is likely to be a microcytic
anaemia, but no conrmatory details of the presence of small pale red cells are given in
this case.
Option 7
Compensatory rise in cardiac output. This patient has severe anaemia. In
order to provide adequate oxygen for the tissues, the low oxygen content per litre must
be compensated by increased flow. This patient shows the features fast pulse, high pulse
pressure of an increased resting cardiac output (hyperdynamic circulation).
Option 2
Pernicious anaemia. This patient has moderately severe anaemia. Because
the red cell count is disproportionately low, the cells must be larger than normal macrocytic. This is explained by the low level of vitamin B12 and the normal folate excludes
another major macrocytic anaemia. The B12 deciency at this age is usually due to failure
of the stomach to produce intrinsic factor pernicious anaemia. The term pernicious was
used because before the discovery of vitamin B12 there was no treatment and the condition got worse and worse until the patient died from an extremely low level of haemoglobin.
Option 8
Decreased blood viscosity. A bruit or murmur in the circulation indicates turbulent flow. Turbulent flow is much more likely as the viscosity of blood decreases. Since
most of the blood viscosity is due to the haematocrit, moderate anaemia could reduce the
viscosity by around half. The increased velocity of flow due to the increased cardiac
output mentioned in (C) would also increase the chance of turbulence.
29
EMQ Question 63
EMQ Question 64
For each of the descriptions AE, select the most appropriate option from the following list.
1. Neutrophil polymorphonuclear
2. Platelet.
1. granulocyte.
3. Lymphocyte.
4. Thrombocytopoenia.
5. Leukaemia.
A. Responsible for ingesting invading bacteria.
B. The blood cell most affected by AIDS.
C. A condition where abnormal white cells invade the bone marrow.
D. The smallest cellular element in the blood.
E. Uniquely capable of becoming sticky.
EMQ Question 65
For each of the descriptions related to body fluids AE, select the most appropriate option from
the following list.
1. Osmolality.
2. Plasma albumin.
3. Glucose.
4. Sodium.
5. Plasma globulin.
A. Responsible for most of the colloid osmotic pressure of the plasma.
B. Responsible for fluid shifts between intracellular and extracellular fluid.
C. Provides about half of osmotically active particles in extracellular fluid.
D. Mainly responsible for opposing the leak of fluid out of capillaries.
E. Determines the freezing point of a solution.
EMQ
For each lipid-related topic AE, select the most appropriate option from the following list.
1. Coronary artery disease risk factor.
2. Source of energy.
3. Cell membrane solubility.
4. Cell membrane structure.
5. Metabolic energy per unit mass.
6. Derived from cholesterol.
7. Body lipid stores.
8. Lipase.
9. Carbohydrate hormones.
10. Protein hormones.
A. When explorers were crossing Antarctica trailing all their food in a hand sleigh there
was an advantage in taking a high proportion of fat rather than carbohydrate.
B. Oestradiol, testosterone and aldosterone share a property which is not shared by insulin
and vasopressin.
C. In life-threatening acute inflammation of the pancreas (pancreatitis) considerable tissue
damage is produced by a chemical which is detected in the bloodstream in large
amounts.
D. In patients who have had a heart attack due to blockage of the blood supply of the
myocardium, drugs may be given to lower the blood cholesterol level.
E. The interior of muscle bres contains many glycogen granules and lipid droplets.
30
EMQ
Answers for 63
A.
B.
C.
D.
E.
Option 5
Metabolic energy per unit mass. Fat liberates just over twice the metabolic
energy per unit mass that is liberated by metabolism of carbohydrates. The two substrates
are both used by the body to provide energy especially in strenuous exercise. So by dragging relatively large amounts of fat the explorers were minimizing the load on their sleigh
and maximizing the energy they obtained from their food.
Option 6
Derived from cholesterol. Oestradiol, testosterone and aldosterone are all
derived in the body from cholesterol. Despite being a risk factor for arterial disease when
present in excess in the blood, cholesterol is a precursor of vital hormones and is synthesized in the body. Insulin is a protein hormone and vasopressin a polypeptide hormone.
Option 8
Lipase. In acute pancreatitis large amounts of lipase escape into the blood
and this leads to widespread fat necrosis as part of the life-threatening state when the pancreatic hormones enter the bloodstream.
Option 1
Coronary artery disease risk factor. Excessive lipids in the blood, including
cholesterol, are a risk factor for coronary atheroma. The lipid prole may also be improved
by moderate exercise and avoidance of obesity.
Option 2
Source of energy. During prolonged exercise energy is derived in approximately equal amounts from carbohydrate and fat. The glycogen granules in particular are
a major source of energy. They become more prominent with physical training and are
depleted after prolonged fasting exercise.
Answers for 64
A.
B.
C.
D.
E.
Option 1
Neutrophil polymorphonuclear granulocyte. These are the commonest of the
white cell types. In an area of serious prolonged infection the neutrophils ingest bacteria, eventually die and accumulate as pus.
Option 3
Lymphocyte. The lymphocytes are responsible for immunity, so a disease
which damages their function leads to immune deciency.
Option 5
Leukaemia. Leukaemia is a cancerous multiplication of abnormal white cells
which replace normal bone marrow cells, suppressing normal formation of white cells, red
cells and other marrow-derived cells.
Option 2
Platelet. Platelets are about half the diameter of red cells, which in turn are
smaller than white cells. Lack of platelets is called thrombocytopoenia.
Option 2
Platelet. Areas of endothelial damage expose collagen to which platelets are
attracted. They adhere to the collagen and become sticky for other platelets so that a platelet plug develops to close the gap and prevent loss of blood.
Answers for 65
A.
B.
C.
D.
E.
Option 2
Plasma albumin. Colloid osmotic pressure is due to protein molecules which
cannot readily cross the capillary wall; albumin constitutes the larger portion of the
plasma protein mass, its molecules are smaller than globulin so it exerts much more
osmotic pressure.
Option 1
Osmolality. Water passes across the cell wall by osmotic forces due to the
sum of the effects of all dissolved particles the osmolality.
Option 4
Sodium. Sodium has a concentration around 135 mmol per litre and provides nearly half of the total osmolality of around 285 mosmol per kg.
Option 2
Plasma albumin. Because most particles are in equilibrium across the capillary wall they do not contribute to the osmotic force opposing fluid leak. The proteins provide an opposing force and albumin is the commonest protein particle.
Option 1
Osmolality. Osmolality can be measured by noting the freezing point of the
solution being tested.
31
EMQ Question 66
EMQ Question 67
For each of the body fluid disturbances AE, select the most appropriate option from the following list of abnormalities.
1. Hyper-osmolality.
2. Hypo-osmolality.
3. Hyponatraemia.
4. Hyperkalaemia.
5. Raised haematocrit.
A. Excessive retention of water by the kidneys.
B. Excessive loss of plasma and extracellular fluid as a result of severe burns.
C. Likely to be present if the blood glucose level is 30 (normal 58) mmol/litre.
D. Produced by drinking excessive amounts of water.
E. Likely to cause swelling of brain cells.
EMQ
For each of the intravenous fluids AE, select the most appropriate option from the following
list of infusions.
1. 50 per cent glucose.
2. 1.8 per cent saline.
3. 5 per cent glucose (dextrose).
4. Normal (0.9 per cent) saline (sodium
5. 8.4 per cent sodium bicarbonate.
4. chloride).
A. An isotonic solution which expands mainly the extracellular fluid volume.
B. An isotonic solution which expands both intra- and extracellular fluid volumes.
C. A major nutrient used in intravenous nutrition.
D. A hypertonic fluid with about twice the osmolality of plasma.
E. A fluid occasionally used to treat severe acidosis.
32
EMQ
Answers for 66
A.
B.
C.
D.
E.
Option 4
Normal saline. Normal saline has the same tonicity (osmolality) as plasma
and extracellular fluid. Sodium doesnt enter intracellular fluid appreciably. The chloride
and water remain with the sodium in the extracellular space.
Option 3
5 per cent glucose. 5 per cent glucose (dextrose) is also isotonic. It has the
same number of particles as 0.9 per cent saline. Saline dissociates so the average particle
molecular weight is about 30. Dextrose has a molecular weight of 180 and does not dissociate so about six times the mass of dextrose is required for isotonicity.
Option 1
50 per cent glucose. A litre of 50 per cent glucose contains 500 grams of
glucose, yielding about 2000 kilocalories (about 9 megajoules, MJ), around the resting
daily requirement of an adult.
Option 2
1.8 per cent saline. This is twice the osmolality of normal saline around
600 as compared with around 300 mosmoles per kg.
Option 5
8.4 per cent sodium bicarbonate. This concentrated bicarbonate solution has
a high buffering capacity for hydrogen ions. However correcting acidbase balance is a
complex procedure rarely beneting from such drastic measures.
Answers for 67
A.
B.
C.
D.
E.
Option 2
Hypo-osmolality. Excessive retention of water dilutes all the body fluids
leading to hypo-osmolality. Water crosses the cell membrane until equilibrium is attained.
Inappropriately high levels of antidiuretic hormone could do this.
Option 5
Raised haematocrit. As fluid is lost, plasma volume declines, so the red
blood cells become an increasing proportion of blood volume.
Option 1
Hyper-osmolality. The high glucose raises the osmolality proportionately, so
a rise of 25 mmol/litre in the extracellular glucose level would raise the osmolality from
285 to 310 mosmol/kg, an appreciable rise. This would draw fluid from cells, including
brain cells, disturbing function.
Option 2
Hypo-osmolality. Drinking excessive amounts of water has the same effect
as excessive retention by the kidney. However healthy people promptly excrete the excess
fluid.
Option 2
Hypo-osmolality. Excess water is drawn into brain cells by osmosis. This also
disturbs brain function.
CARDIOVASCULAR SYSTEM
33
MCQs
Early systole.
Myocardial hypoxia.
Hypothermia.
Stimulation of sympathetic nerves to the heart.
Arterial hypertension.
69. Local metabolic activity is the chief factor determining the rate of blood
flow to the
A.
B.
C.
D.
E.
Heart.
Skin.
Skeletal muscle.
Lung.
Kidney.
71. The second heart sound differs from the first heart sound in that it is
A.
B.
C.
D.
E.
MCQ
Questions 6872
34
MCQ
Answers
68.
A.
B.
False
True
C.
False
D.
True
E.
True
69.
A.
B.
True
False
C.
True
D.
False
E.
False
There is a close relationship between the work of the heart and coronary flow.
Skin blood flow is geared mainly to thermoregulation and normally exceeds that
needed for skins modest metabolic requirements.
Local blood flow is largely determined by the vasoactive metabolites such as
rising PCO2, H concentration and falling PO2. The changes produced by vasomotornerves are small compared with those produced by metabolites.
The entire cardiac output must pass through the lungs regardless of the local
metabolic needs of the pulmonary tissues. It is greatly in excess of the lungs
metabolic needs.
As in skin, renal blood flow (about one quarter of total cardiac output) greatly
exceeds local metabolic needs. The blood is sent to the kidneys for processing.
70.
A.
B.
True
False
C.
D.
True
False
E.
True
71.
A.
B.
C.
D.
E.
False
False
True
False
True
A.
True
B.
C.
D.
False
False
True
E.
False
The pressure head needed to drive cardiac output through the pulmonary circuit
(about 15 mmHg) is much less than that needed in the systemic circuit (about
90 mmHg).
The reverse is true; low alveolar PO2 may cause pulmonary hypertension.
These are conductance units, the reciprocal of resistance units.
Thus there is little rise in pulmonary arterial pressure during exercise despite the
increased flow rate. Release of nitric oxide from the pulmonary vascular endothelium may account for the vasodilatation.
Pulmonary vascular resistance is controlled by local rather than by nervous
mechanisms.
72.
35
Questions 7378
A.
B.
C.
D.
E.
74. Veins
A.
B.
C.
D.
E.
The left atrial wall is about three times thicker than the right atrial wall.
Systolic contraction normally begins in the left atrium.
Excitation spreads directly from atrial muscle cells to ventricular muscle cells.
Atrial and ventricular muscle contracts simultaneously in systole.
The contracting ventricles shorten from apex to base.
76. Isometric (static) exercise differs from isotonic (dynamic) exercise in that
it causes a greater increase in
A.
B.
C.
D.
E.
Venous return.
Pressure in the veins draining the exercising muscle.
Muscle blood flow.
Mean arterial pressure.
Cardiac work for the same increase in cardiac output.
77. The net loss of fluid from capillaries in the legs is increased by
A.
B.
C.
D.
E.
Arteriolar dilation.
Change from the recumbent to the standing position.
Lymphatic obstruction.
Leg exercise.
Plasma albumin depletion.
MCQ
36
MCQ
Answers
73.
A.
B.
C.
D.
E.
False
False
True
False
True
Atrial contraction accounts for only about 20 per cent of lling at rest.
During this phase the AV valves are closed and ventricular volume is constant.
This low-pitched sound is sometimes heard in early diastole.
Filling occurs when atrial pressure exceeds ventricular pressure.
Due to entry of blood accumulated in the atria during ventricular systole.
True
True
False
True
True
A.
B.
C.
False
False
False
D.
E.
False
True
Their wall thickness is similar since the workload of the two atria is similar.
It begins at the sinuatrial node in the right atrium.
Excitation can only pass from atria to ventricles via specialized conducting tissue
in the AV bundle.
Delay of excitation in the AV bundle makes atrial precede ventricular contraction.
Due to the spiral arrangement of some muscle bres; circular bres reduce ventricular circumference.
74.
A.
B.
C.
D.
E.
75.
76.
A.
B.
False
True
C.
False
D.
E.
True
True
77.
A.
B.
True
True
C.
False
D.
E.
True
True
78.
A.
False
B.
True
C.
False
D.
E.
False
True
Korotkoff sounds are produced locally by the turbulence of blood being forced
past the narrow segment of a partially occluded artery.
The sharp taps of Phase 1 are generated as the systolic pressure peaks force blood
under the cuff.
Sudden muffling (Phase 4) or disappearance (Phase 5) of the sounds indicate the
diastolic pressure point.
They are usually higher since palpation may fail to detect the rst tiny pulses.
Otherwise the full cuff pressure may not be transmitted to the artery.
37
Questions 7984
A.
B.
C.
D.
E.
In exercise.
In excitement.
In hypotension.
When parasympathetic drive is decreased.
During a vasovagal attack.
MCQ
38
MCQ
Answers
79.
A.
B.
C.
D.
E.
True
True
True
False
True
False
False
True
True
False
By more than 90 per cent; resistance is related to the fourth power of the radius.
Vascular resistance is not related to wall thickness.
It is directly proportional to length.
Resistance is related to ViscosityLength/Radius4.
Total arteriolar resistance exceeds total capillary resistance though the reverse is
true for single vessels.
True
True
True
False
False
A.
True
B.
C.
True
False
D.
E.
True
True
It is about 90 mmHg, due to the column of blood (about 1 metre) between the
heart and the foot.
The negative intrathoracic pressure during inhalation is transmitted to the veins.
Limb veins collapse above heart level. Negative pressure cannot be transmitted
along a collapsed tube so venous pressure is atmospheric in the raised hand.
The sinuses are held open by their meningeal attachments and cannot collapse.
A central venous pressure line is usually placed here.
80.
A.
B.
C.
D.
E.
81.
A.
B.
C.
D.
E.
82.
83.
A.
B.
False
False
C.
D.
False
True
E.
True
84.
A.
B.
C.
D.
False
True
False
False
E.
True
The SA node is in the right atrium near its junction with the superior vena cava.
Vagal activity slows the rate of impulse generation and thus the heart rate.
The SA node has intrinsic rhythmicity and can generate impulses independently.
Purkinje tissue is conned to the ventricles; atrial bres conduct impulses from
the SA to the AV node.
Impulse generation is due to spontaneous diastolic depolarization of the cells.
39
Questions 8591
A.
B.
C.
D.
E.
MCQ
40
MCQ
Answers
85.
A.
B.
C.
D.
E.
False
False
True
True
False
A.
B.
C.
True
True
True
D.
E.
True
True
This increases the rate of impulse generation and hence heart rate.
The increase in myocardial metabolism generates vasodilator metabolites.
Rapid spread of excitation in the ventricles results in more forceful contractions
as the ventricular bres are activated nearly simultaneously.
This enhances the force of contraction at any given lling pressure.
Due to the increased force of contraction.
False
True
True
True
False
It is low because the capillary bed has a large total cross-sectional area.
The venous bed has a smaller total cross-sectional area than the venular bed.
There is a brief period of retrograde flow as the aortic valve closes.
Axial flow occurs in large vessels; near the walls, flow velocity is zero.
It rises due to the compensatory increase in cardiac output.
True
False
False
True
True
True
False
False
True
False
A.
B.
C.
False
True
False
D.
E.
True
True
86.
87.
A.
B.
C.
D.
E.
88.
A.
B.
C.
D.
E.
89.
A.
B.
C.
D.
E.
90.
91.
A.
B.
C.
D.
E.
True
True
True
True
False
The output from the left and right ventricle is the same.
It depends on what happens to stroke volume.
Lying down normally increases the lling pressure of the heart.
To meet the needs of increased metabolism and increased skin blood flow.
The output does increase due to changes in the lling pressure, level of circulating hormones, etc.
41
Questions 9297
A.
B.
C.
D.
E.
95. The tendency for blood flow to be turbulent increases when there is a
decrease in blood
A.
B.
C.
D.
E.
Vessel diameter.
Density.
Flow velocity.
Viscosity.
Haemoglobin level.
96. Arterioles offer more resistance to flow than other vessels since they have
A.
B.
C.
D.
E.
97. In the denervated heart, left ventricular stroke work increases when
A.
B.
C.
D.
E.
MCQ
92. Arterioles
42
MCQ
Answers
92.
A.
B.
C.
D.
E.
False
True
True
True
False
A.
True
B.
C.
D.
E.
True
False
True
True
93.
94.
A.
B.
C.
D.
E.
False
False
False
True
False
False
False
False
True
True
A.
B.
False
False
C.
D.
E.
False
False
True
95.
A.
B.
C.
D.
E.
96.
97.
A.
B.
C.
D.
True
True
False
True
E.
True
43
Questions 98103
A.
B.
C.
D.
E.
MCQ
44
MCQ
Answers
98.
A.
B.
B.
C.
True
False
False
True
E.
False
The relative amount of smooth muscle increases but that of elastic tissue falls.
With the decreasing vessel diameter and flow velocity, the tendency decreases.
It falls slightly; blood will only flow down a pressure gradient.
Distal arterial pulse pressure is increased by the superimposition of waves
reflected back from the end of the arterial tree.
Blood cannot release its oxygen until it reaches the exchange vessels.
False
True
True
False
True
Complete mixing with the blood is required for estimation of blood volume.
The secondary peak is due to recirculation of indicator.
Due to the more rapid passage of indicator past the sampling site.
It falls as the indicator is diluted in a bigger volume.
Pulmonary artery blood flow equals cardiac output.
A.
B.
C.
True
False
False
D.
True
E.
False
99.
A.
B.
C.
D.
E.
100.
101.
A.
B.
C.
D.
E.
False
True
True
False
False
True
False
False
True
False
A.
B.
C.
D.
True
False
True
True
E.
False
102.
A.
B.
C.
D.
E.
103.
45
Questions 104109
A.
B.
C.
D.
E.
Hypovolaemia is unusual.
It leads to underperfusion of the tissues.
Cardiac output is usually normal.
Central venous pressure is low.
Ventricular function is usually normal.
MCQ
46
MCQ
Answers
104.
A.
False
B.
True
C.
D.
E.
True
False
False
This constricts blood vessels in the lungs causing pulmonary hypertension but
dilates systemic vessels.
Salt and water retention by the kidneys expands ECF and hence blood volume
and cardiac output.
The resulting secretion of cortisol also causes salt and water retention.
This is a consequence of hypertension, not a cause.
This ineffective pumping in ventricular brillation causes severe hypotension.
105.
A.
False
B.
C.
D.
E.
False
False
True
True
Hypovolaemia due to severe haemorrhage is a common cause of peripheral circulatory failure; blood volume may be normal in central circulatory failure.
Both types of failure lead to underperfusion of the tissues.
It is usually reduced in both types of failure.
It is usually raised in central circulatory failure.
Reduced ventricular function is the cause of central circulatory failure.
106.
A.
B.
False
True
C.
D.
E.
False
True
False
107.
A.
B.
C.
D.
E.
False
True
True
True
True
True
False
True
False
True
The direction in which the murmur is conducted indicates the direction of flow.
The characteristic murmur is a systolic murmur conducted to the neck vessels.
This is the direction of flow of the regurgitant blood.
The murmur occurs during ventricular contraction and is therefore systolic.
Mitral flow is greatest in early diastole but rises again during atrial systole.
A.
B.
False
False
C.
D.
E.
True
True
True
In atrial flutter, P waves have a high but regular frequency (about 300/minute).
Ventricular beats are irregular in rate and strength since impulses pass through
the AV node in a random fashion.
The beats generated by ventricular pacemakers have slow but regular frequency.
The increased muscle bulk generates enhanced voltages during depolarization.
Due to chaotic electrical activity in the ventricles.
108.
A.
B.
C.
D.
E.
109.
47
Questions 110115
A.
B.
C.
D.
E.
112. Respiratory failure (low arterial PO2; raised arterial PCO2) leads to
A.
B.
C.
D.
E.
113. Pain due to poor coronary blood flow (angina) may be relieved by
A.
B.
C.
D.
E.
114. Narrowing of the lumen of major arteries supplying the leg is associated
with
A.
B.
C.
D.
E.
MCQ
48
MCQ
Answers
110.
A.
B.
C.
D.
E.
False
True
True
True
True
A.
True
B.
C.
D.
False
True
True
E.
False
In high output failures; however, the ability to raise cardiac output in exercise is
impaired in all types of failure.
With inadequate output, desaturation of blood in the tissues increases.
This increases extracellular fluid and hence blood volume.
The back pressure in veins raises capillary hydrostatic pressure and results in
oedema in dependent parts where venous pressure is already raised due to gravity.
When pulmonary capillary pressure (about 5 mmHg) doubles, it is still less than
plasma oncotic pressure (25 mmHg) so fluid does not accumulate in the alveoli.
111.
112.
A.
B.
C.
D.
E.
True
True
False
False
True
A.
B.
True
True
C.
D.
E.
False
False
True
Pain sensory bres from the heart travel with the sympathetic nerves.
In anaemia, the capacity of the blood to deliver oxygen is decreased but cardiac
work increases due to the rise in cardiac output.
Cold vasoconstriction raises arterial pressure and so increases myocardial work.
These increase heart rate and force and so increase myocardial work
By reducing arterial pressure, vasodilator drugs such as nitrates reduce myocardial work.
113.
114.
A.
True
B.
True
C.
D.
E.
False
True
True
True
False
True
True
False
115.
A.
B.
C.
D.
E.
49
Questions 116120
A.
B.
C.
D.
E.
117. Factors ensuring that ventricular muscle has an adequate oxygen supply
include the
A.
B.
C.
D.
E.
MCQ
50
MCQ
Answers
116.
A.
B.
C.
D.
E.
True
False
True
True
True
A.
False
B.
C.
D.
E.
False
True
False
True
Coronary arteries are functional end arteries and have few anastomotic connections; sudden occlusion of an artery usually leads to local muscle death.
Coronary vessels are compressed by the contracting myocardium in systole.
The extraction rate is about 75 per cent.
Reflex vasodilatation is not important in regulating coronary blood flow.
The rise in metabolic activity in the exercising heart provides the vasodilator
metabolites which adapt coronary flow to supply myocardial oxygen needs.
117.
118.
A.
B.
C.
D.
False
True
True
False
E.
True
119.
A.
True
B.
C.
False
True
D.
E.
False
True
Diastolic pressure is abnormally low due to regurgitation of aortic blood into the
left ventricle in diastole.
Blood regurgitating in diastole causes diastolic turbulence.
The greater stroke volume needed to compensate for regurgitating blood increases
ventricular workload.
Flow increases as ventricular work increases.
A persistent increase in ventricular workload can lead to ventricular failure.
120.
A.
False
B.
C.
True
False
D.
True
E.
False
51
Questions 121126
A.
B.
C.
D.
E.
Arterial compliance.
Systolic arterial pressure.
Diastolic arterial pressure.
Peripheral resistance.
Arterial pulse wave velocity.
MCQ
52
MCQ
Answers
121.
A.
False
B.
C.
D.
E.
True
False
False
False
122.
A.
B.
C.
D.
E.
False
True
False
False
True
Compliance, the change of arterial volume per unit pressure change, decreases.
Systolic ejection causes greater pressure rise when arteries are less distensible.
Poor elastic recoil in diastole allows diastolic pressure to fall further.
Stiffness of the wall is not a factor determining vascular resistance.
Vibrations travel faster in stiff than in lax structures.
123.
A.
B.
C.
D.
E.
True
False
False
True
True
The pressure wave due to atrial contraction passes up freely into the neck.
Atrial systole precedes the ventricular systole that generates the carotid pulse.
It is absent there is no effective atrial systole in atrial brillation.
Right atrial contraction is more forceful to overcome valvular resistance.
If the atrial and ventricular systoles coincide, the A and C waves merge to give a
giant wave.
124.
A.
B.
C.
True
False
True
D.
E.
False
False
125.
A.
B.
C.
False
True
False
D.
E.
True
False
Flow through the circle of Willis normally maintains the viability of the tissue.
There is no signicant collateral circulation.
Normally there is adequate collateral circulation. However, if there is advanced
arterial disease, sudden obstruction may cause gangrene.
The collateral circulation is not good enough to prevent this.
The liver has a dual blood supply; the hepatic artery flow can maintain viability.
126.
A.
B.
C.
D.
E.
True
False
True
False
False
CARDIOVASCULAR SYSTEM
53
EMQs
EMQ
Questions 127138
54
EMQ
B.
C.
D.
E.
Option 1
Increased cerebral vascular resistance. Hyperventilation leads to constriction
of cerebral vessels due to washout of carbon dioxide from the body. This leads to
decreased cerebral capillary pressure and a reduction in cerebral interstitial fluid volume,
thereby reducing the oedema generated by head injury.
Option 5
Increased splanchnic resistance. In circulatory failure, blood pressure is supported by increased peripheral vascular resistance induced by the baroreceptor reflex, particularly in the splanchnic circulation. Splanchnic vasoconstriction occurs early in the
condition. The resultant stagnant hypoxia in the alimentary mucosa is thus a sensitive
index of the early stages of circulatory failure before more severe effects such as hypotension are obvious.
Option 4
Decreased coronary resistance. Myocardial infarction results from complete
or almost complete cessation of perfusion of a region of cardiac muscle due to blocking,
often by thrombosis, of a coronary artery or arteries. This reduces flow by a massive
increase in resistance and a considerable mass of myocardium is threatened by stagnant
hypoxia due to poor flow (ischaemia). Activation of circulating plasminogen to plasmin
allows breakdown of blood clot (thrombolysis) and decreases regional coronary resistance
to a level which allows recovery of ischaemic areas.
Option 2
Decreased cerebral vascular resistance. Carbon dioxide is an important
determinant of cerebral blood flow by its local vasodilator action (in underperfused areas
carbon dioxide accumulates and this leads to vasodilation and restoration of normal perfusion). When there is a raised level of carbon dioxide in arterial blood there is generalized cerebral vasodilation and this leads to increased formation of tissue fluid (oedema).
The resultant increased intracranial pressure leads to headaches and papilloedema, imitating the effects of an intracranial tumour or abscess.
Option 12 Decreased regional perfusion pressure. With persistent diarrhoea and vomiting, extracellular fluid volume can fall severely. The reduced plasma volume leads to
hypotension, especially in the elderly whose compensatory mechanisms are blunted.
Sitting and standing trap circulating fluid in the feet causing a severe fall in arterial blood
pressure. This decreases cerebral perfusion pressure to a point at which a local decrease in
vascular resistance cannot compensate and loss of consciousness (syncope) occurs from
cerebral ischaemia (inadequate blood flow).
55
1.
2.
3.
4.
5.
6.
60
120
180
40
100
240
80
35
110
140
70
15
40
20
110
50
70
15
A. A 30-year-old man has been admitted to hospital for minor elective surgery. He is a
B.
C.
D.
E.
long-distance runner of national standard. His cardiac shadow is enlarged on chest Xray and there is concern about his very slow pulse.
A 50-year-old woman has been admitted to hospital for thyroid surgery and is found to
have signs of severe uncontrolled hyperthyroidism. Her peripheries are warm and moist
and her pulse is rapid and bounding.
A 40-year-old woman trains regularly for physical tness but has been concerned
recently about chest discomfort, fearing coronary artery disease. She undertakes cardiological assessment during progressive exercise on a treadmill and the results correspond
to the nal stage of severity, rarely reached by the patients assessed. At this stage her
systolic arterial pressure was 180 mmHg.
A 40-year-old woman reports recent episodes of threatened loss of consciousness during
exercise and such an episode occurs during treadmill testing in hospital.
A 70-year-old man has been admitted to hospital after he collapsed at home and found
he could not sit up without feeling he was about to faint. He suffers from epigastric
pain treated by a proton pump inhibitor and has recently noticed his bowel motions are
loose and very dark. On admission he is pale and sweating with cold peripheries and his
systolic arterial pressure is 80 mmHg even with the foot of the bed raised.
EMQ
For each of the clinical scenarios AE, select the most appropriate option from the cardiovascular parameters listed below.
56
EMQ
B.
C.
D.
E.
Option 4
These results are typical of a high level athlete a normal resting cardiac
output of 5.6 litres per minute with a very slow pulse rate compensating for a huge resting stroke volume. Such people have relatively large powerful hearts which contrast dramatically with the large weak hearts of patients with cardiac failure, some of whom may
suffer from a pathologically slow heart rate which exacerbates their condition.
Option 5
Hyperthyroidism leads to a hyperdynamic circulation at rest rapid strong
pulse associated with a high pulse pressure and an increased cardiac output (7 litres per
minute in her case). This is required for the increased metabolic rate due to the overactive
thyroid. The increased metabolic rate also generates excess heat, hence the sweating.
Option 3
This woman is typical of patients with chest pain not due to coronary artery
disease. In association with regular training she is very t and can exercise to the maximal level used in the treadmill cardiac stress test. At this stage she shows typical ndings
of a cardiac output of about 20 litres per minute and arterial blood pressure 180/70 (high
systolic due to powerful ejection by the left ventricle and rapidly falling pressure due to
very low peripheral resistance). She has achieved the maximal predicted heart rate (220
minus age in years).
Option 6
Syncope or pre-syncope during exercise can be due to an abnormal ineffective rapid cardiac rhythm (tachycardia). As with the previous case the maximal expected
rate is 180 and a rate of 240 does not allow adequate lling for a useful stroke volume.
Such a low cardiac output (3.6 litres per minute) would lead to loss of consciousness
during mild to moderate exercise.
Option 2
This patient gives a history suggesting peptic ulcer treated by a drug which
raises gastric pH to relieve the pain. The history is strongly suggestive of chronic loss of
blood in the faeces (melaena). With an arterial blood pressure of 80/60 he cannot sustain
adequate cerebral blood flow in the upright posture. This is because of the reduced venous
return experienced by everyone in the upright position. Raising the foot of the bed maximizes venous return. He is suffering from peripheral circulatory failure due to severe
blood loss and blood transfusion is urgently indicated.
57
EMQ
For each of the physiological characteristics AE, select the most appropriate option from the
types of blood vessels listed below.
1. Veins.
2. Arteries.
3. Arterioles.
4. Venules.
5. Arteria-venous anastomoses.
A. The major source of peripheral resistance.
B. Are important in temperature regulation.
C. Their walls contain relatively more elastic tissue than other blood vessels.
D. Their valves prevent retrograde flow.
E. Have the greatest wall thickness to lumen ratio in blood vessels.
58
EMQ
B.
C.
D.
E.
Option 3
Arterioles. Arterioles are the main source of peripheral resistance in the circulation since the fall in blood pressure across arteriolar vessels is greater than in any
other vascular segment.
Option 5
Arterio-venous anastomoses. The AV anastomoses in the extremities such as
the ngers and toes open up when body temperature rises and the resulting increase in
blood flow raises skin temperature so that there is greater heat loss from the skin.
Option 2
Arteries. The arteries, especially those near the heart, are highly elastic. This
tissue is stretched during systole and the energy so stored is fed back during diastole to
maintain the diastolic pressure. Thus the elastic tissue dampens the large pressure gradients generated by the ventricles into the smaller pressure pulses seen in the arterial
system.
Option 1
Veins. These valves aid return of blood to the heart. When veins are compressed by surrounding muscles or other organs, the valves do not allow retrograde flow
of blood, the blood in the veins is forced forward towards the heart.
Option 3
Arterioles. The walls of arterioles are relatively thick relative to their lumen
because of the comparatively high smooth muscle component. This muscle is controlled
by vasoactive substances and vasomotor nerves to regulate local blood flow.
B.
C.
D.
E.
Option 2
Tricuspid valve. This valve closes when right ventricular pressure exceeds
right atrial pressure and so prevents regurgitation of blood into the atrium when the right
ventricle contracts.
Option 3
This valve, situated in the mouth of the aorta, closes during diastole when
aortic pressure exceeds left ventricular pressure. Incompetence of this valve allows reflux
of blood from the aorta back into the ventricle and increases the work of the heart to
maintain the same cardiac output.
Option 1
Mitral valve. This valve closes when left ventricular pressure exceeds left
atrial pressure and so prevents regurgitation of blood into the atria when the ventricle
contracts. When disease results in valve incompetence, a systolic murmur may be heard
over the heart.
Option 5
Pulmonary valve. This valve, situated in the mouth of the pulmonary artery,
closes during diastole when pulmonary artery pressure exceeds right ventricular pressure.
Option 4
Foramen ovale valve. This valve closes the foramen ovale in the inter-atrial
septum when return of blood in the pulmonary veins raises left atrial pressure above right
atrial pressure.
B.
C.
D.
E.
Option 2
Autoregulatory responses. When the perfusion pressure rises, the stretching
of the smooth muscle in the walls of blood vessels causes it to contract and so minimize
the increase in blood flow that would otherwise occur.
Option 4
Vasoconstrictor nerves. These sympathetic nerves are normally active to
exert a steady vasoconstrictor tone. When their activity is decreased, the smooth muscle
in the walls of the blood vessels relaxes to cause an increase in local blood flow.
Option 4
Vasoconstrictor nerves. The neurotransmitter for sympathetic vasoconstrictor nerves is noradrenaline
Option 4
Vasoconstrictor nerves. When arterial pressure falls, it is countered by a
reflex increase in vasoconstrictor tone that raises peripheral resistance.
Option 1
Vasodilator metabolites. The increase in local blood flow after circulatory
arrest (reactive hyperaemia) is due to the accumulation of products of metabolism causing vasodilation during the arrest period.
59
EMQ
For each of the reflex systems AE, select the most appropriate option from the types of receptors listed below.
1. Arterial stretch receptors.
2. Arterial chemoreceptors.
3. Pulmonary stretch receptors.
4. Atrial stretch receptors.
5. Coronary artery chemoreceptors.
A. The reflex regulation of blood pressure.
B. The reflex regulation of ventilation.
C. The reflex regulation of blood volume.
D. System causing reflex hypotension, bradycardia and apnoea.
E. The HeringBreuer reflex.
60
EMQ
B.
C.
D.
E.
Option 1
Arterial stretch receptors. Stretch of these receptors by a rise in blood pressure results in a reflex reduction in heart rate and vasoconstrictor tone to limit the rise in
pressure.
Option 2
Arterial chemoreceptors. A fall in PO2 or pH or a rise in PCO2 stimulates the
arterial chemoreceptors to cause a reflex increase in pulmonary ventilation. The main
stimulation effect of CO2 on breathing is via the respiratory centre in the medulla oblongata but the stimulatory effect of hypoxia is via the arterial chemoreceptors only.
Option 4
Atrial stretch receptors. Stretch of atrial stretch receptors results in a fall in
blood pressure and an increase in urinary output.
Option 5
Coronary artery chemoreceptors. C bres close to the walls of coronary vessels are stimulated by certain circulating substances such as serotonin and veratridine, to
cause hypotension, bradycardia and perhaps apnoea (the BezoldJarisch reflex).
Option 3
Pulmonary stretch receptors. When pulmonary stretch receptors are
stretched during inspiration, they send impulses to the brain via the vagus nerves that
inhibit the inspiratory centre in the medulla oblongata.
D.
E.
Option 5
Skin blood flow. Skin blood flow increases during sweating due to an active
sympathetic cholinergic mechanism.
Option 1
Coronary blood flow. Coronary blood flow is decreased during systole
because of compression of the vessels by the contracting ventricular myocardium.
Option 3
Splanchnic blood flow. Splanchnic blood flow passes through two capillary
beds in one circuit of the circulation, rstly through the capillaries in the alimentary tract
and then through a portal capillary bed in the liver.
Option 4
Cerebral blood flow. Cerebral blood flow is little affected by cardiovascular
reflexes. However it is very sensitive to changes in the PCO2 of the perfusing blood.
Option 2
Skeletal muscle blood flow. Vasodilatation in skeletal muscle during fainting
causes a large fall in peripheral resistance and is one of the factors leading to the fall in
arterial pressure that results in the faint.
Option 5
A flat record. During asystole no ECG complexes can be detected.
Option 1
The T wave. The T wave marks the end of the ventricular depolarization that
gives rise to systole.
Option 4
Depression of the ST segment. Depression of the ST segment is a sign of
ischaemia during cardiac treadmill testing.
Option 3
The PR interval. This delay allows the atria to contract before the ventricles contract.
Option 2
The P wave. Abnormalities in the P waves indicate atrial dysfunction.
Option 4
Late pregnancy. The relative increase in plasma volume in late pregnancy
results in a low haematocrit.
Option 1
Fainting. The vagal element of the vaso-vagal faint can cause severe bradycardia.
Option 5
Hypothermia. The decrease in the metabolic rate in hypothermia reduces
oxygen consumption.
Option 2
Severe haemorrhage. The intense reflex venoconstriction in severe haemorrhage may make it difcult to insert catheters for introducing intravenous fluids.
Option 6
Lying down. Due to the increase in venous return to the heart.
61
EMQ
For each of the features of the capillary circulation AE, select the most appropriate option
from the possible locations and precipitating causes listed below.
