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4 Physiology Supplement Handout Based On Ganong For TOPNOTCH 21 by Jaffar Pineda
4 Physiology Supplement Handout Based On Ganong For TOPNOTCH 21 by Jaffar Pineda
PHYSIOLOGY SUPPLEMENTAL
Instructions: Please Read Ganong’s Review of Medical Physiology 23rd or 25th Ed before using this.
ANSWER: E
3. If a nasal biopsy were performed on the patient described
• Mast cell degranulation produces clinical manifestations of allergy up to
in Question 2 while symptomatic, histologic examination
and including anaphylaxis.
of the tissue would most likely reveal degranulation of
which of the following cell types? • Dendritic cells are antigen presenting cells.
A. Dendritic cells • Lymphocytes are key elements in the production of immunity.
B. Lymphocytes • Neutrophils enters the tissues, particularly if triggered to do so by an
C. Neutrophils infection or by inflammatory cytokines.
D. Monocytes • Monocytes are activated into macrophage and migrate in response to
E. Mast cells chemotactic stimuli and engulf and kill bacteria.
Ganong. Review of Medical Physiology 23rd ed. Chapter , pages 64, 65,71 .
ANSWER: B
4. A biotechnology company is working to design a new
therapeutic strategy for cancer that involves triggering an
enhanced immune response to cellular proteins that are • “The class I MHC proteins (MHC-I proteins) are coupled primarily to
mutated in the disease. Which of the following immune peptide fragments to which the host is not tolerant (eg, those from
cells or processes will most likely not be required for a mutant or viral proteins) are recognized by cytotoxic T cells.
successful therapy? • The digestion of these proteins occurs in proteasomes. The class II MHC
A. Cytotoxic T cells proteins (MHC-II proteins) are concerned primarily with peptide
B. Antigen presentation in the context of MHC-II products of extracellular antigens, such as bacteria, that enter the cell
C. Proteosomal degradation by endocytosis and are digested in the late endosomes.”
D. Gene rearrangements producing T cell receptors
Ganong. Review of Medical Physiology 23rd ed. Chapter 3 , page 71 ..
E. The immune synapse
ANSWER: B
5. The ability of the blood to phagocytose pathogens and • Granulocyte colony-stimulating factor (G-CSF): promotion of the
mount a respiratory burst is increased by: growth of granulocytes which is responsible for phagocytosis and
A. interleukin-2 (IL-2) respiratory burst.
B. granulocyte colony-stimulating factor (G-CSF) • Erythropoietin: stimulates production of RBC.
C. erythropoietin • Interleukin-4 (IL-4): plays a part in mast-cell sensitization and thus in
D. interleukin-4 (IL-4) allergy and in defense against nematode infections.
E. interleukin-5 (IL-5) • Interleukin-5 (IL-5): differentiation of eosinophils
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ANSWER: C
6. Cells responsible for innate immunity are activated most • “The cells that mediate innate immunity include neutrophils,
commonly by: macrophages, and natural killer (NK) cells. All these cells respond to
A. glucocorticoids lipid and carbohydrate sequences unique to bacterial cell walls and
B. pollen to other substances characteristic of tumor and transplant cells.”
C. carbohydrate sequences in bacterial cell walls • Glucocorticoids, pollen, eosinophils, and thrombopoietin are not
D. eosinophils responsible for innate immunity.
E. thrombopoietin
Ganong. Review of Medical Physiology 23rd ed. hapter 3, page 69.
7. A patient suffering from an acute flare in his rheumatoid ANSWER: D
arthritis undergoes a procedure where fluid is removed
from his swollen and inflamed knee joint. Biochemical
analysis of the inflammatory cells recovered from the • “Rheumatoid arthritis is an inflammatory disease in which the nuclear
removed fluid would most likely reveal a decrease in factor-κB, plays a key role. NF-κB is a heterodimer that normally exists
which of the following proteins? in the cytoplasm of cells bound to IκBα, which renders it inactive.”
A. Interleukin-1 • Therefore, IκBα is decreased in rheumatoid arthritis.
B. Tumor necrosis factor-α
C. Nuclear factor-κB Ganong. Review of Medical Physiology 23rd ed. Chapter 3 , page 76.
D. IκBα
E. von Willbrand factor
8. In normal human blood: ANSWER: C
A. the eosinophil is the most common type of white
blood cell • In human blood, iron is mostly in hemoglobin, neutrophil is the most
B. there are more lymphocytes than neutrophils common type of white blood cell, and there are more red blood cells
C. the iron is mostly in hemoglobin than white blood cells and platelets.
D. there are more white cells than red cells
E. there are more platelets than red cells
ANSWER: E
9. Lymphocytes: • Lymphocytes are part of the body’s defense against cancer.
A. all originate from the bone marrow after birth. • “After birth, most of lymphocytes are formed in the lymph nodes,
B. are unaffected by hormones thymus, and spleen from precursor cells that originally came from the
C. convert to monocytes in response to antigens bone marrow.”
D. interact with eosinophils to produce platelets • Lymphocytes cannot be converted to monocytes in response to antigens
E. are part of the body’s defense against cancer and doesn’t interact with eosinophils to produce platelets.
Ganong. Review of Medical Physiology 23rd ed. Chapter 3, page 65.
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ANSWER: A
4. Which of the following is not correctly paired? • “In the natural situation, impulses pass in one direction only, ie, from
A. Synaptic transmission: Antidromic conduction synaptic junctions or receptors along axons to their termination. Such
B. Molecular motors: Dynein and kinesin conduction is called orthodromic. Conduction in the opposite direction
C. Fast axonal transport: ~400 mm/day is called antidromic. Because synapses, unlike axons, permit
D. Slow axonal transport: 0.5–10 mm/day conduction in one direction only, an antidromic impulse will fail to pass
E. Nerve growth factor: Retrograde transport the first synapse they encounter and die out at that point.”
Ganong. Review of Medical Physiology 23rd ed. Chapter 4, page 88 .
5. Which of the following ionic changes is correctly matched ANSWER: C
with a component of the action potential?
• Opening of voltage-gated Na+ channels: Depolarization
A. Opening of voltage-gated K+ channels: After-
hyperpolarization • Opening of voltage-gated K+ channels: Repolarization
B. A decrease in extracellular Ca2+: Repolarization • A decrease in extracellular Ca2+: increased excitability affects
C. Opening of voltage-gated Na+ channels: Resting Membrane Potential
Depolarization • Rapid closure of voltage-gated Na+ channels: Inactivated sate
D. Rapid closure of voltage-gated Na+ channels: Resting Relative Refractory Period
membrane potential • Slow closure of voltage-gated K+ channels: After-hyperpolarization
E. Rapid closure of voltage-gated K+ channels: Relative
refractory period Ganong. Review of Medical Physiology 23rd ed. Chapter 4 , page 85
ANSWER: B
6. A man falls into a deep sleep with one arm under his head.
• “Conversely, pressure on a nerve can cause loss of conduction in large-
This arm is paralyzed when he awakens, but it tingles, and
diameter motor, touch, and pressure fibers while pain sensation
pain sensation in it is still intact. The reason for the loss of
remains relatively intact.”
motor function without loss of pain sensation is
A. A fibers are more susceptible to hypoxia than B
fibers.
B. A fibers are more sensitive to pressure than C fibers.
C. C fibers are more sensitive to pressure than A fibers.
D. Motor nerves are more affected by sleep than sensory
nerves.
E. Sensory nerves are nearer the bone than motor
nerves and hence are less affected by pressure.
Ganong. Review of Medical Physiology 23rd ed. Chapter 4, page 89, 90.
7. Which of the following statements about nerve growth ANSWER: B
factor is not true?
A. It is made up of three polypeptide subunits.
B. It is responsible for the growth and maintenance of • Nerve Growth Factor is made up of three polypeptide subunits. It can
adrenergic neurons in the basal forebrain and the be express both p75 NTR and Trk A receptors. It is necessary for the
striatum. growth and development of the sympathetic nervous system; and
C. It is necessary for the growth and development of the cholinergic neurons in the basal forebrain and the striatum. It is picked
sympathetic nervous system. up by nerves from the organs they innervate.
D. It is picked up by nerves from the organs they
Ganong. Review of Medical Physiology 23rd ed. Chapter 4, page 90
innervate.
E. It can express both p75 NTR and Trk A receptors.
ANSWER:
8. A 20-year-old female student awakens one morning with
severe pain and blurry vision in her left eye; the
symptoms abate over several days. About 6 months later, • “Typical physiological deficits of multiple sclerosis range from muscle
on a morning after playing volleyball with friends, she weakness, fatigue, diminished coordination, slurred speech, blurred or
notices weakness but not pain in her right leg; the hazy vision, bladder dysfunction, and sensory disturbances. Symptoms
symptoms intensify while taking a hot shower. Which of are often exasperated by increased body temperature or ambient
the following is most likely to be the case? temperature.”
A. The two episodes described are not likely to be • “In the most common form, transient episodes appear suddenly, last a
related. few weeks or months, and then gradually disappear. Subsequent
B. She may have primary-progressive multiple sclerosis. episodes can appear years later, and eventually full recovery does not
C. She may have relapsing-remitting multiple sclerosis. occur. Others have a progressive form of the disease in which there are
D. She may have a lumbar disk rupture. no periods of remission.”
Ganong. Review of Medical Physiology 23rd ed. Chapter 4, page 82.
E. She may have Guillain–Barre syndrome.
ANSWER: C
10. Which part of a neuron has the highest concentration of
Na+ channels per square millimeter of cell membrane? • “The number of Na+ channels per square micrometer of membrane in
A. dendrites myelinated mammalian neurons has been estimated to be 50–75 in the
B. cell body near dendrites cell body, 350–500 in the initial segment, less than 25 on the surface
C. initial segment of the myelin, 2000–12,000 at the nodes of Ranvier, and 20–75 at the
D. axonal membrane under myelin axon terminals.”
E. none of the above Ganong. Review of Medical Physiology 23rd ed. Chapter 4, page 85.
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(CHAPTER 6) SYNAPTIC & JUNCTIONAL TRANSMISSION
1. Which of the following electrophysiologic events is correctly ANSWER: C
paired with the change in ionic currents causing the event?
• Endplate potential : increase in Na+ conductance .
A. Fast inhibitory postsynaptic potentials (IPSPs) and closing
of Cl– channels • Fast IPSPs (inhibitory postsynaptic potentials): opening of Cl–
B. Fast excitatory postsynaptic potentials (EPSPs) and an channels
increase in Ca2+ conductance • Fast EPSPs (excitatory postsynaptic potentials): an increase in
C. Endplate potential and an increase in Na+ conductance Na+ conductance
D. Presynaptic inhibition and closure of voltage-gated K+ • Presynaptic inhibition: opening of voltage-gated K+ channels
channels • Slow EPSPs: decrease in K+ conductance
E. Slow EPSPs and an increase in K+ conductance Ganong. Review of Medical Physiology 23rd ed. Chapter6; page 120, 128.
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ANSWER: E
7. Fast inhibitory postsynaptic potentials (IPSPs):
A. are a consequence of decreased Cl- conductance • Fast inhibitory postsynaptic potentials (IPSPs) can be produced
B. occur in skeletal muscle by a localized increase in Cl- transport and by opening of K+
C. can be produced by an increase in Na+ conductance channels, with movement of K+ out of the postsynaptic cell, or by
D. can be produced by a decrease in Ca2+ conductance closure of Na+ or Ca2+ channels. It occurs in the motor neuron
E. interact with other fast and slow potentials to move the presynaptic ending and interact with other fast and slow
membrane potential of the postsynaptic neuron toward or potentials to move the membrane potential of the postsynaptic
away from the firing level neuron toward or away from the firing level.
