3rd Year Comprehensive Examination Ratio

First Year Subject - Medical Physiology

July 7, 2018
CHOOSE THE BEST ANSWER.
Please do readings also in Physiology kasi madami talagang dapat alamin sa physio na hindi ko
naman kaya ilagay sa iisang file po. This ratio is only your guide in studying.

71. Which of the following is a secondary active transport?

A. Na K ATPase Pump C. Ca Pump
B. Na Ca Pump D. H K ATPase Pump

In primary active transport, the energy is derived directly from breakdown of

adenosine triphosphate (ATP) or of some other high energy phosphate compound. In
secondary active transport, the energy is derived secondarily from energy that has been
stored in the form of ionic concentration differences of secondary molecular or ionic
substances between the two sides of a cell membrane, created originally by primary
active transport.
In other words: Yung Primary active transport natin ang gumagawa ng gradient para
gumana ang ayung secondary active transport natin… Recall Cardiac Physiology… Choice
A and C are Primary Active transport pumps present in the Membrane of the Cardiac
Muscle. Na K ATPase Pump will pump 3 Na ions out and 2 K ions in (PISO). Metabolic
Energy here is provided by the downhill gradient of Na provided by Na K pump.. gets
ba?.. Ca pump in the cardiac muscle pumps calcium ions directly out of the cell. Choice
D is a primary active transport present in our gastric parietal cells which is responsible
for acid secretion.. this pump is inhibited by…… blank (recall nio nalang ☺)

72. Resting Membrane Potential is near the equilibrium potential of which ion?
A. Sodium C. Calcium
B. Chloride D. Potassium

73. Release of Neurotransmitter occurs after fusion of vesicular SNAREs with:

A. Syntaxin and SNAP 25 C. Syntaxin and Synaptobrevin
B. Synaptobrevin and Synaptotagmin D. SNAP and Synaptobrevin

Recall that your NTAs are stored in vesicles inside the neurons.
As with other exocytotic process, NTA release involves SNARE proteins: v-SNARES in the
vesicle membrane and t – SNARES on the presynaptic plasma membrane. Zipper like
interactions between Synaptobrevin (a v-SNARE) and Syntaxin and SNAP 25 (two t-
SNARES) bring the vesicle membrane and the presynaptic plasma membrane close
together before fusion.

Prepared By: Tonio Lodito - 3F 2020

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 3rd Year Comprehensive Examination Ratio
First Year Subject - Medical Physiology
July 7, 2018

74. Skeletal muscle contraction would require calcium from the

A. extracellular area after activation of voltage gated calcium channel DHP
B. cytoplasm after chemical activation of mechanically gated calcium channel RYR
C. cisterns after activation of mechanically gated RYR calcium channel by DHP
D. extracellular area after activation of ligand gated calcium channel RYR

The picture above is a T tubule in the Sarcolemma (plasma membrane of the skeletal muscle).
When the action potential reaches the t tubule it activates the voltage gated DHP receptor
(dihyropyridine). DHRP interacts with mechanically gated RYR (ryanodine receptor). When DHP
receptors are activates it “pulls” open the RYR in the cisterns leading to release of calcium
leading to Skeletal Muscle contraction.
Review the difference between skeletal muscle and cardiac muscle with regards to initiation of
contraction…

Prepared By: Tonio Lodito - 3F 2020

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 3rd Year Comprehensive Examination Ratio
First Year Subject - Medical Physiology
July 7, 2018

75. A 40 year old female was diagnosed with multiple organ system atrophy and had symptoms
indicative of failure of sympathetic nerve activity. These symptoms include which of the
following?
A. Increased salivation C. Decreased sweating
B. Bronchodilation D. Mydriasis

Prepared By: Tonio Lodito - 3F 2020

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 3rd Year Comprehensive Examination Ratio
First Year Subject - Medical Physiology
July 7, 2018
Must KNOW pls.. Sweat Glands have Sympathetic Cholinergic innervation. The