1. In the brain.
2. In Vitamin C deciency.
3. In exercising muscle.
4. After haemorrhage.
5. In the spleen.
A. High permeability.
B. Low permeability.
C. High fragility.
D. Net outflow of fluid.
E. Net inflow of fluid.
62
EMQ
C.
D.
E.
Option 5
In the spleen. Splenic capillaries, because of the large slits between adjacent
endothelial cells, are freely permeable to most solutes.
Option 1
In the brain. Because of the bloodbrain barrier, cerebral capillaries are
much less permeable than capillaries elsewhere in the body so that tissue fluid in the brain
differs in composition from that of plasma.
Option 2
In Vitamin C deciency. Capillary (petechial) haemorrhages are a feature of
scurvy caused by Vitamin C deciency.
Option 3
In exercising muscle. Because the arteriolar vasodilation raises capillary
pressure.
Option 4
After haemorrhage. Because arteriolar constriction decreased capillary pressure.
Option 2
The Purkinje system. The modied heart muscle bres in the Purkinje system
can conduct the impulse at about 8 metres/second.
Option 3
The AV node. The slow conduction of the impulse through the AV node
allows the atrial muscle to contract before ventricular contraction begins.
Option 1
The sinoatrial node. The sinoatrial node normally generates impulse faster
than any other cardiac pacemaker and so in responsible for the normal heart rate.
Option 4
Atrial muscle. The P wave results from the spread of excitation from the
sinoatrial node over the atria.
Option 5
The longest action potentials. Ventricular muscle action potentials are much
longer than those in atrial muscle.
C.
D.
D.
Option 3
Pulmonary circulation. Pressure in the pulmonary circuit is much lower than
that in the systemic circuit since it offers much less resistance to flow.
Option 1
Hypothalamic circulation. The capillary bed in the hypothalamus is connected by blood vessels to a second capillary bed in the anterior pituitary gland. This
allows hormones secreted in the hypothalamus to be carried to the pituitary where they
lead to the release of certain pituitary gland hormones.
Option 2
Coronary circulation. Coronary arteries, though they are connected by anastomotic vessels act as functional end arteries so that when one is blocked the ventricular
muscle served by that artery dies.
Option 4
Fetal circulation. During fetal life, blood returning from the placenta to the
right atrium bypasses the pulmonary circuit by (i) passing through the foramen ovale; and
(ii) being diverted from the proximal part of the pulmonary artery via the ductus arteriosus to the aorta.
Option 5
Cerebral circulation. The circle of Willis is a vascular arrangement at the
base of the brain into which all the main arteries to the brain connect so that if one artery
should block, the brain can still be supplied by the other arteries in this anastomotic
arrangement.
RESPIRATORY SYSTEM
63
MCQs
139. In a person breathing normally at rest with an environmental temperature of 25C, the partial pressure of
A. CO2 in alveolar air is about twice that in room air.
B. Water vapour in alveolar air is less than half the alveolar PCO2 level.
C. Water vapour in alveolar air is greater than that in room air even at 100 per cent
humidity.
pH rises.
HCO3 ions pass from red cells to plasma.
Cl ion concentration in red cells falls.
Its oxygen dissociation curve shifts to the right.
Its ability to deliver oxygen to the tissues is enhanced.
Is in the hypothalamus.
Sends impulses to inspiratory muscles during quiet breathing.
Sends impulses to expiratory muscles during quiet breathing.
Is involved in the swallowing reflex.
Is involved in the vomiting reflex.
MCQ
Questions 139144
64
MCQ
Answers
139.
A.
False
B.
C.
False
True
D.
E.
True
True
Room air PCO2 (0.2 mmHg; 0.03 kPa) is negligible compared with alveolar air PCO2
(40 mmHg; 5.3 kPa).
Alveolar H2O vapour pressure at 37oC is 47 mmHg (6.3 kPa).
Alveolar air is saturated with water vapour at 37C. At 25C saturated vapour
pressure is 24 mmHg (3.2 kPa), about half that at 37C.
Expired air is alveolar air plus dead space air.
This is necessary for CO2 excretion by diffusion.
140.
A.
B.
False
True
C.
D.
E.
False
True
True
141.
A.
B.
C.
D.
E.
False
True
False
True
True
142.
A.
False
B.
C.
D.
E.
False
True
True
True
The stretch receptors in internal carotid arteries are carotid sinus baroreceptors;
the carotid bodies are separate structures nearby.
They have the greatest flow rate/unit volume yet described in the body.
They are not excited in anaemia where PCO2 is normal but O2 content is low.
Acidosis stimulates ventilation.
When carotid and aortic bodies are denervated, hypoxia depresses respiration.
143.
A.
B.
C.
D.
E.
False
True
False
False
True
144.
A.
B.
C.
D.
E.
False
True
False
True
True
65
Questions 145151
A.
B.
C.
D.
E.
Intrapulmonary pressure.
Intrathoracic pressure.
Intra-abdominal pressure.
Dead space PO2.
Pressure in the superior vena cava.
When they are expanded above their normal tidal volume range.
In adults than in infants.
Than the compliance of the lungs and thorax together.
When they are lled with normal saline than when they are lled with air.
In standing than in recumbent subjects.
MCQ
66
MCQ
Answers
145.
A.
B.
False
True
C.
D.
E.
False
False
False
146.
A.
False
B.
C.
D.
False
False
False
E.
True
147.
A.
B.
False
True
C.
D.
E.
True
True
True
148.
A.
B.
C.
D.
E.
False
False
True
False
True
149.
A.
B.
C.
D.
E.
True
False
True
True
False
150.
A.
B.
C.
D.
E.
True
True
False
False
True
False
True
True
True
True
151.
A.
B.
C.
D.
E.
67
Questions 152158
A.
B.
C.
D.
E.
Pulmonary ventilation.
Alveolar H2O vapour pressure.
Arterial PO2.
Arterial pH.
Cerebral blood flow.
MCQ
68
MCQ
Answers
152.
A.
B.
C.
D.
E.
True
False
False
True
False
153.
A.
B.
C.
D.
E.
True
True
False
False
True
154.
A.
B.
C.
D.
E.
True
True
False
False
False
155.
A.
B.
C.
True
True
True
D.
True
E.
True
156.
A.
B.
C.
D.
E.
True
True
False
False
False
157.
A.
B.
C.
D.
E.
True
False
False
False
True
158.
A.
B.
C.
False
True
False
D.
E.
False
True
69
Questions 159165
A.
B.
C.
D.
E.
Saturates inspired air with water vapour before it reaches the alveoli.
Removes all particles from inspired air before it reaches the alveoli.
Decreases when blood catecholamine levels rise.
Decreases during a deep inspiration.
Decreases during a cough.
MCQ
159. Pulmonary
70
MCQ
Answers
159.
A.
B.
C.
D.
E.
True
True
False
False
False
160.
A.
B.
C.
D.
E.
True
True
True
False
True
False
True
True
False
True
161.
A.
B.
C.
D.
E.
162.
A.
B.
C.
D.
False
True
True
True
E.
True
163.
A.
B.
C.
D.
E.
True
False
False
True
False
164.
A.
B.
C.
D.
E.
True
False
False
False
True
165.
A.
B.
C.
D.
E.
True
True
True
False
False
71
Questions 166171
A.
B.
C.
D.
E.
168. The CO2 dissociation curve for whole blood shows that
A.
B.
C.
D.
E.
MCQ
72
MCQ
Answers
166.
A.
B.
C.
D.
E.
False
True
True
False
False
167.
A.
B.
C.
D.
E.
False
False
True
True
True
168.
A.
False
B.
C.
D.
False
False
True
E.
False
The curves start and nish differently. The CO2 curve has a steep initial slope
which gradually decreases, but there is no plateau. It is the O2 curve which is sigmoid in shape.
Content continues to rise as PCO2 rises above normal alveolar levels.
CO2 content is zero when PCO2 is zero.
Oxyhaemoglobin is a stronger acid than reduced haemoglobin; the liberated
H.ions drive the reaction H HCO3 H2CO3 CO2 H2O.
This is shown by the oxygen dissociation curve, not the carbon dioxide dissociation curve.
169.
A.
B.
C.
D.
E.
False
False
True
True
True
A.
B.
C.
D.
False
True
False
True
E.
True
170.
171.
A.
B.
True
False
C.
D.
E.
False
True
True
73
Questions 172177
A.
B.
C.
D.
E.
MCQ
74
MCQ
Answers
172.
A.
B.
C.
D.
False
False
False
False
E.
True
173.
A.
B.
C.
D.
E.
False
True
False
True
True
It increases as the walls between alveoli break down to form large sacs.
Destruction of elastic bres holding airways open allows them to narrow.
It is increased as airways close more readily than usual during expiration.
It decreases as the residual volume increases.
Thus it is a typical obstructive airways disease.
174.
A.
B.
C.
D.
E.
True
False
False
False
False
175.
A.
B.
C.
D.
E.
False
True
True
True
True
176.
A.
B.
C.
D.
E.
True
True
False
False
False
177.
A.
B.
C.
True
True
False
D.
E.
False
False
75
Questions 178183
A.
B.
C.
D.
E.
Metabolic acidosis.
Alkaline urine.
Cool extremities.
Raised cerebral blood flow.
Raised plasma bicarbonate.
181. Coughing
A.
B.
C.
D.
E.
183. A 50 per cent fall in the ventilation/perfusion ratio in one lung would
A.
B.
C.
D.
E.
MCQ
178. Cyanosis
76
MCQ
Answers
178.
A.
B.
C.
D.
False
True
False
False
E.
False
179.
A.
B.
C.
D.
False
False
False
True
E.
True
180.
A.
B.
C.
D.
E.
False
False
True
True
False
False
False
False
True
True
181.
A.
B.
C.
D.
E.
182.
A.
B.
C.
D.
E.
False
True
False
False
True
183.
A.
B.
C.
D.
E.
True
True
False
False
False
77
Questions 184187
A. With normal lungs should expire 95 per cent of vital capacity (VC) in 1 second.
B. With restrictive disease may expire a greater than predicted per cent of VC in the rst
C.
D.
E.
second.
Who is female would be expected to expire a greater per cent of VC in 1 second than a
male of the same age.
With obstructive disease may take more than 5 second to complete the expiration.
With normal lungs should achieve a peak flow rate of at least 200 litres/minute.
MCQ
78
MCQ
Answers
184.
A.
False
B.
C.
D.
E.
True
True
True
True
The normal is about 85 per cent at age 20, falling to about 70 per cent at age
6070.
The airways are not obstructed and vital capacity volume is reduced.
Females have, on average, smaller vital capacities than males.
This is typical of moderately severe obstructive airways disease.
200 litres/min is a low gure; most subjects, other than small elderly females,
should do better.
185.
A.
True
B.
C.
D.
E.
False
True
True
True
Reduced V/P ratios allow deoxygenated blood to be shunted to the left side of the
heart.
The peripheral circulation in chronic respiratory failure is usually adequate.
This in turn leads to the secondary polycythaemia typical of the condition.
Hypoxia constricts pulmonary vessels and may cause pulmonary hypertension.
Persistent pulmonary hypertension can lead to right heart failure.
186.
A.
B.
C.
D.
E.
False
False
True
True
False
187.
A.
False
B.
C.
True
False
D.
False
E.
False
At rest, O2 consumption (about 250 ml/min) is about 25 per cent of the total
available.
All but 3 of the 200 ml/l is combined with haemoglobin, the rest is dissolved.
In anaemic hypoxia, cardiac output rises to compensate for the reduced oxygen
content per litre of blood.
If PO2 falls by 25 per cent from normal, there is relatively little change in the
blood oxygen content.
The extraction ratio rises as oxygen consumption rises, e.g. during exercise.
RESPIRATORY SYSTEM
79
EMQs
EMQ
Questions 188194
EMQ Question 188
For each description of respiratory pressures AE, select the most appropriate option from the
following list.
1. Intrapleural pressure.
2. Intra-abdominal pressure.
3. Intra-alveolar pressure.
4. Intra-oesophageal pressure.
5. Atmospheric pressure.
A. Intra-alveolar pressure at end-inspiration and end-expiration.
B. Shows transient rises and falls during the respiratory cycle peaking at mid-expiration
and mid-inspiration respectively.
C. Approximates to intrapleural pressure.
D. Rises markedly during the vomiting reflex.
E. Determines the pressure gradient for inspiration and expiration.
1.
2.
3.
4.
5.
6.
7.
8.
pH
PO2
PCO2
Bicarbonate
Normal
Normal
Reduced
Reduced
Reduced
Reduced
Increased
Increased
Normal
Reduced
Reduced
Reduced
Increased
Increased
Increased
Reduced
Normal
Normal
Increased
Increased
Increased
Reduced
Reduced
Reduced
Normal
Normal
Normal
Increased
Increased
Reduced
Normal
Reduced
A. A healthy 25-year-old has climbed from sea level to a height of 1000 metres (about
B.
C.
D.
E.
80
EMQ
D.
E.
Option 5
Atmospheric pressure. Intra-alveolar pressure returns to atmospheric pressure at the end of each inspiratory and expiratory phase.
Option 3
Intra-alveolar pressure. This dips transiently during inspiration and rises to
a similar extent during expiration.
Option 4
Intra-oesophageal pressure. Since the oesophagus and the intrapleural
spaces are normally closed cavities within the chest, intra-oesophageal pressure normally
approximates to intrapleural pressure.
Option 2
Intra-abdominal pressure. During vomiting this rises markedly to compress
the gut while the way out through the lower oesophageal (cardiac) sphincter is open due
to relaxation of oesophageal smooth muscle.
Option 3
Intra-alveolar pressure. The difference between this and atmospheric pressure constitutes the pressure gradient which determines the flow of air into or out of the
lungs.
B.
C.
D.
E.
Option 2
PO2 reduced, others normal. At 1000 metres, atmospheric pressure and hence
ambient oxygen pressure fall by about 10 per cent. This reduces alveolar and hence arterial PO2 by slightly more, since alveolar water vapour pressure and PCO2 do not change.
However, due to the plateau of the oxygen dissociation curve, arterial saturation falls only
slightly. Bodily function is unaffected, with no change in ventilation, so carbon dioxide,
pH and bicarbonate do not change.
Option 6
All reduced, apart from Po2, which is increased. The ketoacidosis is due to
abnormal accumulation of highly acidic metabolites. Hence the pH is reduced. Bicarbonate
ions have buffered most of the surplus hydrogen ions to minimize the fall in pH, hence
bicarbonate is reduced. The acidosis stimulates ventilation. This reduces PCO2 and also
limits pH fall; the increased ventilation also increases PO2, though as in (A) the effect on
saturation is minute.
Option 8
pH increased, others reduced. In this case, serious hypoxic hypoxia leads
to increased ventilation reflexly via the carotid and aortic bodies. Increased ventilation
improves PO2, but it remains well below normal, causing general tissue hypoxia. The
increased ventilation acts mainly by lowering PCO2, allowing oxygen to replace some of
the carbon dioxide in the alveoli. However, lowered PCO2 causes a respiratory alkalosis so
pH rises. To compensate for the respiratory alkalosis, the renal tubules reduce secretion of
hydrogen ions and lower blood bicarbonate level. However, all these compensations
merely reduce the abnormalities. The combination of tissue hypoxia, decreased cerebral
blood flow (due to the low PCO2), and alkalosis seriously disturb bodily function. Some
people tolerate this quite well, but others, like this person, feel wretched and are at risk of
serious and even fatal complications.
Option 5
pH reduced, others increased. The 55-year-old has inadequate ventilation
related to chronic respiratory disease. The inadequate ventilation is shown by the bluish
colour (cyanosis) due to excessive desaturated haemoglobin. This is another variety of
hypoxic hypoxia. The inadequate ventilation also raises the PCO2, causing a respiratory
acidosis. As with (C), but in the opposite direction, the renal tubules raise the blood bicarbonate level. The increased PO2 can only be explained by the administration of oxygen.
Before this the oxygen level would have been reduced. Such patients require careful monitoring of their blood gases and control of the administered oxygen.
Option 6
All reduced, apart from PO2, which is increased. Here the renal damage
impairs hydrogen ion excretion in the urine and addition of bicarbonate to the blood. Just
like (B) this patient has a metabolic acidosis. The respiratory compensation and its effects
are explained in the same way.
81
1.
2.
3.
4.
5.
6.
VC
FEV1.0RV
FEV1.0/VC
Per cent
PEFR
5.0
3.0
4.5
4.0
3.0
4.0
4.0
2.1
5.0
2.0
2.4
3.4
1.5
1.2
1.2
2.5
0.8
1.2
80
70
90
50
80
85
600
350
200
120
620
450
A. A woman of 19 years who had occasional asthma as a child but is now free of sympB.
C.
D.
E.
toms.
A man of 32 who is having respiratory function testing as part of a routine health
check.
A woman of 77 who is acting as a normal control in a research project.
When this patient comes to discuss the results of respiratory testing, the doctor apologizes that there seems to have been a mistake as the results do not make sense.
A man of 45 with a long history of chronic obstructive pulmonary disease (COPD).
EMQ
For each person AE, select the most appropriate set of results for respiratory function tests
from the following list, where VCvital capacity; FEV1.0 forced expiratory volume in one
second; RVresidual volume all litres; PEFRpeak expiratory flow rate in litres per second.
82
EMQ
B.
C.
D.
E.
Option 6
This is a normal vital capacity for a young female where volumes are smaller
than in males. FEV11.0 is 85 per cent of VC which is normal in young people; RV is also
in keeping. PEFR is also normal for a female. Option 2 would be the next best option but
note the comments in (C).
Option 1
These are all normal values for an average male of this age.
Option 2
These are normal values for a woman of this age. VC is smaller in females
and falls with age. FEV1.0/FVC also falls with age and this is normal at her age. RV tends
to rise with age, although the value is quite small it is a higher proportion of total lung
capacity (VCRV) here than in Option 1. This is a normal PEFR for a woman of this age.
Option 3
This is a nonsense result. FEV1.0 cannot be greater than VC; they may have
been reversed, which would correspond with the percentage of 90. However, these results
would not then correspond with the low PEFR.
Option 4
These results are typical of fairly severe COPD. FEV1.0 is only half the vital
capacity, RV is considerably increased and PEFR is much reduced. The changes would be
those expected in someone whose predicted normal results correspond to Option 1. If this
man had developed restrictive disease, then Option 5 would be appropriate parallel reductions in all volumes including RV, but a well preserved and even increased PEFR as the
airways are not affected by restrictive disease.
Answers to 191
A.
B.
C.
D.
E.
Option 4
Ventilation controlled from above the medulla oblongata. The commonest situation for this huge minute volume is strenuous exercise in a normal person. This is not
a reflex from a fall in arterial oxygen levels, which remain normal, but is controlled from
higher levels where circulatory and respiratory activities are coordinated with muscular
activity. This activity is sometimes identied with the exercise centre though this is more
a function of the brain than a localized area.
Option 2
Reflex hyperventilation. The increased ventilation is reflexly produced via
chemoreceptors in the region of the medulla oblongata. These respond to the huge rise in
hydrogen ions produced centrally from the rise in carbon dioxide level.
Option 1
Voluntary hyperventilation. The hyperventilation lowers the carbon dioxide
level. This causes a respiratory alkalosis and constricts cerebral arterioles. There has been
a suggestion that people who are most distressed by this activity are the most likely to
suffer from severe symptoms at high altitudes where such changes are the result of reflex
hyperventilation.
Option 4
Ventilation controlled from the medulla oblongata. The spontaneous rhythmicity in the inspiratory and expiratory centres here generate the basic breathing pattern
upon which other more complicated activities, including voluntary control as in respiratory function testing, are built.
Option 6
Ventilation associated with dyspnoea. With severe over-inflation lung compliance falls; this increases the work of breathing in and may be less severe when breathing out (patients vary in this). The extra effort is interpreted as something wrong with the
breathing (dyspnoea means bad breathing). In Option 1 the problem is not with the breathing but with the effects it produces. In Option 2 the increased breathing is not experienced
as particularly unpleasant. In Option 5 the increased breathing of exercise is recognized
as normal.
83
EMQ
For each item AE related to oxygen transport, select the most appropriate option from the list
below:
1. Sigmoid.
2. Plateau.
3. Oxygen in solution.
4. Percentage saturation.
5. Oxygen content, ml oxygen per
6. Shift of the curve to the right.
5. litre of blood.
7. Shift of the curve to the left.
A. When the y axis of the oxygen dissociation curve of blood is labelled thus, the curve for
severe anaemia is very similar to that for normal blood.
B. The form in which oxygen passes from blood to tissues.
C. This leads to proportionately greater release of oxygen to the tissues.
D. A property of the oxygen dissociation curve which is related to the varying afnities of
haemoglobin for oxygen particularly at very low oxygen pressures and at the pressures
around the normal range for alveolar oxygen pressures.
E. The reason the plateau phase of the oxygen dissociation curve is not completely horizontal.
84
EMQ
B.
C.
D.
E.
Option 4
Percentage saturation. Regardless of the haemoglobin content, the oxygen
content of blood at a given oxygen pressure will always be very similar, expressed as a
percentage of the capacity. The very slight differences are due to the fact that in severe
anaemia the amount of dissolved oxygen relative to oxygen combined with haemoglobin
is slightly greater since there is a higher proportion of plasma.
Option 3
Oxygen in solution. Only dissolved gases can pass through the tissue fluids.
Option 6
Shift of the curve to the right. When the oxygen dissociation curve of blood
shifts to the right on the x axis, the oxygen content of blood at a given oxygen pressure
shifts downwards on the y axis. Thus the blood retains less oxygen and more is released
to the tissues.
Option 1
Sigmoid. Sigmoid means S-shaped. The rst bend of the S is produced by
the increasing afnity of haemoglobin for oxygen; at low pressures the curve becomes
increasingly steep and then straightens to a steep fairly linear rise. The second bend is produced as full saturation is approached and the steep rise curves to join the plateau.
Option 3
Dissolved oxygen. As the partial pressure of oxygen increases above the
normal alveolar value, the content rises very gradually as the dissolved oxygen increases
in proportion to the pressure. In hyperbaric oxygen conditions this dissolved amount can
be signicant. For example if 3 ml are dissolved per litre when PO2 is 100 mmHg
(13.5 kPa), then at two atmospheres of oxygen, with a PO2 around 1500 mmHg (200 kPa),
the dissolved oxygen amounts to 45 ml/litre. This can be helpful when haemoglobin has
been disabled by combination with carbon monoxide.
B.
C.
D.
E.
Option 6
Carboxyhaemoglobin. This is formed when people breathe even low concentrations of carbon monoxide. The great afnity of carbon monoxide for haemoglobin displaces most of the oxygen so that most haemoglobin is rendered useless and the patient
suffers from potentially fatal anaemic hypoxia.
Option 3
Carbon dioxide in red cells. Carbonic anhydrase is located in red cells rather
than plasma. It provides the necessary acceleration of the formation of carbonic acid and
hence bicarbonate during the short time available for the uptake of carbon dioxide at
tissue level. Without it the dissolved carbon dioxide would build up a pressure which
would seriously slow diffusion from the tissues.
Option 1
Dissolved carbon dioxide. At any given partial pressure carbon dioxide is
many times more soluble than oxygen.
Option 7
Ability of desaturated haemoglobin to buffer hydrogen ions. As mentioned in
(B), generation of bicarbonate is necessary for adequate carriage of carbon dioxide.
Desaturated haemoglobin has a greater ability to buffer hydrogen ions than has oxyhaemoglobin. The law of mass action predicts that the removal of hydrogen ions by buffering favours further conversion of carbon dioxide to bicarbonate. In addition, diffusion
of bicarbonate ions from red cells to plasma lowers the concentration of the other product of the reaction.
Option 5
Carbaminohaemoglobin. Oxyhaemoglobin cannot carry as much CO2 in the
carbamino compound as can reduced haemoglobin.
85
2. Cardiac output.
4. Arterial blood oxygen saturation.
6. Pulmonary arterial blood oxygen
saturation.
A. Abnormality here is the fundamental cause of hypoxic hypoxia at high altitudes.
B. The normal value for this in the resting average adult is around one litre per minute.
C. Abnormality here is the fundamental cause of anaemic hypoxia.
D. Abnormality here is the fundamental cause of hypoxic hypoxia in respiratory disease.
E. This is reduced in stagnant hypoxia, in anaemic hypoxia and also in hypoxic hypoxia.
EMQ
86
EMQ
Answers to 194
A.
B.
C.
D.
E.
Option 4
Arterial blood oxygen saturation. At high altitudes the alveolar oxygen pressure falls to levels at which blood passing through the lungs is inadequately saturated with
oxygen. Therefore arterial blood oxygen saturation is seriously reduced and this is the
fundamental cause of impaired delivery of oxygen at high altitudes.
Option 1
Total available oxygen. This equals the oxygen in ve litres of normally saturated blood with a normal haemoglobin content.
Option 3
Blood haemoglobin concentration. Here the reduction in total available
oxygen is reduced in proportion to the reduction in the blood haemoglobin concentration.
Option 4
Arterial blood oxygen saturation. As with (A) the hypoxic hypoxia is due to
inadequate saturation of blood in the lungs. However this time the cause is impaired lung
function rather than reduced inspired oxygen.
Option 1
Total available oxygen. This depends on cardiac output, blood oxygen capacity and arterial blood saturation percentage. Impaired cardiac output causes stagnant
hypoxia, impaired blood oxygen capacity causes anaemic hypoxia and reduced arterial
blood saturation causes hypoxic hypoxia.
ALIMENTARY SYSTEM
87
MCQs
195. Bile
A.
B.
C.
D.
E.
196. Saliva
A.
B.
C.
D.
E.
Has its reflex centres in the cervical segments of the spinal cord.
Includes inhibition of respiration.
Is initiated by a voluntary act.
Is dependent on intrinsic nerve networks in the oesophagus.
Is more effective when the person is standing rather than when lying down.
MCQ
Questions 195199
88
MCQ
Answers
195.
A.
False
B.
C.
D.
E.
False
True
False
False
Bile contains no digestive enzymes; its bile salts assist in the emulsication and
absorption of fat.
The bilirubin is conjugated by the hepatocytes before excretion.
By forming cholesterol micelles.
Iron is removed from haem in the formation of bilirubin.
It becomes more acid, which improves the solubility of bile solids.
196.
A.
False
B.
False
C.
False
D.
True
E.
False
Serous glands such as the parotids produce a watery juice; mucous glands such
as the sublinguals produce a thick viscid juice.
The functions of salivary amylase (ptyalin) can be affected by enzymes from
other digestive glands.
It is saturated with calcium ions; calcium salts are laid down as plaque on the
teeth.
Saliva is an important route of iodide excretion; its concentration in saliva is
20100 times that in plasma.
Saliva has a neutral pH; acidity in the mouth tends to dissolve tooth enamel.
197.
A.
B.
C.
False
True
True
D.
E.
True
True
198.
A.
B.
C.
True
True
True
D.
E.
False
False
199.
A.
B.
C.
True
True
False
D.
E.
True
True
89
Questions 200205
A.
B.
C.
D.
E.
MCQ
90
MCQ
Answers
200.
A.
B.
C.
D.
E.
True
False
False
True
True
False
True
True
True
True
201.
A.
B.
C.
D.
E.
202.
A.
B.
C.
False
True
False
D.
False
E.
False
203.
A.
B.
False
False
C.
D.
E.
True
False
True
The concentration is higher, due partly to potassium released from cast off cells.
Intestinal secretion is not under vagal control; its enzymes are thought to be constituents of the mucosal cells and released when these are cast off into the lumen.
The mucosal cell brush border contains these enzymes, e.g. maltase and lactase.
Monosaccharides are end-products of digestion and absorbed as such.
For example, enterokinase which converts trypsinogen to trypsin.
204.
A.
False
B.
False
C.
False
D.
E.
True
False
205.
A.
B.
C.
True
False
False
D.
E.
False
True
91
Questions 206211
A.
B.
C.
D.
E.
Digestion of food.
Swallowing of food.
Normal speech.
Antisepsis in the mouth.
Taste sensation.
MCQ
92
MCQ
Answers
206.
A.
False
B.
C.
True
False
D.
True
E.
False
The colon absorbs 12 litres/day; 810 litres is absorbed per day in the small
intestine.
Mucous cells are the predominant cells on the colonic mucosal surface.
The average transit time from caecum to pelvic colon is about 12 hours but passage from the pelvic colon to the anus may take days.
Fibre (cellulose, lignin etc.) in the colonic contents stimulates peristaltic movements by adding bulk to the food residues.
But bacteria such as Escherichia coli make up about a third of faecal weight.
207.
A.
True
B.
C.
D.
False
True
False
E.
True
Vagal stimulation increases acid and pepsinogen secretion; this action is mediated by acetylcholine and gastrin-releasing peptide released from the vagal nerve
endings.
After vagotomy, food must enter the stomach to stimulate gastric secretions.
Salivary enzymes are not effective at the low pH of gastric juice.
But mucosal cells are protected by a coat of mucus impregnated with bicarbonate.
This is normally prevented by the cardiac sphincter.
208.
A.
B.
C.
D.
E.
False
True
True
False
True
209.
A.
B.
False
True
C.
True
D.
E.
False
True
210.
A.
False
B.
C.
D.
E.
False
True
True
True
211.
A.
B.
False
False
C.
D.
E.
True
True
True
Other digestive tract enzymes can take over if salivary enzymes are absent.
But swallowing solids is difcult without salivas moisturizing and lubricant
effects.
Nervous orators with dry mouths continually sip water.
In the absence of saliva, the mouth becomes infected and ulceration occurs.
Substances must go into solution before they can stimulate taste receptors.
93
Questions 212217
A.
B.
C.
D.
E.
Is the relationship between the bodys nitrogen intake and nitrogen loss.
Is positive in childhood.
Becomes more positive when dietary protein is increased.
Becomes negative when a patient is immobilized in bed.
Becomes less negative in the nal stages of fatal starvation.
Is stimulated to secrete gastric juice when food is chewed, even if it is not swallowed.
Cannot secrete HCl when its H1 histamine receptors are blocked.
And the denervated stomach can secrete gastric juice after a meal is ingested.
Empties more quickly than the denervated stomach.
Is stimulated to secrete gastric juice by the hormone secretin
MCQ
94
MCQ
Answers
212.
A.
B.
False
True
C.
D.
E.
False
False
True
213.
A.
B.
C.
D.
E.
False
True
True
False
True
A.
B.
C.
True
True
False
D.
E.
True
False
214.
215.
A.
B.
C.
True
False
True
D.
E.
True
False
True
True
True
False
True
This is caused by the hormone secretin released from the duodenal mucosa.
This postpones further gastric emptying.
Due to the action of cholecystokinin released from the mucosal cells.
The sphincter of Oddi must relax to allow bile to enter the gut.
Pancreozymin stimulates the pancreas to secrete a scanty, enzyme rich juice.
True
True
False
True
False
They emulsify fat creating a greater surface area for lipase to act on.
This property allows them form to micelles for fat transport.
They are absorbed in the terminal ileum.
They are synthesized from cholesterol in the liver.
They are choleretics, substances which stimulate bile secretion.
216.
A.
B.
C.
D.
E.
217.
A.
B.
C.
D.
E.
95
Questions 218222
A.
B.
C.
D.
E.
The enzyme concentration in intestinal juice is lower in the ileum than in the jejunum.
Vitamin B12 is absorbed mainly in the jejunum.
Water absorption is dependent on the active absorption of sodium and glucose.
Absorption of calcium occurs mainly in the terminal ileum.
Glucose absorption is dependent on sodium absorption.
MCQ
218. Absorption of
96
MCQ
Answers
218.
A.
B.
C.
D.
True
True
True
True
E.
False
219.
A.
B.
C.
True
False
False
D.
E.
True
False
220.
A.
B.
C.
D.
E.
True
False
True
False
True
Cells in the pylorus release gastrin when food enters the stomach.
Venous blood pH rises as bicarbonate enters the circulation in the alkaline tide.
Vagal activity plays an important role in gastric juice secretion.
Pancreatic trypsin and chymotrypsin can digest proteins.
Without gastric intrinsic factor, Vitamin B12 is not absorbed from the gut.
A.
True
B.
C.
False
True
D.
E.
False
True
Being proteins, enzymes are digested by proteolytic enzymes as they pass down
the gut.
It is absorbed mainly in the terminal ileum.
Water is absorbed passively down the osmotic gradient set up by active sodium
and glucose absorption.
It occurs mainly in the duodenum.
Sodium is required at the luminal surface for glucose to be absorbed by an active
carrier-mediated process.
221.
222.
A.
True
B.
C.
False
False
D.
False
E.
True
When blood glucose falls, liver glycogen is broken down to form glucose; when
glucose levels rise above normal, glucose is taken up by the liver and stored as
liver glycogen.
The NH4 is converted into urea and excreted in the urine; NH4 is toxic.
Cholecalciferol in produced in skin by the action of sunlight; the liver converts it
to 25-hydroxycholecalciferol and the kidney completes its activation by further
hydroxylation.
They manufacture most of the plasma proteins but lymphocytes manufacture
immune globulins.
The failure to inactivate oestrogens in men with liver failure can lead to breast
enlargement.
97
Questions 223228
A.
B.
C.
D.
E.
Can only occur after the neutral fat has been split into glycerol and fatty acids.
Involves fat uptake by both the lymphatic and blood capillaries.
Is impaired following gastrectomy.
Is required for normal bone development.
Is required for normal blood clotting.
bomb calorimeter.
Fat, metabolized in the body, yields 10 per cent more energy than 1g of carbohydrate.
Protein, metabolized in the body, yields the same energy as when oxidized in a bomb
calorimeter.
Carbohydrate, metabolized in the body, yields about the same energy as 1g of protein.
Protein per kg body weight is an adequate daily protein intake for a sedentary adult.
225. Cholesterol
A. Can be absorbed from the gut by intestinal lymphatics following its incorporation into
B.
C.
D.
E.
chylomicrons.
Can be synthesized in the liver.
In the diet comes mainly from vegetable sources.
Is eliminated from the body mainly by metabolic degradation.
Is a precursor of adrenal cortical hormones.
Account for less than 10 per cent of the total fatty acids in plasma.
Are complexed with the plasma proteins.
Decrease when the level of blood adrenaline rises.
Can be metabolized to release energy in cardiac and skeletal muscle.
Can be metabolized to release energy in the brain.
D. To allow rapid gastric emptying may lead to low blood glucose levels after a meal.
E. To allow rapid gastric emptying may lead to a fall in blood volume and blood pressure
after a large meal.
MCQ
98
MCQ
Answers
223.
A.
B.
False
True
C.
True
D.
True
E.
True
Unsplit neutral fat can be absorbed if emulsied into sufciently small particles.
The smaller fatty acids pass directly into blood; the larger ones are esteried,
packaged into chylomicrons and taken into lymphatics.
The loss of gastric storage capacity results in rapid transit of food through the
small intestine and insufcient time for complete digestion and absorption of fat.
Vitamin D is required for normal bone development; it is a fat-soluble vitamin
and absorbed along with the fat.
Vitamin K which is needed for the synthesis of certain clotting factors in the liver
is also a fat-soluble vitamin.
224.
A.
B.
C.
True
False
False
D.
E.
True
True
225.
A.
True
B.
C.
D.
E.
True
False
False
True
226.
A.
B.
C.
D.
E.
True
True
False
True
False
227.
A.
B.
C.
D.
E.
False
False
False
False
True
228.
A.
B.
C.
D.
False
True
True
True
E.
True
99
Questions 229234
A.
B.
C.
D.
E.
Constipation.
Crampy pain due to intermittent vigorous peristalsis.
Distension due to fluid and gas proximal to the obstruction.
Hypotension.
Vomiting which is more severe with low than with high bowel obstruction.
MCQ
100
MCQ
Answers
229.
A.
True
B.
C.
D.
E.
False
True
False
True
Due to loss of gastric acid which reduces ferric to the ferrous iron, the form in
which it is absorbed. Another problem affecting iron absorption is rapid intestinal transit.
The size increases to cause goitre due to increased TSH stimulation.
The unabsorbed disaccharides such as lactose cause osmotic diarrhoea.
Calcium is absorbed mainly in the duodenum.
The terminal ileum is the main site of bile salt absorption.
230.
A.
B.
C.
D.
E.
True
True
True
False
True
A.
B.
False
False
C.
D.
E.
True
False
False
231.
232.
A.
B.
C.
True
False
True
D.
E.
True
True
233.
A.
B.
C.
D.
True
True
True
True
E.
False
234.
A.
B.
True
False
C.
D.
False
False
E.
False
101
Questions 235241
A.
B.
C.
D.
E.
Body potassium.
Body sodium.
Extracellular fluid volume.
Total peripheral resistance.
Blood pH.
239. Urobilinogen is
A.
B.
C.
D.
E.
240. Surgical removal of 90 per cent of the small intestine may cause a
decrease in
A.
B.
C.
D.
E.
MCQ
102
MCQ
Answers
235.
A.
B.
C.
D.
E.
True
True
True
False
False
236.
A.
B.
C.
D.
E.
True
True
True
False
True
237.
A.
False
B.
C.
D.
E.
True
True
True
True
238.
A.
B.
C.
D.
True
True
False
True
E.
True
239.
A.
B.
C.
D.
E.
True
False
True
True
False
240.
A.
B.
C.
D.
E.
False
True
False
True
True
True
True
False
True
False
241.
A.
B.
C.
D.
E.
103
Questions 242247
A.
B.
C.
D.
E.
243. Gastric
A. Acid secretion in response to a lowered blood sugar is mediated by the hormone gastrin.
B. Emptying is facilitated by sympathetic nerve activity.
C. Acid secretion increases when histamine H2, muscarinic M1 or gastrin receptors are activated.
247. Vomiting
A.
B.
C.
D.
E.
MCQ
104
MCQ
Answers
242.
A.
True
B.
C.
D.
E.
True
False
True
True
243.
A.
B.
C.
False
False
True
D.
E.
True
False
244.
A.
B.
C.
True
False
True
D.
E.
True
True
245.
A.
B.
C.
D.
E.
True
True
True
True
False
246.
A.
B.
C.
D.
E.
True
True
False
True
False
247.
A.
False
B.
C.
D.
E.
False
True
True
False
105
Questions 248249
A. Is unlikely to occur on a high protein diet even if the caloric value of the food exceeds
B.
C.
D.
E.
MCQ
248. Obesity
106
MCQ
Answers
248.
A.
False
B.
C.
D.
True
True
True
E.
False
249.