Ganong. Review of Medical Physiology 23rd ed. Chapter 6, page 119, 120.
ANSWER: C
8. Fast excitatory postsynaptic potentials (EPSPs):
A. are a consequence of decreased Cl- conductance • The EPSP is produced by depolarization of the postsynaptic cell
B. occur in skeletal muscle membrane immediately under the presynaptic ending. The
C. can be produced by an increase in Na+ conductance excitatory transmitter opens Na+ or Ca2+ ion channels in the
D. can be produced by a decrease in Ca2+ conductance postsynaptic membrane, producing an inward current.
E. All of the above Ganong. Review of Medical Physiology 23rd ed. Chapter 6, page 120.
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(CHAPTER 9) VISION
ANSWER: D
1. A visual exam in an 80-year-old man shows he has a • Central scotoma: blind spots in the visual field
reduced ability to see objects in the upper and lower • Heteronymous hemianopia with macular sparing: reduced ability to
quadrants of the left visual fields of both eyes but some see objects in the upper and lower quadrants of opposite sides of the
vision remains in the central regions of the visual field. visual fields but some vision remains in the central regions of the visual
The diagnosis is field
A. central scotoma. • Lesion of the optic chiasm: bitemporal visual loss.
B. heteronymous hemianopia with macular sparing. • Homonymous hemianopia with macular sparing: reduced ability to
C. lesion of the optic chiasm. see objects in the upper and lower quadrants of the left visual fields of
D. homonymous hemianopia with macular sparing. both eyes but some vision remains in the central regions of the visual field
E. retinopathy. • Retinopathy: scarring of the retina that can lead to total loss of vision.
Ganong. Review of Medical Physiology 23rd ed. Chapter 12 , page 198 .
ANSWER: D
2. A 45-year-old woman who had never needed to wear
glasses experienced difficulty reading a menu in a dimly-
lit restaurant. She then recalled that as of late she needed
to have the newspaper closer to her eyes in order to read • Accommodation is when the gaze is directed at a near object, the ciliary
it. A friend recommended she purchase reading glasses. muscle contracts. This decreases the distance between the edges of the
Visual accommodation involves ciliary body and relaxes the lens ligaments, so that the lens springs into a
A. increased tension on the lens ligaments. more convex shape.
B. a decrease in the curvature of the lens.
C. relaxation of the sphincter muscle of the iris. Ganong. Review of Medical Physiology 23rd ed. Chapter 12, page 189
D. contraction of the ciliary muscle.
E. increased intraocular pressure.
ANSWER: C
3. A 28-year-old man with severe myopia made an
appointment to his ophthalmologist when he began to
notice flashing lights and floaters in his visual field. He • “The retina extends anteriorly almost to the ciliary body. It is organized in
was diagnosed with a retinal detachment. The retina 10 layers and contains the rods and cones, which are the visual
A. is epithelial tissue that contains photoreceptors. receptors, plus four types of neurons: bipolar cells, ganglion cells,
B. lines the anterior one-third of the choroid. horizontal cells, and amacrine cells.”
C. has an inner nuclear layer that contains bipolar cells, • “It contains ganglion cells whose axons form the optic nerve. The area of
horizontal cells, andsee amacrine cells. the optic disk contains no visual receptors over the disk, and
D. contains ganglion cells whose axons form the consequently this spot is blind (the blind spot).”
oculomotor nerve.
Ganong. Review of Medical Physiology 23rd ed. Chapter 12 , page 182..
E. contains an optic disk where visual acuity is greatest
ANSWER: B
4. A 62-year-old white woman experienced a rapid onset of
blurry vision along with loss of central vision. A • “Near the posterior pole of the eye is a yellowish pigmented spot, the
comprehensive eye exam showed that she had wet age- macula lutea. This marks the location of the fovea centralis, a thinned-
related macular degeneration. The fovea of the eye out, rod-free portion of the retina that is present in humans and other
A. has the lowest light threshold. primates. In it, the cones are densely packed, and each synapses to a
B. is the region of highest visual acuity. single bipolar cell, which, in turn, synapses on a single ganglion cell,
C. contains only red and green cones. providing a direct pathway to the brain. Consequently, the fovea is the
D. contains only rods. point where visual acuity is greatest.”
E. is situated over the head of the optic nerve. Ganong. Review of Medical Physiology 23rd ed. Chapter 12 , page 183,184.
ANSWER: E
• In the extrafoveal portions of the retina, rods predominate (Figure 12-7),
and there is a good deal of convergence.
Ganong. Review of Medical Physiology 23rd ed. Chapter 12 , page 185, 186 .
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ANSWER: D
7. The correct sequence of events involved in
phototransduction in rods and cones in response to light is:
A. activation of transducin, decreased release of
glutamate, structural changes in rhodopsin, closure of
Na+ channels, and decrease in intracellular cGMP.
B. decreased release of glutamate, activation of
transducin, closure of Na+ channels, decrease in
intracellular cGMP, and structural changes in
rhodopsin.
C. structural changes in rhodopsin, decrease in
intracellular cGMP, decreased release of glutamate,
closure of Na+ channels, and activation of transducin.
D. structural changes in rhodopsin, activation of
transducin, decrease in intracellular cGMP, closure of
Na+ channels, and decreased release of glutamate.
E. activation of transducin, structural changes in
rhodopsin, closure of Na+ channels, decrease in
intracellular cGMP, and decreased release of glutamate.
Ganong. Review of Medical Physiology 23rd ed. Chapter 12 , page 192 .
8. A 25-year-old medical student spent a summer volunteering ANSWER: B
in the sub-Saharan region of Africa. There he noted a high
incidence of people reporting difficulty with night vision due
to a lack of vitamin A in their diet. Vitamin A is a precursor • “In view of the importance of vitamin A in the synthesis of
for the synthesis of retinene1/retinal, it is not surprising that a deficiency in this vitamin
A. rods and cones. produces visual abnormalities. Among these, one of the earliest to
B. retinal. appear is night blindness (nyctalopia).”
C. rod transducin.
Ganong. Review of Medical Physiology 23rd ed. Chapter 12 , page 191.
D. opsin.
E. cone transducin.
9. An 11-year-old boy was having difficulty reading the graphs ANSWER: D
that his teacher was showing at the front of classroom. His
teacher recommended he be seen by an ophthalmologist.
Not only was he asked to look at a Snellen letter chart for
visual acuity but he was also asked to identify numbers in
an Ishihara chart. He responded that he merely saw a bunch • “Color blindness are inherited as recessive and X-linked
of dots. Abnormal color vision is 20 times more common in characteristics. Color blindness is present in males if the X
males than females because most cases are caused by an chromosome has the abnormal gene. Females show a defect only
abnormal when both X chromosomes contain the abnormal gene.”
A. dominant gene on the Y chromosome.
Ganong. Review of Medical Physiology 23rd ed. Chapter 12 , page 196..
B. recessive gene on the Y chromosome.
C. dominant gene on the X chromosome.
D. recessive gene on the X chromosome.
E. recessive gene on chromosome 22.
ANSWER: D
• Area V3A of visual cortex is responsible for motion and not for color
vision. Table: Functions of Visual Projection Areas in the Human Brain
10. Which of the following is not involved in color vision?
A. Activation of a pathway that signals differences
between S cone responses and the sum of L and M cone
responses
B. Geniculate layers 3–6
C. P pathway
D. Area V3A of visual cortex
E. Area V8 of visual cortex
Ganong. Review of Medical Physiology 23rd ed. Chapter 12, page 196 ..
11. A tumor was diagnosed near the base of the skull in a 56- ANSWER: B
year-old woman, impinging on her optic tract. Which of the
following statements about the central visual pathway is
correct?
A. The fibers from each temporal hemiretina decussate in
the optic chiasm, so that the fibers in the optic tracts are
those from the temporal half of one retina and the nasal
half of the other. • “ The visual pathway is from the rods and cones to bipolar cells to
B. In the geniculate body, the fibers from the nasal half of ganglion cells then via the optic tract to the thalamic lateral geniculate
one retina and the temporal half of the other synapse on body to the occipital lobe of the cerebral cortex. The fibers from each
the cells whose axons form the geniculocalcarine tract nasal hemiretina decussate in the optic chiasm; the fibers from the
C. Layers 2 and 3 of the visual cortex contain clusters of nasal half of one retina and the temporal half of the other synapse on
cells called globs that contain a high concentration of the cells whose axons form the geniculocalcarine tract.”
cytochrome oxidase.
Ganong. Review of Medical Physiology 23rd ed. Chapter , page .
D. Complex cells have a preferred orientation of a linear
stimulus and, compared to simple cells, are more
dependent on the location of the stimulus within the
visual field.
E. The visual cortex is arranged in horizontal columns that
are concerned with orientation.
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Ganong. Review of Medical Physiology 23rd ed. Chapter 12, page 196 ..
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Ganong. Review of Medical Physiology 23rd ed. Chapter 13, page 214.
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ANSWER: E
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ANSWER: E
• “Withdrawal reflexes are prepotent, they preempt the spinal
pathways from any other reflex activity taking place at the moment.”
3. Withdrawal reflexes are not • “The withdrawal reflex is a typical polysynaptic reflex that occurs in
A. initiated by nociceptive stimuli. response to a usually painful stimulation.”
B. prepotent. • “A weak stimulus causes one quick flexion movement; a strong
C. prolonged if the stimulus is strong. stimulus causes prolonged flexion and sometimes a series of flexion
D. an example of a flexor reflex. movements.”
E. accompanied by the same response on both sides of the • “When a strong stimulus is applied to a limb, the response includes
body. not only flexion and withdrawal of that limb but also extension of
the opposite limb. This crossed extensor response is properly part
of the withdrawal reflex.”
Ganong. Review of Medical Physiology 23rd ed. Chapter 9, page 163-164.
4. While exercising, a 42-year-old woman developed sudden ANSWER: C
onset of tingling in her right leg and an inability to control
movement in that limb. A neurologic exam showed a
hyperactive knee jerk reflex and a positive Babinski sign. • “When the spinal cord is suddenly transected all cord functions,
Which of the following is not characteristic of a reflex? including the cord reflexes, immediately become depressed, a
A. Reflexes can be modified by impulses from various parts reaction called spinal shock.”
of the CNS • “After a few hours to a few weeks, the spinal neurons gradually
B. Reflexes may involve simultaneous contraction of some regain their excitability, they increase their own natural degree of
muscles and relaxation of others excitability to make up at least partially for the loss.”
C. Reflexes are chronically suppressed after spinal cord
transection Textbook of Medical Physiology 11th ed. Guyton Chapter 54, page 684 .
D. Reflexes involve transmission across at least one synapse
E. Reflexes often occur without conscious perception
ANSWER: E
• “Commands for voluntary movement originate in cortical
association areas. The cortex, basal ganglia, and cerebellum work
cooperatively to plan movements. Movement executed by the cortex
is relayed via the corticospinal tracts and corticobulbar tracts to
5. Increased neural activity before a skilled voluntary movement
motor neurons. The cerebellum provides feedback to adjust and
is first seen in the
smooth movement.”
