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UNIVERSITY OF THE FREE STATE

BLOEMFONTEIN CAMPUS

PHBG3716

DEPARTMENT OF BASIC MEDICAL SCIENCES

CONTACT NUMBER: 051 401 7878

EXAMINATION: ADDITIONAL MID-YEAR EXAMINATION

PAPER 1

ASSESSOR(S): 1. Mr M. Muller
2. Dr P.C. De Wet

MODERATOR(S): 1. Prof A. Crous

2. Dr. J.A. de W. Strauss

TIME: 3 hours MARKS: 150

COMPLETE SECTION A ON THE COMPUTER CARD

SECTION A
(45 marks)

Questions 1 – 10: Answer this section on the computer card. Choose the correct option
and mark the corresponding option (A,B,C,D,E) with a pencil. (10)

1. The systemic circulation:

(A) receives more blood than the pulmonary circulation does.
(B) receives blood from the left ventricle.
(C) is a low pressure system compared to the pulmonary circulation.
(D) receives blood from the right ventricle and is a high pressure system compared to the
pulmonary circulation.
(E) receives more blood than the pulmonary circulation does, and receives blood from the
left ventricle.

2. Which valve(s) prevent regurgitation of blood from a right ventricle to the atrium?
(A) tricuspid.
(B) mitral.
(C) pulmonary.
(D) tricuspid and pulmonary.
(E) all of these.

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3. Semilunar valves:
(A) prevent backflow of blood from the ventricles to the atria.
(B) prevent backflow of blood from the atria to the ventricles.
(C) prevent backflow of blood from the ventricles to the arterial trunks.
(D) prevent backflow of blood from the arterial trunks to the ventricles.
(E) none of the above.

4. The wall of the left ventricle is thicker than the wall of the right ventricle because the:
(A) left ventricle must pump much more blood than the right ventricle so it must have
stronger walls.
(B) right ventricle must pump much more blood than the left ventricle so it has a larger
chamber to accommodate the blood and a correspondingly thinner wall.
(C) left ventricle must pump the same amount of blood into a higher-resistance, higher-
pressure system.
(D) right ventricle must create higher tension within its walls.
(E) left ventricle must pump oxygenated blood, which requires more energy than pumping
deoxygenated blood.

5. Adjacent cardiac muscle cells are joined together end-to-end in the ventricles by:
(A) intercalated discs.
(B) sarcomeres.
(C) Purkinje fibers.
(D) sinoatrial nodes.
(E) atrioventricular nodes.

6. The primary function of the pericardial sac is to:

(A) prevent excessive expansion of the heart as it fills with blood.
(B) secrete a fluid that reduces friction as the heart beats.
(C) serve as a reservoir for blood to be used during strenuous exercise.
(D) provide oxygen and nutrients to the heart muscle.
(E) catch and kill any bacteria in the blood flowing through the heart chambers.

7. The chordae tendineae:

(A) keep the AV valves from everting during ventricular systole.
(B) hold the AV valves open during diastole.
(C) hold the right and left ventricles together.
(D) transmit the electrical impulse from the atria to the ventricles.
(E) contract when the ventricles contract.

8. The heart chamber that has the greatest work load is:
(A) the right ventricle.
(B) the left ventricle.
(C) the left atrium.
(D) the right atrium.
(E) both atria.

9. A lumen that contains blood with a comparatively higher concentration of oxygen is in the:
(A) right ventricle.
(B) inferior vena cava.
(C) pulmonary artery.
(D) pulmonary vein.
(E) coronary veins.

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10. The aortic valve:
(A) prevents the backflow of blood into the aorta during ventricular diastole.
(B) prevents the backflow of blood into the left ventricle during ventricular diastole.
(C) prevents the backflow of blood into the right ventricle during ventricular diastole.
(D) closes when the first heart sound is heard.
(E) none of the above.

Questions 11 – 25: Also answer this section on the computer card. The following
statements are True or False. If you choose True, mark (A) and if False, mark (B) with a
pencil. (15)

11. Antibodies are produced by B and T lymphocytes.

12. Lymphocytes are the only granulocytes that make gamma globulins.

13. In the blood, the gamma globulin-producing leukocytes are more numerous than the
leukocytes that differentiate to become macrophages.

14. Neutrophilia frequently accompanies bacterial infections.

15. Histamine-producing leukocytes are agranulocytes, and they are the least abundant cells in
the buffy coat seen when measuring the hematocrit.

16. The glomerular filtrate contains only substances that are not needed by the body.

17. Twenty-five percent of the cardiac output goes to the kidneys because of their tremendous
nutrient requirement for the active transport of Na+.

18. The glomerular filtrate is almost identical in composition to plasma.

19. In active reabsorption, all of the steps involved in trans-epithelial transport are active.

20. Autoregulation is important in preventing unintentional shifts in the GFR that could lead to
dangerous imbalances of fluid, electrolytes, and wastes.

21. The secretion of vasopressin increases if the extracellular fluid becomes hypertonic.

22. NaCl is actively transported from the descending limb of the loop of Henle to establish the
medullary osmotic gradient.

23. The presence of vasopressin acts to prevent the reabsorption of water from the distal and
collecting tubules.

24. When urine is eliminated from the body, the sphincter muscles in the urethra relax.

25. One can deliberately prevent urination in spite of the micturition reflex by voluntarily inhibiting
the parasympathetic supply to the bladder to stop bladder contraction.