A.
B.
C.
D.
E.
True
True
False
True
False
ALIMENTARY SYSTEM
107
EMQs
EMQ
Questions 250260
108
EMQ
B.
C.
D.
E.
Option 2
Upper small intestine. About four fths of intestinal water is absorbed by
the osmotic gradient created by glucose and sodium absorption in the small intestine, the
remaining fth is absorbed in the colon.
Option 2
Upper small intestine. Most sodium is absorbed by active transport in the
upper small intestine but some is also absorbed in the lower small intestine and in the
colon.
Option 2
Upper small intestine. Iron is absorbed in the ferrous state using an intracellular iron carrier mainly in the upper small intestine but some is also absorbed in the
lower small intestine.
Option 3
Lower small intestine. Vitamin B12 is absorbed complexed with intrinsic
factor in the terminal ileum.
Option 3
Lower small intestine. Like Vitamin B12, bile salts are reabsorbed in the lower
small intestine to be returned to the liver as part of the enterohepatic circulation.
Option 5
Intestinal secretion. Intestinal juice contains the enzymes maltase, lactase
and sucrase that split maltose, lactose and sucrose respectively.
Option 3
Pancreatic secretion. Pancreatic lipase splits neutral fat into glycerol and
fatty acids.
Option 2
Gastric secretion. Gastric juice contains the intrinsic factor needed for the
absorption of Vitamin B12.
Option 4
Bile. Bile salts help to emulsify fat so that the fat droplets offer a large surface area to the action of lipases.
Option 3
Pancreatic secretion. Nucleic acids are split by pancreatic nucleases in the
small intestine.
B.
C.
D.
E.
Option 2
Distension of the viscus wall. For this reflex, the distension of the stomach
wall following ingestion of a meal is thought to stimulate colonic motility that results in
defaecation.
Option 2
Distension of the viscus wall. When food is ingested, the smooth muscle in
the stomach wall relaxes so that the added bulk can be accommodated without much
increase in intragastric pressure.
Option 2
Distension of the viscus wall. When a bolus of food distends a hollow viscus
it sets up a wave of contraction preceded by a wave of relaxation that carries the bolus
along the viscus. Though peristalsis can be modied by autonomic nerves, the mechanism
is based on local nerve networks in the wall of the viscus.
Option 4
Release of gastrin. Gastrin secreted in response to a meal increases tone in
the cardiac sphincter and so prevents regurgitation of gastric contents into the oesophagus during stomach contractions.
Option 5
Release of CCK-PZ. CCK-PZ released from the bowel wall when fat enters
the duodenum causes the gall bladder to contract to empty its contents into the second
part of the duodenum. It also inhibits gastric emptying.
109
EMQ
For each of the structures and substances found in the alimentary tract AE, select the most
appropriate function from the list below.
1. Fat transport.
2. Secrete alkaline mucus.
3. Activates enzymes in pancreatic
4. Secrete serotonin.
3. secretion.
5. Ingest bacteria.
A. Enterochromafn cells.
B. Brunners glands.
C. Micelles.
D. Kupffer cells.
E. Enterokinase.
110
EMQ
B.
C.
D.
E.
Option 4.
Secrete serotonin. Certain duodenal cells called enterochromafn cells contain serotonin and the polypeptide motilin that are thought to influence smooth muscle
motility in the gut.
Option 2
Secrete alkaline mucus. Brunners glands in the duodenum secrete a thick
alkaline mucus that protects the duodenal mucosa against acid when gastric juice enters
the duodenum.
Option 1
Fat transport. Micelles are complexes of lipids and bile salts. The complexes
are water-soluble and this aids their take up by the enterocytes lining the intestinal
mucosa.
Option 5
Ingest bacteria. Kupffer cells are macrophages in the capillary sinusoids of
the liver; when they are decient due to liver disease there is increased risk of organisms
passing from the gut to the systemic circulation via the portal circulation.
Option 3
Activates enzymes in pancreatic secretion. Trypsinogen is a proenzyme
secreted by the pancreas that is activated in the lumen of the small intestine by the
enzyme enterokinase secreted by the intestinal mucosa.
B.
C.
D.
E.
Option 2
Endopeptidases. Secreted by the pancreas in an inactive form, the endopeptidases that include trypsin, chymotrypsin and elastase split the peptide bonds in polypeptides.
Option 5
Deoxyribonuclease. RNA is split by ribonuclease.
Option 3
Sucrase. Two other disaccharidases present in intestinal secretions, lactase
and maltase, split lactose and maltose into galactose and glucose and glucose and glucose
respectively.
Option 4
Alpha-amylase. Alpha amylase is produced by the salivary glands as well as
by the pancreas.
Option 1
Rennin. Found in the gastric juice of infants, rennin aids in milk digestion
by causing it to clot and slow its passage out of the stomach.
B.
C.
D.
E.
Option 5
Bile salts. Bile salts aid fat absorption by helping to emulsify the fat into
very small globules which present a large surface area that can be attacked by pancreatic
lipase. They then form part of the micelles that t neatly between the microvilli of the
enterocytes.
Option 2
Apoferritin. Apoferritin is an intracellular carrier that carries the iron molecules from the mucosal surface of the enterocytes to the inner surface where it is delivered to the carrier molecule, transferrin, in the plasma.
Option 1
A sodium dependent carrier system. The co-transporter molecule for glucose
is called SGLT (sodium dependent glucose transporter).
Option 3
Vitamin D. In Vitamin D deciency, calcium is not taken up by the intestinal mucosa. This results in weakening of the bones as in rickets and osteomalacia.
Option 4
Intrinsic factor. Vitamin B12 has to be complexed with intrinsic factor in
gastric juice before it can be absorbed from the gut.
111
A.
B.
C.
D.
E.
Lacteals.
Brush border.
Oxyntic cells.
Sphincter of Oddi.
Peyers patches.
EMQ
For each of the deciencies of digestive secretions AE, select the most appropriate consequence from the list below.
1. Pale stools.
2. Local infections.
3. Steatorrhoea.
4. Milk intolerance.
5. Anaemia.
A. Saliva deciency.
B. Biliary obstruction.
C. Lactase deciency.
D. Pancreatic juice deciency.
E. Gastric juice deciency.
112
EMQ
Answers to 256
A.
B.
C.
D.
E.
Option 2
Local infections. The flow of saliva helps to control the multiplication of
bacteria in the mouth.
Option 1
Pale stools. Bile entering the alimentary tract is responsible for the normal
brown colour of the stools.
Option 4
Milk intolerance. Lactase deciency is seen in a proportion of the population. There is an inability to digest and absorb milk sugar. This results in an osmotic diarrhoea that can be a problem especially in babies where milk forms a large part of the
dietary intake.
Option 3
Steatorrhoea. Steatorrhoea, the presence of unsplit fat in the faeces, is seen
in the absence of pancreatic juice since dietary fat cannot be hydrolysed and consequently
cannot be absorbed.
Option 5
Anaemia. A macrocytic anaemia develops because there is no intrinsic
factor to facilitate the absorption of Vitamin B12.
B.
C.
D.
E.
Option 5
Gallbladder contraction. CCK, produced by the mucosal cells in the duodenal
wall when fat or other nutrients enter that part of the gut, travels in the blood to the gall
bladder so that the bile contents are sent to the duodenum to help in the digestion and
absorption of fat.
Option 4
Decrease in gastric motility. Fat in the duodenum slows the transit of gastric contents into the small gut and so slows and delays the digestion of the gastric contents.
Option 2
Stimulation of gastric secretion. Pentagastrin is a pharmacological product
containing ve of the amino acids in gastrin that can act like gastrin to stimulate gastric
secretion. It is used to test the functional efciency of the gastric mucosa to secrete gastric juice.
Option 1
Inhibition of gastric secretion. Histamine is the neurotransmitter at vagal
nerve endings in the stomach and acts on H2 receptors. Thus H2 receptor blockers can
reduce acid secretion by the gastric mucosa.
Option 4
Decrease in gastric motility. Adrenaline and similar adrenergic agents cause
intestinal smooth muscle to relax.
C.
D.
E.
Option 2
Fat absorption. Most of the absorbed fat is taken up directly by lacteals, so
called for their white colour following a fatty meal due to the fat globules in the lymph.
Option 3
Glucose absorption. The brush border that is characteristic of the luminal
surface of enterocytes is made up of tiny microvilli protruding into the lumen of the gut
and offering a huge surface area for absorption of the products of digestion.
Option 4
Secretion of gastric acid. These cells, sometimes also called parietal cells, are
found in the mucosa of the body and fundus of the stomach and are responsible for HCl
secretion.
Option 1
Controls entry of bile into the intestine. The sphincter of Oddi lies in the
second part of the duodenum where the bile duct and the pancreatic ducts meet and controls the flow of bile and pancreatic secretions into the duodenum.
Option 5
Lymphoid aggregations in the intestines involved with immunity. These
patches are composed of lymphoid tissue and are responsible for immune reactions and
responses in the gut.
113
EMQ
For each of the surgical interventions (-ectomy means removal) carried out on the alimentary
tract AE, select the most appropriate possible consequence from the list below.
1. No digestive consequences.
2. Bulky liquid stools.
3. Dumping syndrome.
4. Steatorrhoea.
5. Indigestion after fatty meals.
A. Gastrectomy.
B. Pancreatectomy.
C. Colectomy.
D. Cholecystectomy.
E. Appendicectomy.
114
EMQ
B.
C.
D.
E.
Option 3
Dumping syndrome. When the stomach is removed, ingested food passes
very rapidly to the small intestine and can lead to the unpleasant consequences of fluid
loss to the intestinal lumen and excessive insulin secretion. The syndrome is called the
dumping syndrome.
Option 4
Steatorrhoea. This may be seen following pancreatectomy because lack of
lipase allows undigested fat to appear in the faeces.
Option 2
Bulky liquid stools. Removal of the colon limits the ability of the alimentary
tract to reabsorb water and this results in the passage of watery stools.
Option 5
Indigestion after fatty meals. The loss of the gall bladders ability to send bile
to the duodenum after a fatty meal results in poor digestion and absorption of the meal
and hence abdominal discomfort.
Option 1
No digestive consequences. The appendix has no known function other than
as a lymphoid organ and its immune function can be taken over by other lymphoid tissue
in the intestines.
D.
E.
Option 2
Relaxation of sphincters. Vasoactive intestinal polypeptide (VIP) also causes
vasodilatation by relaxing vascular smooth muscle.
Option 5
Inhibition of gastric emptying. Besides its main action of stimulating the gall
bladder to contract, cholecystokinin (CCK) decreases the rate of emptying of the stomach.
Option 4
Inhibition of gut motility. Somatostatin, the growth hormone-inhibiting hormone, originally isolated in the hypothalamus, is secreted by D cells in the intestinal
mucosa. It inhibits the release of several gut hormones including motilin and so inhibits
gut motility.
Option 3
Increase in small intestinal motility. Substance P, a polypeptide found in
intestinal mucosal endocrine cells, acts locally to increase gut motility.
Option 1
Release of gastrin. Gastrin-releasing polypeptide (GRP) is released by the
postganglionic vagal bres that innervate the G cells in the lateral walls of the glands in
the pyloric antrum. Activity in these nerves causes release of the gastrin granules in the
G cells.
NEUROMUSCULAR SYSTEM
115
MCQs
Membrane is negatively charged on the inside with respect to the outside at rest.
Contains intracellular stores of calcium ions.
Is normally innervated by more than one motor neurone.
Becomes more excitable as its resting membrane potential falls.
Becomes less excitable as the extracellular ionized calcium levels fall.
Innervates fewer bres in an eye muscle than does one innervating a leg muscle.
Conducts impulses at a speed similar to that in an autonomic postganglionic neurone.
Is unmyelinated.
Conducts impulses which cause relaxation in some skeletal muscles.
Synapse with skeletal muscle but not with other neurones.
MCQ
Questions 261266
116
MCQ
Answers
261.
A.
B.
True
True
C.
D.
False
True
E.
False
262.
A.
B.
C.
D.
E.
False
False
True
True
False
263.
A.
B.
C.
D.
False
False
True
False
E.
True
264.
A.
B.
C.
D.
True
True
False
True
E.
False
265.
A.
B.
C.
D.
E.
True
False
False
False
False
266.
A.
True
B.
C.
D.
E.
False
False
False
False
The more precise the movement required, the fewer the bres supplied by one
motor neurone.
Somatic motor neurones conduct at 60120 m/sec; autonomic at about 1 m/sec.
Fast-conducting bres are large and myelinated.
Impulses carried by somatic motor neurones are excitatory to skeletal muscle.
Some carry impulses to inhibitory (Renshaw) cells in the anterior horn.
117
Questions 267272
A.
B.
C.
D.
E.
272. Sympathetic
A.
B.
C.
D.
E.
MCQ
267 Impulses serving pain sensation in the left foot are relayed
118
MCQ
Answers
267.
A.
False
B.
C.
D.
E.
False
True
True
False
The ganglion contains sensory cell bodies but no synapses; primary pain bres
carrying these impulses synapse with secondary neurones in the left posterior
horn.
They cross to the right spinothalamic tract.
Pain and temperature bres travel together.
Sensations other than smell are relayed in the thalamus.
They enter consciousness at a subcortical level.
268.
A.
B.
True
False
C.
D.
E.
False
False
False
269.
A.
B.
True
True
C.
D.
True
True
E.
False
True
True
True
True
True
False
False
False
True
True
270.
A.
B.
C.
D.
E.
271.
A.
B.
C.
D.
E.
272.
A.
B.
C.
D.
E.
True
False
False
False
True
119
Questions 273278
A.
B.
C.
D.
D.
MCQ
120
MCQ
Answers
273.
A.
B.
C.
D.
E.
True
False
False
False
False
274.
A.
B.
C.
False
True
False
D.
E.
True
False
275.
A.
B.
C.
D.
E.
False
False
False
True
True
276.
A.
B.
C.
False
False
True
D.
E.
False
True
277.
A.
B.
C.
D.
True
False
True
True
E.
True
278.
A.
True
B.
False
C.
False
D.
False
E.
False
121
Questions 279284
A.
B.
C.
D.
E.
MCQ
122
MCQ
Answers
279.
A.
B.
C.
D.
E.
False
False
True
True
False
280.
A.
B.
C.
D.
True
False
True
False
E.
True
Both are fast bres and reflexes involving them have a short reflex delay.
They are in the posterior root ganglion.
Unconscious proprioception impulses travel in the spino-cerebellar tracts.
The primary neurone axons pass up the ipsilateral posterior columns before synapsing with secondary neurones at the top of the spinal cord.
The secondary neurones cross in the medulla oblongata.
False
False
True
False
True
281.
A.
B.
C.
D.
E.
282.
A.
B.
C.
D.
E.
False
False
True
False
True
283.
A.
B.
C.
D.
E.
True
True
False
True
True
284.
A.
B.
C.
True
True
False
D.
E.
False
True
123
Questions 285289
A.
B.
C.
D.
E.
MCQ
124
MCQ
Answers
285.
A.
False
B.
True
C.
D.
False
True
E.
False
The connections of brain neurones can be changed fairly rapidly to reflect new
patterns of activity and sensory experience; this is referred to as neuronal plasticity.
The left hemisphere is dominant for speech in most people and the right is dominant for skills requiring appreciation of time and space relationships.
They are found mainly in the limbic cortex.
The cortical area given to a particular skin area is related to the richness of its
sensory innervation, not its anatomic size.
Stimulation causes integrated movements not individual muscle contractions.
286.
A.
B.
True
True
C.
True
D.
True
E.
False
287.
A.
B.
C.
D.
E.
True
True
True
False
False
288.
A.
B.
C.
D.
E.
False
False
True
False
True
289.
A.
B.
C.
False
True
False
D.
E.
True
False
It occurs when the membrane potential is reduced to its threshold for ring.
This leads to rapid depolarization towards the sodium equilibrium potential.
Permeability to K increases and the resulting K efflux contributes to membrane
repolarization.
This depolarizes the adjacent axon and leads to propagation of the impulse.
Because of the all or none law, impulse conguration is independent of stimulus strength.
125
Questions 290294
A.
B.
C.
D.
E.
292. Acetylcholine
A. Acts on the same type of receptor on postganglionic bres in sympathetic and parasymB.
C.
D.
E.
pathetic ganglia.
Acts on the same type of receptor on target organs at cholinergic sympathetic and parasympathetic nerve terminals.
Acts on the same type of receptor at autonomic ganglia and at somatic neuromuscular
junctions.
Acts as an excitatory transmitter in the basal ganglia.
In blood is hydrolyzed by the same cholinesterase as is found at neuromuscular junctions.
MCQ
290. Non-myelinated axons differ from myelinated axons in that they are
126
MCQ
Answers
290.
A.
B.
False
False
C.
D.
E.
False
True
True
291.
A.
B.
C.
D.
False
False
False
True
E.
True
292.
A.
True
B.
True
C.
False
D.
True
E.
False
These are nicotinic receptors and the action is blocked at both sites by drugs
such as hexamethonium.
These are muscarinic receptors and the action is blocked at both sites by atropine.
The receptors are different; curare blocks transmission at somatic neuromuscular
junctions but not at ganglia.
Anticholinergic drugs are sometimes useful in the treatment of muscle rigidity in
Parkinsonism.
The pseudocholinesterase found in blood differs from the true cholinesterase
found near neuromuscular junctions.
293.
A.
True
B.
C.
D.
True
True
False
E.
True
294.
A.
B.
False
True
C.
D.
E.
False
True
True
127
Questions 295-300
A.
B.
C.
D.
E.
C. Cardiac and visceral smooth muscle is their spontaneous activity when denervated.
D. Skeletal and cardiac ventricular muscle is their stable resting membrane potential.
E. All varieties of muscle is that contraction strength is related to their initial length.
299. Histological and physiological study of skeletal muscle shows that the
A.
B.
C.
D.
E.
300. Rapid eye movement (REM) sleep differs from non-REM sleep in that
A.
B.
C.
D.
E.
MCQ
128
MCQ
Answers
295.
A.
B.
C.
D.
False
True
True
False
E.
True
296.
A.
B.
C.
D.
E.
False
True
False
True
False
297.
A.
B.
C.
D.
E.
True
True
True
True
True
298.
A.
False
B.
False
C.
True
D.
E.
True
True
299.
A.
B.
C.
False
True
False
D.
E.
True
False
300.
A.
B.
C.
D.
E.
True
False
False
False
True
129
Questions 301307
A.
B.
C.
D.
E.
Greater loss of pain sensation in the right foot than in the left foot.
Greater loss of motor power in the right leg than in the left leg.
Greater loss of conscious proprioception in the right than in the left leg.
Respiratory failure
Loss of the micturition reflex.
305. Pain receptors in the gut and urinary tract may be stimulated by
A.
B.
C.
D.
E.
Unconsciousness.
Loss of pupillary reaction to light.
Loss of tendon jerks in the arms and legs.
Loss of respiratory response to CO2 in the absence of hypoxia.
Nystagmus in response to cold water in the external auditory canal.
MCQ
301. Hemisection of the spinal cord at C7 on the right side would cause
130
MCQ
Answers
301.
A.
False
B.
C.
D.
E.
True
True
False
False
The left would be more affected; pain bres cross the midline shortly after entering the cord.
The main motor tract to the right leg would be severed.
The bres serving proprioception cross at the top of the spinal cord.
Diaphragmatic and some intercostal activity would remain intact.
The reflex centres for micturition are in the sacral cord.
302.
A.
B.
False
False
C.
D.
E.
True
False
False
303.
A.
B.
C.
D.
E.
False
False
True
False
True
304.
A.
B.
C.
D.
E.
True
True
False
False
True
Hydrocephaly occurs because the cranial bone sutures have not closed.
The cranial deformity in hydrocephalus may damage cranial nerves.
It causes papilloedema bulging in the opposite direction.
Vessel compression may reduce cerebral flow severely.
This reflex response helps to maintain cerebral blood flow.
305.
A.
B.
C.
D.
E.
False
True
True
True
True
The intestine may be cut painlessly during operations under local anaesthesia.
Stretch is an adequate stimulus for these receptors.
Chemicals released in inflammation lower the pain threshold (hyperalgesia).
As with a peptic ulcer.
This is the cause of the intermittent pain known as colic.
306.
A.
B.
C.
D.
E.
False
True
False
True
False
True
False
True
False
False
307.
A.
B.
C.
D.
E.
131
Questions 308314
A.
B.
C.
D.
E.
Curare-like drugs.
Lower motor neurone lesions.
Upper motor neurone lesions.
Cerebellar lesions.
Gamma efferent impulses to muscle spindles.
Tremor which is more obvious when the patient is performing skilled movements.
Muscle paralysis.
Increased muscle tone throughout the range of passive movement.
Increased involuntary facial movements during speech.
An unusual gait with small fast regular steps.
Sweat production.
Bronchus diameter.
Gastrointestinal motility.
Total peripheral resistance.
Heart rate.
313. Bulging of the optic disc into the vitreous humour (papilloedema) is
caused by
A.
B.
C.
D.
E.
MCQ
132
MCQ
Answers
308.
A.
B.
C.
D.
E.
True
True
False
True
False
309.
A.
False
B.
C.
D.
E.
True
True
False
False
This may cause fatal compression of the brainstem if the medulla is forced
(coned) into the foramen magnum.
This reduces formation of cerebrospinal fluid.
This facilitates drainage of cerebrospinal fluid.
CSF is in the subarachnoid space.
This would increase intracranial pressure due to gravitational effects and impair
CSF drainage by raising pressure in the venous sinuses.
310.
A.
B.
C.
D.
E.
False
False
True
False
True
Parkinsonism causes tremor which is more obvious when the patient is at rest.
Paralysis is not a feature of the condition.
This is cogwheel or lead pipe rigidity.
The face is mask-like; there is poverty of facial movements.
The bodys centre of gravity is shifted forward.
False
False
True
False
True
The muscles are paralysed and not capable of voluntary or reflex movements.
It is totally independent of upper motor neurone disease.
It leads to disuse atrophy.
Ventilation will be affected if the phrenic and intercostal nerves are involved.
Fasciculation is due to denervation hypersensitivity; muscles become ultrasensitive to small amounts of acetylcholine released from the degenerating nerve
terminals.
A.
B.
False
False
C.
D.
E.
False
True
False
False
False
True
True
True
True
False
False
False
True
311.
A.
B.
C.
D.
E.
312.
313.
A.
B.
C.
D.
E.
314.
A.
B.
C.
D.
E.
133
Questions 315320
A.
B.
C.
D.
E.
Vibration sense.
Pain sensation.
The flexor plantar response to stimulation of the sole.
Touch sensation.
The ability to stand steadily with the eyes closed.
317. Aphasia
A. Is an impairment of language skills without motor paralysis, loss of hearing or vision.
B. Implies impairment of consciousness.
C. Is called motor aphasia if the patient understands what the speech sounds and symbols
mean but lacks the higher motor skills needed to express them.
D. Is called sensory aphasia if the patient does not understand the meaning of the words he
E.
Sweat production.
Resting heart rate.
The strength of skeletal muscle contraction.
Salivation.
Intestinal motility.
lesion.
Loss of two-point discrimination but not touch sensation suggests a lesion in the thalamus.
Loss of all sensations on the left side suggests a right internal capsule lesion.
Loss of all sensations in a skin region suggests a peripheral nerve or posterior root
lesion.
MCQ
134
MCQ
Answers
315.
A.
B.
C.
D.
E.
True
True
True
True
True
True
False
False
True
True
A.
B.
C.
True
False
True
D.
True
E.
False
It is a cortical dysfunction.
Level of consciousness is an independent entity.
It may start with an inability to say the names of familiar objects but end up with
loss of virtually all verbal communication skills.
Patients with sensory aphasia tend to talk rubbish since they are unaware of the
errors in their use of language.
Language skills are carried in the left hemisphere in right and some left-handed
people.
316.
A.
B.
C.
D.
E.
317.
318.
A.
B.
C.
D.
E.
False
False
False
True
True
A.
False
B.
C.
D.
True
False
False
E.
True
Pain is uncommon with spinal cord lesions; the symptoms suggest irritation of a
sensory root or peripheral nerve.
The bres carrying these sensations run in separate tracts in the spinal cord.
It suggests a parietal cortex lesion where such sensory discriminations are made.
It suggests right-sided brain-stem damage since pain is appreciated at subcortical level.
Only peripheral nerves and posterior roots carry all modalities of sensation
together from a circumscribed skin area.
319.
320.
A.
B.
C.
D.
E.
False
False
True
True
False
135
Questions 321326
Muscle tone.
Muscle strength.
Conscious muscle-joint sense.
Ability to make precise muscle movements.
Ability to x the gaze steadily on an object.
MCQ
136
MCQ
Answers
321.
A.
B.
True
False
C.
D.
E.
True
False
False
322.
A.
B.
C.
D.
E.
True
False
False
True
True
323.
A.
True
B.
C.
True
False
D.
E.
True
False
324.
A.
B.
C.
D.
E.
False
True
True
True
False
325.
A.
B.
False
True
C.
True
D.
E.
False
False
326.
A.
B.
True
False
C.
D.
True
True
E.
True
137
Questions 327330
A.
B.
C.
D.
E.
MCQ
138
MCQ
Answers
327.
A.
True
B.
False
C.
True
D.
False
E.
False
Alcohol, lack of oxygen, low blood sugar and hypothermia all impair cellular
function in the brain and lead to a recognizable syndrome of neurological effects.
Higher critical functions depending on cortical cells are rst to go, e.g. driving
ability.
Coma implies that cellular depression has reached the less sensitive cells in the
brainstem mediating consciousness.
Amplitude increases initially to give delta waves in light coma before falling
later.
This brainstem function is preserved until the later stages of deep coma.
328.
A.
True
B.
C.
True
True
D.
E.
False
False
Probably because of failure to protect the foot and letting minor injury persist
without attention.
Again due to loss of the protective effects of pain.
Nerve bres stop conducting near freezing point so there is no further warning
when freezing causes tissue damage.
Pain sensation is blocked by surgical division of the spinothalamic tracts.
It is lost following division of the sensory root of the trigeminal nerve.
329.
A.
B.
C.
D.
E.
True
True
True
True
False
This distends intracranial veins and hence raises pressure within the cranium.
This (Valsalva) manoeuvre raises cerebral venous pressure.
This also raises cerebral venous pressure.
The vasodilation raises the volume of blood within the cranium.
This constricts cerebral vessels and reduces cerebral blood volume.
330.
A.
B.
True
True
C.
D.
E.
True
True
False
NEUROMUSCULAR SYSTEM
139
EMQs
EMQ
Questions 331340
140
EMQ
B.
C.
D.
E.
Option 2
Hypothermia. Accidental hypothermia tends to affect people of all ages
when immersed in cold water or exposed on land to low temperatures without adequate
insulation; it also occurs in elderly people during cold weather, usually when they have
suffered an illness such as a stroke which means they lie poorly insulated in a relatively
low temperature. Diagnosis requires a low reading thermometer, usually inserted rectally,
since a clinical thermometer is shaken down to an initial temperature around 3536C and
this may be taken as the temperature even though the True temperature is 510 degrees
below this. The markedly cold skin is an important clue. Treatment of such patients is
often unsuccessful since they have the damage produced by hypothermia added to the
underlying condition such as a stroke in this case.
Option 11
Brainstem death. This diagnosis is only made after careful repeated expert
examination and after reversible causes such as Options 2, 8 and 9 have been excluded.
Survival of the brainstem would be indicated by preservation of the brainstem corneal and
pupillary reflexes, by the presence of nystagmus (jerky eye movements) provoked by stimulation of the vestibular system by the icy saline and by spontaneous breathing movements in the presence of a high carbon dioxide level. (The pre-oxygen lls the functional
residual capacity with oxygen to prevent hypoxic damage during removal from the ventilator.)
Option 6
Diabetic ketoacidosis. This is a typical history of childhood-onset of insulindependent diabetes mellitus. Lack of insulins action leads to failure to assimilate absorbed
glucose and other nutrients into the body cells, with resulting malnutrition and glycosuria leading to polyuria. In the absence of adequate intracellular glucose, energy production relies excessively on fat as a substrate and this leads to ketones and a huge excess of
hydrogen ions (severe metabolic acidosis with pH 7.1 and bicarbonate down to about a
third of normal due to buffering). This in turn leads to vomiting, coma and hyperventilation to compensate to some degree for the acidosis by lowering the carbon dioxide level.
The blood glucose level would be 510 times normal.
Option 7
Hypoglycaemia. This patient contrasts with the previous one in that he is
known to be a diabetic and his condition suggests a low blood sugar. This is suggested by
the hyperdynamic circulation, a compensation for hypoglycaemia (in contrast, ketoacidosis is associated with a weak pulse and circulatory failure). The sweating is also a sympathetic autonomic response to hypoglycaemia. The initial treatment is an intravenous
injection of concentrated glucose. Such patients not uncommonly have repeated episodes
of unconsciousness due to hypoglycaemia and become known to ambulance personnel.
Option 4
Hepatic failure. The major clue here is the jaundice (yellow discolouration)
which suggests a hepatic cause of coma. Hepatic failure often causes in the early stages a
state similar to alcoholic intoxication and indeed the two could co-exist as excessive alcoholic consumption is a common cause of hepatic failure. However, in this case vomiting
of blood has occurred (common in hepatic failure complicated by portal hypertension and
oesophageal varices). It is likely that some of the blood lost will have been digested and
the products of digestion absorbed from the gut. Digestion and absorption of this high
protein load could cause hepatic coma to develop precipitated by toxic products of protein digestion which cannot be eliminated by the liver.
141
EMQ
For each case of neurological abnormality due to damage in the nervous system AE, select
the most appropriate option for the site of that damage from the following list of sites for the
damaged area (lesion).
1. Lower motor neurones (peripheral).
2. Upper motor neurones (central).
3. Left cerebral hemisphere.
4. Right cerebral hemisphere.
5. Left half of spinal cord.
6. Right half of spinal cord.
A. A 40-year-old man has noticed that his right leg feels different, but he has not noticed
any weakness. On testing, his right leg is not as good as the left at detecting a pin-prick
or a cold metallic object.
B. An 80-year-old woman is found to have moderate weakness on one side of her body.
She seems fairly aware of her surroundings but appears not to be able to speak.
C. A 20-year-old man was involved in a motor bike crash a month ago. He has weakness
and clumsiness in his right arm but there is no abnormality of feeling. The thenar eminence on the right is flatter than that on the left. The biceps reflex on the right is
weaker than that on the left.
D. A 70-year-old woman developed weakness in her right arm and leg a month ago and
was admitted to hospital. The weakness is still present in her right arm and sensation is
not as good as in the left. The biceps reflex on the right is stronger than that on the left.
E. A 30-year-old man in a wheelchair has severe weakness of both legs. The leg reflexes
are brisker than normal.
142
EMQ
B.
C.
D.
E.
Option 5
Left half of spinal cord. This man has impaired pain and temperature sensation in his right leg. These sensory modalities are conveyed in pathways which cross the
mid line soon after entry to the spinal cord, so the lesion is in the left side, affecting the
spino-thalamic tract.
Option 3
Left cerebral hemisphere. The age and symptoms are typical of a stroke. We
are not told the side of the weakness, but since the left cerebral hemisphere is concerned
with speech in the great majority of people, the lesion is most likely to be in the left than
the right hemisphere.
Option 1
Lower motor neurones. Weakness without sensory loss suggests a motor
abnormality. Wasting and impaired reflexes are typical of a lower motor neurone lesion.
Option 3
Left cerebral hemisphere. Persisting weakness of an upper motor neurone
type (brisk reflex), together with loss of sensation suggest the effects of a stroke affecting
the brain on the opposite side.
Option 2
Upper motor neurones. This man has bilateral upper motor neurone weakness of the legs with typically increased reflexes. A common cause would be a spinal cord
injury, in which case further testing should show serious sensory loss on both sides.
C.
D.
E.
Option 9
Sacral spinal segments. This region is like a minor accessory brain in coordinating micturition and defaecation and contributing to sexual reflexes.
Option 2
Hypothalamus. This is the region where responses to both hot and cold environments are coordinated. A hot environment favours vasodilation and sweating; a cold
environment favours vasoconstriction and increased skeletal muscle tone.
Option 5
Brainstem. This is the region where the arterial baroreceptor reflexes are
coordinated.
Option 5
Brainstem. This is also the site for the swallowing and vomiting reflexes.
Option 1
Spinal cord. The tendon reflexes in the limbs, such as the biceps and quadriceps jerks in response to striking their tendons, are spinal reflexes; they are not conned
to any one region of the cord.
B.
C.
D.
E.
Option 7
Autonomic axons. Cardiac function is modied by sympathetic and parasympathetic autonomic motor nerves. These responses are informed by autonomic sensory
bres, e.g. from baroreceptors. Though in general these are small unmyelinated axons,
some of the preganglionic motor bres are myelinated and a little larger.
Option 2
Large myelinated axons. The somatic tendon jerks involve very rapid
responses, for which large myelinated axons (around 15 microns diameter) are required.
Option 2
Large myelinated axons. It is logical to have impulses carried at similar high
speeds in both sensory and motor halves of the reflex arc.
Option 1
Small unmyelinated axons. Such axons (around 1 micron diameter) carry
impulses where speed of response is low, as with slow pain and many autonomic
responses.
Option 2
Large myelinated axons. The reason for the high speed is that saltatory conduction jumps the relatively long internodal distance in these axons at the speed of an
electric current.
143
EMQ
For each paragraph on an aspect of pain AE, select the most appropriate option from the following list.
1. Chemical mediators at site of pain.
2. Medium sized myelinated pain afferents.
3. Small unmyelinated pain afferents.
4. Gating of the pain pathway in the spinal
5. Thalamus.
4. cord.
6. Endorphins and enkephalins.
7. Impulse spread to medullary reflex centre.
8. Impulse spread to vagal nuclei.
A. A pin prick to the foot gives rise to a sudden sharp sensation of pain and withdrawal of
the affected limb.
B. A relatively crude non-specic sensation of pain is believed to be generated from the
site of synapse of bres in the spino-thalamic tracts.
C. Severe pain is usually treated with drugs which act on brain neuronal receptors for
endogenous neurotransmitters believed to be released during severe exercise, especially
when associated with mortal danger.
D. Patients who suffer the severe crushing pain of a myocardial infarction (heart attack)
often vomit.
E. The pain of muscle and joint damage associated with a sports injury is often treated
with drugs which inhibit the formation of prostaglandins.
144
EMQ
B.
C.
D.
E.
Option 2
Medium sized myelinated pain afferents. These are the A bres which conduct rapidly to give the initial sharp sensation of pain; they also initiate the rapid spinal
withdrawal reflex in response to pain.
Option 5
Thalamus. This is where the spino-thalamic tracts terminate and synapse.
The general unpleasant sensation of pain is generated here, with cortical areas indicating
the site of the pain.
Option 6
Endorphins and enkephalins. These are the endogenous neurotransmitters
on whose receptors the powerful opiate analgesics act to relieve severe pain. Their release
during exercise may contribute to the mood-elevating effects of exercise. They may also
account for temporary absence of severe pain as a result of injury on the battleeld.
Option 7
Impulse spread to medullary reflex centre. The vomiting centre is in the
medullar oblongata and can be activated by severe pain from a variety of causes (reflex
vomiting).
Option 1
Chemical mediators at site of pain. Prostaglandins are believed to be important mediators of persistent pain at a site of injury, particularly involving muscles and
joints. Drugs which inhibit prostaglandin formation (NSAIDs: non-steroidal anti-inflammatory drugs) are often effective in this type of pain.
B.
C.
D.
E.
Option 5
Motor neurones. The symptoms are due to gradual destruction of motor neurones, with no suggestion of any sensory loss. Wasting and twitching suggest involvement
of the lower motor neurones. The history is typical of motor neurone disease.
Option 3
Cerebellum. The cerebellum smooths movements and makes them precise.
The patient shows the opposite in the legs causing unsteadiness, in the muscles of speech
causing slurring and in the eyes, causing nystagmus. Intention tremors, i.e. shakiness
during movements, are typical of cerebellar disease.
Option 2
Extrapyramidal system. In contrast to the above, this patient has tremors at
rest. The extrapyramidal system provides appropriate muscle tone and associated movements and these are impaired in the patient whose features are typical of Parkinsonism
(an extrapyramidal disorder).
Option 4
Patchy areas throughout the central nervous system. This patient has had a
variety of temporary disturbances involving various scattered regions: optic nerves,
nerves to the eye muscles, regions controlling arm and leg movements. The condition is
intermittent but tends to lead gradually to permanent difculties. This is typical of multiple sclerosis (MS).
Option 1
One cerebral hemisphere. This patient has motor and sensory loss in one side
of the body due to damage in the cerebral hemisphere on the other side. The features are
typical of a patient with moderate recovery from one or more strokes affecting motor and
sensory pathways in one cerebral hemisphere.
145
EMQ
For each physiological description AE, select the most appropriate option from the following
list of terms related to the autonomic nervous system.
1. Generalized sympathetic activity.
2. Generalized parasympathetic activity.
3. Cholinergic effect.
4. alpha adrenergic effect.
6. 2 beta two effect.
5. 1 beta one effect.
A. Following a painful injury, a persons heart rate abruptly falls from 100 to 50 beats per
minute.
B. In a period of excitement, a persons heart rate rises to 120 beats per minute and the
person is aware of the heart pounding in the chest.
C. After a large meal, a person retires to bed, feeling pleasantly relaxed and warm. Heart
rate is 60 per minute, digestion of the meal is proceeding.
D. A student with asthma inhales a medication which acts by stimulating receptors on
bronchial smooth muscle and is relieved to nd that the chest tightness and wheeze
associated with breathing have disappeared.
E. During strenuous sporting activity a 20-year-old has a heart rate of 200 beats per
minute, is highly alert, has moderately dilated pupils and is sweating profusely.
146
EMQ
B.
C.
D.
E.
Option 3
Cholinergic effect. Severe pain can lead to a burst of activity in cardiac vagal
nerves; these parasympathetic nerves release acetylcholine at their terminals around the
sinuatrial node to cause marked cardiac slowing.
Option 5
1 effect. Tachycardia and increased force of cardiac contraction are specic
cardiac sympathetic effects mediated through stimulation of 1 adrenoceptors in the sinuatrial node and the myocardium respectively.