A. spinal motor neurons.
B. precentral motor cortex.
C. midbrain.
D. cerebellum.
E. cortical association areas.
Ganong. Review of Medical Physiology 23rd ed. Chapter 16, page 242
6. A 58-year-old woman was brought to the emergency ANSWER: B
department of her local hospital because of a sudden change of
consciousness. All four limbs were extended, suggestive of
decerebrate rigidity. A brain CT showed a rostral pontine
hemorrhage. Which of the following describes components of
the central pathway responsible for control of posture?
A. The tectospinal pathway terminates on neurons in the
dorsolateral area of the spinal ventral horn that innervate • The medial brain stem pathways, which work in concert with the
limb muscles. ventral corticospinal tract, are the pontine and medullary
B. The medullary reticulospinal pathway terminates on reticulospinal, vestibulospinal, and tectospinal tracts. These
neurons in the ventromedial area of the spinal ventral pathways descend in the ipsilateral ventral columns of the spinal
horn that innervate axial and proximal muscles. cord and terminate predominantly on interneurons and long
C. The pontine reticulospinal pathway terminates on propriospinal neurons in the ventromedial part of the ventral horn
neurons in the dorsomedial area of the spinal ventral to control axial and proximal muscles.
horn that innervate limb muscles.
Ganong. Review of Medical Physiology 23rd ed. Chapter 16, page 246.
D. The medial vestibular pathway terminates on neurons in
the dorsomedial area of the spinal ventral horn that
innervate axial and proximal muscles.
E. The lateral vestibular pathway terminates on neurons in
the dorsolateral area of the spinal ventral horn that
innervate axial and proximal muscles.
7. A 38-year-old woman with a metastatic brain tumor was ANSWER: C
brought to the emergency department of her local hospital
because of irregular breathing and progressive loss of
consciousness. She also showed signs of decerebrate posturing.
Which of the following is not true about decerebrate rigidity? • “In midcollicular decerebrate cats, section of dorsal roots to a limb
A. It involves hyperactivity in extensor muscles of all 4 limbs immediately eliminates the hyperactivity of extensor muscles. This
B. The excitatory input from the reticulospinal pathway suggests That decerebrate rigidity is spasticity due to facilitation
activates γ-motor neurons, which indirectly activate α- of the myotatic stretch reflex.”
motor neurons.
C. It is actually a type of spasticity due to inhibition of the Ganong. Review of Medical Physiology 23rd ed. Chapter 16, page 247 .
stretch reflex.
D. It resembles what ensues after uncal herniation.
E. Lower extremities are extended with toes pointed inward
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ANSWER: A
• The subthalamic nucleus releases glutamate to excite the
globus pallidus, internal segment.
• The substantia nigra pars reticulata releases GABA to inhibit
8. Which of the following describes a connection between the thalamus.
components of the basal ganglia?
• The substantia nigra pars compacta releases dopamine to
A. The subthalamic nucleus releases glutamate to excite the
inhibit the striatum.
globus pallidus, internal segment.
• The striatum releases acetylcholine to inhibit the substantia
B. The substantia nigra pars reticulata releases dopamine to
nigra pars reticulata.
inhibit the striatum.
• E. The globus pallidus, external segment releases GABA to
C. The substantia nigra pars compacta releases dopamine to
inhibit the subthalamic nucleus .
excite the globus pallidus, external segment.
D. The striatum releases acetylcholine to excite the substantia
nigra pars reticulata.
E. The globus pallidus, external segment releases glutamate to
excite the striatum.
Ganong. Review of Medical Physiology 23rd ed. Chapter 16 , page 251 , 257
9. A 60-year-old man with Parkinson disease, which was ANSWER: E
diagnosed 15 years ago, has been taking carbidopa and
levodopa (Sinemet); until recently, he has been able to continue
to work and help with routine jobs around the house. Now his
tremor and rigidity interfere with these activities. His clinician
has suggested that he undergo deep brain stimulation therapy. • Administration of L-dopa (levodopa), unlike dopamine, crosses
The therapeutic effect of L-dopa in patients with Parkinson the blood– brain barrier and helps repair the dopamine
disease eventually wears off because deficiency. However, the degeneration of these neurons
A. antibodies to dopamine receptors develop. continues and in 5 to 7 years the beneficial effects of L-dopa
B. inhibitory pathways grow into the basal ganglia from the disappear.
frontal lobe.
Ganong. Review of Medical Physiology 23rd ed. Chapter 16, page 254.
C. there is an increase in circulating α-synuclein.
D. the normal action of nerve growth factor (NGF) is disrupted
E. the dopaminergic neurons in the substantia nigra continue
to degenerate.
ANSWER: C
• Granule cells release glutamate to excite basket cells and
stellate cells.
• Basket cells release GABA to inhibit Purkinje cells.
• Climbing and mossy fiber inputs exert a strong excitatory effect
on Purkinje cells.
10. An 8-year-old girl was brought to her pediatrician because her • The axons of Purkinje cells are the sole output of the cerebellar
parents noted frequent episodes of gait unsteadiness and speech cortex, and they release GABA to inhibit the deep cerebellar
difficulties. Her mother was concerned because of a family nuclei.
history of Friedreich ataxia. Which of the following is a correct • Golgi cells are excited by mossy fiber collaterals.
description of connections involving cerebellar neurons?
A. Basket cells release glutamate to activate Purkinje cells.
B. Climbing fiber inputs exert a strong excitatory effect on
Purkinje cells, and mossy fiber inputs exert a strong
inhibitory effect on Purkinje cells.
C. Granule cells release glutamate to excite basket cells and
stellate cells.
D. The axons of Purkinje cells are the sole output of the
cerebellar cortex, and they release glutamate to excite the
deep cerebellar nuclei.
E. Golgi cells are inhibited by mossy fiber collaterals.
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12. At the age of 30, a male postal worker reported weakness in his ANSWER: E
right leg. Within a year the weakness had spread to his entire • Patient’s neurologic examination decribes a lower motor neuron
right side. A neurologic examination revealed flaccid paralysis, problem; therefore the cerebral cortex, basal ganglia, and
muscular atrophy, fasciculations, hypotonia, and hyporeflexia of vestibulocerebellar can be eliminated because they are within
muscles in the right arm and leg. Sensory and cognitive function the CNS (upper motor neurons).
tests were normal. Which of the following diagnosis is likely? • Lower motor neurons (i.e. α-motor neurons.) are those whose
A. A large tumor in the left primary motor cortex axons terminate on skeletal muscles. An example of a disease that
B. A cerebral infarct in the region of the corona radiate leads to lower motor neuron damage is amyotrophic lateral
C. A vestibulocerebellar tumor sclerosis (ALS) which is a selective, progressive degeneration of
D. Damage to the basal ganglia α -motor neurons.
E. Amyotrophic lateral sclerosis Ganong. Review of Medical Physiology 23rd ed. Chapter 16 , page 244.
ANSWER: C
• Basal ganglia is involved in the planning and programming of
13. A primary function of the basal ganglia is: movement or, more broadly, in the processes by which an
A. sensory integration abstract thought is converted into voluntary action.
B. short-term memory • Thalamus: sensory integration
C. planning voluntary movement • Ventral hippocampus: short-term memory
D. neuroendocrine control • Precentral motor cortex: planning voluntary movement
E. slow-wave sleep • Hypothalamus: neuroendocrine control
• Pontine Reticular Formation: slow-wave sleep
Ganong. Review of Medical Physiology 23rd ed. Chapter 16 , page 250.
ANSWER: B
14. Patients with transected spinal cords frequently have a negative
nitrogen balance because:
A. they develop hypercalcemia, and this causes dissolution of
the protein in bone
B. they are paralyzed below the level of the transection • “Due to immobilization, SCI patients develop a negative nitrogen
C. they lack afferent input that normally maintains growth balance and catabolize large amounts of body protein.”
hormone secretion
Ganong. Review of Medical Physiology 23rd ed. Chapter 16 , page 250.
D. they have difficulty voiding, and this causes nitrogen to
accumulate in the urine in the bladder
E. their corticotropin response to stress is reduced
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3. A 45-year-old man had a meal containing wild mushrooms that he ANSWER: C
picked in a field earlier in the day. Within a few hours after eating,
nausea, vomiting, diarrhea, urinary urgency, vasodilation, sweating,
and salivation developed. Which of the following statements about the
parasympathetic nervous system is correct?
A. Postganglionic parasympathetic nerves release acetylcholine to
activate muscarinic receptors on sweat glands • “In contrast, release of acetylcholine onto smooth muscle of
B. Parasympathetic nerve activity affects only smooth muscles and some organs leads to contraction (eg, walls of the
glands. gastrointestinal tract) while release onto other organs leads
C. Parasympathetic nerve activity causes contraction of smooth to relaxation (eg, sphincters in the gastrointestinal tract).”
muscles of the gastrointestinal wall and relaxation of the
Ganong. Review of Medical Physiology 23rd ed. Chapter 17, page 266 .
gastrointestinal sphincter.
D. Parasympathetic nerve activity causes contraction of the radial
muscle of the eye to allow accommodation for near vision.
E. An increase in parasympathetic activity causes an increase in
heart rate.
ANSWER: D
4. Which of the following is correctly paired? • Vasculature of some skeletal muscles: Muscarinic
A. Sinoatrial node: Nicotinic cholinergic receptors cholinergic receptors
B. Autonomic ganglia: Muscarinic cholinergic receptors • Sinoatrial node: β1-adrenergic receptors
C. Pilomotor smooth muscle: β2-adrenergic receptors • Autonomic ganglia: Nicotinic cholinergic receptors
D. Vasculature of some skeletal muscles: Muscarinic cholinergic • Pilomotor smooth muscle: α1-adrenergic receptors
receptors • Sweat glands: α1-adrenergic receptors
E. Sweat glands: α2-adrenergic receptors Ganong. Review of Medical Physiology 23rd ed. Chapter 7, page 135 .
Chapter 17, page 270..
ANSWER: C
• Pathways that control autonomic responses. Direct
projections (solid lines) to autonomic preganglionic
neurons include the hypothalamic paraventricular nucleus,
5. A 57-year-old man had severe hypertension that was found to result parabrachial nucleus, nucleus of the solitary tract,
from a tumor compressing on the surface of the medulla. Which one of ventrolateral medulla, and medullary raphe (not shown).
the following statements about pathways involved in the control of Indirect projections (dashed lines) include the cerebral
sympathetic nerve activity is correct? cortex, amygdala, and periaqueductal grey matter.
A. Preganglionic sympathetic nerves receive inhibitory input from
the rostral ventrolateral medulla.
B. The major source of excitatory input to preganglionic sympathetic
nerves is the paraventricular nucleus of the hypothalamus.
C. The activity of sympathetic preganglionic neurons can be affected
by the activity of neurons in the amygdala.
D. Unlike the activity in δ-motor neurons, sympathetic preganglionic
neurons are not under any significant reflex control.
E. Under resting conditions, the sympathetic nervous system is not
active; it is active only during stress giving rise to the term “flight
or fight” response.
Ganong. Review of Medical Physiology 23rd ed. Chapter 17, page 271
6. Diabetic autonomic neuropathy was diagnosed a few years ago in a ANSWER: C/E
53-year-old woman with diabetes. She recently noted abdominal
distension and a feeling of being full after eating only a small portion
of food, suggesting the neuropathy had extended to her enteric • The enteric nervous system is not a subdivision of the
nervous system to cause gastroparesis. Which of the following parasympathetic nervous system; in fact, it can function
statements about the enteric nervous system is correct? independent of the autonomic innervation to the
A. The enteric nervous system is a subdivision of the parasympa- gastrointestinal tract.
thetic nervous system for control of gastrointestinal function. • the myenteric plexus (Auerbach’s plexus), between the
B. The myenteric plexus is a group of motor neurons located within outer longitudinal and middle circular muscle layers, and
circular layer of muscle in a portion of the gastrointestinal tract. the submucous plexus (Meissner’s plexus), between the
C. The submucosal plexus is a group of sensory neurons located middle circular layer and the mucosa.
between the circular muscle and the luminal mucosa of the • Neurons comprising the enteric nervous system are
gastrointestinal tract. located only in the intestine.
