Promo 2015 Medical Physiology A 2

FINAL EXAMINATION MEDICAL PHYSIOLOGY A (pancreatic acinar cells). In these cells the secretory product (e.g.
,
hormone, neurotransmitter, or digestive enzyme), after synthesis and
1. The following factors are directly related to diffusion rate, Except processing in the rER and Golgi apparatus, is stored in the cytoplasm in
for: secretory granules until an appropriate signal for secretion is received.
A. Variation in energy gradient These signals may be hormonal or neural. Once the cell receives the
B. Thickness of membrane appropriate stimulus, the secretory vesicle fuses with the plasma
C. Area of the membrane membrane and releases its contents into the extracellular fluid. Fusion of
D. Number/size of the channels or pores in the membrane the vesicle with the membrane is mediated by a number of accessory
proteins. One important group is the SNAREs. These membrane proteins
Ratio: help target the secretory vesicle to the plasma membrane. The process of
*Directly proportional secretion is usually triggered by an increase in intracellular [Ca++].
-Concentration, Temperature, Diffusion Coefficient, Surface Area, no. of However, two notable exceptions to this general rule exist: renin secretion
pores, lipid solubility by juxtaglomerular cells of the kidney is triggered by a decrease in
*Inversely proportional intracellular Ca++, as is the secretion of parathyroid hormone (PTH) by the
-Distance, Molecular weight, membrane thickness parathyroid gland.
2. INCORRECT regarding transport of water in human cells: 4. In almost all carrier-mediated transports, when all transporters are
A. Transport is bidirectional now involved in the transport:
B. Never involves activity of a chemical agent A. The transport stops
C. Uses mostly activity of protein channels B. Amount of energy consumed decreases
D. Usually independent of mitochondrial activity C. The transporter develops fatigue
Ratio: D. The rate of transport reaches maximum rate
The transport of water across a cell is usually a passive transport, Ratio:
downhill, no ATP consumption, usually no carrier, bidirectional and uses In most carrier-mediated transport (active transport), when all transporters
hydrophilic CHON channels. are involved, the rate of transport reaches maximum and no additional
increase is seen -> SATURATION a condition in which carriers are
3. In non-constitutive exocytosis, the said activity: exhausted.
A. Does not involve the presence of a chemical agent that will
start the exocytosis 5. Which passive transport is never seen happening in a dead cell?
B. Stores the secretory product in vesicles until a signal for A. Filtration
secretion is received by the cell B. Simple diffusion
C. Usually does not require an increase in intracellular calcium C. Facilitated transport
ions D. None of these
D. Allows the cell to take in agents needed to normalize its Ratio: Facilitated transport is not seen on non-living cells.
activity
Ratio: 6. When a cell is resting or polarized, this is CORRECT:
Exocytosis can be either constitutive or regulated. Constitutive secretion is A. It is not consuming energy
seen, for example, in plasma cells that are secreting immunoglobulin or in B. The sodium-potassium pump stops
fibroblasts secreting collagen. Regulated secretion plasma cells that are C. No passive channels are active in the transport of certain ions
secreting immunoglobulin or in fibroblasts secreting collagen. Regulated D. None of these
secretion occurs in endocrine cells, neurons, and exocrine glandular cells
Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Ratio: A. Having an absolute refractory period
Polarized or resting cell is a cell under resting membrane potential. for B. Generating an electrical change that could not reach the
example in neurons(bigger diameter) the RMP is -90 mVolts, there are 3 threshold potential
factors that would establish and maintain it- Nature of the cell membrane C. An electrical change that is propagated or conducted
(negative), Unequal distribution of ions (due to continuous activity of D. Undergoing adaptation
passive/leak channels), and activity of Na-K pump (3 Na out; 2 K in). Ratio:
Ineffective stimulus causes local potential/hypopolarizing change.