Option 2
Generalized parasympathetic activity. Relaxation is associated with parasympathetic activity and antagonized by sympathetic activity; warmth is associated with
relatively high skin blood flow as sympathetic nerves are switched off; a heart rate of 60,
and digestive activity both require considerable parasympathetic activity to the heart
(vagus nerves) and the gut.
Option 6
2 effects. Stimulation of 2 receptors mediates relaxation of bronchial
muscle; such medication is a common inhalational treatment for asthma.
Option 1
Generalized sympathetic activity. A heart rate of 200 is the maximal predicted for a 20-year-old, it is produced by removal of vagal tone and a maximal level of
sympathetic tone to the heart; increased alertness, dilated pupils and sweating are all indications of sympathetic activity.
C.
D.
E.
Option 2
Motor region. A spindle is a modied muscle bre and the striated region at
each end is due to actin and myosin arrangements which retain the ability to contact.
Option 1
Sensory, non-contractile region. This is the nuclear bag region which detects
stretching of the spindle and sends information along fast-conducting bres to the central nervous system.
Option 4
Contraction of extra-fusal bres. This is the reflex response whereby stretching of the spindle leads to contraction of the muscle containing the spindle.
Option 3
Increased activity in sensory nerve supply. The antagonistic muscles stretch
the muscle and its spindles and the direct effect on the spindle is stimulation of its sensory region and initiation of activity in the nerve endings supplying it.
Option 4
Contraction of extra-fusal bres. Motor activity to the striated spindle ends
makes them contract and stretch the central sensory region; stretching the muscle also
stretches the spindles within it; in both cases the increased sensory output leads to reflex
contraction of the extra-fusal bres of the muscle containing the spindles.
Answers to 339
A.
B.
C.
D.
E.
Option 2
Muscle that moves the skeleton. Skeletal muscle has an orderly arrangement
of actin and myosin molecules that gives it a striated appearance under the microscope.
Option 4
Muscle in the iris of the eye. This type of muscle contains actin and myosin
in a more random arrangement and so appears smooth rather than striated; it requires
stimulation of autonomic nerves to make it contract; sympathetic stimulation contracts
radial bres to dilate the pupil, parasympathetic stimulation contracts circular bres and
dilates the pupil.
Option 1
Muscle in the wall of the heart. The heart beats spontaneously due to
impulses from the sinuatrial node; sympathetic stimulation of beta one receptors increases
the force of contraction.
Option 3
Muscle in the wall of the small intestine. This type of smooth muscle shows
rhythmical contractions, even when removed from the body.
Option 2
Muscle that moves the skeleton. Skeletal muscle contracts only when stimulated by somatic motor nerves releasing acetylcholine; during general anaesthesia, muscle
relaxation is often provided (e.g. during abdominal operations) by drugs which interfere
with the action of motor nerves on the muscle bres.
147
EMQ
For each statement AE about a patient with a long established complete transection of the
spinal cord at the lower cervical region, select the most appropriate option from the following
list of physiological lesions/disturbances.
1. Somatic upper motor neurone lesion. 2. Somatic lower motor neurone lesion.
3. Loss of reflex centre.
4. Loss of sensory input.
5. Loss of sympathetic motor function. 6. Loss of parasympathetic motor function.
A. The patient has difculty maintaining arterial blood pressure in the upright position
because the total peripheral resistance cannot be appropriately increased.
B. The patient is unaware of damaging pressure on the lower limbs.
C. The patient has difculty maintaining normal core temperature in a cool environment
tolerated by other patients.
D. The patients leg muscles are paralysed but can contract in response to striking the
patellar tendon with a patellar hammer.
E. The patient has lost the normal sweating response in the legs to a hot environment.
148
EMQ
B.
C.
D.
E.
Option 5
Loss of sympathetic motor function. Normally when upright we maintain
arterial blood pressure by sympathetically induced vasoconstriction, particularly in the
legs; otherwise blood tends to pool there giving postural hypotension.
Option 4
Loss of sensory input. There is no awareness of any sensation in the legs, so
this warning of impending damage is lost.
Option 5
Loss of sympathetic motor function. Sympathetically induced vasoconstriction is also important in retaining core heat in a cool environment.
Option 1
Somatic upper motor neurone lesion. The motor tracts in the spinal cord are
upper motor neurones with respect to the anterior horn cells which give rise to the axons
of the lower motor neurones supplying the leg muscles; the knee jerk is a spinal reflex
independent of upper motor neurones in long-established paraplegia.
Option 5
Loss of sympathetic motor function. Sweating is yet another activity which
relies on an intact sympathetic motor pathway from the reflex centre to the sweat glands
in the skin.
SPECIAL SENSES
149
MCQs
342. Endolymph
A.
B.
C.
D.
E.
346. The cones in the retina differ from rods in that they are more
A.
B.
C.
D.
E.
Numerous.
Concerned with colour vision.
Sensitive to light.
Concerned with high visual acuity.
Affected by vitamin A deciency.
347. Increasing the salt concentration applied to a salt taste bud increases
A.
B.
C.
D.
E.
MCQ
Questions 341347
150
MCQ
Answers
341.
A.
B.
C.
D.
E.
True
True
False
True
True
342.
A.
B.
C.
D.
E.
True
False
True
False
True
343.
A.
B.
C.
D.
E.
False
False
True
False
True
344.
A.
B.
False
False
C.
D.
E.
False
True
True
345.
A.
B.
C.
D.
E.
True
False
True
False
True
346.
A.
B.
C.
D.
E.
False
True
False
True
False
There are about 6 million cones compared with 120 million rods.
Rods alone give achromatic vision.
The rods are much more sensitive; their pigment is bleached in bright light.
Acuity is highest with foveal (cone) vision.
Vitamin A is essential for rhodopsin synthesis for rod vision only.
347.
A.
B.
C.
D.
E.
False
True
False
True
True
151
Questions 348353
A.
B.
C.
D.
E.
MCQ
152
MCQ
Answers
348.
A.
B.
C.
D.
False
True
True
True
E.
False
349.
A.
B.
C.
D.
E.
True
False
True
False
False
350.
A.
False
B.
C.
D.
True
True
False
E.
False
It is thought that humans can differentiate between 2000 and 4000 different
odours.
The receptors can detect small differences in molecular conguration.
Probably due to the different time of arrival of the odour at the two nostrils.
Though very low concentrations of odorous substances can be detected, differences in concentration of more than 30 per cent are needed to detect a difference
in intensity.
Olfaction ability falls with age.
351.
A.
B.
False
False
C.
True
D.
E.
True
True
352.
A.
B.
False
False
C.
D.
E.
True
False
False
353.
A.
B.
C.
D.
E.
False
True
False
False
False
153
Questions 354359
A. The cornea causes more refraction than the lens.
B. More refraction occurs at the inner surface of the cornea than at the outer surface.
C. The lens, by becoming more convex, can more than double the total refractive power of
the eye.
D. The back surface of the lens contributes more to accommodation than the front.
E. Ageing reduces the maximum refractive power of the eye.
Movement of perilymph.
Linear acceleration.
Rotation at constant velocity.
Gravity.
Movement of endolymph relative to hair cells.
Impinges on the retina in the right eye to the right of the fovea.
Impinges on the retina in the left eye to the left of the fovea.
Generates impulses which travel in the right optic tract.
Generates impulses which produce conscious sensation in the frontal lobe eye elds.
Forms an inverted image on the retina.
359. Utricles
A.
B.
C.
D.
E.
MCQ
154
MCQ
Answers
354.
A.
B.
True
False
C.
D.
E.
False
False
True
This is because of the large change in refractive index from air to cornea.
The outer interface is with air; cornea and aqueous have similar refractive indices.
It can only increase total refractive power by about 1520 per cent.
During accommodation, the front of the lens bulges more than the back.
As the lens stiffens, ability to increase convexity when ciliary muscles contract
is diminished.
355.
A.
B.
C.
False
False
False
D.
E.
False
True
356.
A.
B.
C.
D.
E.
False
False
True
False
True
The optic nerve is an essential part of the reflex pathway for the light reflex.
It still constricts after the sympathetic nerves are cut.
Atropine blocks this parasympathetic action.
Both pupils constrict consensually.
Failure of the pupils to respond to light is a sign of brainstem death.
357.
A.
B.
C.
D.
False
True
False
False
E.
True
358.
A.
B.
C.
D.
E.
True
False
True
False
True
359.
A.
B.
C.
D.
E.
True
True
True
True
True
155
Questions 360365
A.
B.
C.
D.
E.
Contain visual pigment which is more sensitive to red than to blue light.
Are rendered insensitive by ordinary daylight.
Are more widely distributed over the retina than are cones.
Reflect red light more than blue light.
Comprise about 20 per cent of foveal receptor cells.
361. Cones
A.
B.
C.
D.
E.
MCQ
156
MCQ
Answers
360.
A.
B.
C.
D.
E.
False
True
True
True
False
A.
B.
False
False
C.
D.
False
True
E.
False
361.
362.
A.
B.
False
False
C.
D.
E.
False
False
True
They are found also in the soft palate, pharynx and larynx.
The microvilli on top of receptors protrude through taste pores into the buccal
cavity.
They are receptor cells which synapse with primary sensory neurones.
They look alike.
Sweet sensation is experienced at the front of the tongue; bitterness at the back.
363.
A.
B.
C.
D.
E.
True
False
True
False
False
364.
A.
B.
C.
D.
E.
True
False
True
False
False
365.
A.
B.
C.
True
False
True
D.
E.
True
False
157
Questions 366371
A.
B.
C.
D.
E.
A purple pigment.
Highly absorbent of red light.
Most sensitive to violet light.
Regenerated in the dark.
Least sensitive to red light.
In the upper temporal quadrant is detected in the lower nasal quadrant of the retina.
At the centre of the eld of vision is detected in the optic disc.
Focused on the blind spot is in the nasal half of the visual eld.
In the temporal half generates impulses which travel the left optic tract.
In the nasal half is more likely to be perceived in binocular vision than one in the temporal half.
C. At the base of the cochlea vibrates only to incoming high frequency sounds.
D. In the apical region vibrates only to incoming sounds of low frequency.
E. Can be made to vibrate by pressure waves travelling through skull bone.
370. An audiogram
A.
B.
C.
D.
E.
MCQ
158
MCQ
Answers
366.
A.
B.
C.
D.
E.
False
False
False
True
True
It is red.
It is red because it reflects red light selectively.
It is most sensitive to blue-green light (around 500 nm).
In the dark retinene and scotopsin combine to form rhodopsin.
This is because it reflects the red light.
367.
A.
B.
C.
True
False
False
D.
False
E.
True
368.
A.
B.
False
False
C.
False
D.
E.
True
True
369.
A.
B.
True
True
C.
D.
True
True
E.
True
Receptors for bitter taste predominate on the posterior dorsum of the tongue.
Recording from single taste receptors demonstrates that a single receptor can
respond to more than one modality.
All acids taste sour.
Taste receptors are poor at discriminating between intensities; a concentration
difference of more than 30 per cent is needed for discrimination.
Food flavour is accentuated when hot; unpleasant medicine less offensive when
cold.
370.
A.
B.
C.
D.
E.
True
False
True
True
False
True
True
False
True
True
The cochlea does not contribute sensory information needed for balance.
The basilar artery supplies brain stem areas particularly concerned with balance.
The posterior columns transmit proprioceptive information needed for balance.
Vision can compensate for loss of proprioception.
Abrupt loss of input causes severe disturbance followed by gradual adaptation.
371.
A.
B.
C.
D.
E.
159
Questions 372377
A.
B.
C.
D.
E.
blue.
Where red and green are indistinguishable is due to failure of red and green cone
systems.
In which no colours can be detected is due to failure of all the cones systems.
Is more common in women than men.
Is a disability linked to the Y-chromosome.
pia).
Optic chiasma causes blindness in the nasal half of each visual eld (binasal hemianopia).
Left optic radiation causes loss of vision to the right.
Occipital cortex causes loss of the light reflex.
Occipital cortex causes loss of central vision with preservation of peripheral vision.
MCQ
160
MCQ
Answers
372.
A.
B.
C.
D.
E.
True
False
False
False
False
373.
A.
B.
C.
D.
E.
True
False
False
False
False
374.
A.
B.
C.
D.
E.
True
False
False
True
False
375.
A.
B.
C.
D.
False
False
True
True
E.
True
376.
A.
True
B.
False
C.
D.
E.
True
False
False
The left half of each retina is concerned with vision to the right and impulses
from them travel in the left optic tract.
The crossing bres come from the nasal half of each retina and are responsible
for temporal vision; bitemporal hemianopia results.
As with damage to the left optic tract.
This is a brain stem reflex.
The reverse is true because the fovea is bilaterally represented in the cortex.
377.
A.
B.
C.
D.
True
True
False
False
E.
True
161
Questions 378384
A.
B.
C.
D.
E.
380. Typical effects of ageing on the special senses include gradual loss of
A.
B.
C.
D.
E.
Near vision.
Olfactory sensitivity (hyposmia).
90 per cent of the accommodative power of the lens during the lifespan.
Hearing affecting bone and air conduction similarly.
Hearing affecting high and low frequencies similarly.
381. A child who focuses an object on the fovea of the left eye and on the temporal side of the fovea in the right eye is likely to have
A.
B.
C.
D.
E.
A divergent squint.
A refractive error.
Suppression of vision in the left rather than in the right eye.
No suppression of vision in one eye if the left eye is covered for part of each day.
A lesser tendency to suppression of vision in one eye if given exercises requiring binocular vision.
Random light scattering when there is decient pigmentation of the eye due to albinism.
Random light scattering when there is asymmetrical corneal curvature due to astigmatism.
Random light scattering in the cornea when there is vitamin A deciency.
Impairment of rod function when there is vitamin A deciency.
Inability to alter the focal length of the lens when a cataract is present.
MCQ
162
MCQ
Answers
378.
A.
B.
C.
D.
E.
True
True
False
True
False
If only some of the many receptor types involved in olfaction are lost.
Due to damage to the olfactory nerves by distortion of the cranium.
Smell pathways do not pass through the thalamus.
This can prevent odours reaching the receptor cells.
It may indicate a frontal lobe tumour.
379.
A.
B.
C.
D.
E.
False
False
True
True
False
380.
A.
True
B.
C.
D.
E.
True
True
True
False
Recession of the near point is typical of the ageing eye (presbyopia); vision at
2030 cm deteriorates.
It affects over 70 per cent of elderly people.
It falls from 1015 dioptres in childhood to 510 at 30 and to about 1 dioptre at 70.
It is a sensorineural deafness (presbycusis).
High-pitched sounds are more affected.
False
True
False
True
381.
A.
B.
C.
D.
382.
A.
B.
True
False
C.
D.
E.
True
True
True
383.
A.
True
B.
C.
False
True
D.
E.
False
False
Normally absorption of light by dark pigment in the choroid prevents backscattering of light into the retina.
There is a refractive error but not random light scattering.
Lack of vitamin A leads to keratin deposition in corneal epithelium (xerophthalmia).
Rod function does not determine acuity in bright light.
Impairment of acuity with cataract is due to random scattering by lens opacities.
384.
A.
B.
C.
D.
False
True
True
False
E.
False
SPECIAL SENSES
163
EMQs
EMQ
Questions 385394
164
EMQ
C.
D.
E.
Option 5
Due to loss of lens elasticity with ageing. With increasing age, the lens loses
its elasticity, so decreasing the ability of the eye to accommodate for near vision.
Option 4
Causes reflex contraction of circular smooth muscle in the iris. If light is
shone on the retina, the circular ciliary muscles contract to decrease the size of the pupil
so decreasing spherical aberration by the lens.
Option 2
Determined by the maximum convexity the lens can attain. The near point is
the point nearest to the eye where the lens system can focus a sharp image. It depends on
the elasticity of the lens and is nearest in infancy and recedes with age.
Option 3
Usually involves contraction of the ciliary muscles. Accommodation for near
vision depends on contraction of the ciliary muscle to increase the convexity of the lens,
convergence of the axes of the eyes and constriction of the pupils.
Option 1
Normal vision. Emmetropia is the term describing normal refraction in the
eye. It contrasts with hypermetropia (long-sightedness) and myopia (short-sightedness).
B.
C.
D.
E.
Option 4
Contain rhodopsin. Rhodopsin is responsible for vision in poor light. It
(Visual Purple) is the most sensitive visual pigment with a peak sensitivity to light at
505 nm.
Option 2
The minimum amount of light that elicits light sensation. In dark adaptation
the visual threshold falls.
Option 1
Contain the least light-sensitive pigments in the retina. The cones contain
three colour sensitive pigments and are responsible for colour vision and vision in bright
light.
Option 5
Can be measured by use of Snellen letter charts. The results are expressed as
a fraction 20/20 (or 6/6) being normal; a fraction less than unity, e.g. 10/20 indicates
below normal acuity.
Option 3
The rate below which successive images are seen as separate images. Above
that rate the images fuse to provide a continuous image.
C.
D.
E.
Option 4
A condition where visual images do not fall on corresponding retinal points.
This is squint.
Option 5
Double vision. This is usually caused by problems in the control of the external ocular muscles which interfere with the ability of the eyes to form images on corresponding retinal points.
Option 3
Loss of vision. It may be partial or complete.
Option 1
A blind spot. Visual impairment with a scotoma depends on its location on
the retina. Central scotomas are more disabling than peripheral scotomas.
Option 2
Inability to see in the dark. Night blindness is seen where there is a deciency of Vitamin A that is needed for the production of rhodopsin.
165
EMQ
166
EMQ
B.
C.
D.
E.
Option 3
Continuous jerky movements of the eyeballs. These can occur normally
(physiological nystagmus) but are exaggerated in certain diseases affecting the cerebellum.
Option 1
Blindness in half of the visual eld. Usually caused by a lesion in one optic
tract. A lesion affecting one optic nerve causes total blindness in that eye.
Option 4
People who can only distinguish between two primary colours. This is one
form of colour blindness; healthy people (trichromats) can distinguish between the three
primary colours.
Option 2
Loss of central vision with normal peripheral vision. This is due to damage
to the macula.
Option 5
Loss of peripheral vision with normal central vision. This is often seen in
patients with lesions affecting the occipital (visual) cortex.
D.
E.
Option 4
Located in the foramen ovale. It is embedded in the foramen ovale membrane.
Option 5
Bulges in when the oval window bulges in. Tympanic membrane movements
are transmitted by the auditory ossicles to the oval window.
Option 3
Dampens vibrations of the tympanic membrane. This muscle is attached to
the manubrium of the malleus and when it contracts reflexly in response to an incoming
sound, it tightens the tympanic membrane and damps its movements.
Option 2
Dampens vibration of the oval window membrane. The stapedius muscle is
attached to the stapes and pulls on it reflexly to dampen its movements in response to
incoming loud noise.
Option 1
Bulges out when the oval window membrane bulges in. The round window
lies where the scala tympani abuts on the middle ear and by bulging out when the stapes
footplate bulges in reduces the pressure changes with incoming sounds in the inner ear.
B.
C.
D.
E.
Option 4
The sensory organ in the semicircular canals. Each semicircular canal has an
ampulla whose sense organ is stimulated by movement of endolymph caused by rotary
accelerations of the head in the three spatial planes in which the semicircular canals lie.
Option 2
The sensory organ in the utricle. These sensory organs are stimulated by
linear accelerations of the head that modify the pull of the otoliths on the hair cells of the
otolith organ.
Option 1
The gelatinous partition of top of the crista that closes off the ampulla.
When there is movement of fluid in the semicircular canals it causes deflections of the
cupula that alter the output of impulses from the underlying crista ampullaris.
Option 5
The hair processes on receptor cells in the inner ear. These rod-shaped structures protrude from the hair cells and cause generator potentials when they are deformed
by movement of endolymph.
Option 3
The membrane structure overlying the receptor cells in the organ of Corti.
This structure which overlies the organ of Corti may be involved in bending of hair cells
when the basilar membrane is made to vibrate with incoming sound waves.
167
EMQ
For each of the structures concerned with hearing AE, select the most appropriate option from
the list below.
1. A centre for auditory reflexes.
2. Separates scala in the inner ear.
3. Equalizes middle ear with
4. Responsible for bony conduction of
atmospheric pressure.
incoming sound waves.
5. Important in air conduction of incoming sound waves.
A. The basilar membrane.
B. The skull.
C. The auditory ossicles.
D. The Eustachian tube.
E. Inferior colliculi.
168
EMQ
Answers to 391
A.
B.
C.
D.
E.
Option 2
Separates scala in the inner ear. The basilar membrane on which the organ
of Corti lies separates the scala media from the scala tympani.
Option 4
Responsible for bony conduction of incoming sound waves. If the middle ear
is completely destroyed by disease, some hearing ability remains as sound waves can be
conducted through the bone of the skull to the inner ear.
Option 5
Important in air conduction of incoming sound waves. The malleus, incus
and stapes form a good lever system to transmit sound waves from the tympanic membrane to the round window without much attenuation.
Option 3
Equalizes middle ear with atmospheric pressure. The Eustachian tube connects the middle ear to the pharynx so that the pressure on either side of the tympanic
membrane is about atmospheric.
Option 1
A centre for auditory reflexes. The cochlear nerve carries auditory impulses
from the organ of Corti to the inferior colliculi, centres for auditory reflexes.
B.
C.
D.
E.
Option 2
Associated with bitter taste sensation. The taste buds sensing bitter tastes are
located in the vallate papillae in a V-shaped area on the back part of the upper surface of
the tongue.
Option 4
Associated with sweet taste sensation. Taste buds that sense sweet stimuli
are in the fungiform papillae on the dorsal surface towards the front of the tongue.
Option 5
Associated with salt taste sensation. The taste buds at the side of the tongue
respond to salt and sour taste stimuli.
Option 3
Carries taste impulses serving the sensation of bitterness. The glossopharyngeal nerve carries impulses from the posterior third of the surface of the tongue and thus
serves bitter taste sensation.
Option 1
Carries taste impulses serving the sensation of sweetness. The chorda tympani branch of the facial nerve carries sensory impulses from the anterior two-thirds of
the tongue and thus serves the sensation of sweetness.
B.
C.
D.
E.
Option 4
A tract containing the second order sensory neurones carrying pain and temperature sensation. These tracts carry pain and temperature impulses from receptors on
the opposite side of the body to the thalamus.
Option 1
Third order sensory pathway from thalamus to the postcentral gyrus. In the
postcentral gyrus the sensory impulses generate conscious sensation.
Option 5
A tract containing the ascending second order neurones carrying touch and
pressure sensation. These tracts carry touch and pressure impulses from the opposite side
of the body to the thalamus.
Option 2
The tracts carrying proprioception impulses in rst order sensory neurones
to the nucleus gracilis and cuneatus. These tracts carry impulses from muscle spindles and
other receptors on the same side of the body that ascend in rst order sensory neurones
to the gracile and cuneate nuclei. From there second order neurones cross to the opposite
side of the body in the sensory decussation to join the medial lemniscus and ascend to the
thalamus.
Option 3
A tract in the brainstem carrying sensory impulses to the thalamus. This is
the common sensory pathway in the brainstem carrying all sensory impulses to the thalamus.
169
EMQ
For each of the sensory disturbances AE, select the most appropriate option from the list
below.
1. The gradual loss of hearing ability
2. The loss of ability to recognize objects by
with age.
touch.
3. Absence of smell sensation.
4. Night blindness.
5. A refractive error due to the cornea having different refractive power in the horizontal and transverse planes.
6. A disorder of hearing where the patient complains of hearing abnormal noise.
A. Astereognosis.
B. Astigmatism.
C. Presbycusis.
D. Anosmia.
E. Tinnitus.
170
EMQ
B.
C.
D.
E.
Option 2
The loss of ability to recognize objects by touch. This ability is a cortical
function and its loss suggests damage to the sensory cortex in the postcentral gyrus of the
parietal lobe.
Option 5
A refractive error due to the cornea having different refractive power in the
horizontal and transverse planes. This common refractive error is corrected by provision
of cylindrical lenses that make refraction in the vertical plane equal refraction in the horizontal plane.
Option 1
The gradual loss of hearing ability with age. This affects about one third of
people over seventy and is probably due to cumulative damage to the hair cells in the
organs of Corti. It tends to be worse in people who have lived and worked in noisy environments.
Option 3
Absence of smell sensation. As with hearing, sensitivity to smell stimuli
tends to decrease with age. Temporary anosmia is a feature of the common cold.
Option 6
A disorder of hearing where the patient complains of hearing abnormal
noise. The noise is described as ringing, buzzing, roaring etc.
URINARY SYSTEM
171
MCQs
MCQ
Questions 395400
172
MCQ
Answers
395.
A.
B.
C.
D.
False
False
True
False
E.
True
396.
A.
B.
C.
True
True
False
D.
E.
True
True
397.
A.
B.
C.
D.
E.
False
True
False
True
False
398.
A.
B.
C.
D.
E.
True
False
False
False
True
399.
A.
B.
True
True
C.
D.
E.
True
True
False
400.
A.
B.
C.
D.
E.
True
False
False
True
False
173
Questions 401406
A.
B.
C.
D.
E.
Reabsorption is active.
Reabsorption is critically related to tubular transit time.
Reabsorption is complete below a certain threshold load.
Renal clearance falls with its plasma concentration.
Excretion rate is zero until its Tm value is reached.
404. When a patients mean arterial blood pressure falls by 50 per cent
A.
B.
C.
D.
E.
MCQ
174
MCQ
Answers
401.
A.
True
B.
C.
D.
E.
True
False
False
False
A clearance value above the glomerular ltration rate (about 140 ml/minute)
indicates secretion.
Some of the unltered fraction must have been secreted.
This suggests that the substance is normally reabsorbed by an active process.
This can be explained by water reabsorption.
Again, this can be explained by a relatively greater reabsorption of water.
402.
A.
B.
C.
D.
E.
False
False
True
False
True
403.
A.
B.
True
False
C.
D.
E.
True
False
True
404.
A.
B.
False
False
C.
D.
True
True
E.
True
405.
A.
False
B.
C.
True
True
D.
E.
True
False
About 80 per cent of the ltered water is reabsorbed before it reaches the distal
tubules.
The rate is related to acidbase requirements.
By conversion of glutamine to glutamate; NH3 is a buffer for the H being
excreted.
H secretion is related to the bodys acidbase balance.
Further modication takes place in the collecting ducts.
406.
A.
B.
False
True
C.
D.
E.
True
True
True
175
Questions 407411
A.
B.
C.
D.
E.
About 10 per cent when arterial pressure falls 10 per cent below normal.
About 5 per cent when metabolic activity in the kidney falls by 5 per cent.
During emotional stress.
After moderate haemorrhage.
Gradually from the inner medulla to the outer cortex per unit weight of tissue.
408. Urea
A.
B.
C.
D.
E.
MCQ
176
MCQ
Answers
407.
A.
False
B.
C.
D.
E.
False
True
True
False
Due to autoregulation, flow changes little with small changes in perfusion pressure.
Normal renal blood flow is vastly in excess of its metabolic requirements.
Due to sympathetic vasoconstrictor nerves and circulating catecholamines.
A reflex response to the fall in blood pressure so caused.
Cortical flow is 1020 times higher than medullary flow.
408.
A.
B.
C.
True
True
False
D.
E.
False
True
409.
A.
False
B.
C.
D.
E.
True
False
False
True
The reflex centres are in the sacral cord; their activity is modulated by higher
centres.
This breaks the reflex arc.
Parasympathetic nerves are motor to the detrusor muscle.
Valves where the ureters enter the bladder do not allow such reflux.
During ejaculation, sympathetic activity constricts the bladder neck sphincter and
prevents retrograde ejaculation of semen into the bladder.
410.
A.
B.
C.
True
True
True
D.
False
E.
False
More than half of the ltered sodium is actively absorbed in the proximal tubules.
Negatively charged chloride ions follow the positively charged sodium.
Most of the potassium is reabsorbed in the proximal tubule; some is re-excreted
in the distal tubules in exchange for sodium.
Rennin is an enzyme found in gastric juice that causes milk to clot. The juxtaglomerular cells that secrete renin are found where the distal tubule makes contact with the afferent arteriole.
This hormone acts mainly on distal parts of the nephron.
411.
A.
True
B.
C.
False
True
D.
True
E.
True
Inulin is freely ltered but not reabsorbed or secreted in the tubules; therefore the
amount excreted in the urine equals the amount ltered at the glomerulus.
Aldosterone increases Na and Cl reabsorption and so reduces their clearance.
At high plasma levels, the Tm for PAH is exceeded and PAH is not completely
cleared in one passage through the kidney.
About 60 compared with 120 ml/minute; half the ltered urea is passively reabsorbed.
The amount ltered is the amount excreted.
177
Questions 412417
A.
B.
C.
D.
E.
413. Aldosterone
A. Is a steroid hormone secreted by the adrenal medulla.
B. Production ceases following removal of the kidneys and their juxtaglomerular cells.
C. Production decreases in treatment with drugs which block angiotensin-converting
enzyme.
414. As fluid passes down the proximal convoluted tubule, there is a fall of
more than 50 per cent in the
A.
B.
C.
D.
E.
Plasma.
Interstitial fluid.
Intracellular fluid.
Urine.
Cerebrospinal fluid.
MCQ
178
MCQ
Answers
412.
A.
B.
False
False
C.
False
D.
E.
True
True
413.
A.
B.
False
False
C.
True
D.
E.
False
True
414.
A.
False
B.
C.
D.
E.
False
True
False
True
Sulphate concentration rises since relatively more water than sulphate is reabsorbed.
It is little changed, since similar proportions of sodium and water are reabsorbed.
These are completely reabsorbed by active transport.
Potassium is reabsorbed in proportion to water.
Due to reabsorption of about 80 per cent of the water.
False
False
False
True
True
A.
B.
C.
True
True
False
D.
E.
False
False
415.
A.
B.
C.
D.
E.
416.
417.
A.
B.
C.
True
True
False
D.
False
E.
True
Both are usually totally reabsorbed so their renal clearance is about zero.
PAH clearance is a measure of renal plasma flow, not renal blood flow.
It provides an estimate of the glomerular ltration rate since the amount ltered
is close to the amount excreted.
Phosphate clearance is increased by parathormone and lowers the blood phosphate level.
Small amounts of protein are ltered but reabsorbed.
179
Questions 418423
A.
B.
C.
D.
E.
symptoms.
The specic gravity of the urine tends to be elevated, e.g. about 1.030.
Blood PCO2 tends to be low.
Ionized calcium levels in the blood tend to be high.
Anaemia is common.
A plot of bladder pressure on the ordinate axis against bladder volume on the abscissa.
Little rise in pressure with rise in volume at low bladder volumes.
A steep rise in pressure when volume rises above 100 ml.
That females generate higher pressures during micturition than males.
That patients with chronic urinary tract obstruction can generate higher than normal
micturition pressures.
Urine volume.
Body potassium.
Body sodium.
Blood volume.
Blood viscosity.
MCQ
418. Potassium
180
MCQ
Answers
418.
A.
B.
True
True
C.
D.
E.
True
True
True
419.
A.
B.
C.
D.
E.
False
False
True
True
False
Rennin is the enzyme secreted by infants gastric mucosa which curdles milk.
Renin promotes angiotensin I formation from a circulating precursor.
Angiotensin I is converted to angiotensin II by a converting enzyme in the lungs.
Renins action helps to restore this volume.
There is no direct feedback between the two systems.
420.
A.
B.
True
False
C.
True
D.
False
E.
True
421.
A.
B.
True
False
C.
D.
E.
False
False
False
422.
A.
B.
C.
D.
E.
True
True
False
False
True
Bladder pressure is measured while known volumes of fluid are run into it.
An example of receptive relaxation like that seen in the stomach.
The deflection usually occurs when around 500 ml is introduced.
The male urinary tract offers a higher peripheral resistance.
The increased work load causes muscular hypertrophy which allows generation
of higher micturition pressures.
423.
A.
B.
C.
D.
E.
False
False
True
True
False
181
Questions 424429
A.
B.
C.
D.
E.
Urea.
Potassium.
Osmolality.
Plasma proteins.
Hydrogen ions.
cut.
The pelvic nerves are cut.
Anticholinergic drugs are administered.
Alpha-adrenergic receptor antagonists are administered.
Beta-adrenergic receptor agonists are administered.
Be covered by immunosuppression even when the donor is the recipients identical twin.
Raise postoperative glomerular ltration rate to the 1020 ml/minute level.
Correct abnormal calcium metabolism.
Correct anaemia.
Abolish the need for further renal dialysis.
428. Drugs which interfere with active transport of sodium in the proximal
tubule tend to increase
A.
B.
C.
D.
E.
Urine production.
Plasma osmolality.
Chloride excretion.
Interstitial fluid volume.
Plasma specic gravity.
MCQ
424. Dialysis fluid used in the treatment of renal failure should contain the
normal plasma levels of
182
MCQ
Answers
424.
A.
B.
C.
False
False
False
D.
False
E.
True
425.
A.
B.
C.
False
True
True
D.
True
E.
True
426.
A.
B.
False
True
C.
D.
True
False
E.
True
Sympathetic trunks carry pain afferents, not stretch receptor afferents to the cord.
These carry the stretch receptor afferents from the bladder and parasympathetic
motor bres to the bladder; the micturition reflex is lost.
These block the parasympathetic motor bres to the detrusor muscle.
Alpha receptor antagonists relax bladder sphincter muscle: they are used to facilitate bladder emptying in patients with benign prostatic hypertrophy.
They tend to relax the detrusor muscle.
427.
A.
B.
C.
D.
E.
False
False
True
True
True
428.
A.
B.
C.
D.
E.
True
False
True
False
True
429.
A.
True
B.
C.
D.
True
True
False
E.
False
Carbonic anhydrase in tubular cells catalyses the combination of CO2 and H2O to
form H2CO3 which ionizes into H and HCO3 ions.
This is determined mainly by renal bicarbonate formation.
This falls as the plasma bicarbonate level falls.
More K is secreted by the tubules in exchange for sodium since there are fewer
H ions to compete with K in the sodium/potassium exchange pump.
Failure to reabsorb HCO3 results in an osmotic diuresis of alkaline urine.
183
Questions 430434
A.
B.
C.
D.
E.
Blood urea.
Blood uric acid.
Creatinine clearance.
Acidbase disturbance when he or she vomits.
Acidbase problem on a high protein diet.
Difculty in
Loss of tone
Loss of tone
Loss of pain
Infertility in
432. Sudden (acute) renal failure differs from gradual (chronic) renal failure
in that
A.
B.
C.
D.
E.
MCQ
184
MCQ
Answers
430.
A.
B.
C.
True
True
False
D.
E.
False
True
431.
A.
B.
C.
D.
E.
False
True
False
True
True
432.
A.
True
B.
False
C.
D.
E.
False
False
False
Potassium retention is one of the greatest hazards of acute renal failure and may
cause death from myocardial depression.
The blood urea level is determined by the severity of the condition, not by its rate
of progression.
Both may depress the marrow and lower RBC, polymorph and platelet counts.
Both impair renal bicarbonate production.
Protein restriction is advisable in both cases.
433.
A.
False
B.
False
C.
D.
E.
False
False
False
A low protein diet is helpful but some protein is needed to provide essential
amino acids for tissue maintenance.
This would not cover insensible loss plus urine volume; also in some stages of
renal failure urine volume is increased.
Potassium intake is required to replace potassium lost in urine.
Anaemia is due to bone marrow depression, not iron deciency.
Sufcient dietary intake is needed to prevent excessive tissue protein catabolism.
434.
A.
True
B.
True
C.
True
D.
False
E.
False
This raises plasma bicarbonate to compensate for the raised PCO2 in respiratory
acidosis.
In acidosis, tubular cells excrete more to buffer the additional H ions being
secreted.
The increased secretion of H ions in exchange for Na results in decreased secretion of K ions.
The ratio decreases as hydrogen ions are taken up by the phosphate buffer
system.
The urine remains bicarbonate-free.
URINARY SYSTEM
185
EMQs
EMQ
Questions 435444
186
EMQ
B.
C.
D.
E.
Option 2
Stress incontinence. During coughing and sneezing intrathoracic and intraabdominal pressure is raised. In the presence of impaired sphincter action at the bladder
outlet, a common consequence of damage during delivery, the raised pressure can expel
some urine from the bladder. Laughing may have a similar effect.
Option 5
Automatic bladder. The patient had a spinal injury which has led to loss of
bladder control. Such injuries isolate the micturition centre in the sacral cord from higher
centre control. In such patients the bladder can empty automatically when distended by
means of the bladder stretch reflex centred in the sacral cord. Pressure on the abdomen
can initiate the reflex at a convenient time before it occurs automatically.
Option 4
Acute retention of urine. In elderly men, prostatic enlargement leads to progressive compression of the prostatic urethra. This leads to increasing resistance to flow
so that the urinary stream is poor. If the obstruction becomes complete so that micturition
is impossible, the bladder becomes painfully distended.
Option 1
Atonic bladder with overflow. This is another case of spinal injury isolating
the micturition centre in the sacral cord from higher centre control. However, in the acute
phase that comes on immediately and lasts for some weeks after the injury, the patient
usually shows a complete absence of spinal stretch reflexes below the level of the lesion
spinal shock. The micturition stretch reflex is abolished so that the bladder loses tone,
becomes distended and leaks uncontrollably due to the high pressure in the passively distended organ. Catheterization is important, to prevent damage to the bladder by such
over-stretching.
Option 3
Chronic prostatic obstruction. This is another case of prostatic obstruction
but without acute retention of urine. Gradual narrowing of the prostatic urethra raises the
urethral resistance which the bladder must overcome. Hypertrophy of the bladder wall
occurs (as in the left ventricle in systemic hypertension), hence bladder pressure during a
micturating cystometrogram (record of bladder pressure versus volume) is increased. As in
the failing heart, the bladder muscle fails to empty as completely as usual.
E.
Option 2
Distal convoluted tubule. Cells here have the ability to secrete hydrogen ions
until the luminal pH has fallen to 45.
Option 1
Proximal convoluted tubule. This is the major site for reabsorption, which is
facilitated by microvilli similar in many respects to those in the small intestine.
Option 6
Ureter. Passage of a calculus here is associated with the severe pain of renal
colic, referred to one or other loin.
Option 2
Distal convoluted tubule. These cells form and secrete ammonia to buffer
hydrogen ions secreted in the same region, especially when the rate of hydrogen ion secretion is high; this prevents luminal pH from falling below 4.
Option 5
Collecting duct. Depending on the circulating level of anti-diuretic hormone,
the osmolality of the ltrate rises along the collecting duct, to a maximum about four
times that of plasma.