D. Neurons comprising the enteric nervous system are located only
in the stomach and intestine. Ganong. Review of Medical Physiology 23rd ed. Chapter 26, page 448 .
E. The enteric nervous system can function independent of the
autonomic innervation to the gastrointestinal tract.
ANSWER: A
7. Which of the following drugs would NOT be expected to increase
sympathetic discharge or mimic the effects of increased sympathetic
discharge? • Prazosin is an alpha1-selective blocker prototype used in
A. Prazosin hypertension and benign prostatic hyperplasia .
B. Neostigmine • All other drugs are symphatomimetics.
C. Amphetamine
D. Isoproterenol Katzung. Pharmacology Examination & Board Review 10th Edition.
Chapter 11 page 102
E. Methoxamine
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(CHAPTER 14) ELECTRICAL ACTIVITY OF THE BRAIN, SLEEP–WAKE STATES, & CIRCADIAN RHYTHMS
ANSWER: C
1. In a healthy, alert adult sitting with their eyes closed, the dominant • alpha (8–13 Hz): awake but at rest with the mind
EEG rhythm observed with electrodes over the occipital lobes is wandering and the eyes closed.
A. delta (0.5–4 Hz). • delta (0.5–4 Hz) : stage 3 NREM sleep
B. theta (4–7 Hz). • theta (4–7 Hz) : early stage of slowwave sleep
C. alpha (8–13 Hz). • beta (18–30 Hz) : aroused, alert state
D. beta (18–30 Hz). • fast, irregular low-voltage activity : motor activity in
E. fast, irregular low-voltage activity. response to the stimulus
Ganong. Review of Medical Physiology 23rd ed. Chap 15, pg 233, 234.
ANSWER: D
Ganong. Review of Medical Physiology 23rd ed. Chapter 15, page 239
3. A gamma rhythm (30–80 Hz) ANSWER: C
A. is characteristic of seizure activity.
B. is seen in an individual who is awake but not focused. • “The gamma rhythm has been suggested as a mechanism
C. may be a mechanism to bind together sensory information into a to “bind” together diverse sensory information into a
single percept and action. single percept and action .”
D. is independent of thalamocortical loops.
Ganong. Review of Medical Physiology 23rd ed. Chapter 15, page 236 .
E. is generated in the hippocampus.
ANSWER: D
4. For the past several months, a 67-year-old woman experienced
difficulty initiating and/or maintaining sleep several times a week. A
friend suggested that she take melatonin to regulate her sleep–wake
cycle. Melatonin secretion would probably not be increased by • Direct light stimulation of the retina would send signals to
A. stimulation of the superior cervical ganglia. the optic nerve that would lead to decrease activity of the
B. intravenous infusion of tryptophan. pineal gland and decrease in secretion of melatonin.
C. intravenous infusion of epinephrine.
Ganong. Review of Medical Physiology 23rd ed. Chapter , page .
D. stimulation of the optic nerve.
E. induction of pineal hydroxyindole-O-methyltransferase.
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5. Childhood absence epilepsy was diagnosed in a 10-year-old boy. His ANSWER: A
EEG showed a bilateral synchronous, symmetric 3-Hz spike-and-wave
discharge. Absence seizures
A. are a form of nonconvulsive generalized seizures accompanied by
momentary loss of consciousness. • “Absence seizures (formerly called petit mal seizures) are
B. are a form of complex partial seizures accompanied by momentary one of the forms of nonconvulsive generalized seizures
loss of consciousness. characterized by a momentary loss of consciousness.
C. are a form of nonconvulsive generalized seizures without a loss of They are associated with 3/s doublets, each consisting of a
consciousness. typical spike and rounded wave, and lasting about 10 s.”
D. are a form of simple partial seizures without a loss of
Ganong. Review of Medical Physiology 23rd ed. Chap 15, page 233..
consciousness.
E. are a form of convulsive generalized seizures accompanied by
momentary loss of consciousness.
6. A 57-year-old professor at a medical school experienced numerous ANSWER:B
episodes of a sudden loss of muscle tone and an irresistible urge to • “Narcolepsy is characterized by a sudden onset of REM
sleep in the middle of the afternoon. The diagnosis was narcolepsy, sleep, unlike normal sleep which begins with NREM, slow-
which: wave sleep.”
A. is characterized by a sudden onset of NREM sleep. • “Narcolepsy has a familial incidence strongly associated
B. has a familial incidence associated with a class II antigen of the with a class II antigen of the major histocompatibility
major histocompatibility complex. complex on chromosome 6.”
C. may be due to the presence of an excessive number of orexin- • “Brains from humans with narcolepsy often contain fewer
producing neurons in the hypothalamus. hypocretin (orexin)-producing neurons in the
D. is often effectively treated with dopamine receptor agonists. hypothalamus.”
E. is the most common cause of daytime sleepiness. Ganong. Review of Medical Physiology 23rd ed. Chap15 , page 237.
7. Narcolepsy is triggered by abnormalities in the: ANSWER: C
A. skeletal muscle • “Brains from humans with narcolepsy often contain fewer
B. medulla oblongata hypocretin (orexin)-producing neurons in the
C. hypothalamus hypothalamus.”
D. olfactory bulb
E. neocortex Ganong. Review of Medical Physiology 23rd ed. Chap15 , page 237.
Ganong. Review of Medical Physiology 23rd ed. Chap 19, page 290.
2. The optic chiasm and corpus callosum are sectioned in a dog, and ANSWER: E
with the right eye covered, the animal is trained to bark when it
sees a red square. The right eye is then uncovered and the left eye • This is an example of Intercortical Transfer of Memory “If a
covered. The animal will now cat or monkey is conditioned to respond to a visual stimulus
A. fail to respond to the red square because the square does not with one eye covered and then tested with the blindfold
produce impulses that reach the right occipital cortex. transferred to the other eye, it performs the conditioned
B. fail to respond to the red square because the animal has response.”
bitemporal hemianopia. • “This is true even if the optic chiasm has been cut, making the
C. fail to respond to the red square if the posterior commissure is visual input from each eye go only to the ipsilateral cortex.”
also sectioned. • “Partial callosal section experiments indicate that the memory
D. respond to the red square only after retraining. transfer occurs in the anterior commissure of the corpus
E. respond promptly to the red square in spite of the lack of input callosum.”
Ganong. Review of Medical Physiology 23rd ed. Chapter 15, page 239
to the left occipital cortex.
3. A 32-year-old man had medial temporal lobe epilepsy for over 10 ANSWER: C
years. This caused bilateral loss of hippocampal function. As a
• Hippocampus: ability to encode events of the recent past into
result, this individual might be expected to experience a
long-term memory.
A. disappearance of remote memories.
B. loss of working memory. • Neocortical areas: remote memories.
C. loss of the ability to encode events of the recent past into long- • Prefrontal cortex: working memory.
term memory. • Inferior temporal lobe: ability to recall faces and forms but
D. loss of the ability to recall faces and forms but not the ability to not the ability to recall printed or spoken words.
recall printed or spoken words. • Amygdala: production of inappropriate emotional responses
E. production of inappropriate emotional responses when when recalling events of the recent past.
recalling events of the recent past. Ganong. Review of Medical Physiology 23rd ed. Chap19, pg 294, 298, 398 .
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4. A 70-year-old woman fell down a flight of stairs, hitting her head ANSWER: A/ D
on the concrete sidewalk. The trauma caused a severe intracranial
hemorrhage. The symptoms she might experience are dependent • Damage to the angular gyrus in the categorical hemisphere :
on the area of the brain most affected. Which of the following is Anomic aphasia
incorrectly paired? • Damage to Broca area in the categorical hemisphere : Slow
A. Damage to the parietal lobe of the representational speech or Nonfluent Aphasia.
hemisphere : Unilateral inattention and neglect • Inferior parietal lobule: unilateral inattention and neglect
B. Loss of cholinergic neurons in the nucleus basalis of Meynert • Damage to the parietal lobe of the representational
and related areas of the forebrain : Loss of recent memory hemisphere : Asteriognosis and Agnosia.
C. Damage to the mammillary bodies : Loss of recent memory • Loss of cholinergic neurons in the nucleus basalis of Meynert
D. Damage to the angular gyrus in the categorical hemisphere : and related areas of the forebrain : Loss of recent memory
Nonfluent aphasia • Damage to the mammillary bodies : Loss of recent memory
E. Damage to Broca area in the categorical hemisphere : Slow Ganong. Review of Medical Physiology 23rd ed. Chapter , pg 293, 296, 298
speech
ANSWER: B
5. The representational hemisphere is better than the categorical
hemisphere at • “Lesions in the categorical hemisphere produce language
A. language functions. disorders, whereas extensive lesions in the representational
B. recognition of objects by their form. hemisphere do not. Instead, lesions in the representational
C. understanding printed words. hemisphere produce astereognosis—the inability to identify
D. understanding spoken words. objects by feeling them.”
E. mathematical calculations. Ganong. Review of Medical Physiology 23rd ed. Chapter 19, page 298.
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4. A scientist finds that infusion of growth hormone into the median ANSWER: C
eminence of the hypothalamus in experimental animals inhibits the
secretion of growth hormone and concludes that this proves that • Growth hormone secretion is under feedback control,
growth hormone feeds back to inhibit GHRH secretion. Do you accept like the secretion of other anterior pituitary hormones. It
this conclusion? acts on the hypothalamus to antagonize GHRH release.
A. No, because growth hormone does not cross the blood-brain Growth hormone also increases circulating IGF-I, and IGF-I
barrier in turn exerts a direct inhibitory action on growth
B. No, because the infused growth hormone could be stimulating hormone secretion from the pituitary. It also stimulates
dopamine secretion. somatostatin secretion.
C. No, because substances placed in the median eminence could be • GH in systemic circulation is the one responsible for the
transported to the anterior pituitary. feedback, and not the one in the portal system.
D. Yes, because systemically administered growth hormone inhibits
growth hormone secretion. Ganong. Review of Medical Physiology 23rd ed. Chapter 24, page 384
E. Yes, because growth hormone binds GHRH, inactivating it.
ANSWER: B
5. The growth hormone receptor • Growth hormone receptor:
A. activates Gs. o Activates PLC
B. requires dimerization to exert its effects. o Requires dimerization to exert its effects.
C. must be internalized to exert its effects. o Is not internalized to exert its effects, only the JAK
D. resembles the IGF-I receptor. STAT migrates in the nucleus.
E. resembles the ACTH receptor. o resembles the prolactin receptor.
Ganong. Review of Medical Physiology 23rd ed. Chapter 24, page 381,
382; chapter 25, page 401
ANSWER: E
6. Which of the following hormones exerts the least effect on growth?
A. growth hormone • Growth overall is a complex phenomenon that is affected
B. testosterone not only by growth hormone and somatomedins, but
C. T4 also, as would be predicted by the previous discussion, by
D. insulin thyroid hormones, androgens, estrogens,
E. Vasopressin glucocorticoids, and insulin .
Ganong. Review of Medical Physiology 23rd ed. Chapter24 , page 384.