7. At the latter part of depolarization, this condition occurs: Local potential:
A. The voltage gated sodium channels are closed by the activation • sub threshold (cannot reach the threshold or the lowest effective
gates stimulus intensity)
B. The cell is about to reach the equilibrium potential for sodium • does not reach the Critical Firing Level
C. The inactivation gates of the voltage gated sodium channels • lower magnitude
are about to open • lesser electrical activity
D. The membrane increases its conductance for chloride • never transmitted
Ratio:
*Local depolarization or Hypopolarization 10. When local potentials undergo summation, it leads to:
-opening of the activation gates of Na channels A. Inactivation of sodium channels
-almost all Na channels open and causes sodium influx resulting to B. Generation of an electrical change that could not reverse the
the reversal of polarity of the cell, making the inner part more positive membrane polarity
-depolarization is not continuous; the gates will close if there is C. A change where in it allows excitable cells to perform its
equilibrium between the amount of Na inside and the amount of Na outside function
-the closing of the channels is at the level of the peak of AP. D. Development of an electrical change that is never propagated
Ratio:
8. In the normal subnormal period of the action potential; Local potential undergo summation. 2 types of summation:
A. The cell could react immediately the cell could react Temporal summation/wave summation/ frequency summation: exposed
immediately to sub-threshold stimulus excitable cells to successive sub threshold stimuli. Which will eventually
B. The cell generates an action potential when affected by reach the threshold potential
threshold stimulus Spatial Summation- application of simultaneous sub threshold potential.
C. The cell generates an action potential when affected by an
intensity greater than threshold 11. A patient wherein the problem is associated with injuries/
D. The cell is absolutely refractory to stimulation abnormalities involving the oligodendroglia could lead to:
A. Uncontrolled release of NTA at the synapse
Ratio: After Hyperpolarization B. Sensitivity of receptors to its NTA
-AKA positive after potential C. Slowing of neural transmission in the CNS
-cell is less excitable in this period D. Slowing of impulse transmission in the motor neurons
-increase K conductance Ratio:
-increase amount of stimulus is needed to elicit another AP Oligodendroglia produces myelin sheath which main purpose is to increase
-period of SUBNORMAL CELL the speed at which impulses propagate along the myelinated fiber. Along
unmyelinated fibers, impulses move continuously as waves, but, in
9. When an excitable tissue is affected by an ineffective stimulus, it is myelinated fibers, they hop or "propagate by saltatory conduction." Injury
capable of: to oligodendroglia will cause slowing of neural transmission in the CNS.

12. The immediate effect of an action potential affecting the pre- tetanic stimulus train causes an increase in synaptic efficacy, known as
synaptic region is: posttetanic potentiation. Posttetanic potentiation, like facilitation, is an
A. Release of transmitter at the synaptic cleft enhancement of the postsynaptic response, but it lasts longer: tens of
B. Opens up the voltage gated Ca channels in its membrane seconds to several minutes after the cessation of tetanic stimulation.
C. Opens up voltage gated Na channels in its membrane Such repeated stimulation leads to an increased number of quanta of
D. Activates syntaxin in its membrane transmitter being released. This increase is thought to be due to residual
amounts of Ca++ that remain in the presynaptic terminal after each
Ratio: stimulus and help potentiate subsequent release of transmitter.
Signal Transmission at Synapses
14. If a NTA affects initially activity of ligand gated channels affecting
a. NTA is produced and stored in vesicles. potassium and chloride transport of a cell, it could lead to:
b. Action potential activates the pre-synaptic area A. Generation of an action potential
c. Voltage gated Calcium channels open B. Generation of a local depolarizing change
d. Calcium influx occurs C. Generation of a hyperpolarizing change
• involves Synaptotagmin which trigger the actual fusion of a docked D. Continuous polarization of the excitable cell
vesicle.
e. Calcium attaches to vesicles causing it to fuse with the pre synaptic Ratio:
membrane IPSPs, like EPSPs, are triggered by the binding of neurotransmitter to
• Synaptobrevin(VAMP-Vesicle Associated Membrane Protein) comes receptors on the postsynaptic membrane and typically involve an increase
into contact with Syntaxin which is a T-Snare(from the target or in membrane permeability as a result of the opening of ligand-gated
presynaptic plasma membrane) together they form a bridge to channels. They differ in that IPSP channels are permeable to only a single
facilitate the movement of NTA from the vesicle to the synaptic ionic species, either Cl- or K+. Thus, IPSPs will have a reversal potential
cleft. Snap 25 another T-snare protein enhances the interaction of equal to the Nernst potential of the ion carrying the underlying current.