76. When Alpha-1 receptors are stimulated by epinephrine, there will be:
A. An increase in cAMP → increasing Na+ conductance
B. An increase in IP3 → increasing Ca++ conductance
C. A decrease in cAMP → increasing K+ conductance
D. A decrease in IP3 → decreasing Ca++ conductance

77. A 12 month old child was given chickenpox vaccination, this is an example of:
A. Naturally acquired active immunity C. Artificially acquired active immunity
B. Naturally acquired passive immunity D. Artificially acquired passive immunity

Naturally acquired active immunity – past infections (measles, chickenpox and etc.)
Naturally acquired passive immunity – breastmilk (colostrum)
Artificially acquired active immunity – Vaccinations
Artificially acquired Passive immunity – Artificial Immunoglobulins (rabies IG, Tetanus Ig
and etc.)
Difference of Active and passive…. Pag active katawan yung gagawa ng antibodies..
kumbaga the body is actively producing antibodies. Pag passive, antibodies na agad ang
binigay.. gets ba? Yung artificial and natural alam niyo na yan.

78. The process of erythropoiesis

A. can be affected by the cells present in the kidneys
B. is inhibited by erythropoietin
C. is stimulated by tissue oxygenation

Prepared By: Tonio Lodito - 3F 2020

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 3rd Year Comprehensive Examination Ratio
First Year Subject - Medical Physiology
July 7, 2018
D. is never affected by the activity of hepatocytes

Choice A is the best answer in this question. Our kidney produces 90% of erythropoietin
and erythropoietin stimulates RBC production.
Choice C may seem correct but it must be “lack” or “decreased” tissue oxygenation
Choice D is incorrect because 10% of the body’s EPO is produced in the liver

79. Active transport of calcium across the cardiac sarcolemma is correctly described by which of
the following statements?
A. lt is increased during systole
B. It is reduced by cardiac glycosides
C. It promotes net movement of calcium into the cell
D. It is decreased by hypernatremia

This figure is the Cardiac Sarcolemma, the 3 pumps present in the membrane are the Na
K ATPase pump, Na Ca exchanger, and the Ca ATPase pump. Na K pump and the Ca
pump are primary active transport type of pumps. And the Na Ca pump is a secondary
active transport pump. Na K pump pumps Potassium In and Sodium out (PISO). 2
Potassium and 3 Sodium ions are transported across.. this creates a electrochemical
gradient for the activation of the secondary active transport, the Na Ca exchanger which
pumps 3 Na in and 1 Ca ion out (recall concept of secondary active transport. THE NA
KA PUMP can be inhibited by cardiac glycosides (digoxin) o if we inhibit the Na K pump
the we also affect the Na Ca exchanger… gets? Choice A is wrong because it is increased

Prepared By: Tonio Lodito - 3F 2020

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 3rd Year Comprehensive Examination Ratio
First Year Subject - Medical Physiology
July 7, 2018
during diastole.. diba nag cocontract ang muscle pag systole so kelangan mo ng calcium
kaya you need it inside the cell. Choice C is wrong because active transport of Ca is going
out of the cell.

80. Which of the following statements is correct about closure of the atrioventricular valves
during systole?
A. It requires papillary muscle contraction
B. lt occurs at the end of isovolumetric contraction phase
C. It is impaired by diseases that affect the chordae tendinae
D. It prevents backflow of blood into the ventricles

Chordae tendinae are structures attached to the AV valves. This chordae tendinae are
attached to the papillary muscles which are part f the ventricular wall. Diseases affecting
Chordae tendinae (example is RHD) affects closure of the valves therefore resulting in
backflow of blood into the atria. Choice A is wrong because contrary to belief, valve
closure don’t require the contraction of these papillary muscles. The Valves close via a
passive process when there is a backward pressure gradient from the flow of blood. The
PMs only prevent bulging of the Valves into the atria during contraction of the ventricle.
Choice B is wrong because Av valve closure occurs at the Beginning of the Isovolumetric
contraction phase. Choice D is wrong because AV valves prevent backflow into the
atria.