187
EMQ
For each urinary solute AE, select the most appropriate option from the following list of concentrations to be found in the urine of healthy people.
1. Always greater than in plasma.
2. Always less than in plasma.
3. Always the same as in plasma.
4. Can be less than or greater than in plasma.
A. Sodium.
B. Hydrogen ions.
C. Potassium ions.
D. Urea.
E. Para-aminohippurate (PAH).
188
EMQ
B.
C.
D.
E.
Option 4
Can be less than or greater than in plasma. The plasma sodium level is
around 140 mmol per litre; with a low sodium intake of 50 mmol per day and a urinary
volume of one litre, the sodium concentration would be 50 mmol per litre; with a fairly
high sodium intake of 250 mmol per day and the same urinary volume, the concentration
would be 250 mmol per litre.
Option 4
Can be less than or greater than in plasma. Plasma pH is around 7.4; urinary pH can vary from less than 5 to around 8.
Option 1
Always greater than in plasma. The intakes and outputs of potassium are of
a similar order to those given for sodium, so to maintain balance, the urinary concentrations are also similar to those of sodium; however the plasma potassium concentration is
only about 4 mmol per litre.
Option 1
Always greater than in plasma. About 99 per cent of ltered water is reabsorbed, but only about half of the ltered urea.
Option 1
Always greater than in plasma. Not only is all the ltered PAH excreted
(compare urea above), but, provided the tubular maximum is not exceeded, all the PAH
reaching the kidney is also excreted.
C.
D.
E.
Option 5
20 mmHg. This is similar to the pressure drop along systemic capillaries
when pressure at the arteriolar end is 35 mmHg and that at the venous end is 15 mmHg.
Option 5
20 mmHg. This would represent the situation at the proximal ends of the
glomerular capillaries; further along the capillaries, their hydrostatic pressure falls, while
the oncotic pressure rises as protein-poor fluid is ltered; both factors reduce the ltration pressure.
Option 2
5 mmHg. This would represent the situation in a patient with serious hypotension (due, for example, to haemorrhage), just before ltration pressure dropped to zero
when no further urine could be formed (anuria).
Option 5
20 mmHg. With this capillary pressure, ltration would not occur; without
any flow, capsular pressure would fall to near zero.
Option 1
0 mmHg. Like capillaries, nephrons need a pressure drop along them to
permit flow distally.
C.
D.
E.
Option 3
Active tubular reabsorption. Reabsorption of glucose in the proximal convoluted tubules by a carrier mechanism relies on active reabsorption of sodium ions.
Option 4
Passive tubular reabsorption. Urea, like creatinine, is freely ltered, but,
whereas virtually all the creatinine remains in the tubular lumen, about half the ltered
urea passively diffuses back into the renal capillaries.
Option 4
Passive tubular reabsorption. Water follows absorbed solutes, particularly
sodium and chloride ions, passively by osmosis, as they are reabsorbed into the capillaries.
Option 1
Active tubular secretion. An active pump exchanges absorbed sodium for
secreted potassium and hydrogen ions.
Option 5
Glomerular ltration. The ideal substance for measuring glomerular ltration rate is freely ltered and neither absorbed from nor secreted into the tubules in any
way; inulin and creatinine are close to the ideal.
189
EMQ
For each of the hormonal actions AE related to the kidney, select the most appropriate option
from the following list of hormones.
1. Aldosterone.
2. Antidiuretic hormone.
3. Cortisol.
4. Glucagon.
5. Insulin.
6. Parathormone.
7. Renin.
8. Erythropoietin.
A. An action that prevents glucose being lost in the urine of healthy people.
B. An action that decreases the renal clearance of sodium and thereby increases the extracellular volume.
C. An action that promotes the formation of angiotensin I.
D. An action that lowers extracellular phosphate by increasing the renal clearance of phosphate.
E. An action that tends to lower both intracellular and extracellular osmolality.
190
EMQ
B.
C.
D.
E.
Option 5
Insulin. Insulin, by favouring rapid entry of absorbed glucose into cells for
conversion to glycogen, normally keeps the blood glucose level below the renal threshold
for glucose excretion.
Option 1
Aldosterone. This hormone favours reabsorption of ltered sodium, thereby
decreasing its clearance. The reabsorbed sodium is accompanied by chloride (following the
electrical gradient) and water (following the osmotic gradient); all these are distributed
mainly extracellularly, adding to the extracellular volume.
Option 7
Renin. This hormone acts on the circulating precursor, angiotensinogen to
form angiotensin I.
Option 6
Parathormone. This hormone stimulates the release of calcium and phosphate from bone; it also increases phosphate clearance by decreasing the reabsorption of
ltered phosphate from the tubules.
Option 2
Antidiuretic hormone. This hormone increases reabsorption of water from
the collecting ducts; as water enters the extracellular fluid its osmolality decreases; the
higher intracellular osmolality draws over half this water into cells, restoring osmotic
equality of the intra- and extracellular fluids.
B.
C.
D.
E.
Option 6
Impaired consciousness. Drowsiness and coma are related to a variety of disturbances; dialysis reduces toxins by creating a gradient for passive diffusion, it can also
correct electrolyte and acidbase disturbances.
Option 3
Abnormal cardiac rhythms. Although these too are related to a variety of
disturbances, a very high extracellular/plasma potassium level is the major cause.
Option 2
Abnormal arterial blood pressure. The pressure may be too high or too low;
in both cases it may be corrected by increasing or decreasing extracellular and hence
blood volume; this may be done by sucking fluid out of the patients blood by a raised
dialysate osmolality or by lowering the dialysing equipment (or drainage bag with peritoneal dialysis) to remove fluid by gravity.
Option 4
Hyperventilation. Hyperventilation is a sign of serious acidosis, so the pH of
the dialysate fluid should be increased.
Option 1
Raised blood urea. A raised urea raises total osmolality; as an extreme
example, a rise of 30 mmol per litre would increase the normal osmolality (around
290 mosmol/kg) by just over 10 per cent; having the dialysate fluid free of urea allows a
gradient for diffusion out of the patients blood.
B.
C.
D.
E.
Option 4
Thick limb of loop of Henle. This is where salt is actively pumped from the
tubular lumen, without water following, so the tubular fluid becomes markedly hypotonic;
in the absence of anti-diuretic hormone the fluid remains hypotonic as it enters the renal
pelvis to become urine.
Option 7
Middle medullary interstitial fluid. The medullary interstitium shows a gradient
normal osmolality to severe hyperosmolality across the medulla from renal cortex to pelvis.
Option 8
Inner medullary interstitial fluid. This is the last region the collecting ducts traverse, so if they are in a state of permeability to water due to the presence of antidiuretic hormone most of the water is drawn out of the duct lumen and the urine is very concentrated.
Option 1
Proximal convoluted tubule. In both gut and kidney the two key body
requirements, glucose and sodium, are avidly absorbed/reabsorbed into the body.
Option 1
Proximal convoluted tubule. The major buffer, bicarbonate, is also conserved
at this stage, by a fairly complex process involving active secretion of hydrogen ions into
the lumen; the quotation marks are used because the bicarbonate entering the renal capillaries has been generated in the tubule cells; the secreted hydrogen ions join with the ltered bicarbonate to generate water and carbon dioxide molecules which are lost in the
crowd.
191
EMQ
For each nding AE related to renal transplantation, where both donor and recipient are
adult, select the most appropriate variable related to that nding from the following list.
1. Glomerular ltration rate.
2. Renal plasma flow.
3. Brainstem death.
4. Persistent vegetative state.
5. Tissue compatibility.
6. Coma due to drug overdose.
7. Immunological rejection.
8. Erythropoietin.
9. Renin.
10. Aldosterone.
A. Prior to removal of the donor kidney, it had been established that the unconscious, articially ventilated donor had persistently absent corneal and pupillary reflexes, there
was no eye movement response to ice cold water in the external auditory meatus, nor
was there any ventilatory response to carbon dioxide when the donor was temporarily
disconnected from the ventilator.
B. A careful comparison of recipient and donor showed that their cells share an encouraging number of common antigens.
C. A month after transplantation the creatinine clearance is reported to be 85 ml/minute,
which is regarded as satisfactory.
D. On the same occasion the para-aminohippurate clearance is reported to be
55 ml/minute, which does not seem compatible with the result reported in (C).
E. On a later occasion the patient is found to have a blood haemoglobin level of
143 g/litre, whereas prior to renal transplantation and while maintained satisfactorily on
dialysis, the level was usually around 110 g/litre.
192
EMQ
B.
C.
D.
E.
Option 3
Brainstem death. The reflex responses mentioned are all mediated through
the brainstem and their persistent absence suggests death of the brain stem and hence of
the brain since the brain stem is the least sensitive part of the brain; brainstem function
is retained in the persistent vegetative state. Drug-induced coma is potentially reversible
and organ donation is thus not considered.
Option 5
Tissue compatibility. Tissue typing is analogous to but involves more factors
than determining blood group; shared antigens reduce the risk of transplant rejection.
Option 1
Glomerular ltration rate. Creatinine is freely ltered but not appreciably
reabsorbed or secreted, so its clearance is a practical indicator of glomerular ltration rate.
This result, over half the value for two normal kidneys, will provide excellent renal function. The value tends to rise in the weeks after transplantation, as the disturbances associated with the upheaval of transplantation settle down. In addition, the kidney tends to
hypertrophy, as would happen in someone who had one kidney removed with the other
one normal.
Option 2
Renal plasma flow. Para-aminohippurate is normally completely eliminated
from the circulation as it passes through the kidney, so indicates the renal plasma flow.
With a normal haematocrit, the result would indicate a renal blood flow of 100 ml/minute,
less than 10 per cent of normal and inconsistent with the above good creatinine clearance.
Option 8
Erythropoietin. Dialysis can correct many disturbances of renal failure, but
the lack of erythropoietin means the patient is subject to anaemia; the transplanted kidney
provides adequate erythropoietin for a normal haemoglobin level.
B.
C.
D.
E.
Option 4
Active exchange of sodium for hydrogen ions. Stimulation of this pump to
retain sodium also favours secretion of hydrogen ions, making the alkalosis worse. In
addition, such patients are usually also short of potassium (lost with the vomited fluid)
and this is made worse since potassium and hydrogen ions compete for the exchange. This
condition is hypokalaemic alkalosis and the cure is to give intravenous sodium plus a safe
supplement of potassium.
Option 6
Active sodium reabsorption. As well as the above exchange, sodium absorption can be balanced electrically by chloride absorption; water follows by osmosis to
restore the extracellular fluid volume.
Option 7
Active chloride reabsorption. It has been shown that the loop of Henle
actively reabsorbs chloride, which is balanced electrically by sodium (reverse of above);
in this case water cannot follow, so the lumen becomes hypotonic and the interstitium
hypertonic.
Option 3
Erythropoietin. Active tubular cells become hypoxic when perfused with
anaemic blood; this leads to synthesis of erythropoietin which stimulates the red bone
marrow.
Option 8
Water channels. Antidiuretic hormone induces these, so that the hypertonic
renal medullary interstitium can osmotically draw water out of the collecting ducts, leaving a small volume of concentrated fluid to pass to the bladder.
ENDOCRINE SYSTEM
193
MCQs
A hormone is half the time taken for it to disappear from the blood.
Insulin is between ve and ten hours.
Thyroxine is longer than that of adrenaline.
Thyroxine is longer than that of triiodothyronine.
Noradrenaline is longer than that of acetylcholine.
Cortisol.
Insulin.
Adrenaline.
Antidiuretic hormone.
Growth hormone.
448. Melatonin
A.
B.
C.
D.
E.
449. Thyroid hormones, when secreted in excess, may cause an increase in the
A.
B.
C.
D.
E.
Peripheral resistance.
Frequency of defaecation.
Energy expenditure required for a given workload.
Duration of tendon reflexes.
Heart rate when cardiac adrenergic and cholinergic receptors are blocked.
Volume.
Osmolality.
Potassium concentration.
Renin concentration.
ACTH concentration.
MCQ
Questions 445450
194
MCQ
Answers
445.
A.
B.
False
False
C.
D.
E.
True
True
True
446.
A.
B.
C.
D.
E.
True
True
True
False
False
447.
A.
True
B.
C.
D.
E.
False
True
True
True
The median eminence secretes corticotropin-releasing hormone (CRH), the releasing hormone for ACTH.
Aldosterone secretion is regulated mainly by the renin/angiotensin system.
This negative feedback helps to maintain the blood cortisol level.
This is part of the circadian rhythm which produces high morning cortisol levels.
Most forms of stress increase ACTH output by their neural input to the median
eminence of the hypothalamus where CRH is formed.
448.
A.
False
B.
C.
D.
True
False
True
E.
True
449.
A.
B.
C.
False
True
True
D.
E.
False
True
450.
A.
B.
C.
D.
E.
False
False
True
True
True
195
Questions 451456
A.
B.
C.
D.
E.
454. Parathormone
A.
B.
C.
D.
E.
MCQ
196
MCQ
Answers
451.
A.
B.
False
False
C.
D.
E.
False
True
True
452.
A.
B.
C.
D.
E.
False
False
True
False
False
Both act on alpha receptors but noradrenaline is the more potent stimulant.
Both act on beta receptors but adrenaline is the more potent stimulant.
Noradrenaline raises but adrenaline reduces it.
Adrenaline raises but noradrenaline reflexly reduces it.
Both constrict skin vessels due to their alpha receptor stimulant properties.
453.
A.
B.
True
True
C.
D.
E.
False
True
True
It is an anabolic hormone.
Secretion in the pituitary is stimulated by growth hormone releasing factor and
inhibited by somatostatin from the hypothalamus.
Blood levels are similar in children and adults.
Sleep is a time for anabolic activity.
Somatomedins (insulin-like growth factors, IGF) from the liver inhibit the pituitary secretion of growth hormone and stimulate release of somatostatin from the
hypothalamus.
454.
A.
B.
C.
False
True
False
D.
E.
False
True
It is regulated directly by the calcium level in the blood that perfuses it.
It stimulates osteoclasts to resorb bone; excessive secretion causes cysts to form.
The high blood calcium levels with parathormone and the resulting increase in
calcium ltration in the glomeruli result in an increased calcium output in urine.
It increases phosphate excretion by reducing renal phosphate reabsorption.
It does this indirectly by stimulating 1,25-dihydroxycholecalciferol production.
455.
A.
True
B.
C.
D.
False
False
False
E.
True
It is formed in neurones whose cell bodies lie in the hypothalamus and whose
axons transport it to the posterior pituitary gland.
The water retention it induces makes plasma osmolality fall.
It increases the permeability of the collecting ducts.
Secretion is affected by 1 per cent changes in osmolality; the sensitivity of the
hypothalamic receptors to osmolar change accounts for the constancy of plasma
osmolality.
Volume changes detected by vascular low-pressure receptors affect ADH secretion.
456.
A.
B.
C.
D.
False
True
True
False
E.
True
197
Questions 457462
A.
B.
C.
D.
E.
458. Cortisol
A.
B.
C.
D.
E.
MCQ
198
MCQ
Answers
457.
A.
B.
C.
D.
E.
True
False
True
True
False
458.
A.
True
B.
False
C.
D.
E.
True
True
True
459.
A.
B.
C.
D.
E.
True
False
True
True
False
460.
A.
B.
True
False
C.
True
D.
E.
True
False
461.
A.
B.
C.
True
True
True
D.
E.
False
True
462.
A.
B.
C.
D.
E.
True
True
False
False
True
199
Questions 463468
A.
B.
C.
D.
E.
465. Thyrocalcitonin
A.
B.
C.
D.
E.
MCQ
463. Insulin
200
MCQ
Answers
463.
A.
B.
C.
D.
E.
False
False
True
True
True
464.
A.
B.
False
True
C.
False
D.
E.
True
True
465.
A.
False
B.
C.
D.
E.
False
True
False
False
466.
A.
B.
C.
True
False
False
D.
E.
True
True
467.
A.
B.
C.
D.
E.
True
True
False
True
False
468.
A.
B.
C.
D.
E.
False
True
True
True
True
201
Questions 469475
A.
B.
C.
D.
E.
470. Prolactin
A.
B.
C.
D.
E.
472. Thyroxine
A.
B.
C.
D.
E.
473. Parathormone
A.
B.
C.
D.
E.
Include cholesterol.
Are mostly bound to plasma proteins.
Include sex hormones.
Are excreted mainly in the bile after conjugation.
Are essential for the maintenance of life.
MCQ
469. Vitamin D
202
MCQ
Answers
469.
A.
B.
C.
D.
True
True
True
False
E.
True
False
False
True
True
False
False
True
True
False
True
470.
A.
B.
C.
D.
E.
471.
A.
B.
C.
D.
E.
472.
A.
B.
C.
D.
E.
False
True
True
True
False
473.
A.
B.
C.
D.
E.
False
True
False
True
True
474.
A.
B.
C.
D.
E.
False
False
False
True
True
475.
A.
B.
C.
D.
E.
False
True
True
False
True
203
Questions 476482
A.
B.
C.
D.
E.
482. When a patient with diabetes insipidus is treated successfully with antidiuretic hormone the
A.
B.
C.
D.
E.
MCQ
204
MCQ
Answers
476.
A.
B.
C.
D.
E.
False
False
False
True
False
477.
A.
B.
C.
D.
E.
False
False
True
True
True
478.
A.
B.
C.
True
False
True
D.
E.
False
False
479.
A.
B.
C.
D.
E.
False
False
False
True
True
480.
A.
B.
C.
D.
E.
True
True
False
False
False
True
True
False
True
True
481.
A.
B.
C.
D.
E.
482.
A.
B.
C.
False
False
False
D.
E.
False
True
205
Questions 483489
A.
B.
C.
D.
E.
Chronic malnutrition.
Castration.
Premature puberty.
Thyroid deciency.
Adrenal deciency.
487. Insulin
A.
B.
C.
D.
E.
Amenorrhoea.
Diabetes insipidus.
Skin pallor.
Impaired ability to survive severe stress.
A fall in basal metabolic rate (BMR).
MCQ
206
MCQ
Answers
483.
A.
B.
C.
D.
E.
True
True
True
False
False
484.
A.
B.
C.
D.
E.
False
False
True
True
False
485.
A.
B.
C.
D.
E.
True
True
True
False
True
486.
A.
B.
C.
D.
E.
True
False
True
True
True
487.
A.
B.
C.
D.
E.
False
False
True
True
False
488.
A.
B.
C.
D.
E.
True
False
False
False
False
489.
A.
B.
C.
D.
True
False
True
True
E.
True
207
Questions 490496
A.
B.
C.
D.
E.
Skin thickness.
Bone strength.
Blood glucose.
Arterial pressure.
The rate of wound healing.
A homonymous hemianopia.
Giantism.
Reduced levels of somatomedins in blood.
Enlargement of the liver.
A raised blood glucose level.
Ketones.
Glycogen.
Glucose.
Fat.
Amino acids.
MCQ
208
MCQ
Answers
490.
A.
B.
C.
D.
E.
True
True
False
True
False
False
False
True
True
True
491.
A.
B.
C.
D.
E.
492.
A.
B.
C.
D.
E.
False
False
True
True
False
493.
A.
False
B.
C.
D.
E.
False
False
True
True
Damage to the crossing nasal retinal bres in the optic chiasma leads to bitemporal hemianopia.
After puberty when the epiphyses have closed, excess GH causes acromegaly.
GH leads to increased production of somatomedins in the liver.
Body organs as well as the peripheries increase in size in acromegaly.
Growth hormone has diabetogenic effects.
494.
A.
B.
True
False
C.
D.
True
True
E.
False
Blood glucose can drop more rapidly than diabetic ketosis can develop.
The pulse is usually strong in hypoglycaemic coma but weak in hyperglycaemic
coma because of fluid depletion.
Hypoglycaemia does not affect the pH.
However, glucose may be present if urine containing glucose entered the bladder
before the onset of hypoglycaemia.
Usually acetone is absent in hypoglycaemic coma.
495.
A.
B.
C.
D.
True
False
True
True
E.
False
Due to salt and water loss from lack of gluco- and mineralocorticoids.
The haemoglobin level rises due to haemoconcentration.
It falls since loss of aldosterone leads to potassium retention.
Low blood volume may lead to hypotension and hypovolaemic circulatory failure.
It tends to rise due to the oliguria associated with the hypotension.
496.
A.
B.
C.
D.
E.
False
False
True
False
False
209
Questions 497501
A.
B.
C.
D.
E.
Intragastric fluids.
Intravenous insulin.
Isotonic glucose.
Isotonic sodium chloride.
Oxygen by breathing mask if hyperventilation is present.
C. Diabetes mellitus shows a delayed return to the fasting blood glucose level.
D. An insulin-secreting tumour shows no rise in blood glucose level during the test.
E. Malabsorption syndrome shows a lower than normal peak level for blood glucose.
Plasma osmolality.
Menstrual frequency.
Axillary hair.
Sexual desire (libido).
Breast size.
MCQ
210
MCQ
Answers
497.
A.
B.
C.
D.
False
True
True
True
E.
False
Vomiting is likely so intravenous fluids are needed to correct the fluid decit.
Insulin is needed to reverse the derangement of metabolism.
A water decit is remedied by intravenous isotonic glucose.
This remedies the extracellular fluid decit; the pH disturbance is corrected by
restoring normal metabolism and fluid balance.
The hyperventilation is due to acidosis, not oxygen lack.
498.
A.
False
B.
C.
D.
E.
False
True
False
False
499.
A.
True
B.
C.
D.
E.
False
False
False
False
Phosphate retention results in a fall in the ionized calcium level in blood; this
stimulates the parathyroid to produce more parathormone (secondary hyperparathyroidism).
The increased level of ionized calcium in blood depresses parathyroid activity.
Pituitary hormones are not involved in the regulation of parathyroid activity.
This raises ionized calcium levels and depresses parathyroid activity.
This decreases the total blood calcium but not the ionized calcium level that regulates parathormone secretion.
500.
A.
B.
C.
D.
True
True
True
False
E.
True
The level is higher due to impaired glucose homeostasis even in the fasting state.
The renal threshold for glucose is about twice the normal fasting level.
Due to impaired insulin response to the glucose stimulus.
Blood glucose rises but then falls to a low level due to excessive insulin secretion.
The curve is flattened due to impaired glucose absorption.
501.
A.
B.
C.
D.
E.
False
True
True
True
True
ENDOCRINE SYSTEM
211
EMQs
EMQ
Questions 502512
212
EMQ
B.
C.
D.
E.
Option 3
Increased urinary phosphate excretion. Parathormone liberates both calcium
and phosphate ions from bone and in order not to exceed the solubility product for these
ions it is necessary to excrete the excess phosphate. Parathormone favours this by inhibiting reabsorption of ltered phosphate. It thereby tends to raise the solubility product for
these ions in urine, favouring development of renal calculi.
Option 7
Hydroxylation of cholecalciferol. Cholecalciferol is ingested or synthesized in
the skin under the influence of sunlight. To become an active hormone promoting absorption of calcium from the gut it must be converted into 1:25 dihydroxycholecalciferol. The
rst hydroxylation takes place in the liver.
Option 1
Increased blood calcium. Parathormone stimulates osteoclasts to erode bone,
thereby releasing calcium and phosphate. This raises the blood calcium level; the phosphate is excreted as discussed above.
Option 7
Hydroxylation of cholecalciferol. The second hydroxylation necessary for
activating vitamin D (cholecalciferol) takes place in the kidney under the influence of
parathormone. Both hydroxylations (liver and kidney) are necessary before vitamin D can
regulate total body calcium (mainly in bones) by stimulating its active absorption in the
upper small intestine.
Option 6
Decreased alimentary absorption of calcium. When vitamin D is decient
(dietary plus lack of adequate sunlight) the substrate for hydroxylation and activation is
not available and absorption of calcium is decient so that there is inadequate calcium
for normal bone mineralization.
C.
D.
E.
Option 4
Stimulates melanin formation in melanocytes. Melanocyte-stimulating hormone results in a darker pigmentation of the skin.
Option 2
Polypeptide growth factors secreted by the liver. Their production is stimulated by the action of growth hormone on hepatic cells. Somatomedins interact with
growth hormone and affect growth, cartilage and protein metabolism.
Option 1
Causes milk ejection in the lactating breast. It is also important in causing
the uterus to contract at parturition.
Option 5
Promotes water retention in the kidney. Also known as antidiuretic hormone,
vasopressin affects the permeability of certain parts of the renal tubule to allow greater
reabsorption of water ltered in the glomerulus.
Option 3
Stimulates sperm formation in the male. In the female, LH stimulates ovulation and luteinization of the corpus luteum.
C.
D.
E.
Option 4
Thyroid deciency in children. Such children are dwarfed, mentally retarded
and pot bellied. Early treatment is urgent to prevent permanent mental retardation.
Option 2
Adrenal cortical overactivity in children. The adrenal cortex can manufacture the sex hormones needed to initiate and maintain the secondary sexual characteristics of puberty. Disordered hypothalamic or pituitary function can also cause precocious
puberty.
Option 1
Non-dysjunction of chromosome 21. The non-disjunction of chromosome 21
during meiosis usually occurs in the ovary and increases in frequency with the age of the
mother. Both of the chromosomes go to one of the daughter cells during meiosis.
Option 5
An XO chromosomal pattern. In this condition (Turners syndrome), the
zygote does not receive a sex chromosome from one of the parents. The gonads are rudimentary or absent and the child develops female external genitalia. There is small stature
and sexual maturation does not occur at puberty.
Option 3
Pituitary deciency. There are several causes of dwarsm but one of the
causes is a hypothalamic or pituitary disorder that diminishes the secretion of growth hormone.
213
EMQ
For each substance AE, select the best option for its functional description from the following list.
1. A mineralocorticoid.
2. An androgen.
3. An alpha globulin that binds with
4. A glucocorticoid.
cortisol.
5. Causes breast development.
A. Corticosterone.
B. Progesterone.
C. Aldosterone.
D. Transcortin.
E. Dihydroepiandrosterone.
214
EMQ
E.
Option 4
A glucocorticoid. Glucocorticoids promote protein catabolism, glucogenesis and gluconeogenesis.
Option 5
Causes breast development. Progesterone can be manufactured from pregnenolone in the adrenal cortex.
Option 1
A mineralocorticoid. Aldosterone promotes fluid retention by facilitating
sodium retention by the renal tubules.
Option 3
An alpha globulin that binds with cortisol. Most circulating cortisol is bound
to transcortin and is inactive. Cortisol is freed and becomes physiologically active when
free cortisol levels fall.
Option 2
An androgen. This can cause virilization in female patients with adrenocortical tumours.
B.
C.
D.
E.
Option 5
A glycoprotein stored in colloid in thyroid gland follicles. Thyroglobulin is
manufactured in the thyroid follicular cells and is secreted by exocytosis of granules into
the colloid for storage. The hormones remain bound to the colloid until they are secreted
into blood capillaries.
Option 1
The most active form of the thyroid hormones. T4, which contains four iodine
molecules, is less physiologically active than T3.
Option 4
A pituitary gland hormone that stimulates the thyroid gland. TSH secretion
from the anterior pituitary gland is controlled by the hypothalamic hormone, thyrotropinreleasing hormone (TRF).
Option 2
A disease caused by thyroxine deciency in adults. A disease characterized
by low basal metabolic rate, coarse hair and skin, poor cold tolerance and mental slowness.
Option 3
Protrusion of the eyeballs seen in patients with thyroid overactivity. Due to
swelling of the external ocular muscles and other orbital tissues.
B.
C.
D.
E.
Option 4
Results in impaired calcication of bone in children. Rickets is due to lack
of vitamin D in children. Poor calcium absorption in the gut results in bones with low
mineral content that are easily deformed.
Option 2
Results in bone formation. Osteoblasts are bone-forming cells that can lay
down collagen and other proteins for the bone matrix.
Option 1
Results in decalcication of bone in adults. Osteomalacia is due to lack of
Vitamin D in adults, usually childbearing women. It results in demineralization and deformation of the bones. When this affects pelvic bones, it may interfere with normal parturition.
Option 3
Results in breakdown of bone matrix. Osteoporosis is caused by loss of bony
matrix and the resulting bone weakness permits easy bone fracture to occur, especially in
the elderly.
Option 5
Results in inhibition of bone resorption. Calcitonin is a hormone secreted by
the parafollicular cells of the thyroid gland. It lowers the blood calcium level by inhibiting bone resorption.
215
EMQ
For each effect related to glucose metabolism AE, select the best option for a possible cause
from the following list.
1. Hypoglycaemia.
2. Metabolic acidosis.
3. Insulin deciency.
4. Insulin.
5. Somatostatin.
A. Inhibition of insulin secretion.
B. Increased potassium uptake by muscle.
C. Negative nitrogen balance.
D. Increased secretion of glucagon.
E. Increased ventilation (Kussmaul breathing).
216
EMQ
C.
D.
E.
Option 5
Somatostatin. This is one of the effects of somatostatin secreted by the D
cells of the islets of Langerhans.
Option 4
Insulin. Insulin increases both potassium and glucose uptake by muscle
cells. Injections of glucose and insulin are sometimes given to lower potassium levels in
blood when they are dangerously high.
Option 3
Insulin deciency. This results from the increased breakdown of protein for
gluconeogenesis in insulin deciency.
Option 1
Hypoglycaemia. Glucagon acts to raise blood glucose by glycogenolysis and
gluconeogenesis.
Option 2
Metabolic acidosis. The increase in ventilation with Kussmaul breathing
results from stimulation of the respiratory system by the hydrogen ions liberated from
keto-acids formed in severe diabetes.
B.
C.
D.
E.
Option 3
Stones in the urinary tract. Excessive parathormone secretion in hyperparathyroidism mobilizes calcium from bone. This calcium is excreted by the kidneys.
Phosphate is also mobilized from the bones in hyperparathyroidism and excreted in the
urine. When the calcium phosphate solubility product is exceeded, precipitation of calcium phosphate occurs and results in the formation of stones.
Option 4
Tachycardia, sweating and heat intolerance. The high metabolic rate in
hyperthyroidism results in increased heat production and this is associated with tachycardia, sweating and heat intolerance.
Option 2
Thirst, polyuria, obesity and tiredness. The high blood glucose level in diabetes cause polyuria and consequential thirst. Obesity increases the tendency to develop
type 2 diabetes.
Option 1
Periodic episodes of severe hypertension. Tumours in the adrenal medulla
called phaeochromocytomas that release noradrenaline and adrenaline periodically can
cause this.
Option 5
Enlargement of the hands and feet and protrusion of the lower jaw. Excessive
growth hormone production in the adult after the epiphyses have closed results in thickening and enlargement of bones rather than their lengthening.
D.
E.
Option 2
Polycythaemia. Erythropoietin acts on bone marrow cells to increase the
production of erythrocytes.
Option 4
Amenorrhoea. This is due to loss of FSH and LH secretions that are responsible for maintaining the menstrual cycle.
Option 1
Hypertension. Renin from the kidneys causes hypertension by converting
angiotensinogen to angiotensin I that is subsequently converted to angiotensin II that
results in salt and water retention by the kidneys and an increase in peripheral resistance.
Option 3
Increased water and salt excretion. ANP is produced by atrial cells when they
are stretched and causes increased loss of sodium and water by an action on the renal
tubules.
Option 5
Increased skin pigmentation. One of the features of Addisons disease caused
by loss of adrenal function is a bronze pigmentation of the skin. ACTH which is secreted
in large amounts when adrenal cortical function is depressed, has some melanocytestimulating hormone (MSH) effect and this accounts for the skin pigmentation in
Addisons disease.
217
EMQ
For each hormonal disturbance AE, select the best option from the following list of effects.
1. Poor wound healing, thin skin and
2. Raised arterial pressure, slow heart rate and
muscle wasting.
raised peripheral resistance.
3. Glycogenolysis, gluconeogenesis
4. Increased glycogen synthesis, potassium
and lipolysis.
uptake, triglyceride deposition and
5. Excessive thirst and urinary output.
hypoglycaemia.
A. Excessive secretion of glucagon.
B. Insufcient secretion of vasopressin.
C. Excessive secretion of glucocorticoids.
D. Excessive secretion of noradrenaline.
E. Excessive secretion of insulin.
218
EMQ
C.
D.
E.
Option 3
Glycogenolysis, gluconeogenesis and lipolysis. These are some of the mechanisms by which glucagon raises the blood glucose level.
Option 5
Excessive thirst and urinary output. Lack of vasopressin (ADH) secretion
causes diabetes insipidus. In this condition there is reduced water reabsorption in the renal
tubules and a consequential loss of body fluid that leads to thirst.
Option 1
Poor wound healing, thin skin and muscle wasting. Glucocorticoids promote
gluconeogenesis by the breakdown of protein in skin and muscle to form glucose.
Option 2
Raised arterial pressure, slow heart rate and raised peripheral resistance.
Noradrenaline constricts arterioles to raise arterial pressure and a consequential reflex
slowing of the heart.
Option 4
Increased glycogen synthesis, potassium uptake, triglyceride deposition and
hypoglycaemia. These are some of the actions of insulin that lowers the blood sugar level.
Answers to 512
A.
B.
C.
D.
E.
Option 2
An effect on adrenal cortical activity. CRH from the hypothalamus stimulates
the anterior pituitary gland to produce ACTH.
Option 1
An effect on somatomedin levels in the blood. GRH stimulates the anterior
pituitary gland to secrete GH (growth hormone), which in turn promotes somatomedin
synthesis in the liver.
Option 3
An effect on lactation. PIH is involved in prolactin secretion from the anterior pituitary gland. Reduction of PIH secretion seems to be the main factor in controlling
prolactin secretion. Prolactin stimulates milk formation in the breasts.
Option 5
An effect on TSH secretion. TRH (thyrotropin-releasing hormone) stimulates
the anterior pituitary gland to secrete TSH (thyroid-stimulating hormone) that in turn
increases activity in the thyroid gland.
Option 4
An effect on spermatogenesis. LHRH (luteinizing hormone-releasing hormone) stimulates the anterior pituitary gland to secrete LH (luteinizing hormone) that in
the male promotes spermatogenesis.
REPRODUCTIVE SYSTEM
219
MCQs
Contain 23 chromosomes.
Have enzymes in their heads which aid penetration of the ovum.
Are produced faster at 37 than at 32oC.
Are motile in the seminiferous tubules.
Are stored mainly in the seminal vesicles.
Is a steroid.
Acts directly on the uterus to maintain the endometrium.
Is formed in the anterior pituitary
Blood level rises steadily throughout pregnancy.
Can be detected in the urine as an early sign of pregnancy.
519. Compared with the adult, the newborn has less ability to
A.
B.
C.
D.
E.
Excrete bilirubin.
Maintain a constant body temperature.
Tolerate brain hypoxia.
Manufacture antibodies.
Resist infection.
MCQ
Questions 513519
220
MCQ
Answers
513.
A.
B.
C.
D.
E.
False
True
True
False
True
A.
B.
C.
D.
False
True
False
True
E.
True
514.
515.
A.
B.
C.
D.
E.
True
True
False
False
False
False
True
True
True
False
True
True
False
False
True
False
False
False
False
True
True
True
False
True
False
516.
A.
B.
C.
D.
E.
517.
A.
B.
C.
D.
E.
518.
A.
B.
C.
D.
E.
519.
A.
B.
C.
D.
E.
221
Questions 520526
A.
B.
C.
D.
E.
Secretion of testosterone.
Secretion of luteinizing hormone.
Secretion of follicle-stimulating hormone.
A testicular temperature of 37oC.
A sperm count of more than 1010/ml.
526. The male postpubertal state differs from the prepubertal in that
A.
B.
C.
D.
E.
MCQ
222
MCQ
Answers
520.
A.
B.
C.
D.
False
True
True
True
E.
True
False
False
False
False
True
The enlargement is due more to an increase in the size of the muscle cells.
Spontaneous uterine contractions occur during pregnancy.
The enlargement is due mainly to oestrogen and progesterone.
It falls due to the increase in plasma volume.
It increases by about one-third.
521.
A.
B.
C.
D.
E.
522.
A.
B.
C.
D.
E.
False
True
True
False
False
523.
A.
B.
C.
D.
E.
False
False
False
False
True
524.
A.
B.
C.
D.
E.
True
True
True
False
False
525.
A.
False
B.
C.
True
True
D.
E.
True
True
These depress milk formation during pregnancy; prolactin stimulates milk formation.
By release of prolactin-inhibiting hormone (dopamine).
This causes prolactin secretion which initiates and maintains lactation after delivery.
Milk formation ceases due to loss of prolactin.
Due to loss of oxytocin in response to suckling.
526.
A.
B.
C.
D.
E.
False
True
True
True
True
223
Questions 527532
A.
B.
C.
D.
E.
MCQ
224
MCQ
Answers
527.
A.
B.
C.
D.
E.
False
False
True
False
True
528.
A.
B.
C.
D.
E.
False
False
False
True
True
529.
A.
True
B.
C.
False
False
D.
True
E.
True
Due to deoxygenated pulmonary arterial blood passing through the ductus arteriosus to the descending aorta.
The IVC receives oxygenated blood from the placenta.
Deoxygenated SVC blood streams to the right ventricle while oxygenated IVC
blood streams via the foramen ovale to the left ventricle.
Since the lungs are not ventilated, oxygen is lost rather than gained in its passage through the fetal lungs.
Umbilical venous blood is only about 80 per cent saturated with oxygen and fetal
arterial oxygen levels cannot exceed this; fetal tissues are adapted to survive in
relative hypoxia.
530.
A.
B.
C.
D.
E.
False
False
False
False
False
A.
B.
C.
D.
False
False
True
True
E.
False
531.
532.
A.
B.
C.
D.
E.
True
True
True
True
True
225
Questions 533539
A.
B.
C.
D.
E.
539. The 21st day of the menstrual cycle differs from the seventh in that the
A.
B.
C.
D.
E.
MCQ
226
MCQ
Answers
533.
A.
B.
C.
D.
E.
True
True
False
False
True
534.
A.
B.
C.
D.
E.
True
True
False
False
False
535.
A.
B.
C.
False
False
False
D.
E.
False
True
536.
A.
B.
C.
D.
E.
True
True
True
False
True
537.
A.
B.
C.
D.
E.
False
True
False
True
False
The immature ova are formed before birth and no more are developed after birth.
Because of their secretion of oestrogen and progesterone.
Identical twins are derived from a single ovum.