Synaptobrevin and Syntaxin. Typically, the Nernst potential for these ions is somewhat negative relative
f. NTA is released into the cleft by exocytosis to the resting potential, so when IPSP channels open, there is an outward
g. NTA bind with receptor at the post synaptic area flow of current through them that results in hyperpolarization of the
h. Post-synaptic are generates Excitatory Post Synaptic potential (EPSP) membrane.
or Inhibitory post synaptic potential (IPSP)
i. Summation of generated EPSP—-> Action Potential 15. Among the different SNARES in the pre-synaptic area, which SNARE
is initially activated when an action potential affects the area:
13. In the activity of synapses, the response is expected to be greater A. Synaptobrevin
when: B. Syntaxin
A. Tetanic potentiation is seen C. Synaptotagmin
B. Occlusion is observed D. SNAP-25
C. Convergence happens Ratio: refer to no.12
D. The post synaptic cleft is always in a depolarized state
16. The length of meromyosin is maintained by:
Ratio: A. Tropomodulin
Posttetanic potentiation is similar to PPF; however, in this case the B. Titin
responses are compared before and after stimulation of the presynaptic C. Alpha actinin
neuron tetanically (tens to hundreds of stimuli at a high frequency). Such a D. Cap Z protein

Ratio:
Meromyosin is a single strand of myosin filament,
divided into light meromyosin and heavy meromyosin
that when combined will form a myosin molecule. A
bunch of myosin molecule fused together will form
the myosin filament.
The side by side relationship between the myosin
and actin filament is maintained by a large number
of filamentous molecules of a protein called Titin.
And because it is filamentous, it is very springy.
These springy titin molecules act as a framework
that holds the myosin and actin filaments in place
so that the contractile machinery of the sarcomere
will work. One end of the titin molecule is elastic
and is attached to the Z disk, acting as a spring and
19. ATPase activity is needed in which events of muscle twitch?
changing length as the sarcomere contracts and
relaxes. The titin molecules also appears to act as A. Spread of action potential to transverse tubule
B. Mechanical activation of RYR by DHP receptors
a template for initial formation of portions of
contractile filaments of the sarcomere, especially C. Sequestration of Ca in the sarcoplasmic reticulum
the myosin filaments. D. All of the above
Ratio:
Relaxation of skeletal muscle occurs as intracellular Ca++ is resequestered
17. Events during sarcolemmal depolarization
by the SR. Uptake of Ca++ into the SR is due to the action of a Ca++
A. Opening of Ca channels
B. Active K non-gated channels pump (Ca++-ATPase). This pump is not unique to skeletal muscle and is
found in all cells in association with the endoplasmic reticulum.
C. Opening of Cl channels
Accordingly, it is named SERCA, which stands for sarcoplasmic endoplasmic
D. Deactivated cGMP-gated Na channels
reticulum calcium ATPase.