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ANSWER: 20
5. Mole for mole, which of the following has the greatest effect on
plasma osmolality? • The injection of extremely minute quantities of ADH—as
A. Progesterone small as 2 nanograms—can cause decreased excretion
B. Cortisol of water by the kidneys (antidiuresis) but allows
C. Vasopressin continuing excretion of electrolytes, thus decreasing
D. Aldosterone the plasma osmolarity back toward normal.
E. Dehydroepiandrosterone Guyton.Textbook of Medical Physiology 11th ed. Chapter 58, page
733. Chapter 75 , page 928.
ANSWER: D
6. The secretion of which of the following would be least affected by a • In cases when there is decrease in extracellular fluid
decrease in extracellular fluid volume? volume (e.i. hemorrhage) aside from activating the renin
A. CRH –angiotensin-aldosterone system and vasopressin, the
B. Arginine vasopressin physiologic stress also increases release of CRH which
C. Dehydroepiandrosterone stimulates ACTH which in turn will also affect the output
D. Estrogens of aldosterone as well as that of glucocorticoids and
E. Aldosterone dehydroepiandrosterone
Ganong. Review of Medical Physiology 23rd ed. Chap22 , page 356..
ANSWER: D
7. A young man presents with a blood pressure of 175/110 mm Hg. He is • The patient had glucocorticoid-remediable
found to have a high circulating aldosterone but a low circulating aldosteronism (GRA) which is an autosomal dominant
cortisol. Glucocorticoid treatment lowers his circulating aldosterone disorder in which the increase in aldosterone secretion
and lowers his blood pressure to 140/85 mm Hg. He probably has an produced by ACTH is no longer transient.
abnormal: • The hypersecretion of aldosterone and the
A. 17α-hydroxylase. accompanying hypertension are remedied when ACTH
B. 21β-hydroxylase. secretion is suppressed by administering
C. 3β-hydroxysteroid dehydrogenase. glucocorticoids.
D. aldosterone synthase. • The genes encoding aldosterone synthase and 11β-
E. cholesterol desmolase. hydroxylase are 95% identical and are close together on
chromosome 8.
Ganong. Review of Medical Physiology 23rd ed. Chapter 22, page 356
ANSWER: A
8. A 32-year-old woman presents with a blood pressure of 155/96 mm
Hg. In response to questioning, she admits that she loves licorice and • Patient had apparent mineralocorticoid excess (AME)
eats some at least three times a week. She probably has a low level of secondaryto prolonged ingestion of licorice which
A. type 2 11β-hydroxysteroid dehydrogenase activity. contains glycyrrhetinic acid, that inhibits 11β-
B. ACTH. hydroxysteroid dehydrogenase type 2.
C. 11β-hydroxylase activity. • If 11β-hydroxysteroid dehydrogenase type 2 is
D. glucuronyl transferase. inhibited or absent, cortisol has marked
E. norepinephrine. mineralocorticoid effects.
Ganong. Review of Medical Physiology 23rd ed. Chapter 22 , page 355
ANSWER:
• It increases transport of ENaCs from the cytoplasm to the
cell membrane.
9. In its action in cells, aldosterone • Aldosterone binds to a cytoplasmic receptor, and the
A. increases transport of ENaCs from the cytoplasm to the cell receptor-hormone complex moves to the nucleus.
membrane. • Evidence is accumulating that aldosterone also binds to
B. does not act on the cell membrane. the cell membrane and increases the activity of
C. binds to a receptor excluded from the nucleus. membrane Na+–K+ exchangers.
D. may activate a heat shock protein. • Among the genes activated by aldosterone is the gene for
E. also binds to glucocorticoid receptors. serum- and glucocorticoid regulated kinase (sgk) , a
serine-threonine protein kinase.
• Aldosterone doesn’t bind to glucocorticoid receptors.
Ganong. Review of Medical Physiology 23rd ed. Chapter 22 , page 355
(CHAPTER 21) HORMONAL CONTROL OF CALCIUM, & PHOSPHATE METABOLISM & THE PHYSIOLOGY OF BONE
1. A patient with parathyroid deficiency 10 days after inadvertent ANSWER: C
damage to the parathyroid glands during thyroid surgery would
probably have:
A. low plasma phosphate and Ca2+ levels and tetany. • After parathyroidectomy:
B. low plasma phosphate and Ca2+ levels and tetanus. o Decline in the plasma calcium level.
C. a low plasma Ca2+ level, increased muscular excitability, and o Neuromuscular hyperexcitability appear.
spasm of the muscles of the upper extremity (Trousseau sign). o Hypocalcemic tetany.(chvostek’s and trousseau’s).
D. high plasma phosphate and Ca2+ levels and bone o Plasma phosphate levels usually rise.
demineralization.
Ganong. Review of Medical Physiology 23rd ed. Chapter 23 , page 368
E. increased muscular excitability, a high plasma Ca2+ level, and
bone demineralization.
2. In an experiment, a rat is infused with a small volume of a calcium ANSWER: E
chloride solution, or sodium chloride as a control. Compared to the
control condition, which of the following would result from the • When the plasma Ca2+ level is high, little 1,25-
calcium load? dihydroxycholecalciferol is produced and the kidneys
A. Bone demineralization produce the relatively inactive metabolite 24,25-
B. Increased formation of 1,25-dihydroxycholecalciferol dihydroxycholecalciferol instead.
C. Decreased secretion of calcitonin
D. Decreased blood coagulability Ganong. Review of Medical Physiology 23rd ed. Chapter 23 , page 366
E. Increased formation of 24,25-dihydroxycholecalciferol
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ANSWER: D
• Kidneys: converts 25-Hydroxycholecalciferol into
1,25-Dihydroxycholecalciferol (active form) using
3. Which of the following is not involved in regulating plasma Ca2+ levels? 1α-Hydroxylase and 24,25-Dihydroxycholecalciferol
A. Kidneys (inactive form) using 24-Hydroxylase.
B. Skin • Skin: sunlight activates 7-Dehydrocholesterol into
C. Liver Vitamin D3 (cholecalciferol)
D. Lungs • Liver: converts Vitamin D3 (cholecalciferol) to 25-
E. Intestine Hydroxycholecalciferol with the use of 25-Hydroxylase
• Intestine: increases absorption of calcium in response to
increased vitamin D level
Ganong. Review of Medical Physiology 23rd ed. Chapter 23, page 366
4. 1,25-Dihydroxycholecalciferol affects intestinal Ca2+ absorption ANSWER: A
through a mechanism that: • 1,25 dihydroxycholecalciferol stimulates the expression of
A. includes alterations in the activity of genes. a number of gene products involved in calcium transport
B. activates adenylyl cyclase. (Ca2+–ATPase) and handling via its receptor
C. decreases cell turnover. (calbindin) which acts as a transcriptional regulator in its
D. changes gastric acid secretion. ligand-bound form.
E. involves degradation of apical calcium channels. Ganong. Review of Medical Physiology 23rd ed. Chapter 23 , page 365
5. Which of the following would you expect to find in a patient whose ANSWER: C
diet has been low in calcium for 2 months? • Increased formation of 1,25 dihydroxycholecalciferol
A. Increased formation of 24,25-dihydroxycholecalciferol • Increased amounts of calcium-binding protein in
B. Decreased amounts of calcium-binding protein in intestinal intestinal epithelial cells
epithelial cells • Increased parathyroid hormone secretion
C. Increased parathyroid hormone secretion • A low plasma calcitonin concentration
D. A high plasma calcitonin concentration • Decreased plasma phosphate
E. Increased plasma phosphate Ganong. Review of Medical Physiology 23rd ed. Chapter 23 , page 368
6. A mouse is engineered to lack a transcription factor necessary for the ANSWER: D
normal development of osteoclasts. Compared to normal littermate • Osteoclast forms acid proteases using two types of
mice, which of the following would be reduced in the knock-out substances: (1) proteolytic enzymes, released from the
animals? lysosomes of the osteoclasts, and (2) several acids,
A. Phosphate deposition in trabecular bone including citric acid and lactic acid, released from the
B. Hydroxyapatite levels in bone mitochondria and secretory vesicles.
C. Osteoblast proliferation • The enzymes digest or dissolve the organic matrix of the
D. Secretion of acid proteases bone, and the acids cause solution of the bone salts.
E. Bone collagen Ganong. Review of Medical Physiology 23rd ed. Chapter 79 , page 982
7. The skeleton of a normal male college student would be expected to ANSWER: E
display which of the following features, relative to that of his 7-year-
old brother? • The patient age group (college) approximates the time of
A. Merging of cortical bone and trabecular bone. epiphyseal closure in men. Linear bone growth can occur
B. Differentiation of osteoclasts and osteoblasts. as long as the epiphyses are separated from the shaft of
C. An extended amount of proliferating cartilage that contributes to the bone, but such growth ceases after the epiphyses
bone elongation. unite with the shaft (epiphysial closure).
D. A meeting of the lacunae with the trabecular bone.
Ganong. Review of Medical Physiology 23rd ed. Chapter 23, page 371
E. Epiphyses that are united with the bone shaft.
8. At epiphysial closure ANSWER: E
A. cortical bone and trabecular bone merge • Linear bone growth can occur as long as the epiphyses are
B. osteoclasts and osteoblasts undergo differentiation separated from the shaft of the bone, but such growth
C. there is an extended amount of prolifering cartilage that ceases after the epiphyses unite with the shaft
contributes to bone elongation (epiphysial closure).
D. lacunae meet the trabecular bone
E. ephyses unit with the shaft to end normal linear bone growth Ganong. Review of Medical Physiology 23rd ed. Chapter 23, page 371
(CHAPTER 22) REPRODUCTIVE DEVELOPMENT & FUNCTION OF THE FEMALE REPRODUCTIVE SYSTEM
ANSWER:
1. If a young woman has high plasma levels of T3, cortisol, and renin • The cytotrophoblast of the human chorion contains
activity but her blood pressure is only slightly elevated and she has no prorenin
symptoms or signs of thyrotoxicosis or Cushing syndrome, the most • The rate of adrenocortical secretion of the
likely explanation is that glucocorticoids is moderately increased throughout
A. she has been treated with TSH and ACTH. pregnancy
B. she has been treated with T3 and cortisol. • The increased thyroxine (as well as T3) production is
C. she is in the third trimester of pregnancy. caused at least partly by a thyrotropic effect of human
D. she has an adrenocortical tumor. chorionic gonadotropin.
E. she has been subjected to chronic stress. Ganong. Review of Medical Physiology 23rd ed. Chapter 25, page 425
Guyton.Textbook of Medical Physiology 11th ed.Chap82 , page 1034.
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ANSWER: C
• Relaxin is a polypeptide hormone that is produced in the
3. Which of the following is not a steroid? corpus luteum, uterus, placenta, and mammary glands
A. 17α-hydroxyprogesterone in women and in the prostate gland in men.
B. Estrone • During pregnancy, it relaxes the pubic symphysis and
C. Relaxin other pelvic joints and softens and dilates the uterine
D. Pregnenolone cervix.
E. Etiocholanolone • In men, it is found in semen, where it may help maintain
sperm motility and aid in sperm penetration of the ovum
Ganong. Review of Medical Physiology 23rd ed. Chapter 25 , page 420
ANSWER: A
• fetal ACTH DHEAS estrogen
4. Which of the following probably triggers the onset of labor? • This makes the uterus :
A. ACTH in the fetus o more excitable (increases the number of gap junctions
B. ACTH in the mother between myometrial cells)
C. Prostaglandins o production of more prostaglandins, which in turn
D. Oxytocin cause uterine contractions
E. Placental renin • In early labor, the oxytocin concentration in maternal
plasma is not elevated from the prelabor value.