81. Increase in afterload will result to which of the following?

A. increase in end systolic volume
B. decrease in systolic pressure
C. decrease in diastolic pressure
D. increase in end diastolic volume

Afterload is the load against which the muscle exerts its contractile force. Basically it is
the force in which the heart must contract
Formulas: MUST KNOW!!!
CO = SV x HR
SV = EDV-ESV
End Diastolic volume is the volume of blood in the ventricle before it contracts (it is
determined by the preload)
End Systolic volume is the volume of blood after contraction of the ventricle (it is
affected by the afterload)

82. An increase of which of the following will DECREASE venous return?

A. total blood volume
B. right atrial pressure
C.MCSFP
D. venous tone

Prepared By: Tonio Lodito - 3F 2020

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 3rd Year Comprehensive Examination Ratio
First Year Subject - Medical Physiology
July 7, 2018
Right atrial pressure will prevent flow of blood back to the heart. Why? We know that
veins are low pressure vessels unlike arteries they can pump against high pressure. So
when there is increased pressure in the Right Atrium the blood will backflow to the
veins. Choice A C D promote venouse return when they are increased.

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Case: Vicente, A 15 year olermale was diagnosed to have pneumonia. His vital signs were as
follows: CR: 110/min, RR: 38/min, Temp: 37.0°C. His O2 saturation was 80%.

83. The reason for his low oxygen in the blood is:
A. V/Q mismatch C. Increase airway resistance
B. Diffusion impairment D. Anemia

When we have pneumonia, the interstitium (the barrier between our blood and the air
in the alveoli) thickens. And due to Fick’s Law, Diffusion will decrease if there is a
increase in a thickness of the membrane in which the substance will pass through.
V/Q mismatch will be seen in other conditions such as Atelectasis, because there are
areas of the lung that are collapsed but is still being perfused by blood.

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Case: Joseph, a 10 year old known asthmatic had severe attack. His vital signs at the E.R. were
CR: 115/min, RR: 40/min, Temp: 37.5°C. His ABG showed pH: 7.49, PCO2: 30 mmHg, PO2:
70 mmHg, HCO3: 10 megs.

84. This could explain Joseph's hypoxemia.

A. decrease airway resistance, increase in airflow
B. increase airway resistance, increase airflow
C. decrease airway resistance, decrease airflow
D. increase airway resistance, decrease airflow

Patients with asthma will have constricted airways. When airways are constricted there
will be increased airways resistance and therefore will have decreased airflow.

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85. Pulmonary surfactant deficiency may be seen in

A. extremely premature babies C. patients exposed to toxic gasses
B. severe pneumonia D. All of the above

Prepared By: Tonio Lodito - 3F 2020

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 3rd Year Comprehensive Examination Ratio
First Year Subject - Medical Physiology
July 7, 2018
Extremely premature babies will have surfactant deficiency because stable surfactant
production begins at 7th month of gestation. Severe pneumonia and toxic gases can
decrease surfactant because severe trauma to the lungs can decrease the number of the
type 2 pneumocytes in our lungs which is responsible for surfactant production.

86. Aboral movement of food is made possible by which extrinsic innervation of the GIT?
A. Parasympathetic nervous system C. Myenteric plexus
B. Sympathetic nervous system D. Meissner's plexus

Aboral means away from the mouth. Parasympathetic NS is stimulatory to the motility
of GIT and inhibitory to the sphincters thus promoting aboral movement of food.
Sympathetic NS is inhibitory to the motility of GIT and stimulatory to the sphincters thus
promoting adoral or no movement. Myenteric and MEissner plexuses are submucosal
plexus and are part of the intrinsic innervation of the GIT

87. You were listening on a GI physiology lecture when you felt an increasing pressure in your
anal canal. Which of the following events are expected to occur provided that the rectal
pressure is below a reflexive evacuation?
A. A voluntary contraction of the internal anal sphincter.
B. Involuntary contraction of the tunica muscularis of rectum.
C. Stimulation of the sigmoid colon upon distention of the rectum.
D. All of the above