Follicles disappear and are replaced by brous tissue.
Withdrawal of ovarian hormones leads to vasoconstriction.
538.
A.
B.
C.
False
False
True
D.
E.
True
True
539.
A.
B.
C.
D.
E.
True
True
False
False
True
227
Questions 540546
A.
B.
C.
D.
E.
Nitrogen retention.
Mean arterial pressure of around 20 mmHg.
Arterial PCO2.
Tone in the urinary tract
The renal threshold for glucose.
Gains more weight in the last ten weeks of gestation than in the rst 30 weeks.
Has a higher haemoglobin level at term than a normal adult.
Stores sufcient iron in the liver to last a year after birth.
Has a similar metabolic rate per metre2 as an adult.
Passes rectal contents in the last three months of gestation.
Psychological stress.
Severe weight loss.
Continuous administration of oestrogens.
An adrenal tumour.
Continuous administration of gonadotropin-releasing hormone (GnRH).
MCQ
540. The newborn baby differs from the adult in that its
228
MCQ
Answers
540.
A.
B.
C.
D.
E.
True
False
False
False
True
A.
True
B.
C.
D.
E.
False
False
False
False
About 300 g nitrogen is retained, half by maternal tissues and half by fetal tissues.
Blood pressure tends to fall, such a rise suggests disease.
It tends to fall due to increased ventilation.
Tone decreases and may lead to ureteric reflux and urinary infections.
It falls, and glucose may appear in urine at normal blood glucose levels.
541.
542.
A.
B.
C.
D.
E.
True
False
True
True
True
543.
A.
B.
C.
D.
E.
True
True
True
True
False
544.
A.
B.
C.
D.
E.
True
True
False
False
False
545.
A.
B.
C.
D.
True
True
True
True
E.
True
546.
A.
B.
C.
D.
E.
True
True
True
True
True
229
Questions 547552
A. Blood in umbilical veins contains more amino acid than maternal blood in uterine
B.
C.
D.
E.
veins.
Aorta has a higher rate of blood flow than the distal pulmonary artery.
Aortic blood pressure is lower than pulmonary arterial pressure.
Systemic resistance is higher than its pulmonary resistance.
Heart rate suggests fetal distress if it exceeds 100 beats/minute.
Liver stores sufcient vitamin K for the rst few months of life.
Blood volume is closer to 750 than 250 ml.
Blood glucose level fluctuates more than the fetal level.
Gut usually lacks certain enzymes needed for digestion of milk.
Peripheral vascular resistance is higher than that of the adult.
MCQ
230
MCQ
Answers
547.
A.
B.
C.
D.
True
True
True
False
E.
False
Amino acids are actively transported from maternal to fetal blood in the placenta.
Due to high flow through the ductus arteriosus to the aorta.
Blood flows from the pulmonary artery to the distal aorta.
Distal aortic flow is greater than distal pulmonary artery flow and the pressure is
lower (resistancepressure/flow).
It is normally about 140/minute; below 100 suggests distress.
548.
A.
B.
C.
D.
False
True
False
False
E.
False
549.
A.
B.
C.
D.
False
True
False
False
E.
True
550.
A.
B.
C.
D.
E.
False
True
True
True
False
False
False
True
False
True
551.
A.
B.
C.
D.
E.
552.
A.
B.
False
True
C.
D.
E.
False
True
True
231
Questions 553558
A.
B.
C.
D.
E.
Conning intercourse to the period from the 1020th day of the menstrual cycle.
Bilateral ligation and division of the uterine tubes.
Bilateral ligation and division of the vas deferens.
The use of agents which prevent the fertilized ovum from implanting.
Mechanical barriers (condoms and caps) which are the most effective methods.
MCQ
232
MCQ
Answers
553.
A.
B.
C.
D.
E.
False
True
False
True
False
554.
A.
B.
C.
D.
E.
True
True
True
True
False
555.
A.
B.
True
False
C.
D.
E.
False
False
True
556.
A.
B.
C.
D.
E.
False
True
True
True
False
557.
A.
B.
C.
D.
True
False
False
True
E.
False
Even though only one sperm ultimately fuses with the ovum.
Vasopressin and oxytocin are not needed for fertilization.
This would only reduce fertility moderately.
The higher temperature in the abdomen impairs function in the spermatogenic
epithelium.
Male and female causes are about equally common in infertile couples.
558.
A.
B.
True
False
C.
D.
E.
True
False
True
233
Questions 559565
A.
B.
C.
D.
E.
563. Women having their first child after the age of 35 have a greater
A.
B.
C.
D.
E.
565. Pregnant women with five or more previous deliveries have a greater
risk of having
A.
B.
C.
D.
E.
Anaemia.
An unfavourable presentation of the baby in the pelvis.
Complications due to rhesus incompatibility.
Serious loss of blood after delivery.
Involuntary urination while coughing (stress incontinence).
MCQ
234
MCQ
Answers
559.
A.
False
B.
C.
D.
True
False
True
E.
False
560.
A.
B.
C.
D.
E.
False
False
False
True
True
False
True
False
True
False
561.
A.
B.
C.
D.
E.
562.
A.
B.
C.
D.
E.
False
True
True
True
False
563.
A.
B.
C.
D.
E.
True
True
False
True
True
564.
A.
B.
C.
D.
E.
True
True
False
False
True
565.
A.
B.
C.
D.
E.
True
True
True
True
True
235
Questions 566567
A.
B.
C.
D.
E.
Is abnormal.
In large amounts can cause enlargement of the clitoris.
Does not affect the voice.
May lead to growth of facial hair.
May result in amenorrhoea.
Liver function.
Alimentary tract function such as obstruction.
Renal function.
Cerebral function.
Cardiac function.
MCQ
236
MCQ
Answers
566.
A.
B.
C.
D.
E.
False
True
False
True
True
567.
A.
B.
C.
D.
E.
False
False
False
False
True
REPRODUCTIVE SYSTEM
237
EMQs
EMQ
Questions 568576
238
EMQ
B.
C.
D.
E.
Option 2
Total mass of all fetuses. Despite each fetus being small for its age, the total
mass is exceptionally large, exaggerating the likelihood of labour before completion of the
usual nine months of gestation.
Option 6
Assisted reproduction. Insertion of early embryos into the uterus as a means
of treating infertility is a common cause of multiple birth; such embryos are at increased
risk of abortion, so it is usual to insert several.
Option 1
Individual fetal mass. Each fetus of a multiple set is smaller than average at
the time of labour, so is less likely to be hindered by a relatively small birth canal.
Option 3
Fetal prematurity. The more premature the fetus, the less mature is its liver,
and the less able is it to conjugate the bilirubin load after birth; more seriously, it is also
much more likely not to have developed the capacity to produce adequate surfactant to
reduce the otherwise punishing effect of surface tension forces in the newborn lung.
Option 7
Perinatal mortality. This term refers to the risk of death in late pregnancy
and early infancy; it mounts dramatically with the number of fetuses because of the combined effects of placental inadequacy, prematurity, and the problems of dealing with
multiple infants at one delivery.
B.
C.
D.
E.
Option 5
Erection of the penis. Erection depends on relaxation of smooth muscle in
arterioles supplying the erectile tissue of the penis; its failure is described as impotence,
in which condition ejaculation is not possible.
Option 1
Ovulation. The contraceptive pill leads to feedback inhibition of release of
the gonadotrophins follicle-stimulating hormone and luteinizing hormone which control
maturation and release of the ovum.
Option 7
Implantation. The intrauterine device interferes with implantation of the fertilized ovum.
Option 2
Spermatogenesis. This type of garment can raise the testicular temperature
to a level where spermatogenesis is considerably impaired, leading to reduced fertility.
Option 6
Ejaculation. Ejaculation depends on sympathetic nerves for expulsion of
seminal fluid into the urethra, and also for contraction of the bladder neck to prevent retrograde ejaculation into the bladder.
239
EMQ
For each aspect AE of the male and female reproductive systems, select the most appropriate
option from the following list of hormones.
1. Follicle-stimulating hormone.
2. Gonadotrophin-releasing hormone.
3. Inhibin.
4. Luteinizing hormone.
5. Oestradiol.
6. Progesterone.
7. Testosterone.
A. A peptide hormone formed in testes and ovaries which acts as a local growth factor and
also gives negative feedback to the hypothalamicpituitary axis.
B. A steroid hormone formed in the testes which is necessary for normal spermatogenesis.
C. A peptide hormone formed in the hypothalamus which is necessary for normal spermatogenesis.
D. A steroid hormone which accounts for the rise in metabolic rate in the second half of
the menstrual cycle.
E. A peptide hormone which plays a major role in both ovulation and the activity of the
interstitial (Leydig) cells in the testis.
240
EMQ
B.
C.
D.
E.
Option 3
Inhibin. This hormone (like many others) exists in several forms sometimes
referred to as the inhibins; in the testis it is formed by Sertoli cells which nurture spermatozoa, so are a marker for spermatogenesis, completing the feedback loop.
Option 7
Testosterone. Among its widespread effects, testosterone, which is formed by
interstitial cells of the testis, is responsible for spermatogenesis in the seminiferous
tubules.
Option 2
Gonadotrophin-releasing hormone. This key hormone is required for the
release of follicle-stimulating and luteinizing hormones in both sexes, so is responsible for
all sexual activity; control by the hypothalamus allows the complicated control which is
different in the two sexes, so that, while male sexual activity shows no regular fluctuation, female sexual activity follows the monthly cycle, which can be modied by nutritional and psychological factors.
Option 6
Progesterone. As implied by its name, this hormone is particularly associated
with gestation; in the second half of the cycle it stimulates development in the endometrium which favours implantation of a fertilized ovum.
Option 4
Luteinizing hormone. A surge of this hormone is the precursor of ovulation
and it also acts in the testis, giving it the secondary name of interstitial cell-stimulating
hormone; note that, as in the body generally, hormones are either peptide or steroid based;
in the reproductive system the peptides tend to be common to male and female, whereas
the steroids make the difference.
B.
C.
D.
E.
Option 6
Increased metabolic rate. These symptoms are like those of hyperthyroidism;
in both cases the resting metabolic rate is increased; this leads to a parallel increase in
heat production, so a cooler environment is needed for thermoneutrality.
Option 1
Smooth muscle relaxation. The hormones of pregnancy induce smooth
muscle relaxation in many parts of the body; loss of tone in the bladder hinders complete
emptying and favours reflux into the ureters; the urinary stasis favours infection.
Option 1
Smooth muscle relaxation. This time the muscle involved is the cardiac
sphincter; loss of tone favours reflux of acid from the stomach into the oesophagus where
the very low pH causes burning pain heartburn of pregnancy.
Option 3
Brainstem reflex. Morning sickness is a classical sign of early pregnancy;
the vomiting reflex is stimulated, possibly by the sudden change in hormonal levels, sharp
rise in chorionic gonadotrophin, and rises in oestrogen and progesterone.
Option 1
Smooth muscle relaxation. Again this is the problem, this time affecting the
lower bowel so that emptying of the rectum is inefcient.
241
A. Vaginal secretions are at their most fluid; the endometrium has regenerated but is not
B.
C.
D.
E.
EMQ
For each aspect of labour AE, select the most appropriate option from the following list of
muscle activities.
1. Smooth muscle relaxation.
2. Smooth muscle contraction.
3. Skeletal muscle relaxation.
4. Skeletal muscle contraction.
A. The onset of the rst stage of labour is when regular spasms of abdominal pain begin
(labour pains).
B. The onset of the second stage of labour is when the uterine cervix becomes fully dilated.
C. During the second stage of labour the mother is encouraged to make powerful bearing
down/pushing actions to help deliver the baby.
D. After the third stage of labour which ends with the expulsion of the placenta, the
mother may be given oxytocin, or encouraged to put the infant to the breast.
E. During the rst stage of labour, the mother is encouraged to avoid bearing down actions
and breath-holding so that the baby is not forced against an incompletely dilated
cervix.
242
EMQ
C.
D.
E.
Option 2
Smooth muscle contraction. Labour begins when the state of uterine quiescence is replaced by regular, painful, contractions of the uterine smooth muscle.
Option 1
Smooth muscle relaxation. Full relaxation of the smooth muscle in the uterine cervix sets the stage for passage of the baby; in the body generally, expulsion is
achieved by contraction behind and relaxation in front of what is being expelled; in the
heart expulsion of contents takes place on a very short time scale, in the bladder and
rectum it is longer, and in the uterus the time scale is relatively very long.
Option 4
Skeletal muscle contraction. This is a form of the Valsalva manoeuvre, where
abdominal skeletal muscle contracts to favour expiration against a closed glottis; this
manoeuvre helps expulsion of abdominal contents when the relevant orice is open as
well as in delivery of the baby, the maneouvre has a part is speeding micturition and defaecation, and in producing vomiting.
Option 2
Smooth muscle contraction. Oxytocin favours powerful contraction of the
uterine smooth muscle which helps to limit bleeding after delivery (post-partum haemorrhage); stimulation of the breast by the baby leads to release of endogenous oxytocin from
the posterior pituitary.
Option 3
Skeletal muscle relaxation. The mother cannot influence the uterine contractions, but can favour relaxation of the abdominal muscles by avoiding the Valsalva
manoeuvre, usually expressed as not pushing down, but rather breathing shallowly.
B.
C.
D.
E.
Option 4
Day 14. This is the middle of the cycle, when ovulation is just occurring;
fluid vaginal secretions favour passage of spermatozoa; if the ovum is fertilized it will be
ready to implant in about a week when the endometrium will be at its most receptive.
Option 1
Day 0. The menstrual cycle is timed from when the patient rst notices the
menstrual discharge.
Option 4
Day 14. The sudden peaking of the level of luteinizing hormone initiates
ovulation; at this stage the level of oestradiol is falling from its initial peak in the proliferative phase; the level of progesterone is about to start rising steeply.
Option 2
Day 4. The menstrual discharge lasts around four days on average.
Option 5
Day 21. At this stage progesterone is having its maximal effect and the
endometrium is at its most receptive; in the absence of a fertilized ovum the progesterone
level will fall leading to menstruation; if an ovum implants, the gonadotrophic hormone
it produces will stimulate the corpus luteum to maintain and increase secretion of progesterone so maintaining the endometrium and the pregnancy.
E.
Option 3
Seminiferous tubules. This is where the spermatozoa originate and begin
their development.
Option 1
Leydig cells. These are the interstitial cells between the seminiferous tubules.
Option 4
Epididymis. This is the main storage and maturation site.
Option 5
Seminal vesicles. These contribute about two-thirds of the ejaculate volume;
the alkalinity protects the sperm against vaginal acidity and the fructose is a source of
energy.
Option 7
Vas deferens. This transports the spermatozoa under the influence of sympathetic stimulation of the smooth muscle in its wall.
243
EMQ
For each stage of pregnancy AE, select the most appropriate option from the following list of
months.
1. Month one.
2. Month two.
3. Month ve.
4. Month eight.
A. The levels of oestradiol and progesterone are around their maximum; the level of chorionic gonadotrophin is submaximal.
B. Morning sickness is relatively mild, if present; joint discomfort is not usually a problem
either.
C. The levels of oestradiol, progesterone and chorionic gonadotrophin are all rising rapidly.
D. The level of chorionic gonadotrophin is approaching its maximum; the levels of oestradiol and progesterone are well below their maximum.
E. Heartburn from regurgitation of gastric acid to the oesophagus is favoured by a marked
loss of smooth muscle tone in the lower oesophagus and by a marked rise in intraabdominal pressure.
244
EMQ
B.
C.
D.
E.
Option 4
Month eight. In the last trimester (3-month period) of pregnancy, the hormones sustaining pregnancy are having their maximal effect; the maximal level of chorionic gonadotrophin occurs in the rst trimester when it is maintaining the corpus luteum.
Option 3
Month ve. The middle trimester tends to have the least discomfort; morning sickness has usually subsided and the physical effects of a relatively huge uterus in
the last trimester are not yet marked.
Option 1
Month one. The gonadotrophin rises rapidly to produce the corpus luteum
essential in the rst trimester, and the corpus luteum rapidly increases its activity to initiate the major changes of pregnancy via oestradiol and progesterone.
Option 2
Month two. The middle of the rst trimester is the mirror image of the last
trimester in terms of these hormones.
Option 4
Month eight. Regurgitation is favoured by relaxation of the lower oesophageal sphincter, particularly by progesterone and by the concomitant surge in uterine size
and intra-abdominal pressure; both of these effects subside dramatically on delivery of the
baby, and so does the heartburn.
D.
E.
Option 5
4045 years. This is the last epoch with a moderate fertility; by this time the
primordial ova are four decades old.
Option 3
2025 years. In both sexes most physical characteristics are around the
optimal.
Option 6
5055 years. A minute number of conceptions take place around the age of
50; nearly all women have reached the menopause with its surge of gonadotrophins
directed at the senescent gonads.
Option 1
1015 years. Changes in fat and hair distribution, the onset of menstruation
(menarche) and the adolescent growth spurt usually begin in this epoch.
Option 7
6065 years. Some 15 years after the menopause these changes are associated with withdrawal of oestrogens and progesterone; many women take hormonal
replacement therapy during this period; it relieves hot flushes and other symptoms which
may be related to the surge in gonadotrophins; some protection against coronary artery
disease and osteoporosis can be balanced against adverse long-term effects.
10
GENERAL QUESTIONS
245
MCQs
577. Ultrafiltration
A.
B.
C.
D.
E.
(A) and venous concentration (V) are known for a given substance.
Cardiac output to be calculated by injecting an indicator into the pulmonary artery and
monitoring its concentration downstream in a systemic artery.
Renal plasma flow to be calculated using PAH as the substance measured.
Cardiac output to be estimated using the lungs as the organ and carbon dioxide as the
substance measured.
Cerebral blood flow to be measured using nitrous oxide as the substance taken up by
the brain.
579. Mitochondria
A.
B.
C.
D.
E.
581. During the Valsalva manoeuvre (forced expiration with glottis closed)
A.
B.
C.
D.
E.
582. Jejunal mucosal cells are similar to proximal convoluted tubular cells in
that both
A.
B.
C.
D.
E.
MCQ
Questions 577582
246
MCQ
Answers
577.
A.
True
B.
False
C.
True
D.
True
E.
True
It depends on pore size and hydrostatic pressure gradients; colloids are larger particles than crystalloids.
Substances cross cellular walls by active transport or down electrochemical gradients; hydrostatic pressure gradients are not involved.
An outward hydrostatic pressure gradient exists at the arterial end of the capillary.
The pressure gradient across glomerular capillary walls is greater than that in
other capillaries.
But active secretion is also involved in the formation of CSF.
578.
A.
B.
C.
True
False
True
D.
E.
True
True
579.
A.
B.
C.
D.
E.
True
False
True
True
False
580.
A.
B.
C.
D.
E.
False
False
True
True
False
True
True
False
False
True
581.
A.
B.
C.
D.
E.
582.
A.
B.
C.
D.
E.
True
False
True
True
True
247
Questions 583589
A.
B.
C.
D.
E.
Oxygen consumption.
Cardiac output.
Stroke volume.
Arterial PCO2.
Minute volume.
585. In bone
A.
B.
C.
D.
E.
Heart rate.
Central venous pressure.
Intrapulmonary pressure.
Abdominal girth.
Afferent impulse trafc in the vagus nerves.
MCQ
583. Exercise which doubles the metabolic rate is likely to at least double the
248
MCQ
Answers
583.
A.
B.
C.
D.
E.
True
False
False
False
True
584.
A.
B.
C.
D.
True
False
True
True
E.
True
585.
A.
B.
C.
D.
E.
True
False
True
True
True
586.
A.
B.
True
False
C.
D.
E.
True
False
False
587.
A.
B.
C.
D.
False
False
False
True
E.
False
588.
A.
B.
C.
D.
E.
False
False
True
True
False
589.
A.
B.
C.
D.
E.
True
False
False
True
True
249
Questions 590596
A.
B.
C.
D.
E.
Intrapleural pressure.
Intra-abdominal pressure.
Cardiac output.
Arterial blood pressure.
Heart rate.
Refers to the cyclical changes in blood pressure that accompany the respiratory cycle.
Can be observed in normal people.
Has a greater amplitude in old than in young people.
Is mediated mainly through sympathetic nerves to the heart.
Can be used as an index of autonomic nerve function.
MCQ
590. Lysosomes
250
MCQ
Answers
590.
A.
B.
C.
D.
E.
True
True
True
True
True
False
True
True
True
False
Volume expands as blood shifts from veins in the lower extremities to the chest.
A reflex response to an increased central blood volume.
Apical perfusion increases during recumbency.
Due to vascular distension in the lungs and pushing up of the diaphragm.
An increase in central blood volume results in increased urine formation.
591.
A.
B.
C.
D.
E.
592.
A.
B.
C.
D.
E.
False
True
False
True
True
One mole of any ion in solution exerts one osmole of osmotic pressure.
Because calcium is divalent.
A normal solution has one equivalent weight of ion per litre.
This is the atomic weight in grams.
1 osmole of a substance in 1 litre of water depresses the freezing point by 1.86C.
593.
A.
B.
C.
D.
E.
True
True
False
False
True
594.
A.
B.
True
False
C.
D.
E.
False
True
True
It facilitates H and HCO3 formation from H2O and CO2 and H is secreted.
Carbaminohaemoglobin is formed when CO2 combines directly with amino
groups of the globin component of haemoglobin.
Blockade of the enzyme does not affect CSF formation.
It facilitates H and HCO3 formation from CO2 and H2O and HCO3 is secreted.
Blockade of the enzyme reduces the rate of formation of aqueous humour. It may
be used to lower intraocular tension in patients with glaucoma.
595.
A.
False
B.
C.
D.
E.
True
False
False
True
It refers to the cyclical changes in heart rate that accompany the respiratory
cycle.
It is a normal, harmless phenomenon.
It decreases in amplitude with age.
It is mediated by vagal nerves and abolished by vagal blockade with atropine.
It is impaired in vagal autonomic neuropathy.
596.
A.
B.
C.
D.
False
False
True
True
E.
False
251
Questions 597603
A.
B.
C.
D.
E.
About 25 mmHg.
Similar to that of 0.9 per cent saline.
Similar to that of 0.9 per cent glucose solution.
Opposing the tendency of fluid to leave capillaries.
Equal to that of intracellular fluid.
hydrate.
Tends to lower the pH of urine.
Permits the body to synthesize the essential amino acids.
Yields more toxic metabolites than fat or carbohydrate.
Should exceed 2 g/kg body weight/day to satisfy normal body requirements.
MCQ
252
MCQ
Answers
597.
A.
B.
C.
D.
E.
True
True
True
True
True
598.
A.
B.
C.
D.
E.
True
False
False
True
True
599.
A.
B.
C.
D.
E.
True
True
True
True
False
600.
A.
B.
C.
False
True
False
D.
False
E.
True
False
True
True
False
False
601.
A.
B.
C.
D.
E.
602.
A.
B.
C.
D.
True
True
False
True
E.
False
Due, perhaps, to the additional metabolic work in processing protein in the body.
Protein is the main dietary source of the acidic residues excreted by the kidney.
Essential amino acids cannot be synthesized in the body.
These metabolites, normally detoxied in the liver, may cause hepatic encephalopathy in hepatic failure.
One gram per kilogram is adequate.
603.
A.
B.
C.
D.
E.
False
True
True
False
False
253
Questions 604610
A.
B.
C.
D.
E.
MCQ
254
MCQ
Answers
604.
A.
B.
C.
D.
True
False
True
True
E.
False
605.
A.
B.
C.
D.
E.
True
False
False
True
False
606.
A.
B.
C.
D.
E.
False
False
False
False
False
True
False
False
True
True
607.
A.
B.
C.
D.
E.
608.
A.
B.
C.
D.
True
True
False
True
E.
False
609.
A.
B.
C.
D.
E.
True
True
False
False
False
False
True
True
False
True
610.
A.
B.
C.
D.
E.
255
Questions 611616
A.
B.
C.
D.
E.
Diuretic drugs.
Supplementing the normal diet with slimming foods.
Conning the diet to foods of low caloric value.
Increasing exercise without increasing food intake.
Reducing food intake relative to energy expenditure.
613. In percentage terms, arterial PCO2 is more affected than arterial O2 content by
A.
B.
C.
D.
E.
615. When kept afloat by a life jacket, survival time in water at 15C is
A.
B.
C.
D.
E.
MCQ
256
MCQ
Answers
611.
A.
B.
C.
D.
E.
False
False
False
True
True
False
False
True
True
False
A.
B.
C.
False
False
True
D.
E.
True
True
612.
A.
B.
C.
D.
E.
613.
614.
A.
B.
C.
True
True
False
D.
E.
False
False
615.
A.
B.
C.
False
False
True
D.
E.
False
True
616.
A.
B.
C.
D.
E.
True
False
True
True
True
257
Questions 617622
A.
B.
C.
D.
E.
622. Someone who has received an electric shock causing ventricular fibrillation
A.
B.
C.
D.
E.
MCQ
617. Obesity
258
MCQ
Answers
617.
A.
B.
C.
D.
E.
True
True
True
False
True
Being 20 per cent overweight reduces life expectancy by about 20 per cent.
The diabetes may then be cured by weight reduction.
Both genetic and environmental factors may operate.
This is a very rare cause.
This leads to malabsorption, but the resulting malnutrition may have side effects.
A.
B.
C.
True
True
False
D.
E.
True
False
618.
619.
A.
B.
C.
D.
E.
False
True
True
False
False
620.
A.
B.
C.
D.
E.
True
True
True
True
False
A.
False
B.
C.
D.
E.
True
True
True
False
Being less soluble, less goes into solution during compression so there is less
bubble formation during decompression.
This also reduces the time needed for decompression.
It is less narcotic than nitrogen.
It is less viscous than nitrogen.
Neither combine with haemoglobin.
621.
622.
A.
B.
C.
D.
E.
True
False
False
True
False
259
Questions 623629
A.
B.
C.
D.
E.
Thirst.
Increased water reabsorption in the proximal convoluted tubules.
Release of vasopressin.
A fall in intracellular fluid volume.
Suppression of sweat secretion.
MCQ
260
MCQ
Answers
623.
A.
B.
C.
D.
E.
False
True
True
False
False
624.
A.
B.
C.
D.
E.
False
False
False
True
False
625.
A.
B.
C.
D.
E.
False
False
True
True
False
626.
A.
B.
C.
D.
E.
False
True
True
False
False
627.
A.
B.
C.
D.
E.
True
True
False
False
True
628.
A.
B.
C.
True
False
True
D.
E.
True
False
629.
A.
B.
C.
D.
E.
True
False
True
True
False
261
Questions 630636
A.
B.
C.
D.
E.
636. The effects of moving from sea level to an altitude of 5000 metres
include an increase in
A.
B.
C.
D.
E.
Alveolar ventilation.
Blood bicarbonate level.
Appetite for food.
Exercise tolerance.
Simulation of the bone marrow.
MCQ
262
MCQ
Answers
630.
A.
B.
C.
False
True
False
D.
E.
True
True
631.
A.
False
B.
True
C.
D.
E.
True
False
True
Blood pressure rises due to reflex stimulation of the heart and peripheral vasoconstriction.
Accumulation of CO2 is mainly responsible for the reflex cardiovascular and respiratory responses.
Deoxygenated haemoglobin appears in the arterial blood.
Respiratory effort increases with chemoreceptor stimulation.
Part of the generalized sympathetic response to stress.
632.
A.
B.
C.
D.
E.
False
False
False
True
True
633.
A.
B.
C.
D.
E.
True
True
False
False
False
634.
A.
B.
C.
D.
E.
True
True
False
False
True
But the side effects are likely to be worse than the disease.
Again side effects may be troublesome.
This paralyses skeletal muscles without inhibiting sweating.
The nerves responsible for sweating are cholinergic.
This is an effective therapy.
635.
A.
B.
C.
D.
E.
True
False
False
False
False
636.
A.
B.
C.
D.
E.
True
False
False
False
True
263
Questions 637639
A.
B.
C.
D.
E.
639. Normal healthy young adults can tolerate loss of half of their
A.
B.
C.
D.
E.
MCQ
264
MCQ
Answers
637.
A.
B.
False
True
C.
D.
E.
False
True
True
638.
A.
B.
True
False
C.
D.
E.
True
True
False
639.
A.
B.
C.
True
True
True
D.
True
E.
True
10
GENERAL QUESTIONS
265
EMQs
EMQ
Questions 640649
266
EMQ
B.
C.
D.
E.
Option 2
Intracellular membrane-bound structures containing enzymes that can
destroy most cellular structures. The postmortem breakdown of the lysosomal membranes
releases lysosomal enzymes that autolyse (cause self-destruction of) the cell.
Option 4
Structures lying close to the nucleus responsible for organizing the microtubular systems. Centrosomes are made up of two centrioles. At mitotic division the centrosomes are duplicated and one goes to each end of the mitotic spindle. The microtubules
they control allow movement within the cell.
Option 5
Membrane-bound organelles associated with numerous enzymes that catalyse a variety of anabolic and catabolic reactions. They are involved in the oxidation of
some long chain fatty acids. Drugs that can modify peroxisome behaviour are being used
in the attempt to lower lipid levels in the blood.
Option 3
Granules in a layer produced by high-speed centrifugation of cells. This is
the generic name for the cellular organelles brought down by high-speed centrifugation.
Option 1
Sites of protein synthesis rich in RNA. Ribosomes can be attached to the
endoplasmic reticulum where they synthesize proteins such as hormones.
B.
C.
D.
E.
Option 1
Sudden laryngeal obstruction. The obstruction leads to a rapid rise in PCO2
before the kidneys can compensate by generating bicarbonate thus raising the blood
bicarbonate level.
Option 5
Severe diarrhoea. Severe diarrhoea results in loss of bicarbonate in the stools
and thus to a fall in the blood bicarbonate level.
Option 2
Severe chronic respiratory disease. The raised PCO2 in chronic respiratory disease may be compensated for by renal generation of bicarbonate to raise the blood bicarbonate level.
Option 4
Mountain climbing. The respiratory drive caused by the action of low Po2 on
arterial chemoreceptors washes out CO2. This lowers the PCO2 to cause an alkalosis.
Eventually the kidneys compensate by eliminating more bicarbonate.
Option 3
Chronic renal failure. The fall in blood bicarbonate used in buffering the
acid residues of protein digestion in chronic renal failure is compensated for by an
increased respiratory drive that results in a fall in PCO2.
267
EMQ
For each of the electrical potentials AE, select the best option for a possible description from
the following list.
1. The graded, non-propagated potential changes across cell membranes induced by
neurotransmitter substances.
2. The voltage gradient between the inside and the outside of a cell.
3. The unstable membrane potentials seen in smooth and cardiac muscle.
4. All or non-propagated potentials in excitable tissues.
5. The graded, non-propagated potential changes seen in sensory end organs.
A. Action potentials.
B. Membrane potentials.
C. Generator potentials.
D. Pacemaker potentials.
E. Post-synaptic potentials.
268
EMQ
B.
C.
D.
E.
Option 4
All or none-propagated potentials in excitable tissues. Action potentials
travel as a wave of reversed polarity caused by an initial increase in membrane permeability to sodium followed by a slower increase in membrane permeability to potassium.
Option 2
The voltage gradient between the inside and the outside of a cell. This potential is maintained actively by metabolic processes and disappears if these processes are
poisoned. Resting membrane potentials range from about 60 to about 90 millivolts, negative inside with respect to outside.
Option 5
The graded, non-propagated potential changes seen in sensory end organs.
When a stimulus is applied to a sensory end organ it causes a non-propagated depolarization whose size is related to the strength of the stimulus. When the generator potential
reaches the threshold for ring, it gives rise to an action potential that travels along the
axon away from the end organ.
Option 3
The unstable membrane potentials seen in smooth and cardiac muscle. The
membranes of pacemaker cells show an unstable membrane potential that falls spontaneously until it reaches the threshold for ring when it gives rise to one or more propagated
action potentials.
Option 1
The graded, non-propagated potential changes across cell membranes
induced by neurotransmitter substances. When an impulse reaches the terminal processes
of a pre-synaptic nerve, it causes neurotransmitter to be released that induces postsynaptic potentials in the post-synaptic neurone. When the potential reaches the threshold for ring in the post-synaptic nerve an action potential is induced that travels over
the entire membrane of the post-synaptic cell.
C.
D.
E.
Option 3
Involved in the breakdown of catecholamines. Catecholamines are inactivated by oxidation by the enzyme MAO that is found in some neurones.
Option 5
Involved in the breakdown of acetylcholine. Cholinesterase is found in high
concentration near motor nerve endings in muscle and rapidly hydrolyses acetylcholine
following its release from the nerve endings.
Option 2
Involved in the genesis of inhibitory post-synaptic potentials (IPSPs). GABA
is released from pre-synaptic nerve endings and causes hyperpolarization of the post-synaptic membrane so causing an IPSP.
Option 4
A neurotransmitter in the brain involved in basal ganglia activity.
Degeneration of dopaminergic neurones in the substantia nigra is associated with
Parkinsons disease.
Option 1
A neurotransmitter in the brain involved in determining mood. Serotonin
containing nerves have been found in the brain stem. Selective serotonin uptake inhibitor drugs are used in the treatment of depression.
269
EMQ
For each of the items related to body energy AE, select the best option for its description from
the following list.
1. The increase in energy expenditure
2. A thioester high-energy compound.
following ingestion of food.
3. A method to estimate the metabolic rate.
4. A phosphorolated high-energy
5. The rate of metabolism in a resting subject.
compound.
A. Measurement of oxygen consumption.
B. Specic dynamic action (SDA).
C. ATP.
D. BMR.
E. Acetyl-coenzyme A.
270
EMQ
C.
D.
E.
Option 3
A method to estimate the metabolic rate. The rate of metabolism can be estimated from the oxygen consumption if the respiratory quotient is known.
Option 1
The increase in energy expenditure following ingestion of food. The extra
energy expenditure required to assimilate ingested food into the body is referred to as its
SDA. It is required for all types of food but protein requires the most energy for its assimilation.
Option 4
A phosphorolated high-energy compound. Adenosine triphosphate (ATP) is
widely distributed in the body and much energy is stored in its phosphate bonds. This
energy can be released when required to energy-requiring processes such as muscle
contraction and membrane polarization.
Option 5
The rate of metabolism in a resting subject. The basal metabolic rate is a
measure of total energy expenditure at rest in the post-absorptive state. It can be measured by measuring oxygen consumption.
Option 2
A thioester high-energy compound. This sulphur containing high-energy
compound is derived from mercaptan. It combines with substances in reactions that would
otherwise require outside energy.
B.
C.
D.
E.
Option 4
The knee jerk. This is a spinal reflex with two neurones. The afferent nerve
from the muscle spindle synapses with a motor bre in the anterior horn of the spinal
cord.
Option 2
The withdrawal reflex. This reflex has more than two synapses in the reflex
pathway.
Option 3
Salivation on seeing or thinking about food. This is a learned reflex that can
be reinforced or inhibited by learned experience and involves the cerebral cortex.
Option 5
The baroreceptor reflex. This reflex is inborn and is not modied by learned
experiences.
Option 1
Nerve-mediated skin vasodilatation following skin damage. An axon reflex
is a local reflex that does not involve the spinal cord. Stimulation of a sensory nerve
receptor results in a local response mediated by a local branch of the sensory nerve.
D.
E.
Option 3
Stretch. Stretching of the muscle spindles leads to reflex contraction of the
muscle being stretched as in the knee jerk.
Option 1
Pain. These nerve endings are stimulated by stimuli that tend to damage the
tissues in which the bare nerve endings lie.
Option 2
Angular acceleration of the head. The sensory end organs in the crista
ampullaris are stimulated when movement of fluid in the semicircular canals moves the
hair cells in the cupulae.
Option 4
Sound waves in the inner ear. These sensory organs lie in the organ of Corti
and are stimulated when sound waves cause vibrations in the basilar membrane in the
inner ear.
Option 5
Sweet substances in solution. These taste receptors are found towards the
front of the tongue and can detect sweet taste stimuli.
271
EMQ
For each clinical disturbance AE, select the best option for its possible cause from the following list.
1. Renal failure.
2. Respiratory failure.
3. Heart failure.
4. Peripheral circulatory failure.
5. Liver failure.
A. Lowered central venous pressure.
B. A raised plasma bicarbonate level.
C. Metabolic acidosis and anaemia.
D. Raised central venous pressure.
E. A lowered blood urea.
272
EMQ
B.
C.
D.
E.
Option 4
Peripheral circulatory failure. In circulatory failure such as may occur in
severe shock or haemorrhage, the fall in venous return to the heart lowers central venous
pressure.
Option 2
Respiratory failure. The retention of CO2 in respiratory failure leads to an
acidosis that is compensated for by generation of bicarbonate by the kidney.
Option 1
Renal failure. In renal failure, failure to excrete acid residues of metabolism
causes acidosis. Anaemia is often seen since erythropoietin is normally manufactured by
the kidneys.
Option 3
Heart failure. In heart failure where the heart cannot pump forward all the
blood being delivered to it, there is a rise in central venous pressure that increases the
diastolic lling of the heart.
Option 5
Liver failure. The liver is responsible for the deamination of amino acids and
the conversion of the NH4 residues into urea.
C.
D.
E.
Option 3
Alerting reactions. Stimulation of the ascending reticular formation leads to
increased electrical activity in the cortex and results in a state of alertness.
Option 5
Postural reflexes. Diseases affecting this part of the brain such as Parkinsons
disease result in abnormal distribution of muscle tone. Substantia nigra neurones are
dopaminergic.
Option 4
Temperature regulation. Temperature regulating centres are found in the
hypothalamus.
Option 1
Fear and rage reactions. The limbic region is associated with the emotions.
Option 2
Vision. Visual impulses are conveyed to the occipital cortex in the optic
tracts where they give rise to conscious visual images.
B.
C.
D.
E.
Option 3
A form of inhibition in which activation of one neural group causes inhibition of neurones surrounding the activated group. This is seen in the neurones of the occipital cortex where central excitation reduces activity in surrounding neurones.
Option 5
A state where neurones in the brain and spinal cord are less excitable than
normal. A general state of inhibition of excitability of the neurones in the CNS can be
induced by general anaesthetic and other drugs that depress the central nervous system.
Option 2
Inhibition produced by release of transmitters that affect the membrane
potential of efferent neurones. Here the inhibition of the post-synaptic membrane is caused
by the action of pre-synaptic nerve terminals directly on the membrane of the post-synaptic cell body.