Ganong. Review of Medical Physiology 23rd ed. Chapter 25, page 425
ANSWER: E
5. Full development and function of the seminiferous tubules require: • Factors that affects spermatogenesis in the seminiferous
A. somatostatin tubules:
B. LH o FSH acts on the Sertoli cells to facilitate the last stages
C. Oxytocin of spermatid maturation.
D. FSH o Androgen affects maturation from spermatids to
E. androgens and FSH spermatozoa depends on androgen acting on the
Sertoli cells.
Ganong. Review of Medical Physiology 23rd ed. Chapter 25 , page 404
ANSWER: A
• fetal ACTH DHEAS estrogen
6. Which of the following probably triggers the onset of labor? • This makes the uterus :
A. ACTH in the fetus o more excitable (increases the number of gap junctions
B. ACTH in the mother between myometrial cells)
C. Prostaglandins o production of more prostaglandins, which in turn
D. Oxytocin cause uterine contractions
E. Placental renin • In early labor, the oxytocin concentration in maternal
plasma is not elevated from the prelabor value.
Ganong. Review of Medical Physiology 23rd ed. Chapter 25, page 425
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(CHAPTER 24) ENDOCRINE FUNCTIONS OF THE PANCREAS & REGULATION OF CARBOHYDRATE METABOLISM
ANSWER:
• Pancreatic endocrine and exocrine cells structure:
1. Which of the following are incorrectly paired? o A cells: glucagon
A. B cells: insulin o B cells: insulin
B. D cells: somatostatin o D cells: somatostatin
C. A cells: glucagons o F cells: pancreatic polypeptide
D. Pancreatic exocrine cells: chymotrypsinogen o Pancreatic exocrine cells: chymotrypsinogen
E. F cells: gastrin • Gastrin is a hormone that is released by G cells in the antrum
of the stomach both in response to a specific neurotransmitter
released from enteric nerve endings.
Ganong. Review of Medical Physiology 23rd ed. Chap21, pg316. Chap26, pg432
ANSWER: D
• Insulin increases protein synthesis
2. Which of the following are incorrectly paired? • Progesterone does not have anabolic effects.
A. Epinephrine: increased glycogenolysis in skeletal muscle • Hypoglycemia triggers increased secretion of at least four
B. Insulin: increased protein synthesis counter-regulatory hormones:
C. Glucagon: increased gluconeogenesis o Epinephrine: glycogenolysis in skeletal muscle
D. Progesterone: increased plasma glucose level o Glucagon: gluconeogenesis
E. Growth hormone: increased plasma glucose level o Cortisol: plasma glucose level
o Growth hormone: plasma glucose level
• **The end result is increased blood glucose level
Ganong. Review of Medical Physiology 23rd ed. Chapter 21, page . 325
ANSWER: D
3. Which of the following would be least likely to be seen 14 days • B cells are responsible pof the production of insulin.
after a rat is injected with a drug that kills all of its pancreatic B o Destroyed b cells low insulin less protein syntesis
cells? elevated amino acids in the plasma.
A. A rise in the plasma H+ concentration • Since the body cannot utilized glucose, it would release
B. A rise in the plasma glucagon concentration counterregulatory hormones :
C. A fall in the plasma HCO3 – concentration glucagon,cortisol,epinephrine,growth hormone.
D. A fall in the plasma amino acid concentration • Increased H+ and decreased HCO3- is caused by Ketoacidosis
E. A rise in plasma osmolality secondary to accumulation of acetoacetic acid.
• Hyperglycemia increased plama osmolarity.
Ganong. Review of Medical Physiology 23rd ed. Chapter 21, page .323.
4. When the plasma glucose concentration falls to low levels, a ANSWER: C
number of different hormones help combat the hypoglycemia.
After intravenous administration of a large dose of insulin, the • “The keys to counter-regulation appear to be epinephrine and
return of a low blood sugar level to normal is delayed in glucagon: if the plasma concentration of either increases, the
A. adrenal medullary insufficiency. decline in the plasma glucose level is reversed; but if both fail
B. glucagon deficiency. to increase, there is little if any compensatory rise in the
C. combined adrenal medullary insufficiency and glucagon plasma glucose level. The actions of the other hormones are
deficiency. supplementary.”
D. thyrotoxicosis. Ganong. Review of Medical Physiology 23rd ed. Chapter 21 , page .326.
E. acromegaly
5. Insulin increases the entry of glucose into: ANSWER: E
A. all tissues.
B. renal tubular cells. • GLUT 4 is an insulin-stimulated glucose transporter that
C. the mucosa of the small intestine. promotes uptake of glucose to skeletal and cardiac muscle,
D. most neurons in the cerebral cortex. and adipose tissue.
Ganong. Review of Medical Physiology 23rd ed. Chapter 21, page .320.
E. skeletal muscle.
6. Glucagon increases glycogenolysis in liver cells but ACTH does ANSWER:
not because: • Membranes of liver cells contain receptors different from those
A. cortisol increases the plasma glucose level. in adrenocortical cells.
B. liver cells have an adenylyl cyclase different from that in • Glucagon acts on phospholipase C on hepatic
adrenocortical cells. cellsincrease cytoplasmic Ca2+ glycogenolysis.
C. ACTH cannot enter the nucleus of liver cells. • ACTH binds to high-affinity receptors on the plasma
D. the membranes of liver cells contain receptors different from membraneof adrenocortical cells. This activates adenylyl
those in adrenocortical cells. cyclase via Gs.
E. liver cells contain a protein that inhibits the action of ACTH. Ganong. Review of Medical Physiology 23rd ed. Chapter 21 , page . 321.
7. A meal rich in proteins containing the amino acids that stimulate ANSWER: C
insulin secretion but low in carbohydrates does not cause
hypoglycemia because
A. the meal causes a compensatory increase in T4 secretion. • The increase in glucagon secretion following a protein meal
B. cortisol in the circulation prevents glucose from entering is also valuable, since the amino acids stimulate insulin
muscle. secretion and the secreted glucagon prevents the
C. glucagon secretion is also stimulated by the meal. development of hypoglycemia while the insulin promotes
D. the amino acids in the meal are promptly converted to storage of the absorbed carbohydrates and lipids.
glucose
Ganong. Review of Medical Physiology 23rd ed. Chapter 21, page . 330
E. insulin does not bind to insulin receptors if the plasma
concentration of amino acids is elevated.
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(CHAPTER 26) DIGESTION, ABSORPTION, & NUTRITIONAL PRINCIPLES
1. Maximum absorption of short-chain fatty acids produced by ANSWER:
bacteria occurs in the • Short-chain fatty acids are absorbed by specific transporters
A. stomach. present in colonic epithelial cells. SCFAs make a significant
B. duodenum. contribution to the total caloric intake and exert a trophic
C. jejunum. effect on the colonic epithelial cells, combat inflammation,
D. ileum. and maintain acid–base equilibrium.
E. colon. Ganong. Review of Medical Physiology 23rd ed. Chapter 27 , page 458 .
2. A premenopausal woman who is physically active seeks advice ANSWER: D
from her primary care clinician regarding measures she can take
to ensure adequate availability of dietary calcium to ensure bone
health later in life. Which of the following dietary components • Role of vitamin D derivative: Ca2+ absorption is adjusted to
should enhance calcium uptake? body needs; absorption is increased in the presence of Ca2+
A. Protein deficiency and decreased in the presence of Ca2+ excess.
B. Oxalates
C. Iron Ganong. Review of Medical Physiology 23rd ed. Chapter 27 , page 458 .
D. Vitamin D
E. Sodium
3. A decrease in which of the following would be expected in a child ANSWER: E
exhibiting a congenital absence of enterokinase? • The protein assimilation machinery, which rests heavily on
A. Incidence of pancreatitis the proteases in pancreatic juice, is arranged such that these
B. Glucose absorption enzymes are not activated until they reach their substrates in
C. Bile acid reabsorption the small intestinal lumen. This is accomplished by the
D. Gastric pH restricted localization of an activating enzyme, enterokinase.
E. Protein assimilation Ganong. Review of Medical Physiology 23rd ed. Chapter 27 , page 466.
ANSWER: A
• Hartnup disease is a congenital defect in the transport of
neutral amino acids does not lead to nutritional deficiencies of
these amino acids because peptide transport (PepT1)
compensates.
4. In Hartnup disease (a defect in the transport of neutral amino
acids), patients do not become deficient in these amino acids due
to the activity of:
A. PepT1.
B. brush border peptidases.
C. Na+, K+ ATPase.
D. cystic fibrosis transmembrane conductance regulator (CFTR).
E. trypsin.
3. Gastric pressures seldom rise above the levels that breach the ANSWER:
lower esophageal sphincter, even when the stomach is filled
with a meal, due to which of the following processes? • The stomach accommodates the meal by a process of receptive
A. Peristalsis relaxation. When food enters the stomach, the fundus and
B. Gastroileal reflex upper portion of the body relax, this permits an increase in
C. Segmentation volume without a significant increase in pressure.
D. Stimulation of the vomiting center
Ganong. Review of Medical Physiology 23rd ed. Chapter 28 , page 473
E. Receptive relaxation
ANSWER: A
• Motilin released cyclically and stimulates interdigestive
myoelectric complexes from stomach and small intestine every
4. The migrating motor complex is triggered by which of the
90 minutes in a fasted person.
following?
A. Motilin • NO intestinal smooth muscle relxation.
B. NO • CCK strongly contracts the gallbladder, expelling bile into the
C. CCK small intestine where the bile in turn plays important roles in
D. Somatostatin emulsifying fatty substances.
E. Secretin • Somatostatin inhibits intestinal secretions.
• Secretin promote pancreatic secretion of bicarbonate which in
turn helps to neutralize the acid in the small intestine.
Guyton.Textbook of Medical Physiology 11th ed.Chap62 , page 776
5. A patient is referred to a gastroenterologist because of ANSWER: B
persistent difficulties with swallowing. Endoscopic examination
reveals that the lower esophageal sphincter fails to fully open
as the bolus reaches it, and a diagnosis of achalasia is made. • In achalasia, the myenteric plexus of the esophagus is deficient
During the examination, or in biopsies taken from the sphincter at the LES in this condition and the release of NO and VIP is
region, a decrease would be expected in which of the following? defective, therefore there will be no anterograde relaxation
A. Esophageal peristalsis or relaxation ahead of the stimulus.
B. Expression of neuronal NO synthase
C. Acetylcholine receptors Ganong. Review of Medical Physiology 23rd ed. Chapter 28, page 470, 473.
D. Substance P release
E. Contraction of the crural diaphragm
ANSWER: B
• The concentration of sodium ions rises with a concomitant loss
6. Compared to hepatic bile, gallbladder bile contains a reduced of chloride and bicarbonate as the bile is concentrated in the
concentration of which of the following? gallbladder.
A. Bile acids • Other substances which are highly concentrated in the
B. Chloride ions gallbladder bile:
C. Protons o Calcium ions
D. Glucose o Bile salts
E. Calcium ions o Cholesterol
o Lecithin
Ganong. Review of Medical Physiology 23rd ed., Chapter 29 page .486
Guyton.Textbook of Medical Physiology 11th ed.Chapter 64, page 587, 803.