88. An increase in which of the following will increase rate of tubular reabsorption?
A. ∏B B. EFP C. ∏C D. ∏I

Pa chek nalang sa old notes natin sa renal andito yung mga symbls na yan.
89. Which of the following is true when a patient suffers from respiratory acidosis secondary to
COPD?
A. H2CO3 excretion by the kidneys is increased.
B. NaH2P04 excretion is increased.
C. Urine pH is increased.
D. Decreased Gln metabolism in the kidneys.

90. Defects in these structures in the nephron will result to dysregulation of tubular cell
proliferation and differentiation, and K handling of the renal tubules.
A. Glomerolus B. Primary cilia C. Mesangial cells D. JG cells

Prepared By: Tonio Lodito - 3F 2020

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 3rd Year Comprehensive Examination Ratio
First Year Subject - Medical Physiology
July 7, 2018
Primary cilia are attached to mechanically gated K channels In the tubules. They respond
to flow of the filtrate across the tubules. People with Polycystic kidney disease have
defects in this primary cilia

91. Osmosis is BEST defined as:

A. Movement of Solute from greater to lesser solute concentration through a porous
membrane
B. Movement of solvent from greater to lesser solute concentration through a
semipermeable membrane
C. Movement of both solute and solvent from lesser to greater concentration through a
porous membrane
D. Movement of solvent from lesser to greater solute concentration through a
semipermeable membrane

Key words for osmosis… Dapat SOLVENT ang gagalaw. Tapos semipermeable
membrane. Tapos from lesser to greater solute conc. Apply this to the concept of
hypotonic hypertonic and isotonic solutions.

92. Skeletal muscle contraction would require calcium from the

A. extracellular area after activation of voltage - gated calcium channel DHP
B. cytoplasm after chemical activation of mechanically-gated calcium channel RYR
C. cisterns after activation of mechanically - gated RYR calcium channel by DHP
D. extracellular area after activation of ligand -gated calcium channel RYR

93. Which of the following statements is correct about closure of the atrioventricular valves
during systole?
A. It requires papillary muscle contraction
B. It occurs at the end of isovolumetric contraction phase
C. It is impaired by diseases that affect the chordae tendinae
D. It prevents backflow of blood into the ventricles

94. The following is true during inspiration

A. Transverse diameter of the thorax decreases
B. Internal intercostals increases AP-L diameter of thorax
C. Diaphragm pushes the abdominal contents downward
D. Abdominal muscles contract

Choice A is wrong because the transverse diameter f the thorax increases during
inspiration because the thorax fills with air.
Choice B is wrong because External intercostals are the one the increases the AP-L
diameter of thorax
Choice D is wrong because the Abd muscles contract during expiration.

Prepared By: Tonio Lodito - 3F 2020

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 3rd Year Comprehensive Examination Ratio
First Year Subject - Medical Physiology
July 7, 2018

95. Increasing which of the following decreases the glomerular filtration (GFR) rate?
A. Afferent arteriolar diameter C. Renal blood flow
B. Efferent arteriolar diameter D. Peritubular capillary flow

96. Immature defense mechanism

A. Introjection B. Projection C. Anticipation D. Controlling

97. Neurotic Defense mechanism

A. Intellectualization B. Denial C. Sublimation D. Schizoid fantasy

98. Mature defense mechanism

A. Ascetism B. Repression C. Controlling D. Reaction formation

99. Acting-out
A. Internalizing the qualities of an object.
B. Temporarily or transiently inhibiting thinking.
C. Expressing an unconscious wish or impulse through action to avoid being conscious of
an accompanying affect.
D. None of these

100. May be used in normal or pathological states

A. Schizoid fantasy B. Denial C. Distortion D. All of these

Prepared By: Tonio Lodito - 3F 2020

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