Option 1
Inhibition produced by the action of neurotransmitters on the terminal processes of afferent nerves. In this case nerve endings of afferent neurones release neurotransmitters close to the nerve endings of other neurones to modulate release of
neurotransmitter from them.
Option 4
Inhibition of a conditioned reflex by an application of a new stimulus just
before the application of the conditioned stimulus. Conditioned reflexes can be reinforced
or inhibited by external stimuli given at about the same time as the conditioned stimulus.
11
273
MCQs
Is greater than the carbon dioxide produced per minute during long distance running.
In the resting adult is nearer 100 than 150 ml.
During intense mental activity can rise to twice the resting level.
During brisk walking is nearer ve times than twice the resting level.
In an Olympic athlete can rise to 50 litres.
Local PCO2.
Local H concentration.
Local muscle temperature.
Arterial pressure.
Vasodilator nerve activity.
skeletal muscle.
The increase in skeletal muscle blood flow for a given work load decreases.
MCQ
Questions 650655
274
MCQ
Answers
650.
A.
B.
C.
D.
True
False
False
False
E.
True
True
True
True
True
False
651.
A.
B.
C.
D.
E.
652.
A.
B.
C.
True
False
False
D.
E.
True
False
The respiratory quotient is less than 1.0 during long distance running.
It is around 250300 ml.
Brain oxygen consumption increases in relatively small active areas, but the total
changes little.
This is a useful way of maintaining tness, particularly in older people.
The maximum recorded is less than ten litres.
653.
A.
B.
C.
D.
E.
True
True
True
False
False
654.
A.
B.
C.
True
True
False
D.
E.
True
True
655.
A.
B.
C.
False
True
True
D.
False
E.
False
275
Questions 656661
A.
B.
C.
D.
E.
A heart rate equal to the maximal predicted for the persons age.
An R-R interval of about 500 milliseconds.
R waves with an amplitude greater than one millivolt.
Ventricular tachycardia.
ST depression of one millimetre.
659. Cold
A. Injury to feet exposed for long periods to 510oC is due to frostbite.
B. Injury to the extremities is made less likely by increased afnity of haemoglobin for O2
at low temperatures.
people.
Water immersion of the hand at 5oC is painless.
MCQ
656. Isotonic (dynamic) exercise differs from isometric (static) exercise in that
there is less
276
MCQ
Answers
656.
A.
B.
C.
D.
E.
False
True
False
False
True
657.
A.
B.
C.
D.
E.
False
False
False
True
False
658.
A.
True
B.
C.
D.
E.
True
False
False
True
659.
A.
B.
C.
D.
E.
False
False
True
False
False
The tissues do not freeze at this temperature; trench foot injury can occur.
Hypoxia is an increased risk due to poor release of oxygen to the tissues.
Increased muscle tone and shivering account for this.
Fat people have much better insulation of their body core.
It is very painful, a warning of the danger of such temperatures.
660.
A.
B.
False
False
C.
False
D.
E.
True
False
True
True
True
False
False
661.
A.
B.
C.
D.
E.
277
Questions 662667
A.
B.
C.
D.
E.
664. Secondary amenorrhoea (disappearance of previously established menstruation) in a 25-year-old female athlete is associated with
A. A strenuous daily training schedule.
B. Weight loss rather than weight gain.
C. Direct depression of the ovaries rather than loss of gonadotrophins and their releasing
hormone.
D. Reversal of the condition when strenuous exercise is discontinued and normal body
E.
weight regained.
A body fat content of 25 per cent.
Glycogen by exercising muscle leads to a respiratory quotient nearer 0.7 than 0.8.
Fat liberates more than twice the energy liberated by the same weight of carbohydrate.
Fatty acids by skeletal muscle plays no part in normal exercise.
Amino acids for energy is decreased by cortisol.
An 80 kg male athlete in training requires nearer 2000 kcal (8.4 MJ) than 3000 kcal
(12.6 MJ)/day.
666. Hypoxia in
A.
B.
C.
D.
E.
667. During strenuous exercise (12 METS, where one MET is the resting metabolic rate, corresponding to an oxygen consumption of 3.5 ml per
minute) as compared with moderate (6 METS) dynamic exercise, there is
a higher
A.
B.
C.
D.
E.
MCQ
278
MCQ
Answers
662.
A.
B.
C.
D.
E.
True
False
True
False
True
663.
A.
B.
True
False
C.
True
D.
E.
False
True
664.
A.
B.
C.
True
True
False
D.
True
E.
False
665.
A.
B.
C.
D.
E.
False
True
False
False
False
666.
A.
B.
C.
D.
False
False
False
False
E.
True
Lack of oxygen leads to anaerobic glycolysis and increases lactic acid formation.
It stimulates ventilation and leads to a respiratory alkalosis.
It is stagnant hypoxia due to inadequate tissue blood flow.
But beta-receptor stimulation leads to relaxation of airway smooth muscle and
should relieve hypoxia when caused by asthma.
Due to the carbon monoxide content of the smoke.
667.
A.
B.
C.
True
True
True
D.
E.
False
True
279
Questions 668673
A. Increases jumping height when someone jumps from a height immediately before take
B.
C.
D.
E.
off.
Improves performance during sprinting.
Contributes more to performance when sprinting on a cinder track than on a concrete
surface.
Can be improved by training.
Is greater in weight lifters than in skiers.
years of age.
In males as compared with females.
During prolonged periods of bedrest.
When both ovaries are removed in a premenopausal woman.
During treatment with adrenal glucocorticoids.
671. For the average healthy, normal male aged 20, the
A.
B.
C.
D.
E.
672. Heat
A.
B.
C.
D.
E.
Load during maximal exertion should not exceed three times resting heat load.
Syncope is caused by an inappropriately high cardiac output.
Stroke is a less serious condition than heat syncope.
Adaptation results in the subject having a smaller rise in core temperature for a given
level of work.
Adaptation takes about six days rather than six weeks to develop.
MCQ
280
MCQ
Answers
668.
A.
B.
C.
True
True
False
D.
E.
True
False
The elastic tissue in extensor muscles is stretched by the initial downward jump.
Elastic recoil aids the activity independently of muscular contractions.
The concrete surface reflects more of the energy stored during landing the foot
on the surface.
Training which stretches the muscles achieves this.
Compared with skiers, weight lifters produce little muscle stretch and rebound
during training.
669.
A.
B.
C.
True
False
True
D.
E.
True
True
670.
A.
B.
C.
False
False
True
D.
E.
False
True
False
False
True
False
False
671.
A.
B.
C.
D.
E.
672.
A.
B.
False
False
C.
False
D.
E.
True
False
673.
A.
True
B.
True
C.
False
D.
E.
False
True
Injections of isotonic potassium but not sodium into the skin are extremely painful.
Due to the accumulation of pain-producing metabolites when blood flow is inadequate to clear the metabolites generated by muscle exercise.
Accumulation of such metabolites is very slow in the resting limb; with more prolonged occlusion, anaesthesia due to nerve hypoxia usually occurs before
metabolite retention in the tissues rises to the levels needed to stimulate pain
nerve endings.
Endorphins inhibit pain pathways.
Thawing releases pain mediators and restores function to numbed nerves.
281
Questions 674679
A.
B.
C.
D.
E.
Vital capacity.
Airway conductance.
Bodys resting oxygen consumption.
Oxygen-carrying capacity of the blood.
Rate of pulmonary blood flow.
Haemoglobin level.
Oxygen saturation of the blood.
Vital capacity.
Cardiac vagal tone during maximal exercise.
Resting stroke volume.
MCQ
282
MCQ
Answers
674.
A.
B.
C.
True
False
True
D.
False
E.
True
675.
A.
B.
C.
D.
True
True
False
False
E.
False
676.
A.
False
B.
C.
D.
E.
False
False
False
True
Not unless the individual has been training at high altitude; for some activities a
maximal haematocrit is set to discourage articial means of raising the oxygen
carrying ability of blood.
This also is likely to be normal (around 98 per cent in arterial blood).
Ventilation is not usually a limiting factor for endurance activity.
There will only be sympathetic tone to the heart at maximal exercise.
This permits a low resting pulse rate and a high maximal cardiac output.
677.
A.
B.
C.
False
True
True
D.
E.
False
True
678.
A.
B.
C.
D.
E.
True
True
False
True
True
679.
A.
B.
C.
D.
E.
True
True
True
False
True
283
Questions 680684
A.
B.
C.
D.
E.
Implies a rate of energy consumption ten times that of the basal metabolic rate.
Requires an oxygen uptake of 2 to 3 litres per minute in the average adult.
Requires an oxygen uptake of less than 2 litres per minute in a 20 kg child.
Is not suitable for a person on insulin treatment for diabetes mellitus.
Is probably too much for a t 90-year-old person to maintain for one hour.
Heart rate.
Parasympathetic activity.
Beta adrenoceptor blockade.
Circulating levels of adrenaline.
Resting respiratory rate.
12.6 MJ).
Convalescing from a wasting illness would be nearer 3000 than 2000 kcal (12.6 versus
8.4 MJ).
In training averaging 10 METS for 6 hours/day is more than twice that required for sedentary conditions.
Athlete should be sufcient to avoid ketoacidosis.
Should contain as little carbohydrate as possible.
MCQ
284
MCQ
Answers
680.
A.
B.
False
False
C.
False
D.
E.
False
False
681.
A.
B.
False
True
C.
D.
True
False
E.
True
Conventionally it is ten times the resting rate (higher than the basal rate).
10 METS require 10 times the resting oxygen consumption of around
250 ml/minute.
Resting metabolic rate is roughly proportional to body mass.
Such people should exercise at this level, but advice is needed on dietary and
insulin needs.
The world record for the mile at this age is between ten and fteen minutes,
implying much less than ten METS for about a quarter of an hour.
682.
A.
B.
False
False
C.
False
D.
E.
True
True
683.
A.
B.
C.
D.
E.
True
False
False
True
True
684.
A.
True
B.
True
C.
True
D.
E.
True
False
This gives a daily decit of about 500 kcal which would be supplied by metabolizing fat stores.
This provides a positive energy balance and allows replenishment of body protein and fat, assuming an adequate protein content of the diet.
Metabolizing at 10 METS for 6 hours (60 MET hours) would itself use up more
than the daily sedentary requirement (e.g. sleeping for 8 hours, about 8 MET
hours; average 2 METS for 16 hours, 32 MET hours).
Ketoacidosis impairs muscle function.
A moderate carbohydrate intake is required to avoid ketoacidosis; a relatively
high carbohydrate intake is required for exercise.
285
Questions 685686
A.
B.
C.
D.
E.
MCQ
286
MCQ
Answers
685.
A.
True
B.
False
C.
D.
E.
True
True
False
This is necessary to maintain a normal alveolar oxygen level and full blood
oxygen saturation.
It is increased due to the low oxygen content at low atmospheric pressures; ventilatory ability can then be a limiting factor.
This occurs above the anaerobic/lactate threshold.
Ventilation is somewhat reduced if this input to the brain is blocked.
The precise matching of ventilation to exercise requirements is postulated to take
place in an exercise centre which receives an input from the cortical neurones
initiating the exercise.
686.
A.
B.
C.
False
True
True
D.
E.
True
True
11
287
EMQs
EMQ
Questions 687691
288
EMQ
B.
C.
D.
E.
Option 4
Fast twitch muscle. This is a test of muscle strength as opposed to endurance; it is related to muscle bulk and not skill, so the dominant hand is not always the
strongest.
Option 3
Slow twitch muscle. In contrast to the above, this is a test of endurance, a
property of the less bulky slow twitch muscles.
Option 2
Anaerobic metabolism. Lactic acid is a marker for anaerobic metabolism; a
relatively low value at a high level of performance indicates good tness.
Option 5
Maximal oxygen consumption. Oxygen consumption is calculated from the
difference between inspired (atmospheric) and expired oxygen multiplied by the ventilation rate; it is assumed to be maximal when a plateau is reached around the time of
exhaustion; heart rate should be maximal and the respiratory exchange ratio (carbon
dioxide output/oxygen uptake) should have risen to above 1.0; lactic acid is usually 510
times the resting value.
Option 3
Slow twitch muscle. For most people this is the ultimate test of the slow
twitch endurance muscle.
B.
C.
D.
E.
Option 5
Low level sympathetic activity. As the runners generate increased heat from
their exercising muscles there is temperature reflex release of sympathetic tone to the skin
blood vessels; removal of the resting constrictor tone causes vasodilation.
Option 2
Higher centre respiratory control. The precise matching of ventilation (and
cardiac output) to muscular activity is evidence of sophisticated cerebral activity above
the level of the automatic, reflex centres in the medulla; this concept has led to the term,
exercise centre.
Option 6
High level sympathetic activity. Sweating is induced by activity in cholinergic sympathetic nerves to sweat glands.
Option 3
Local metabolic control of vascular tone. The huge increase in muscle blood
flow is due to metabolic changes generated locally by the active muscles.
Option 8
High vagal tone. Endurance athletes, such as marathon runners, demonstrate
their tness by having very low (e.g. 3040 beats per minute) heart rates due to very high
resting cardiac vagal tone; this is related to their having large powerful hearts with a high
stroke volume so resting cardiac output requires only a low heart rate; during exercise
they can reach the usual high rates, so multiplying their resting cardiac output during
maximal exercise much more (say 6 times) than the average person (say 34 times).
289
EMQ
For each aspect of physical exertion in people with insulin-dependent diabetes mellitus AE,
select the most appropriate option from the following list of physiological terms.
1. Decreased insulin requirement.
2. Increased insulin requirement.
3. Hyperglycaemia.
4. Hypoglycaemia.
5. Parasympathetic effects.
6. Sympathetic effects.
A. Prior to a two-hour period of strenuous physical afternoons activity, diabetic patients
require to increase their nutritional intake and adjust their dose of insulin compared
with that taken before a sedentary afternoon.
B. A major risk for such people is that they will develop a period of confusion during
strenuous activity or during the following evening or night.
C. During such a period of confusion, the patient often shows pallor and sweating.
D. Prior to a period of strenuous activity it is reassuring rather than alarming to nd the
blood glucose around the renal threshold for glycosuria.
E. After a full day of strenuous activity, the person with diabetes may set the alarm several
times during the night so as to be able to test the blood glucose level.
290
EMQ
B.
C.
D.
E.
Option 1
Decreased insulin requirement. Prolonged strenuous exercise requires
increased nutritional intake; with exercise, the insulin requirement for nutritional uptake
into cells is much reduced.
Option 4
Hypoglycaemia. As nutrients are depleted during exercise, even a reduced
dose of insulin may lower the blood glucose level below that which will sustain normal
cerebral activity; a falling glucose level causes progressively, confusion, coma and risk of
brain damage and death.
Option 6
Sympathetic effects. These effects give a useful clue to the diagnosis; sympathetic stimulation leads to skin vasoconstriction and sweating, also tremor and tachycardia; hypoglycaemia also activates the gastric vagus to increase secretion and activity,
possibly inducing hunger and facilitating rapid transit of a remedial high-energy snack.
Option 3
Hyperglycaemia. The renal threshold is about twice the normal fasting level;
such transient hyperglycaemia is of little consequence compared with the risks of trying
to keep the blood glucose normal and thereby risking the vastly greater danger of hypoglycaemia.
Option 4
Hypoglycaemia. The blood glucose can dip severely some hours after prolonged exertion; nocturnal hypoglycaemia is particularly pernicious as the person may
lapse into coma during sleep; it is much better to disturb sleep and conrm a threatening
fall in blood glucose before it progresses to interfere with consciousness.
B.
C.
D.
E.
Option 4
High level of myoglobin. Myoglobin is the muscular intracellular form of
haemoglobin; aerobic endurance muscle has high levels for oxygen storage to maintain a
smooth flow of oxygen to the mitochondria.
Option 5
Low density of capillaries. Capillary density determines the rate of oxygen
uptake and is low in powerful fast-twitch anaerobic muscles.
Option 2
Energy produced outside mitochondria. Anaerobic activity derives energy
from glycolysis outside the mitochondria; since this produces high energy phosphate at a
low rate per molecule of glucose, much glucose must be broken down.
Option 2
Energy produced outside mitochondria. These people major in fast twitch
muscle which can produce huge amounts of energy for a matter of seconds, but their
muscle is poor in mitochondria, which alone can sustain steady energy production for
endurance activities.
Option 3
Low level of myoglobin. Rapid twitch muscle lacks the pigment myoglobin.
Option 3
2 METS. This is the borderline between being able to get out and about and
being totally housebound and 100 per cent disabled.
Option 6
16 METS. The average t young to middle-aged person can reach around
10 METS; athletes around 1520 METS; super Olympic athletes may exceed this.
Option 4
4 METS. Brisk walking involves almost half way to maximal exertion for
many people.
Option 5
8 METS. Since the average person can reach about 10 METS, 8 METS is
close to the maximal sustainable for a moderate period of time.
Option 4
4 METS. Maximal exertional ability declines after around 2530 years; the
world record for the mile at 90 years of age is just under a quarter of an hour, not much
above the brisk walking speed.
12
INTERPRETIVE QUESTIONS
291
MCQs
MCQ
Questions 692708
MCQ Question 692
Figure 12.1 shows two blood oxygen dissociation curves. A represents the oxygen partial pressure in normal alveoli, H the lowered alveolar oxygen pressure in hypoxic lungs due to high
altitude or pulmonary disease and V the mixed systemic venous oxygen pressure in the person
suffering from hypoxia. In this diagram:
a. If (i) is a normal persons curve, then (ii) is the hypoxic persons curve, rather than vice
versa.
b. The blood in curve (i) has a higher red cell level of 2,3-diphosphoglycerate (2,3-DPG).
c. The O2 saturation of blood leaving the hypoxic lungs is lower with curve (ii) than with
curve (i).
d. The oxygen extracted by the tissues equals oxygen uptake in the lungs for both curves
in both people, other things being equal.
e. The curve labelled (i) is more suitable for fetal conditions than the curve labelled (ii).
100%
(i)
Blood oxygen saturation
(ii)
X
Z
0
Figure 12.1
292
MCQ
Answers to 692
a.
b.
c.
True
False
True
d.
True
e.
True
293
0
A
Figure 12.2
MCQ
Figure 12.2 indicates some events during two respiratory cycles, where Iinspiration and
Eexpiration. In the second cycle, tidal volume was three times that in the rst cycle.
Expiration was not forced. It can be concluded that:
a. Record A shows the changes in intrapleural pressure.
b. Record B shows the changes in intrapulmonary pressure.
c. Record C shows the rate of gas flow into and out of the lungs.
d. The compliance of the lungs and chest wall is increased markedly in the second cycle.
e. Maximum airflow occurs at the end of inspiration.
294
MCQ
True
b.
True
c.
False
d.
False
e.
False
Intrapleural pressure is negative throughout the cycle and is minimum at the end
of inspiration; it becomes more negative with a deeper inspiration.
Intrapulmonary pressure (that is intra-alveolar pressure) reaches its minimum
around mid-inspiration and its maximum around mid-expiration.
The flow record closely follows the intrapulmonary pressure record B since flow
is directly related to pressure gradient between alveoli and atmosphere; record C
shows changes in lung volume.
Compliance, the volume change for a given pressure change, is similar in both;
though the pressure gradient is increased about three times in the second cycle,
so is the tidal volume.
Airflow is zero at end inspiration; it is maximum in mid-inspiration and midexpiration.
295
Log PCO 2
HCO 3
HCO 3
X
U
Z
V
L
Y
W
U
L
pH
Figure 12.3
MCQ
In the acidbase diagram shown in Figure 12.3, where L and U represent the lower and upper
levels of normal respectively, a patient whose arterial blood values were found to be at point:
a. V might have a compensated metabolic alkalosis.
b. W might have an uncompensated respiratory alkalosis.
c. X might have a compensated metabolic alkalosis.
d. Y might have a partly compensated respiratory acidosis.
e. Z might be suffering from severe vomiting.
296
MCQ
False
b.
c.
True
True
d.
False
e.
True
Since all parameters are within normal range, acidbase balance is normal; for a
metabolic alkalosis (compensated or uncompensated) the bicarbonate level must
be above normal.
The rise in pH is associated with a low PCO2 but a normal HCO3.
Or a compensated respiratory acidosis; in both cases bicarbonate and carbon
dioxide levels are raised proportionately, so that the ratio PCO2 to HCO3 is normal,
giving a normal pH.
The patient has a partly compensated metabolic acidosis (low bicarbonate); the
low pH indicates incomplete compensation; for a respiratory acidosis the carbon
dioxide level must be above normal.
The patient has an uncompensated metabolic alkalosis caused by severe loss of
gastric acid.
297
Right hand
10 ml
10
Left forearm
Minutes
Figure 12.4
MCQ
Figure 12.4 shows simultaneous records of changes in right hand and left forearm volume
when collecting pressures are applied intermittently by means of cuffs on the right wrist and
left upper arm respectively. The volume of the hand in the plethysmograph was 300 ml and the
volume of the forearm was 600 ml. These records (venous occlusion plethysmograms) show:
a. A greater hand blood flow in the third than in the fourth plethysmogram.
b. That the rate of blood flow per unit volume of tissue is similar in the hand and forearm.
c. That hand blood flow is more variable than forearm blood flow.
d. That forearm blood flow is nearer 20 than 50 ml/minute.
e. That the collecting cuffs are not occluding the arteries.
298
MCQ
False
b.
False
c.
True
d.
e.
False
True
Flow is measured as increase in volume with time and hence is directly proportional to the slope of the volume record during collection.
The total blood flow rates are similar on the two sides; since hand volume is half
that of the forearm, its rate of flow per unit volume of tissue is approximately
double forearm flow.
The slopes are more variable; the more variable flow is due to greater variability
in the level of sympathetic vasoconstrictor tone.
The rate of flow is quite close to 50 ml/minute.
If the arteries were occluded, flow would be zero.
299
VC
FEV1.0
FEV1.0/VC%
PFR
Observed (O)
Predicted (P)
O/P
4.0
2.0
50%
200
5.3 litres
4.4 litres
83%
645 litres/minute
76%
45%
56%
31%
MCQ
Results are given in the table below of a persons vital capacity (VC), forced expiratory volume
in one second (FEV1.0) and peak flow rate (PFR). The subject of these tests:
a. Is more likely to be a man of 25 than a woman of 65.
b. Is more likely to be suffering from restrictive lung disease than obstructive airways disease.
c. May have asthma, chronic bronchitis or emphysema.
d. Typically will have an arterial PCO2 50 per cent above normal.
e. May have a compensated respiratory acidosis.
300
MCQ
True
b.
False
c.
d.
e.
True
False
True
The predicted values are those of a man of 25 (height 70, 1.8 m); for a woman
of 65 (63, 1.6 m), the FEV1.0 of 2.0 litres would be normal.
The relatively severe reduction in FEV1.0 and PFR are typical of severe obstructive disease; in restrictive disease, FEV1.0 and VC are reduced to a similar extent.
All of these produce a similar obstructive pattern of respiratory function.
Respiratory failure is a rare complication of obstructive airways disease.
If the condition leads to some carbon dioxide retention. Note: typically implies
a majority of cases; may implies a possibility, which could be a small minority
of cases.
301
LV Stroke work
A
V
X
Z
LV End-diastolic pressure
Figure 12.5
MCQ
Figure 12.5 shows left ventricular (LV) function curves of the FrankStarling type. If point X
on curve B represents the conditions in the normal heart at rest then point:
a. Z might represent conditions in the failing ventricle at rest.
b. Y might represent resting conditions in the ventricle in hypertension prior to failure.
c. Y, rather than point V, might represent conditions in the ventricle after administration
of a beta adrenoceptor agonist drug.
d. V might represent conditions in a patient with aortic valve stenosis prior to failure.
e. W might represent the conditions in hypovolaemic circulatory failure.
302
MCQ
True
False
c.
False
d.
e.
True
True
303
A
60
Y
40
20
0
PCO 2
Figure 12.6
100 mmHg
13.3 kPa
MCQ
304
MCQ
False
b.
True
c.
d.
False
False
e.
False
The reverse is true; deoxygenated blood can carry more CO2 than oxygenated
blood at a given carbon dioxide pressure.
In the lungs the blood oxygen saturation rises shifting the curve from A to B and
the CO2 content and pressure fall from point X to point Y.
It would merely shift the position on a given dissociation curve.
Plasma does not become saturated with CO2; CO2 content remains proportional to
PCO2; the initial sharp rise is due to formation of carbamino compounds this falls
off sharply as the number of free amino groups declines.
The amount of CO2 in solution is the same for both curves for any PCO2; differences in total CO2 content are due to differences in bicarbonate and carbamino
content; at low oxygen pressures, the desaturated haemoglobin is increasingly
more effective in buffering hydrogen ions and, by the law of mass action, favours
formation of bicarbonate ions from carbon dioxide.
305
Sound energy
B
W
C
100
Figure 12.7
10 000 Hz
MCQ
In Figure 12.7, the line VXYW represents the threshold of hearing at various frequencies for a
normal subject. The:
a. Sound waves with the characteristics represented by point Z are audible to the subject.
b. Interval AB on the ordinate represents 2.0 rather than 20 decibels.
c. Point D on the abscissa corresponds to 5000 rather than 1000 Hz.
d. Segment XY includes the frequencies most important in the auditory perception of
speech.
e. Curve is shifted downwards in the presence of background noise.
306
MCQ
False
b.
False
c.
d.
False
True
e.
False
Anything below the line is inaudible, having less energy than the threshold value
for detection at a particular frequency (Hz).
AB and BC both represent 20 decibels; thus sounds at the extremes of the hearing range need relatively high energy to be heard.
It corresponds to 1000 Hz; the frequency (or pitch) scale is logarithmic.
The ear is most sensitive to sounds in the range 10003000 Hz (XY), which
includes the frequencies most important in distinguishing the different words in
speech.
It is shifted upwards since extraneous (masking) noise raises auditory threshold,
that is the lowest energy level at which a sound of a particular frequency can just
be detected.
307
Glucose mass/min
D
H
0
Plasma glucose concentration
Figure 12.8
MCQ
308
MCQ
True
False
c.
True
d.
True
e.
False
309
MCQ
In a patient with a red cell count (RCC) of 41012/litre, a haemoglobin (Hb) of 7.5 g/100 ml
and a haematocrit of 0.28:
a. The mean corpuscular haemoglobin (MCH) is nearer 20 picograms (pg) than 20 nanograms (ng). 1pg1012 g; 1 ng109 g.
b. The mean cell volume (MCV) is nearer 95 than 70 fl (1 femtolitre1 m3).
c. The mean corpuscular haemoglobin concentration (MCHC) is nearer 30 than
35 g/100 ml.
d. The cause of the anaemia is most likely to be vitamin B12 deciency.
e. The patient requires a blood transfusion.
310
MCQ
True
Hb/litre
75g
18.751012 g18.75 pg
MCH
RCC/litre
41012
litres70 fl.
Red cell count/litre
41012
Since the normal volume is about 7595 fl, these cells are microcytic.
c.
True
Hb
7.5
MCHC
26.8 g/100 ml
Haematocrit
0.28
Since the normal MCHV is about 3035 g/100 ml, these cells are hypochromic.
d. False This microcytic, hypochromic picture is characteristic of iron deciency.
e.
False Moderate iron deciency anaemia of this sort responds well to iron therapy:
blood transfusions should not be used unless absolutely necessary.
311
(A)
(B)
Lead
Figure 12.9
II
III
V1
V4
V6
MCQ
Figure 12.9 shows two electrocardiogram records from a patient. Record B was taken one year
after record A was obtained. In these records:
a. The QRS axis in A is directed to the left rather than to the right of vertical.
b. The QRS complexes V1, V4 and V6 in A suggest left, rather than right, ventricular hypertrophy.
c. The change from A to B suggests a return towards normality.
d. The QRS axis in B is directed downwards rather than upwards.
e. The inversion of T in leads III and V1 in record A indicates myocardial ischaemia.
312
MCQ
False
b.
False
c.
True
d.
True
e.
False
The net QRS in lead I is negative, indicating an axis to the right rather than the
left; this is conrmed by lead III having a large positive deflection.
The R dominance in V1 and the prominent S wave in V4 suggest an abnormally
great contribution from the right ventricle in these leads.
In record B, V1 now shows a normal S wave; V4 has lost its S wave to show only
a normal R wave.
It is roughly 60o below the horizontal (close to the axis of lead II). The swing from
right (A) to left (B) indicates return of left ventricular dominance, as do the V lead
changes.
Occasional T wave inversion is common and usually has no sinister signicance.
313
Lung volume
D
C
B
A
Intra-oesophageal pressure
Figure 12.10
MCQ
Figure 12.10 shows some relationships between lung volume (increasing upward) and oesophageal pressure (increasing to the right) during normal tidal breathing. In this diagram:
a. The intra-oesophageal pressure is equal to atmospheric pressure at point A.
b. The changes during the respiratory cycle follow the path ABDC.
c. The slope of the line AD increases when lung compliance increases.
d. The width of the loop CB increases when airway resistance increases.
e. AD increases in length during exercise.
314
MCQ
False
b.
True
c.
d.
True
True
e.
True
315
W
Y
X
V
Figure 12.11
MCQ
Figure 12.11 shows the visual eld of a normal left eye as plotted by perimetry. When the eye
is focused on point Y, an object at point:
a. W is detected in the lower nasal quadrant of the left retina.
b. Y is detected in the region of the fovea of the macula.
c. Z rather than at point X may be invisible.
d. W is appreciated as a result of impulses transmitted in the left rather than the right
optic tract.
e. V is seen in monocular vision.
316
MCQ
True The image is inverted and reversed with respect to the object.
True The point focused upon is detected at the macula where visual acuity is greatest.
False The reverse is the case; the optic disc is medial to the fovea, hence the blind spot
is in the temporal (lateral) part of the eld of vision.
False Impulses from the temporal region of the eld of vision cross the midline at the
optic chiasma.
True The visual elds of the two eyes do not overlap for this point.
317
Left ureter
Right ureter
0.2
100.0
1000.0
6.0
10.0
150.0
MCQ
Samples taken from the ureters of a man with severe one-sided renal artery stenosis gave the
results shown in the table below. Plasma creatinine level was 1 mg/100 ml and the PAH level
was 3 mg/100 ml. In this patient:
a. Glomerular ltration rate (creatinine clearance) was 10 times as great on the left side as
on the right.
b. Renal plasma flow was approximately 67 ml/minute on the left.
c. Renal blood flow was 900 ml/minute on the right (haematocrit33 per cent).
d. The right kidney had the narrowed renal artery.
e. It is likely that he was hypertensive.
318
MCQ
False Creatinine clearance (UV/P) was 20 ml/minute on the left and 60 ml/minute
(normal) on the right.
True From PAH clearance a very low value.
False Blood flowplasma flow1/1 Ht3003/2450 ml/minute.
False The left side had the abnormality.
True Due to excessive renin release from the ischaemic kidney; the excessive renin
leads to excessive formation of angiotensin I and angiotensin II; the latter constricts blood vessels and increases plasma volume.
319
300
200
10
B
100
5
C
0
0
2
Hours
Figure 12.12
15
MCQ
Figure 12.12 shows results obtained during a glucose tolerance test on three people. The person
represented by curve B was normal. The oral glucose load was given at time zero. It can be
deduced that:
a. Curve A is consistent with a diagnosis of diabetes mellitus.
b. Curve C is more consistent with a diagnosis of an insulin-secreting tumour than of malabsorption.
c. A person showing curve B, who has glucose in the urine 30 minutes after glucose ingestion, is likely to have a low renal threshold for glucose.
d. The renal clearance of glucose two hours after glucose ingestion in patient A is nearer
10 than 30 per cent of the renal plasma flow, assuming a normal renal threshold.
e. The renal clearance of glucose for the patient showing curve B is likely to be about
60 ml/minute 30 minutes after glucose ingestion.
320
MCQ
True
b.
False
c.
d.
True
True
e.
False
The fasting glucose level and the peak level are markedly raised and there is
delayed return of blood glucose to the fasting level.
Curve C is typical of the flattening obtained with malabsorption; with an insulin-secreting tumour, the fasting level would tend to be low, with a more marked
rise to a peak and a subsequent trough below the initial level.
The normal renal glucose threshold is about 180 mg/100 ml (10 mmol/l).
About 150/330 of the ltered glucose is being lost, corresponding to a clearance
of 4050 per cent of the GFR, i.e. about 60 ml which is about 10 per cent of renal
plasma flow.
Since blood glucose does not exceed the renal threshold for glucose, renal clearance will be zero.
321
(mmHg)
(A)
60
50
200
150
100
50
(ml min1)
(C)
(beats min 1)
40
(B)
30
mmHg (ml/min1 )
10
(D)
4
2
0
0
Hours
(After Sanhueza et al. J. Physiol. (2003) 546, 899.)
Figure 12.13
MCQ
Figure 12.13 shows mean results of experiments in which sheep fetal (A) arterial pressure, (B)
heart rate, (C) femoral artery blood flow and (D) femoral vascular resistance were measured
before, during and after a period (marked by the rectangle) when the mother was made
hypoxic. The results suggest that:
a. Maternal hypoxia causes a 50 per cent rise in fetal blood pressure.
b. The fall in femoral blood flow with maternal hypoxia is due to the slowing of the heart.
c. Maternal hypoxia causes vasoconstriction in the fetal lower limbs.
d. The fetal responses are similar to those seen in the diving reflex seen in seals and other
animals that dive under water.
e. The response might aid survival by redistributing cardiac output towards the brain.
322
MCQ
False
b.
False
c.
True
d.
True
e.
True
The increase is not more than 25 per cent from a mean value around 46 mmHg
to a mean value around 56 mmHg in the second half of the period of hypoxia.
Blood flow is not normally a function of heart rate; notice that the change in
heart rate was modest from around 175 to around 140 beats per minute and it
was accompanied by a rise in arterial pressure (A).
The fall in flow despite the increase in perfusion pressure indicates vasoconstriction and this is conrmed by the rise in femoral vascular resistance resistance
rose about three-fold when flow fell to about one third.
Diving animals show a bradycardia and peripheral vasoconstriction when they
dive under water.
The vasoconstriction in the lower body diverts a greater fraction of the cardiac
output to the cerebral circulation which does not constrict in response to a
hypoxic stimulus.
323
30
25
20
15
Girls
Boys
10
5
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Age in years
Figure 12.14
MCQ
Figure 12.14 shows the growth rates of males and females from birth to 20 years. It indicates
that:
a. Growth for both sexes is most rapid between the ages of 0 and 2 years.
b. Boys and girls have similar growth rates around age 1314.
c. Boys stop growing at a later age than girls.
d. Boys grow less quickly at age 5 than at age 16.
e. The growth rate for girls of 12 is less than for boys of 16.
324
MCQ
True
True
c.
True
d.
e.
True
True
12
INTERPRETIVE QUESTIONS
325
EMQs
EMQ
Questions 709714
EMQ Question 709
Figure 12.15 shows some of the changes that occur throughout the phases of a menstrual cycle.
For each of the physiological variables ae below, select the most appropriate option from the
following list of traces.
1. Trace A.
2. Trace B.
3. Trace C.
4. Trace D.
a. Oestradiol level.
b. Core temperature.
c. Luteinizing hormone level.
d. Progesterone level.
e. Inhibin level.
A
D
0
14
Days
Figure
Figure12.15
12.16
28
326
EMQ
b.
c.
d.
e.
Option 3
Trace C. Oestrogens produced by the follicular cells of the developing ovum
dominate the follicular phase of the cycle and peak about the time of ovulation; the level
is still somewhat raised during the luteal phase.
Option 1
Trace A. Core temperature tends to rise about the time of ovulation and then
falls again coming up to the following menstruation.
Option 4
Trace D. Luteinizing hormone secretion peaks at about the time of ovulation
(in a similar manner to follicle-stimulating hormone, but its concentration tends to be
greater).
Option 2
Trace B. Progestogens formed by the corpus luteum dominate the luteal
phase of the cycle and cause the endometrium to enter the secretory phase.
Option 2
Trace B. Inhibin is a hormone produced by the ovary that inhibits secretion
of follicle-stimulating hormone by the anterior pituitary gland. It peaks in the luteal phase
of the cycle with a time course similar to the progestogen level.
327
Percentage
1400
1200
1000
800
600
400
200
0
B
C
D
E
1
Exercise workload
Figure 12.16
EMQ
Figure 12.16 shows the effect of increasing grades of exercise (from rest in period 1 to near
maximal exercise in period 4) on some cardiovascular and respiratory variables. For each of
the traces AE, select the most appropriate variable from the list below.
1. Oxygen consumption.
2. Cardiac output.
3. Heart rate.
4. Mean arterial pressure.
5. Total peripheral resistance.
a. Trace A.
b. Trace B.
c. Trace C.
d. Trace D.
e. Trace E.
328
EMQ
b.
c.
d.
e.
Trace A: Option 1
Oxygen consumption. Oxygen consumption can increase during
exercise from a resting value of 0.25 litre/minute to 3 litres/minute (1200 per cent) or
more.
Trace B: Option 2
Cardiac output. Cardiac output increases fairly linearly with
increasing exercise from a resting value of about 5 to a peak value of over 20 litres per
minute.
Trace C: Option 3
Heart rate. Heart rate increases fairly linearly with exercise from
a resting value of about 60 to a maximum of about 180 (220 minus age in years) beats
per minute, a rise to about 300 per cent of the resting value.
Trace D: Option 4
Mean arterial pressure. Though cardiac output rises markedly in
exercise, peripheral resistance falls markedly; rises in mean pressure are usually slight.
Trace E: Option 5
Total peripheral resistance. Total peripheral resistance falls markedly due to vasodilation in the exercising skeletal muscles
329
Pressure (mmHg)
120
C
80
40
A
B
0
40
120
Volume (ml)
Figure 12.17
EMQ
Figure 12.17 shows four points on the pressurevolume diagram of a left ventricle. For each
of the descriptions ae below, select the best option from the following list of points and lines.
1. D
2. C
3. A
4. B
5. DC
6. DA
7. AB
8. CB
9. CD
10. AD
11. BA
12. BC
13. ABCD
14. DCBA
15. DCAB
16. ADCB
a. The beginning of diastole.
b. The end of systole.
c. Isometric contraction.
d. The segment between two points where the trace would depart maximally from a
straight line.
e. One cardiac cycle starting with the onset of diastolic lling.