ANSWER: E
• Colectomy antibiotic bowel preparation + resection of the
7. Removal of the entire colon would be expected to cause: entire colon eradicate intestinal bacteria and colonic
A. death bacteria decreased deconjugation of bilirubin decreased
B. megaloblastic anemia absorption of uribilinogen decreased urobilinogen excretion
C. severe malnutrition in the kidneys.
D. a decrease in the blood level of ammonia in patients with • Anemia due to decreased B12 and malnutrition because of
cirrhosis of the liver protein malabsorption is not a consequence because both are
E. decreased urinary urobilinogen reabsorb in the small intestines.
• Ammonia is handled by the liver, and levels will increase in
cirrhosis.
Ganong. Review of Medical Physiology 23rd ed. Chapter 29, page . 483
(CHAPTER 29) ORIGIN OF THE HEARTBEAT & THE ELECTRICAL ACTIVITY OF THE HEART
ANSWER: C
1. Which part of the ECG (eg, Figure 29–5) corresponds to
• The P wave: atrial depolarization
ventricular repolarization?
A. The P wave • The QRS duration: ventricular depolarization
B. The QRS duration • The T wave: ventricular repolarization
C. The T wave • The U wave: inconstant finding, prominent in hypokalemia.
D. The U wave • The PR interval: time between atrial depolarization and
E. The PR interval conduction through AV node.
Ganong. Review of Medical Physiology 23rd ed. Chapter 30, page 492 ...
2. Which of the following normally has a slowly depolarizing ANSWER: A
“prepotential”?
A. Sinoatrial node • “Pacemaker or prepotentials are normally prominent only in the SA
B. Atrial muscle cells and AV nodes, wherein there is no sharp, rapid depolarizing spike
before the plateau ass there is in other parts of the conduction system
C. Bundle of His
and the atrial and ventricular fibers.”
D. Purkinje fibers Ganong. Review of Medical Physiology 23rd ed. Chapter 30 , page 491 .
E. Ventricular muscle cells
ANSWER: A
3. In second-degree heart block
A. the ventricular rate is lower than the atrial rate. • In second-degree heart block, not all atrial impulses are
B. the ventricular ECG complexes are distorted. conducted to the ventricles. For example, a ventricular beat
C. there is a high incidence of ventricular tachycardia. may follow every second or every third atrial beat (2:1
D. stroke volume is decreased. block, 3:1 block, etc). This would lead to ventricular rates
E. cardiac output is increased. which is lower than the atrial.
Ganong. Review of Medical Physiology 23rd ed. Chapter 30, page 497 ..
ANSWER: D
4. Currents caused by opening of which of the following channels
• Initial depolarization: Na + influx through rapidly opening
contribute to the repolarization phase of the action potential of
ventricular muscle fibers? Na +channels (the
A. Na+ channels • Rapid repolarization: inactivation of Na+ channels
B. Cl− channels • Plateau phase: Ca2+ influx through more slowly opening
C. Ca2+ channels Ca2+ channels .
D. K+ channels • Repolarization: net K+ efflux through multiple types of K+
E. HCO3− channels channels
Ganong. Review of Medical Physiology 23rd ed. Chapter 30 , page 491 ..
5. In complete heart block ANSWER: D
A. fainting may occur because the atria are unable to pump • Individuals with complete heart block, ventricles beat at a low
blood into the ventricles. rate independently of the atria, there may also be periods of
B. ventricular fibrillation is common. asystole lasting a minute or more. The resultant cerebral
C. the atrial rate is lower than the ventricular rate. ischemia causes dizziness and fainting (Stokes–Adams
D. fainting may occur because of prolonged periods during syndrome)
which the ventricles fail to contract. Ganong. Review of Medical Physiology 23rd ed. Chapter 30 , page 497 .
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(CHAPTER 30) THE HEART AS A PUMP
1. The second heart sound is caused by ANSWER: A
A. closure of the aortic and pulmonary valves. • S2: closure of the aortic and pulmonary valves.
B. vibrations in the ventricular wall during systole. • S4: vibrations in the ventricular wall during systole.
C. ventricular filling. • S3: ventricular filling.
D. closure of the mitral and tricuspid valves. • S1: closure of the mitral and tricuspid valves.
E. retrograde flow in the vena cava. Ganong. Review of Medical Physiology 23rd ed. Chapter 31 , page 513...
(CHAPTER 31) BLOOD AS A CIRCULATORY FLUID & THE DYNAMICS OF BLOOD & LYMPH FLOW
ANSWER: C
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ANSWER: D
• Fluid movement = k[(Pc – Pi) – (πc – πi)]
3. The pressure in a capillary in skeletal muscle is 35 mm Hg at the • where
arteriolar end and 14 mm Hg at the venular end. The interstitial o k = capillary filtration coefficient
pressure is 0 mm Hg. The colloid osmotic pressure is 25 mm Hg o Pc = capillary hydrostatic pressure 35-14= 11mmHg
in the capillary and 1 mm Hg in the interstitium. The net force o Pi = interstitial hydrostatic pressure 0
producing fluid movement across the capillary wall at its o πc = capillary colloid osmotic pressure 25mmHg
arteriolar end is o πi = interstitial colloid osmotic pressure 1mmHg
A. 3 mm Hg out of the capillary.
B. 3 mm Hg into the capillary.
C. 10 mm Hg out of the capillary.
D. 11 mm Hg out of the capillary.
E. 11 mm Hg into the capillary
Ganong. Review of Medical Physiology 23rd ed. Chapter 32, page 541.
ANSWER: E
• flow varies DIRECTLY and resistance INVERSELY with the
fourth power of the radius .
5. When the radius of the resistance vessels is increased, which of
the following is increased? • in which:
A. Systolic blood pressure
B. Diastolic blood pressure
C. Viscosity of the blood • F is the rate of blood flow,
D. Hematocrit • DP is the pressure difference
E. Capillary blood flow • r is the radius of the vessel
• l is length of the vessel
• h is viscosity of the blood.
Ganong. Review of Medical Physiology 23rd ed. Chapter , page .
ANSWER: A
6. A 30-year-old patient comes to her primary care clinician • Increased hematocrit increased viscosity Increase
complaining of headaches and vertigo. A blood test reveals a resistance increase mean blood pressure
hematocrit of 55%, and a diagnosis of polycythemia is made.
Which of the following would also be increased? • in which:
A. Mean blood pressure
B. Radius of the resistance vessels • R is resistance,
C. Radius of the capacitance vessels • DP is the pressure difference
D. Central venous pressure • r is the radius of the vessel
• l is length of the vessel
E. Capillary blood flow
• h is viscosity of the blood.
Ganong. Review of Medical Physiology 23rd ed. Chapter 32 , page 542 .
7. A pharmacologist discovers a drug that stimulates the ANSWER: A
production of VEGF receptors. He is excited because the drug • VEGF agonist responsible for vasculogenesis or development
might be of value in the treatment of of new blood supply that will help bypass the blocked
A. coronary artery disease. arteries as seen in coronary artery disease.
B. cancer. • VEGF antagonists and other angiogenesis inhibitors have now
C. emphysema. entered clinical practice as adjunctive therapies for many
D. diabetes insipidus. malignancies
E. dysmenorrhea. Ganong. Review of Medical Physiology 23rd ed. Chapter 32, page . 539
8. Why is the dilator response to injected acetylcholine changed to ANSWER: E
a constrictor response when the endothelium is damaged?
A. More Na+ is generated. • Acetylcholine act directly on vascular smooth muscle would
B. More bradykinin is generated. produce much greater constriction if their effects were not
C. The damage lowers the pH of the remaining layers of the restricted by simultaneous release of NO from the intact blood
artery. vessels.
D. The damage augments the production of endothelin by the • Damage endothelium NO is not released absence of
endothelium. relaxation of vascular smooth muscle predominance of
E. The damage interferes with the production of NO by the vasoconstriction effect of acetylcholine.
Ganong. Review of Medical Physiology 23rd ed. Chapter 33 , page 564 .
Endothelium
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(CHAPTER 32) CARDIOVASCULAR REGULATORY MECHANISMS
1. When a pheochromocytoma (tumor of the adrenal medulla) ANSWER: B
suddenly discharges a large amount of epinephrine into the
circulation, the patient's heart rate would be expected to
A. increase because the increase in blood pressure stimulates
the carotid and aortic baroreceptors. • Pheochromocytoma large amount of epinephrine
B. increase because epinephrine has a direct chronotropic released direct chronotropic effect increase in heart
effect on the heart. rate.
C. increase because of increased tonic parasympathetic • Low blood pressure stimulates the baroreceptor to increase
discharge to the heart. the heart rate.
D. decrease because the increase in blood pressure stimulates
Ganong. Review of Medical Physiology 23rd ed. Chapter 31, page 514 ..
the carotid and aortic chemoreceptors.
E. decrease because of increased tonic parasympathetic
discharge to the heart.
2. Orthostatic hypotension due to a malfunction in the ANSWER: A
baroreceptor reflex was diagnosed in a 65-year-old man who
had been experiencing frequent episodes of syncope as he got
out of bed in the mornings. Activation of the baroreceptor reflex • Baroreceptors are very important in short-term control of
A. is primarily involved in short-term regulation of systemic arterial pressure. Activation of the reflex allows for rapid
blood pressure. adjustments in blood pressure in response to abrupt
B. leads to an increase in heart rate because of inhibition of the changes in blood volume, cardiac output, or peripheral
vagal cardiac motor neurons. resistance.
C. inhibits neurons in the CVLM.
D. excites neurons in the RVLM. Ganong. Review of Medical Physiology 23rd ed. Chapter 33, page 561 .
E. occurs only under situations in which blood pressure is
markedly elevated.
3. A 45-year-old woman had a blood pressure of 155/95 mm Hg ANSWER: D
when she was at her clinician's office for a physical. It was her • Glutamate: stimulatory
first time to see this clinician and her first physical in over 10 • GABA: inhibitory
years. The clinician suggested that she begin monitoring her • Glutamate receptors were activated in the NTS glutamate
blood pressure at home. Sympathetic nerve activity would be receptors were activated in the CVLM GABA receptors
expected to increase were activated in the RVLM decrease sympathetic output.
A. if glutamate receptors were activated in the NTS. • Sympathetic signals are increased during sexual
B. if GABA receptors were activated in the RVLM. excitement, anger, and stress thru descending tracts to the
C. if glutamate receptors were activated in the CVLM. vasomotor area from the cerebral cortex (particularly the
D. during stress. limbic cortex).
E. when one transitions from an erect to a supine posture. Ganong. Review of Medical Physiology 23rd ed. Chapter 33 , page 557.
4. Which of the following neurotransmitters are correctly matched ANSWER: D
with an autonomic pathway?
A. GABA is released by NTS neurons projecting to the RVLM. • Glutamate: stimulatory
B. Glutamate is released by CVLM neurons projecting to the IML • GABA: inhibitory
C. GABA is released by NTS neurons projecting to the nucleus • Glutamate receptors were activated in the NTS glutamate
ambiguus. receptors were activated in the CVLM GABA receptors
D. GABA is released by CVLM neurons projecting to the RVLM. were activated in the RVLM decrease sympathetic output.
Ganong. Review of Medical Physiology 23rd ed. Chapter 33 , page 557.
E. Glutamate is released by CVLM neurons projecting to the NTS
5. A 53-year-old woman with chronic lung disease was ANSWER: D
experiencing difficulty breathing. Her arterial PO2 and PCO2
were 50 mm Hg and 60 mm Hg, respectively. Which one of the
following statements about chemoreceptors is correct?