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Questions 26 – 35: Also answer this section on the computer card. Choose the correct
option and mark the corresponding option (A,B,C) with a pencil. (10)

A. Increase
B. Decrease
C. No effect

Factor Effect on Vasopressin Effect on thirst

secretion
Angiotensin II 26. 27.
Pain and trauma 28. 29.
Alcohol 30. 31.
Caffeine 32. 33.
Dry mouth 34. 35.

Questions 36 – 45: Also answer this section on the computer card. Choose the correct
option and mark the corresponding option (A or B) with a pencil. (10)

Choose the definition which best describes for the following terms.
36. Renal autoregulation.
A. Spontaneous changes in GFR prevented by intrinsic control.
B. Spontaneous changes in GFR prevented by extrinsic control.

37. Surfactant.
A. A lipid substance secreted by Type I and II alveolar cells to decease surface tension.
B. Type II cells: secrete alveolar fluid caontaining a mixture of phospholipds and lipoproteins.

38. Micturition reflex.

A. Reflex to increase urine production.
B. Reflex for bladder emptying /urination and is initiated by stretch receptors in bladder wall.

39. Pores of Kohn.

A. Pores for collateral ventilation.
B. Pores for involuntary ventilation.

40. Transcellular fluid compartment.

A. Fluid in spaces (inra ocular, pericardial, peritoneal etc) not able to measure.
B. Fluid in spaces (inra ocular, pericardial, peritoneal etc) 1-2L, part of ECF.

41. Respiratory quotient.

A. RQ = CO2 produced / O2 used.
B. RQ= Volume oxygen necessary for cells to survive.

42. Circulatory hypoxia.

A. Not enough oxygenated blood given to tissues.
B. Not enough red blood cells produced.

43. Extracellular fluid hypertonicity.

A. Very high water concentration in the extracellular fluid.
B. Associated with dehydration due to inadequate H20 ingestion eg.

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44. Bronchoconstriction.
A. Constriction of respiratory airways.
B. Constriction of arterioles.

45. Negative water balance.

A. Dehydration
B. Overhydration

ANSWER ALL THE QUESTIONS IN YOUR ANSWER BOOK

SECTION B
(60 marks)

Question 1 [10 marks]

1.1 Discuss the general functions of plasma proteins. (5)

1.2 Provide the name of the only plasma protein that is not produced within the liver. (1)

1.3 Explain the role of the plasma protein specifically involved in the blood clotting cascade.
(4)

Question 2 [15 marks]

2.1 Draw a simplified diagram to illustrate the process of erythropoiesis. (5)

2.2 Erythropoiesis is not solely regulated by the oxygen concentration. Name two micro nutrients
that also aid erythropoiesis regulation. (2)

2.3 Fill in the missing sections in your answer book:

Any condition during which the blood has a low oxygen carrying capacity is classified as
A)___________. There are two classes of actions that cause this illness. The first class of
actions causes the C)____________ and the second class leads to a C)___________.
(3 x 1 = 3)

2.4 Explain what happens to haemoglobin when an erythrocyte reaches the end of its life cycle.
(5)

Question 3 [8 marks]

Tabulate the electrical events of the intrinsic conduction system of the heart as they correlate with
the mechanical events that occur during the cardiac cycle as can be seen on an ECG. (8)

Question 4 [5 marks]

4.1 Discuss how the atrial “Bainbridge” reflex will influence cardiac output. (4)

4.2 Motivate why this reflex is an autonomic and not a conscious action. (1)

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Question 5 [14 marks]

5.1 Distinguish between venous return and venous capacity. (2)

5.2 Venous blood vessels have specialised adaptive mechanisms to mediate blood flow.
Discuss each of the following adaptive mechanisms.

A) Venous valves. (3)

B) Respiratory pump. (3)

C) Muscular pump. (3)

5.3 Decide whether or not the cardiac cycle does aid venous return and motivate your
answer. (3)

Question 6 [8 marks]

6.1 Define circulatory shock. (1)

6.2 Draw an annotated flow chart that correctly shows how hypovolemic shock leads to
circulatory shock. (7)

ANSWER ALL THE QUESTIONS IN YOUR ANSWER BOOK

SECTION C
(45 marks)

Question 1 [10 marks]

Read the following statement and explain the appropriate mechanisms that are involved.

“The kidneys can excrete urine of varying concentrations depending on the body’s state of
hydration.”

Question 2 [10 marks]

Describe how sodium and blood pressure balance are interconnected. Mention the renin-
angiotensin-aldosterone system and ANP in your answer.

Question 3 [8 marks]

Explain the mechanics of ventilation as it relates to Boyles’ Law.

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Question 4 [11 marks]

Use the figure below to answer the corresponding questions.

4.1 Which number(s) relate(s) only to an amount of air inhaled? (2)

4.2 Number _________________ identifies the _________________, which is the maximum

amount of air that can be exhaled after maximum inhalation. (2)

4.3 Number _________________ identifies the __________________, which is the minimum

amount of air left in the lungs after maximum exhalation. (2)

4.4 Number 3 identifies the ________________, which is the sum of the _________________,
identified as number _________________, and ________________, identified as number
________________. (5)

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Question 5 [6 marks]

Use the figure below to answer the corresponding questions.

5.1 This figure depicts the process (1)

(A) of bicarbonate secretion in the kidneys.
(B) that helps raise the blood’s pH.
(C) that is the kidney’s response to alkalosis.
(D) of H+ reabsorption in the kidneys.
(E) none of the above.

5.2. Identify the number(s) for bicarbonate ions: ______. (3)

5.3 In this figure ______ is labeled number 2 and is being secreted while ______ labeled number
4 is being reabsorbed. (2)

❖

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