330
EMQ
b.
c.
d.
e.
Option 1
D. At the beginning of diastole ventricular volume is around 50 ml and the
pressure is around 120 mmHg (above atmospheric) because the isometric phase of diastole
has not yet occurred.
Option 1
D. At the end of systole, ventricular volume has returned to 50 ml and the
pressure is around 120 mmHg, having fallen from a maximal value around 140 mmHg as
the aortic valve closes.
Option 12 BC. By denition volume is unchanged during isometric contraction, while
pressure rises from about zero to a level which will open the aortic valve at arterial diastolic pressure, around 90 mmHg; thus isometric contraction is represented by the vertical
line BC.
Option 9
CD. The two segments BC and DA represent isometric systole and isometric
diastole, so are completely straight. During ventricular lling, AB, there is a small (around
5 mmHg) rise in pressure during atrial systole. In contrast, during the ejection phase of
ventricular systole, CD, the pressure rises from arterial diastolic to arterial systolic (from
around 90 to 140 mmHg) and then falls back to around 120 mmHg as the aortic valve
closes.
Option 13 ABCD. Diastolic lling starts when ventricular volume is around 50 ml and
its pressure close to atmospheric. The pressurevolume trace then moves to B where lling
is complete, and continues in an anti-clockwise direction.
331
Air flow
0
Y
W
X
6
Lung volume
Figure 12.18
EMQ
Figure 12.18 shows four points on the flowvolume diagram of the lungs of a healthy young
man. W is the lung volume at total lung capacity and Y is the lung volume at residual volume.
Z and X represent maximal outflow and maximal inflow respectively. The person has breathed
in and out a vital capacity as quickly as possible. For each of descriptions ae below, select the
best option from the following list of points, lines and areas.
1. W
2. X
3. Y
4. Z
5. WZ
6. ZW
7. ZY
8. YZ
9. WX
10. XW
11. XY
12. YX
13. ZX
14. XZ
15. Totally inside the loop below.
16. Partially outside the loop below.
a. The line which corresponds most closely to the rst part of a forced expiratory volume
in one second manoeuvre.
b. The point at which lung volume is closest to one litre.
c. The position of the loop during strenuous exercise in the same person.
d. The nal part of the manoeuvre of measuring a fast vital capacity.
e. The point at which intra-alveolar pressure is likely to be most negative.
332
EMQ
Option 5
WZ. The manoeuvre starts at total lung capacity and the volume expired in
the rst second is measured.
Option 3
Y. The residual volume of a healthy young man is usually a little over a litre.
Option 15 Totally inside the loop. Although volumes and flows increase with exercise,
they are still below the maximal; the loop for tidal breathing is smaller still.
Option 7
ZY. After the rst second of rapid expiration the person must continue
breathing out until residual volume is reached, usually in a further second or two.
Option 2
X. This is the point of maximal inflow; at this point the pressure gradient
between atmosphere and alveoli is also maximal, with alveolar pressure subatmospheric.
333
200
100
A
C
Figure 12.19
EMQ
Figure 12.19 shows some of the effects of simulating mildly increased gravitational stress by
lower body suction. For each of the physiological variables ae below, select the most appropriate option from the following list of trends.
1. Trend A.
2. Trend B.
3. Trend C.
a. Forearm blood flow.
b. Cardiac output.
c. Mean arterial pressure.
d. Total peripheral resistance.
e. Renin secretion.
334
EMQ
d.
e.
Option 3
Trend C. The forearm blood flow falls as part of the general vasoconstriction that helps to maintain arterial blood pressure.
Option 3
Trend C. As the blood pools in the lower body due to suction, the lling
pressure of the heart decreases and so the cardiac output falls.
Option 1
Trend A. During this relatively mild gravitational stress, arterial pressure is
quite well maintained by mechanisms that compensate for the shift of blood volume
towards the feet.
Option 2
Trend B. The shift of blood initiates reflex mechanisms to increase total
peripheral resistance to help to maintain arterial pressure.
Option 2
Trend B. The diminished blood flow to the kidneys with vasoconstriction
related to the fall in cardiac output and output results in the release of renin from the juxtaglomerular apparatus that again helps to maintain arterial blood pressure.
335
Question 714
B
100
50
100
50
8
6
4
30
20
10
15
20
35
40
Time (min)
(After Barcroft and Swan (1953) Sympathetic Control of Human Blood
Vessels, Edward Arnold, London.)
Figure 12.20
150
EMQ
Figure 12.20 shows the effects of intravenous adrenaline and noradrenaline infusions on some
cardiovascular variables. For each event or trace ae below, select the best option from the following list.
1. Arterial pressure.
2. Heart rate.
3. Cardiac output.
4. Peripheral resistance.
5. The period of adrenaline infusion.
6. The period of noradrenaline infusion.
a. Event A.
b. Trace C.
c. Trace D.
d. Trace E.
e. Trace F.
336
EMQ
b.
c.
d.
e.
Event A: Option 5
Period of adrenaline infusion. This corresponds to a period of
increased heart rate and widening of the pulse pressure with a fall in diastolic pressure,
whereas at the second event heart rate decreased and both systolic and diastolic pressure
increased, indicating that noradrenaline was infused during period B.
Trace C: Option 2
Heart rate. Adrenaline accelerates the heart but noradrenaline
causes reflex slowing produced by the steep rise in mean arterial pressure. This is the only
scale giving an initial value (around 80) corresponding to a normal (slightly apprehensive)
heart rate.
Trace D: Option 1
Arterial pressure. Adrenaline lowers the diastolic pressure but
noradrenaline raises it. This is the only dual trace corresponding to systolic and diastolic
pressures; the initial value 130/80 corresponds to normal blood pressure.
Trace E: Option 3
Cardiac output. Adrenaline raises cardiac output but noradrenaline reduces it because of the reflex depression of cardiac activity. Again the scale corresponds to an initially normal/slightly raised cardiac output around 67 litres/minute.
Trace F: Option 4
Peripheral resistance. Noradrenaline raises total peripheral resistance because of its predominant effect on alpha adrenoceptors which mediate vasoconstriction; adrenaline lowers it because of its predominant effect on beta adrenergic
receptors which mediate vasodilation. These units are appropriate for peripheral resistance: from the equation
Mean arterial pressureCardiac outputPeripheral resistance
we can derive that
Peripheral resistanceMean arterial pressure/Cardiac output
For the initial state this equals approximately 100/71415 as in F (the units are
mmHg/litre/minute).
Note that for this question it was necessary to consider all aspects of the diagram together,
rather than consecutively.
INDEX
A wave of venous pulsation in neck, 123
abdominal pressure, 188
ABO blood group see blood group antigens
absolute refractory period, ventricles, 79
absorption, 218, 224, 250, 255
calcium, 255, 502
fat/lipid, 218, 223, 255, 258
glucose, 246, 255, 258
intestinal, 246, 250
impaired, 229
sodium see sodium
vitamin B12, 250, 251, 255
see also reabsorption
accommodation for near vision, 351, 385
loss of ability, 385
ACE inhibition, 478
acetylcholine, 292
acetyl-coenzyme A, 644
Achilles (ankle jerk) reflex, 302
acidbase balance see pH
acidosis, 624
bicarbonate administration, 66
metabolic, 41, 508, 641
hypokalaemic acidosis, 444
in renal failure, 647
respiratory, 42, 59, 434, 641, 694, 696
acquired immune deficiency syndrome see AIDS
action potentials, 642
cardiac, 137
nerve fibre, 289
Addisons disease, 510
adenohypophysis see pituitary gland, anterior
adenosine triphosphate (ATP), 644
adrenal gland
adrenaline secretion, 461
cortex
CRH effects on activity, 512
decreased activity, 510
hormones secreted by, 475
paediatric overactivity, 504
failure, 495
medulla
overactivity, hypertension with, 509
tumour, 485, 509
adrenaline, 461, 467
adrenal secretion, 461
injection/infusion, 101, 452, 714
gastric motility decrease with, 257
adrenoceptors, 279
blockade, 312
-adrenoceptors, 337
one/two, 337
blockade, 324
adrenocorticotrophic hormone (ACTH), 447,
479
afferent inhibition, 649
age-related changes, 601, 606
body mass, 610
females, 576
lens elasticity, 385
respiratory system/function, 144
special senses, 380, 394
agglutinogens see blood group antigens
AIDS and HIV disease, 57
lymphocytes, 64
337
air
flow (gas flow) in lungs, 693, 694
see also flowvolume diagrams
in pleural cavity, 171
albumin, plasma, 10, 65
aldosterone, 413, 440
antagonist, 423
secretion, 413, 415
increased, 445
alerting reactions, 648
alimentary tract, 195-260
motility, 252, 257, 260
surgical removal of various parts, 259
see also specific regions
alkaline mucus, secretion, 253
alkalosis
metabolic, 41, 59, 694
respiratory, 41, 43, 45, 694
alpha-adrenoceptors see adrenoceptors
alpha rhythm (EEG), 281
altitude see high altitude
alveolar pressure, 188, 693
alveolar ventilation in breathing, 148
amblyopia, 387
amenorrhoea, 510
secondary, 545
athlete, 663
ammonia, renal handling, 436
amniotic fluid, 542
ampullary crest (crista ampullaris), 390, 646
amylase, 254
anaemia, 35, 62, 701
in gastric juice deficiency, 256
hypoxia in, 194
iron-deficiency, 36, 62, 701
in renal failure, 647
anaerobic activity, 690
metabolism in, fitness measurement, 687
androgens, 505, 520
female secretion, 566
angina, 113
angiotensin I/II, 419, 439
angiotensin-converting enzyme inhibition, 478
ankle jerk reflex, 302
anorexia, 198
anosmia, 394
antibodies, 13
ABO blood group see blood group
antidiuretic hormone (vasopressin), 440, 455, 503
deficiency and insufficient secretion (and diabetes
insipidus), 421, 482, 511
antigens, 22
blood group see blood group antigens
antihaemophilic globulin (factor VIII) deficiency, 54,
58
anxiety, sporting event, 683
aortic chemoreceptors, 158
aortic valve, 130
incompetence, 119
stenosis, 697
aphasia, 307
apoferritin, 255
appendicectomy, 259
appetite loss, 198
aqueous humour, 360
338
Index
Index
blood (continued)
pulmonary capillary, 166
stored, 61
viscosity, decreased, 62
bloodbrain barrier, 136, 273
blood flow, 133
autoregulation, 131
cerebral, 133
coronary see coronary blood flow
forearm, measurement by venous occlusion
plethysmography, 126, 695
renal, 404, 406, 407
skeletal muscle
in exercising limb, 653
in fainting, 133
skin, 133
splanchnic, in sweating, 133
to tissues/organs (in general), local metabolic
activity affecting, 69
turbulent, 95
velocity, 87
see also circulation
blood gases, 139, 189
in acidbase imbalances, 59
in respiratory failure, 112
see also carbon dioxide; oxygen
blood group antigens (agglutinogens), 2, 33
group A, 5
antibodies (agglutinins), 25
group B, antibodies (agglutinins), 25
in transfusion reactions, 37, 61
blood pressure, 70
arterial
adrenaline and noradrenaline (i.v. infusion)
effects, 714
dialysis patient, abnormal, 441
mean see mean arterial blood pressure
auscultatory measurement, 78
high see hypertension
reflex regulation, 132
venous see venous pressure
blood transfusion see transfusion
blood vessels see entries under vascular;
vasculature
blood volume
increased, 60
see also plasma, volume
reflex regulation, 132
restoration after haemorrhage, 619
see also hypovolaemic circulatory failure
blue bloaters, 186
bone, 586
metabolism, 507, 585
bowel see intestine
boys, growth rates, 708
see also males
brain, 648
capillary permeability, 136
function, depressed, 327
oedema, 67
respiratory centre see medulla oblongata
vasculature see cerebral vessels
see also specific parts
brainstem
death, 306, 331, 443
339
brainstem (continued)
reflexes, 333
in pregnancy, 571
sensory pathways, 393
breast (mammary glands), 525
lactating, 503, 512
progesterone causing development, 505
breathing
alveolar ventilation in, 148
divers see divers
Kussmaul, 508
work of, 162
see also ventilation
breathlessness see dyspnoea
bronchi
complete obstruction, 174
smooth muscle contraction, 149
bronchial asthma see asthma
brown fat, 213
bruits, auscultation, 116
Brunners glands, 253
brush border, glucose absorption, 258
buffering, 605
by desaturated haemoglobin, 193
burns, fluid disturbances, 67
calcification (bone) disorders, 507
calcitonin (thyrocalcitonin), 465, 507
calcium, 502, 592
absorption, 255, 502
blood levels
fall, causes, 471
raised, 55, 502
one mole, 592
calculi see stones
capillaries, 136, 140
bleeding/haemorrhage from, 58
in vitamin C deficiency, 136
blood values in, 140
density, in fast twitch anaerobic muscle, 690
fluid loss and leakage, 65
in legs, 77
glomerular, hydrostatic pressure, 395, 438
pulmonary, blood in, 166
carbaminohaemoglobin, 193
carbohydrate
absorption, 224
as energy source, 63
carbon dioxide, 146
retention, 179
transport, 146, 160, 193
see also respiratory quotient
carbon dioxide dissociation curve of blood, 161,
698
carbon dioxide tension (PCO2), 139, 698
arterial, 189, 613
in acidbase imbalances, 59
effects of raised PO2, 155
in respiratory failure, raised, 112
carbonic anhydrase, 594
inhibitor, 429
carboxyhaemoglobin, 193
cardiac sphincter contraction, 252
cardiovascular system, 68-138
see also circulation; heart
340
Index
Index
cupula, 390
Cushings syndrome, 492
cutaneous physiology see skin
cyanosis, 178
pink puffers vs blue bloaters, 186
cystometrogram, 422
dark adaptation, 344, 348, 386
dead space, respiratory, 164
death
brainstem, 306, 331, 443
fetal, 567
local tissue, vascular obstruction causing, 125
perinatal, multiple pregnancy, 568
defaecation, 200
deglutition (swallowing) reflex, 197, 333
delta waves (EEG), 303
deoxyribonuclease, 265
depolarization, nerve cell membrane, 286
dextrose, 5% and 50%, 66
diabetes insipidus, 421, 482, 510
diabetes mellitus, 500
insulin treatment, 662
ketoacidosis, 189, 331, 497
ketosis, 496
oral glucose tolerance test for, 476, 500, 706
severe, 483, 491
type-1 (insulin-dependent), and exercise, 689
type-2, 509
dialysis, 424, 441
diarrhoea, severe, 236
metabolic acidosis, 641
dichromatism, 388
dietary energy intake, appropriate, 684
see also food; malnutrition
digestive tract see alimentary tract
digital artery spasm with cold, 414
dihydroepiandrosterone, 505
dilution indicators, 29
cardiac output estimation, 99
2,3-diphosphoglycerate, 674
diplopia, 387
disaccharidases, 251, 254
divers, breathing
air at 30m depth, 177
helium instead of nitrogen, 621
DNase (deoxyribonuclease), 265
dominant autosomal genetic disorders, 635
dopamine, 643
dorsal (posterior) column of spinal cord, 393
damage, 316
double vision, 387
Downs syndrome, 504
ductus arteriosus, 138
dumping syndrome, 259
duodenum
fat in, 252, 257
pancreatic juice lack in, 241
passage of gastric contents to, 216
ulcer see peptic ulcer
dwarfism, 504
dynamic vs static exercise, 76, 656
dyspnoea (breathlessness)
pink puffers, 186
ventilation associated with, 191
341
ear
inner, 390
hair cells, 355, 390, 646
middle, 375, 391
see also audition
ear drum (tympanic membrane), 353, 358, 389
ECG see electrocardiography
ectopic beats (extrasystoles), ventricular, 120
EEG see electroencephalography
egg (ovum), fertilization, 514
ejaculation/ejaculate see semen
elastic recoil, leg muscle/tendons, 668
elasticity
arteries, 129
lens with ageing, loss, 385
lung in emphysema, loss, 173
electric shock causing ventricular fibrillation, 622
electrical potentials, 642
electrocardiography, 90, 109, 134, 137, 702
treadmill exercise danger signs, 657, 670
electroencephalography, 276
rhythm, 281
rhythm, 303
embolism, pulmonary, 121
emesis see vomiting
emmetropia, 385
emphysema, pulmonary elastic tissue loss, 173
endocrinology see hormones
endolymph, 342, 390
endopeptidases, 254
endoplasmic reticulum, 584
endorphins, 335
endurance fitness, Olympic level, 676
endurance running see running
energy, 644
dietary intake, appropriate, 684
sources of
carbohydrate, 63
fat, 63
enkephalins, 335
enteric nervous system, polypeptide secretions, 260
enterochromaffin cells, 253
enterokinase, 253
enzymes
digestive, 203, 204, 207, 251, 253, 254
intracellular, 640
eosinophils, 23
epididymis, 574
equilibrium potential, 298
erection, penile, 535, 569
erythrocytes (red cells), 9
antigens see blood group antigens
breakdown, 4
circulating, 14
CO2 in, 193
formation, increased, 40
erythropoietin, 444
increased secretion, 510
transplanted kidney, 443
Eustachian tube, 391
excitatory post-synaptic potential, 268
exercise (and sport), 670-91, 710
capillary pressure in muscle during, 136
hyperaemia in skeletal muscle during, 83
isometric vs isotonic, 76, 656
342
exercise (continued)
maximal, 629
athlete, 663
ventilation increase, 685
metabolic rate in see metabolic rate
syncope/pre-syncope during, 128
see also athletes
exophthalmos, thyroid overactivity, 506
external inhibition, 649
extracellular fluid
decreased, 60
intracellular vs, 1
osmolality rise, 628
extrapyramidal motor system disease, 336
parkinsonism, 310, 336
extrasystoles, ventricular, 120
eye
atropine application, 374
involuntary oscillatory movements (nystagmus),
379, 388
left, visual field, 367, 704
protrusion of eyeball in thyroid disease, 506
refraction system, 354, 385
visual acuity see visual acuity
see also vision and specific parts of eye
facial nerve and taste sensation, 392
factor VIII deficiency, 54, 58
faeces/stools
bulky liquid, with colectomy, 259
chronic loss of blood in, 128
discharge, 200
pale, in biliary obstruction, 256
see also constipation; diarrhoea
fainting/syncope
in exercise, 128
heart rate decrease, 135
skeletal muscle blood flow in, 133
vasovagal, 103, 135
fat (lipid), 63
absorption, 218, 223, 255, 258
brown, 213
in duodenum, 252, 257
emulsification, 251
increased body fat, 208
stores (adult), 231
transport, 253
fatty acids, free (non-esterified), plasma, 226
fatty meals, cholecystectomy causing indigestion,
259
fear reaction, 648
females (women)
androgen secretion, 566
growth rates, 708
life cycle, 576
males and, reproductive comparisons, 522
oestrogen and progesterone administration,
554
pregnancy see pregnancy
subfertility, 557, 569
fertility, reduced (incl. infertility), 557, 569
males, 564, 569
see also contraception
fertilization of ovum, 514
fetal haemoglobin, 523
Index
fetus, 544
circulation, 138, 529, 547
arterial pressure in maternal hypoxia (sheep),
707
death, 567
prematurity in multiple pregnancy, 568
size at birth, 532
fever, 623
fibrinogen conversion to fibrin, 28
Fick principle, 578
cardiac output estimation, 100, 578
fitness (physical) of athletes, 650
endurance, Olympic level, 676
measurement, 687
flexor (withdrawal) reflex, 645
flowvolume diagrams of lungs, 712
fluid
body, 1-67
osmolality see osmolality
renal, 398, 402, 421, 436, 442
dialysis, 424
follicle-stimulating hormone, 570
food
appetite loss, 198
energy expenditure increase after ingestion, 644
salivation seeing or thinking about, 645
specific dynamic action of, 219, 644
see also dietary energy intake; malnutrition
foot, pain sensation, 267
foramen ovale (sphenoid), 389
foramen ovale valve (heart), 130
forced expiratory volume in one second (FEV1), 184,
192, 696
forearm blood flow, 713
measurement by venous occlusion
plethysmography, 126, 695
fovea centralis, 341, 381
fungiform papillae receptors, 646
GABA, 643
gallbladder
contraction, CCK-induced, 252, 257
surgical removal (cholecystectomy), 259
gallstones, 227
gamma-amino-butyric acid, 643
gas(es)
blood see blood gases
flow in lungs see air, flow; flowvolume
diagrams
gastrectomy, 235, 259
gastric physiology see stomach
gastrin release, 252, 260
gastrocolic reflex, 252
gastrointestinal tract see alimentary tract
generator potentials, 642
genetic disorders, 625, 632, 635
girls, growth rates, 708
see also females
glomerulus
capillaries, pressures, 395, 438
filtration, 438, 439
in renal transplantation, 443
glossopharyngeal nerve and taste sensation, 392
glucagon, pancreatic, 456
increased and excessive secretion, 508, 511
Index
glucocorticoid, 505
excessive production, 492, 511
injections, effects, 451
glucose, 508
absorption, 246, 255, 258
administration (dextrose), 5% and 50%, 66
blood/plasma levels, 400
abnormal see hyperglycaemia; hypoglycaemia
metabolism, 508
renal handling, 700, 705
in urine, 439, 440
glucose tolerance test, oral, 476, 500, 706
glycogen, 63
skeletal muscle stores, 686
glycosuria, 439, 440
Golgi apparatus, 604
gonadotrophin (gonadotrophic hormone)
human chorionic see chorionic gonadotrophin
pituitary see follicle-stimulating hormone;
luteinizing hormone
gonadotrophin-releasing hormone (GRH), 512,
569
granulocytes, neutrophil, 11
gravitational stress, 713
growth, males and females rates of, 708
growth factors, hepatic secretion, 503
growth hormone, 453, 512
secretion, 468
excessive, causes and effects, 493, 509
impaired, 498
growth hormone-inhibiting hormone, 260
GRP, 260
gustation see taste
gyrus, postcentral, 393
H2 receptor blockers and gastric secretion, 257
haematocrit (packed cell volume), 38, 701
fall in late pregnancy, 135
haemodialysis, 441
haemoglobin
carbamino group bound to, 193
CO combined with, 193
CO2 combined with, 193
concentration in anaemic hypoxia, 194
desaturated, buffering of H+ ions by, 193
fetal, 523
haemolytic disease of newborn, 33
haemorrhage see bleeding
haemostasis
disorders, 58
platelets in, 6
hair cells (ear), 355, 390, 646
head, angular acceleration, 646
headache, 326
hearing see audition
heart, 75
arrest (asystole), 102
ECG, 134
auscultation, 108, 116
autonomic nervous system and, 81, 86, 334, 337
block, complete, 118
disease/abnormalities (in general)
exercise tolerance limits with, 674
treadmill exercise test for see treadmill exercise
test
343
heart (continued)
failure, 110, 647
see also ventricles, failure
impulse conduction, 137
delay, 134
murmurs, 116
muscle see myocardium; ventricles, muscle
output, 91
adrenaline and noradrenaline (i.v. infusion)
effects, 714
in anaemia, compensatory rise, 62
exercise and, 710
gravitational stress and, 713
techniques of estimation, 99, 100, 578
Purkinje system, 93, 137
rate, 337
adrenaline and noradrenaline (i.v. infusion)
effects, 714
decrease in fainting, 135
in exercise, 710
rhythm disturbances see arrhythmias
sounds
first, 71, 85
second, 71
sympathetic drive to, 81, 86
valves, 130
disease, 119, 697
heat (and hot environments), 668, 682
adaptation, 630, 658, 672, 682
exercise in, 658, 672
height, short (adults), childhood factors, 486
helium, divers breathing, 621
hemianopia, 388
hemiplegia, right-sided stroke, 321
hepatic physiology see liver
hereditary disorders, 625, 632, 635
HeringBreuer reflex, 132
high altitude, 152, 636
acidbase imbalance, 59, 641
arterial blood values, 59, 189, 194, 692
effects of moving to, 636
exercise hindrance, 677
sudden exposure to 100mmHG atmospheric
pressure (e.g. aircraft), 618
histamine receptor type 2 blockers and gastric
secretion, 257
HIV disease see AIDS
hormone(s), 445-512
renal actions, 440
reproductive/sex, 570
in pregnancy, 575
hormone replacement therapy, 576
hot environment see heat
human chorionic gonadotrophin see chorionic
gonadotrophin, human
hydrogen ions
active exchange of sodium ions for, 444
buffering see buffering
concentrations, 597
urine vs plasma, 437
excess, elimination, 439
see also pH
hydrostatic pressure, intravascular
colloid osmotic pressure, ratio of, 637
glomerular capillaries, 395, 438
344
Index
jaundice, 234
jejunal mucosal cells and proximal convoluted
tubules, similarities, 583
jugular venous pulse and pressure, 110
ketoacidosis, diabetic, 189, 331, 497
ketosis, diabetic, 496
kidney
blood flow, 404, 406, 407
calculi, 502
chronic failure, 420, 430, 432
metabolic acidosis, 641
transplantation in, 427, 443, 620
Index
kidney (continued)
clearance, 397, 411, 417, 439
failure (and damage)
acute, 432, 647
chronic see subheading above
dialysis, 424, 441
progressive, treatment, 433
severe, arterial blood values, 59, 189
functional regions, 442
see also specific parts
glucose handling, 700, 706
hormonal actions, 440
hypertension related to, 510, 705
water retention see water
knee jerk (quadriceps/patellar) reflex, 261, 333, 334,
645
in spinal cord transection, 340
Kupffer cell, ingestion of bacteria, 253
Kussmaul breathing, 508
labour, 572
premature, 561
lactase, 251, 254
deficiency, 256
lactation, 503, 512
lacteals, 258
lactic acid, blood, 655
laryngeal obstruction, sudden, respiratory acidosis,
641
legs
capillary fluid loss, 77
elastic recoil of muscle/tendons, 668
narrowing of major arteries, 114
oedema, 32
see also limb
lemniscus, medial, 393
lens
elasticity loss with ageing, 385
maximum convexity, 385
leukaemia, 64
Leydig cells, 574
light
bright, visual acuity impairment in, 383
from object to right of visual axis, 357
poor, dark adaptation, 344, 348, 386
light reflex, pupillary, 356, 385
limb
exercise-related pain, 673
lower see leg
skeletal muscle blood flow to, in exercise, 653
sweating, excessive, 634
limbic system, 648
lipase, 63, 251
lipids see fat
liver, 205
cells, 222
failure and dysfunction, 237, 242, 647
coma, 331
growth factors secreted by, 503
long-sightedness, 384
loop of Henle, 442, 444
lower motor neurones see motor neurone
lungs
chronic obstructive disease (COPD), 175, 182,
186, 190
345
lungs (continued)
compliance, 151, 163, 693, 703
elastic tissue loss in emphysema, 173
expansion, 153
flowvolume diagrams, 712
function (respiratory function), 190
age and, 144
tests, 190, 696
gas/air flow, 693, 694
residual volume, 154
stretch receptors, 132
surfactant see surfactant
surgical removal of one, 180
vessels see pulmonary vasculature
volume, and oesophageal pressure, 703
luteinizing hormone, 503, 570, 573, 709
luteinizing hormone-releasing hormone, 512
lying down, 591
right atrial pressure increase, 135
lymph, 26
lymphocytes, 15
in AIDS, 64
lymphoid aggregations (Peyers patches) in intestine,
258
lysosomes, 591, 640
macular damage or sparing, 388
males (men)
growth rates, 708
infertility, 564, 569
pre- and postpubertal state, differences, 526
women and, reproductive comparisons, 522
malnutrition limiting exercise tolerance, 678
maltase, 251, 254
mammary glands see breast
marathon running see running
mass, body see weight
mean arterial blood pressure
50% fall, renal responses, 404
in exercise, 710
gravitational stress and, 713
medulla, renal, interstitial fluid, 442
medulla oblongata
respiratory centre see respiratory centre
vomiting centre, 335
melaena, 128
melanocyte-stimulating hormone (MSH), 503
melatonin, 448
membranes
cell/plasma, 588
ion channels see ions
nerve see nerve cell
potentials, 642, 649
skeletal muscle, 18
intracellular (organelles), 640
men see males
menopause, 562
menstrual cycle, 513, 539, 573, 709
menstruation, absence see amenorrhoea
metabolic acidosis see acidosis
metabolic activity (local) affecting blood flow to
tissues, 69
metabolic alkalosis, 41, 59, 641, 694
metabolic energy per unit mass, fat and
carbohydrate, 63
346
Index
neonates/newborns (continued)
poor physical condition, features, 560
size at birth, 532
neoplasm see tumour
nephron, 436
osmolality, 402, 436
nerve cell membranes
depolarization, 286
potentials in efferent neurones, 649
resting, permeability, 291
nerve endings, bare, 646
nerve fibre see axon
nerve impulses, 274, 282
foot pain, sensation, 267
pre-synaptic neurones, 295
from utricle receptors, 364
nerve supply, stomach, 215
nervous systems, inhibition in, 649
neurology, 261-340
neuromuscular junction
skeletal muscle, 262
sympathetic transmission, 272
neuromuscular system, 261-340
neurotransmission, synaptic
at neuromuscular junction, sympathetic, 272
neurotransmitter action, inhibition produced by,
649
neurotransmitter release, inhibition produced by,
649
neutrophil granulocytes, 11, 64
reduced counts, 47
newborns see neonates
night blindness, 387
nitrogen
balance, 214
divers breathing helium instead of, 621
non-unmyelinated axons, 290, 334
noradrenaline
excessive secretion, 511
intravenous infusion, 101, 452, 714
vasoconstriction and, 131
normocytic anaemia, 62
nucleic acids, digestion, 154, 251
nucleus, cell, 599, 640
nucleus gracilis, 393
nutritional status and exercise tolerance, 678
see also dietary energy intake; food
nyctalopia, 387
nystagmus, 379, 388
obesity, 248, 617
treatment, 611
obstructive airways disease, chronic (COPD), 175,
182, 186, 190
occipital cortex and vision, 648
Oddis sphincter, 258
oedema
cerebral, 67
legs, 32
optic disc, 313
in pink puffers, 186
oesophageal-gastric sphincter contraction, 252
oesophagus
pressure, 188
lung volume and, 703
Index
oesophagus (continued)
smooth muscle tone, 249
oestrogen (incl. oestradiol)
administration to women, 554
in menstrual cycle, 709
in pregnancy, 575
see also hormone replacement therapy
olfactory cells, 343
olfactory system, 350
impaired sense of smell, 378, 394
Olympic level endurance fitness, 676
ophthalmology see eye
optic disc oedema, 313
oral glucose tolerance test, 476, 500, 706
organ of Corti, 390
organ transplantation see transplantation
organelles, cell, 640
see also specific organelles
osmolality, 19, 65, 440
abnormal, 67
extracellular fluid, rise, 628
renal/urinary, 402, 421, 436, 440, 442
osmotic pressure
colloid see colloid osmotic pressure
of plasma, total, 600
ossicles, auditory, 391
osteoblast activity, 507
osteomalacia, 507
osteoporosis, 507, 669
otolith organ, 390
oval foramen see foramen ovale
oval window, 389
ovaries, 537
dysgenesis, 504
overflow incontinence, 435
ovulation
contraceptives inhibiting, 569
failure, 559
ovum, fertilization, 514
oxygen
consumption/uptake, 194
decrease in hypothermia, 135
exercise, 652, 710
increased, various causes, 210
maximal, in physical fitness measurement,
687
measurement, 644
metabolic equivalent of (METS), 667, 681,
691
content (blood)
fetal circulation, 529
mixed venous, 169
dissociation curve (blood), 161, 174, 192,
674
dissolved/in solution, 192
partial pressure (blood) see oxygen tension
saturation, 192, 192
supply/delivery, 187, 194
to ventricular muscle, 117
total available, 186, 194
transport, 192, 194
see also respiratory quotient
oxygen debt, 167
oxygen tension/partial pressure (PCO2), 139, 692,
698
347
348
Index
Index
349
350
skin
bleeding from small cut, 12
blood flow, in sweating, 133
pain, 325
pigmentation increase in Addisons disease, 510
vasodilatation following skin damage, 645
skull and hearing, 391
sleep, 581
deep, 271
hormones in, 446
REM vs non-REM, 300
small intestine, 221
absorption see absorption
motility, substance P and, 260
smooth muscle, 339
surgical removal of 90%, 240
smell sensation see entries under olfactory
smooth muscle (visceral), 293
bronchial, contraction, 149
iris, 339, 385
oesophageal, tone, 249
other muscle types compared with, 293, 298
in pregnancy, 571
in labour, 572
small intestinal, 339
Snellen letter charts, 386
sodium (ions), 65, 440
absorption, 218, 250, 255
reabsorption, 440, 444
active exchange for hydrogen ions, 444
depletion, 50
drugs affecting renal transport, 428
hormones affecting clearance, 440
osmolality and, 65
plasma levels
compared with urine, 437
fall, 48
retention, 49, 50
see also salt
sodium bicarbonate administration in acidosis, 66
sodium-dependent glucose transporter, 255
somatomedins, 453, 503, 512
somatostatin, 260
sound(s), heart see heart, sounds
sound waves and transmission, 363, 389, 390, 391,
646
spasm, digital artery, with cold, 414
special senses, 341-94
specific dynamic action of food, 219, 644
specific gravity, 16
spermatozoa, 515
formation/development (spermatogenesis), 524,
574
hormones affecting, 503, 512
testicular temperature affecting, 569
sphincter(s)
cardiac, contraction, 252
Oddis, 258
VIP causing relaxation of, 260
spinal cord, 284
left half damage, 332
lower cervical region see cervical spinal cord
posterior/dorsal column see dorsal column
reflexes, 333
transection, 323, 340
Index
Index
351
transfusion, blood, 61
massive, 58, 61
multiple repeated, 61
reactions, 37, 61
transplantation
rejection, minimizing/prevention, 46, 616
renal, 427, 443, 620
transport maximum, 403
treadmill exercise test, cardiac abnormality, 670
ECG signs, 657, 670
tricuspid valve, 130
triglycerides, splitting, 251
triiodothyronine (T3), 506
trisomy 21 (Downs syndrome), 504
trypsinogen, 253
tubules, renal
collecting, 412, 436
distal convoluted, 405, 436
fluid in, 398, 402, 421, 436
proximal convoluted, 398, 409, 414, 436, 442
drugs affecting sodium transport in, 428
jejunal mucosal cells and, similarities, 583
reabsorption see reabsorption
secretion in, 401
active, 439
transport maximum, 403
see also nephron
tumour
adrenal medullary, 485, 509
pituitary, 493
Turners (XO) syndrome, 504, 549
twin pregnancy, 568
tympanic membrane, 353, 358, 389
ultrafiltration, 577
unmyelinated axons, 290, 334
upper motor neurone lesion, 332
urea, 408
blood/plasma levels
dialysis patient, raised, 441
in liver failure, 647
urine vs, 437
clearance, 439
ureters
calculi, 436
in renal artery stenosis, 705
urethra, chronic obstruction, 425
urinary system/tract, 390-444
pain receptors, 305
urination (micturition), voluntary, 409
urine, 415
acute retention, 435
solutes, 437
urobilinogen, 239
uterine smooth muscle in labour, 572
utricles, 359, 364, 390
vagus/vagal nerve, 288, 338
endurance running and, 688
Valsalva manoeuvre, 582, 594
labour, 572
valve
cardiac see heart, valves
venous, 129
vas deferens, 574
352
Index
vascular resistance, 80
arteriolar, 96, 129
cerebral see cerebral vessels
coronary, decreased, 127
pulmonary, 72, 159
splanchnic, increased, 127
vasculature, 129
obstruction causing local tissue death, 125
tone, and endurance running, 688
see also specific (types of) vessels
vasoactive intestinal polypeptide, 260
vasoconstrictor nerves, 131
vasodilatation in skin following damage, 645
vasodilator metabolites, 131
vasopressin see antidiuretic hormone
vasovagal fainting/syncope, 103, 135
veins, 74
valves, 129
venous blood, mixed, oxygen content, 169
venous capacity in severe haemorrhage, reduced, 135
venous occlusion plethysmography, forearm blood
flow measurement by, 126, 695
venous pressure
central
lowered, in peripheral circulatory failure, 647
raised, in heart failure, 647
standing at rest, 82
venous pulsation in neck, A wave of, 123
ventilation, 156, 191
alveolar, breathing and, 148
control, 191
increased, various causes, 156, 508
maximal exercise, 685
reflex regulation, 132
see also breathing; hyperventilation
ventilation/perfusion ratio, 147
impaired, 183
ventricles
absolute refractory period, 79
blood flow (coronary) see coronary blood flow
extrasystoles, 120
failure in LV, 124
fibrillation, electric shock causing, 622
filling, 73
function in LV, 697
muscle contraction
isometric, 89
in LV, strength increases, 88
muscle oxygen supply, 117
pressurevolume diagram in LV, 711
repolarization, T wave, 134
stroke work in LV see stroke work
vestibular disease, unilateral, 382
VIP, 260
viscus/viscera
pain, 315
smooth muscle see smooth muscle
wall distension, 252
vision, 385-8
dark adaptation, 344, 348, 386
long-sightedness, 384
loss see blindness
near, accomodation for see accommodation
occipital cortex and, 648
short-sightedness (myopia), 372
various disturbances, 385, 387, 388
visual acuity, 352, 386
impairment in bright light, 383
visual field, left eye, 367, 704
visual pathways, interruption, 376
visual threshold, 386
vital capacity (VC), 165, 184, 192, 696
vitamin A and vision, 387
vitamin B12
absorption, 250, 251, 255
deficiency, 62
intrinsic factor and see intrinsic factor
vitamin C deficiency, capillary haemorrhages,
62
vitamin D (and cholecalciferol), 469
deficiency, 255, 502
hydroxylation, 502
vomiting, 247
metabolic alkalosis, 694
vomiting reflex, 333, 335
warfarin, 58
water
absorption, 250
channels (kidney), 444
cold, sudden application, 638
drinking, 603
excessive, 67
excretion, increased, 510
immersion, 659
to chest level, 608
survival at 15C with life jacket, 615
retention, 503
excessive, 67
total body
decreased, 60
increased, 60
as percentage of body weight, 3
see also divers
weight, body
ageing and, 610
total body water as percentage of, total body
water as percentage of, 3
see also obesity
withdrawal reflex, 645
women see females
X chromosomes
numerical anomalies, 549
recessive genetic disorders, 632
XO syndrome, 504, 549