A. Peripheral chemoreceptors are very sensitive to small
increases in arterial PCO2. • Increase intracranial pressuredecreased medullary blood
B. Activation of arterial chemoreceptors leads to a fall in flow decreased oxygen and excess buildup of carbon
arterial pressure. dioxide and hydrogen ions central chemoreceptors
C. Peripheral chemoreceptors are located in the NTS. become stimulated.
D. Central chemoreceptors can be activated by an increase in
Guyton.Textbook of Medical Physiology 11th ed.Chapter 18 , page 212 .
intracranial pressure that compromises blood flow in the
medulla.
E. Central chemoreceptors are activated by increases in tissue
pH
6. Why is the dilator response to injected acetylcholine change to a ANSWER: E
constrictor response when the endothelium is damaged?
A. More Na+ is generated • Acetylcholine act directly on vascular smooth muscle would
B. More bradykinin is generated produce much greater constriction if their effects were not
C. The damage lowers the pH of the remaining layers of the restricted by simultaneous release of NO from the intact blood
artery vessels.
D. The damage augments the production of endothelin by the • Damage endothelium NO is not released absence of
endothelium relaxation of vascular smooth muscle predominance of
E. The damage interferes with the production of NO by the vasoconstriction effect of acetylcholine.
Ganong. Review of Medical Physiology 23rd ed. Chapter 33 , page 564 .
endothelium
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(CHAPTER 33) CIRCULATION THROUGH SPECIAL REGIONS
1. Blood in which of the following vessels normally has the lowest ANSWER:
Po2?
A. Maternal artery • Maternal artery: 98% oxygen saturation
B. Maternal uterine vein • Umbilical vein: 80% oxygen saturation
C. Maternal femoral vein • Umbilical artery: 60% oxygen saturation
D. Umbilical artery
Ganong. Review of Medical Physiology 23rd ed. Chapter 34, page .582..
E. Umbilical vein
ANSWER: A
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• Reaction 1
o is catalyzed by carbonic anhydrase.
A. Reaction 2 is catalyzed by carbonic anhydrase. o helps decrease the pH of blood during hyperventilation.
B. Because of reaction 2, the pH of blood declines during o occurs primarily in plasma but can also occur in the red
hyperventilation. blood cell, at faster rate with the help of carbonic anhydrase
C. Reaction 1 occurs in the red blood cell. • The reactions move to the left when there is excess H+ in the
D. Reaction 1 occurs primarily in plasma. tissues.
E. The reactions move to the right when there is excess H+ in Guyton.Textbook of Medical Physiology 11th ed.Chapt 40, pgs 510-511.
the tissues.
4. In comparing uncompensated respiratory acidosis & uncompen- ANSWER: D
sated metabolic acidosis which one of the following is true?
A. Plasma pH change is always greater in uncompensated
respiratory acidosis compared to uncompensated metabolic
acidosis.
B. There are no compensation mechanisms for respiratory
acidosis, whereas there is respiratory compensation for
metabolic acidosis.
C. Uncompensated respiratory acidosis involves changes in
plasma [HCO3−], whereas plasma [HCO3−] is unchanged in
uncompensated metabolic acidosis.
D. Uncompensated respiratory acidosis is associated with a
change in Pco2, whereas in uncompensated metabolic
acidosis Pco2 is constant. Ganong. Review of Medical Physiology 23rd ed. Chapter 36, pages 615-616 ..
ANSWER:
5. O2 delivery to the tissues would be reduced to the greatest
extent in • oxygen concentration: a normal subject breathing
A. a normal subject breathing 100% O2 on top of Mt. Everest atmospheric O2 on top of Mt. Everest
B. a normal subject running a marathon at sea level • oxygen transport: a patient with carbon monoxide poisoning
C. a patient with carbon monoxide poisoning • oxygen utilization: a patient who has ingested cyanide
D. a patient who has ingested cyanide • oxygen delivery: a patient with moderately severe metabolic
E. a patient with moderately severe metabolic acidosis acidosis. (high H+ shifts the O2-Hgb curve to the RIGHT)
Ganong. Review of Medical Physiology 23rd ed. Chapter , page .
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(CHAPTER 36) REGULATION OF RESPIRATION
ANSWER: D
1. The main respiratory control neurons • Main respiratory control neurons:
A. send out regular bursts of impulses to expiratory muscles o is not active during normal, quiet breathing, when
during quiet respiration. expiration is passive
B. are unaffected by stimulation of pain receptors. o are located in the medulla.
C. are located in the pons. o send out regular bursts of impulses to inspiratory muscles
D. send out regular bursts of impulses to inspiratory muscles during quiet respiration.
during quiet respiration. o are affected by impulses from the pain receptors and
E. are unaffected by impulses from the cerebral cortex. cerebral cortex.
Guyton.Textbook of Medical Physiology 11th ed.Chapter 41 , pages 514-515
ANSWER: B
2. Intravenous lactic acid increases ventilation. The receptors • Carotid bodies:
responsible for this effect are located in the o Peripheral chemoreceptors located at the bifurcation of the
A. medulla oblongata. common carotid arteries.
B. carotid bodies. o Stimulated in cases of:
C. lung parenchyma. ▪ Decreases in arterial PO2 (<60 mm Hg)
D. aortic baroreceptors. ▪ Increases in arterial PCO2
E. trachea and large bronchi. ▪ Increases in arterial [H+]
Ganong. Review of Medical Physiology 23rd ed. Chapter 37 , page 628.
ANSWER: B
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7. Variations in which of the following components of blood or CSF ANSWER:
do not affect respiration?
A. Arterial HCO3− concentration • The rhythmic discharges from the brain that produce affects
B. Arterial H+ concentration respiration are alterations in arterial PO2, PCO2, H+, and HCO3-
C. Arterial Na+ concentration concentration, and this chemical control of breathing is
D. CSF CO2 concentration supplemented by a number of non-chemical influences.
Ganong. Review of Medical Physiology 23rd ed. Chapter 37, page 625 ..
E. CSF H+ concentration
8. Stimulation of the central (proximal) end of a cut vagus nerve ANSWER: E
would be expected to • “ Stretching of the lungs during inspiration initiates impulses in
A. increase heart rate afferent pulmonary vagal fibers. These impulses inhibit
B. stimulate inspiration inspiratory discharge. This is why the depth of inspiration is
C. inhibit coughing increased after vagotomy and apneusis develops if the vagi are cut
D. raise blood pressure after damage to the pneumotaxic center.”
E. cause apnea Ganong. Review of Medical Physiology 23rd ed. Chapter 37, page 627.
ANSWER: A
3. If the clearance of a substance which is freely filtered is less than • Inulin
that of inulin, o freely filtered
A. there is net reabsorption of the substance in the tubules. o neither reabsorbed nor secreted in the tubules
B. there is net secretion of the substance in the tubules. o nontoxic,
C. the substance is neither secreted nor reabsorbed in the o not metabolized by the body.
tubules. • If the clearance of a substance which is freely filtered is less
D. the substance becomes bound to protein in the tubules. than that of inulin = (+) tubular REABSORPTION of substance.
E. the substance is secreted in the proximal tubule to a greater • If the clearance of a substance which is freely filtered is more
degree than in the distal tubule. than that of inulin = (+) tubular SECRETION of subtance.
Ganong. Review of Medical Physiology 23rd ed. Chapter 37 , page 626.
ANSWER: A
• Proximal tubule:
4. Glucose reabsorption occurs in the • reabsorbs about 65% of the
A. proximal tubule. filtered sodium, chloride,
B. loop of Henle. bicarbonate, and potassium
C. distal tubule. and essentially all the
D. cortical collecting duct. filtered glucose and amino
E. medullary collecting duct. acids.
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ANSWER: E
• The mineralocorticoids act primarily in the cortical collecting
ducts to increase the number of active epithelial sodium channels
(ENaCs) in this part of the nephron
Ganong. Review of Medical Physiology 23rd ed. Chapter 38, page 658.
ANSWER: C
3. Renin is secreted by
A. cells in the macula densa.
B. cells in the proximal tubules.
C. cells in the distal tubules.
D. granular cells in the juxtaglomerular apparatus.
E. cells in the peritubular capillary bed.
Ganong. Review of Medical Physiology 23rd ed. Chapter 22, page 357.
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ANSWER: E
4. Erythropoietin is secreted by • Erythropoietin is produced by:
A. cells in the macula densa. o interstitial cells in the peritubular capillary bed of the kidneys
B. cells in the proximal tubules. o perivenous hepatocytes in the liver.
C. cells in the distal tubules. o in the brain, where it exerts a protective effect against
D. granular cells in the juxtaglomerular apparatus. excitotoxic damage triggered by hypoxia
E. cells in the peritubular capillary bed. o in the uterus and oviducts, where it is induced by estrogen and
appears to mediate estrogen-dependent angiogenesis.
Ganong. Review of Medical Physiology 23rd ed. Chapter 39 , page 677..
5. When a woman who has been on a low-sodium diet for 8 days ANSWER: D
is given an intravenous injection of captopril, a drug that
inhibits angiotensin-converting enzyme, which of the following
would be expected? • Angiotensin II inhibitors like captopril lower blood pressure
A. BP to rise because cardiac output would fall principally by decreasing peripheral vascular resistance.
B. BP to rise because peripheral resistance would fall Cardiac output and heart rate are not significantly changed.
C. BP to fall because cardiac output would fall
D. BP to fall because peripheral resistance would fall Katzung. Basic and Clinical Pharmacology 13th ed.page 254.
E. Plasma renin activity to fall because circulating angiotensin
I level would rise
ANSWER: C
• Administration of a drug that blocks β-adrenergic receptors
6. Which of the following would not be expected to increase renin inhibits the stimulation of renin production by catecholamines
secretion? (mediated by β1 receptors).
A. Administration of a drug that blocks angiotensin- • Administration of a drug that blocks angiotensin-converting
converting enzyme enzyme and AT1 receptors renal arterial pressure renin
B. Administration of a drug that blocks AT1 receptors secretion.
C. Administration of a drug that blocks β-adrenergic receptors • Constriction of the aorta between the celiac artery and the renal
D. Constriction of the aorta between the celiac artery and the arteries renal arterial pressure renin secretion.
renal arteries • Administration of a drug that reduces ECF volume renal nerve
E. Administration of a drug that reduces ECF volume discharge and decreased renal arterial pressure renin secretion
Ganong. Review of Medical Physiology 23rd ed. Chapter 22, page 358.
Katzung. Basic and Clinical Pharmacology 13th ed.page 245.
ANSWER:
7. Which of the following is least likely to contribute to the • Effects of ACE inhibitors:
beneficial effects of angiotensin-converting enzyme inhibitors o Vasodilation decreased peripheral resistance reduced
in the treatment of heart failure? afterloaddecreased cardiac growth
A. Vasodilation o Decreased plasma aldosterone reduced long-term
B. Decreased cardiac growth remodelling.
C. Decreased cardiac afterload o Increased plasma renin activity increased angiotensin and
D. Increased plasma renin activity aldosterone secretion vasoconstriction and salt retention
E. Decreased plasma aldosterone increased afterload, preload, and cardiac remodelling
increased severity of heart failure.
Katzung. Basic and Clinical Pharmacology 13th ed.page 298.
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ANSWER: B
Ganong. Review of Medical Physiology 23rd ed. Chapter 36, page 615 .
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