Ratio:
The active K non-gated channel- K leak channels are always open during
20. Effect of binding ATP in one of the myosin heads
sarcolemmal depolarization and repolarization
A. Transfer of myosin from one actin to another actin
18. Which of the following occurs after a muscle twitch B. Decrease binding of myosin with actin
A. Active Na-Ca exchange in the sarcolemma C. Conformational change of tropomyosin
B. Opening of the voltage-gated K channels D. Activation of SERCA 1 in the tubules of sarcoplasmic reticulum
Ratio:
C. Phosphorylation of phospholamban to activate SERCA 2
D. Activate K leak channels and Na-K ATPase pump Once myosin and actin have bound, ATP-dependent conformational changes
in the myosin molecule result in movement of the actin filaments toward
the center of the sarcomere. Such movement shortens the length of the
Ratio:
sarcomere and thereby contracts the muscle fiber. The mechanism by
which myosin produces force and shortens the sarcomere is thought to
involve four basic steps that are collectively produces force and shortens
the sarcomere is thought to involve four basic steps that are collectively

termed the cross-bridge cycle. In the resting state, myosin is thought to 22. True statement about Treppe
have partially hydrolyzed ATP (state a). When Ca++ is released from the A. Results from increasing stimulus intensity causing an increasing
terminal cisternae of the SR, it binds to troponin C, which in turn promotes mechanical response
movement of tropomyosin on the actin filament such that myosin binding B. An increasing mechanical response resulting from an increasing
sites on actin are exposed. This then allows the "energized" myosin head to stimulus frequency but allowing the muscles to completely
bind to the underlying actin (state b). Myosin next undergoes a relax
conformational change termed "ratchet action" that pulls the actin filament C. Increasing magnitude of mechanical response after successive
toward the center of the sarcomere (state c). Myosin releases ADP and Pi stimulation without allowing the muscle to completely relax
during the transition to state c. Binding of ATP to myosin decreases the D. Decreasing magnitude of mechanical response after successive
affinity of myosin for actin, thereby resulting in the release of myosin stimulation of muscle
from the actin filament (state d). Myosin then partially hydrolyzes the ATP, Ratio:
and part of the energy in the ATP is used to recock the head and return to When a muscle begins to contract after a long period of rest, its initial
the resting state. If intracellular [Ca++] is still elevated, myosin will strength of contraction may be as little as one half its strength 10 to 50
undergo another cross-bridge cycle and produce further contraction of the muscle twitches later. That is, the strength of contraction increases to a
muscle. The ratchet action of the cross-bridge is capable of moving the plateau resulting from an increasing stimulus frequency but allowing the
thin filament approximately 10 nm. The cycle continues until the SERCA muscle to completely relax. This phenomenon is called Treppe or staircase
pumps Ca++ back into the SR. As [Ca++] falls, Ca++ dissociates from effect, staircase phenomenon
troponin C, and the troponin-tropomyosin complex moves and blocks the
myosin binding sites on the actin filament. If the supply of ATP is 23. Stretching the skeletal muscle maximally beyond resting length
exhausted, as occurs with death, the cycle stops in state "c" with the A. Increases total tension and passive tension
formation of permanent actin-myosin complexes (i.e., the rigor state). In B. Decreases total tension but increases passive tension
this state the muscle is rigid and the condition is termed "rigor mortis." C. Decreases total tension but increases active tension
D. Decreases total and active tension
21. Muscle fatigue results from an increase Ratio:
A. pH resulting in decrease actin-myosin interaction At resting length, total tension is equal to active tension because passive
B. H+ ion resulting in decrease binding of calcium in Troponin C tension is ZERO.
C. Phosphate resulting in increased calcium sequestration by Total tension = Active tension + Passive Tension (0); therefore
SERCA Total Tension=Active tension.
D. ADP resulting in increased activity of Na-K ATPase pump
Ratio: Stretching the skeletal muscle beyond resting length causes increased in
Muscle Fatigue: passive tension thereby increasing the Total Tension because Passive
• decreased available energy source tension now is not equal to ZERO.
• body’s protective response to limit muscle activation and prevent injury
• increased body temperature 24. Skeletal muscle type/s utilized in running 42 km.
• increased lactic acid due to anaerobic metabolism A. Slow oxidative type
• increased acidity (H ions) causes detachment of Ca from the Troponin C B. Fast oxidative type
• inhibit release of Ca from cisterns C. Fast glycolytic type
• decreased binding of myosin to actin D. All of the above
• Trop C Insensitivity Ratio:
• Increased ADP With that kind of activity, all types of muscles were already utilized.
• increased free radicals (Sports Physio)

25. Contraction of this/these muscle/s requires initial activation of Ratio:
thick filament Epinephrine—> Sympathetic effect. Generally, Sympathetic is Excitatory
A. Skeletal muscle except:
B. Smooth muscle Enteric Nervous System - decreased motility
C. Cardiac muscle Bronchi (airways) - dilation/ relaxation
D. A and C only Eyes - pupillary dilation—> MIOSIS)
Ratio: Gallbladder and bile ducts - relaxation
The basic mechanism underlying contraction of smooth muscle involves an Detrussor muscle of Urinary bladder- relaxation
interaction of myosin with actin (as in striated muscle), although there are
some important differences. Specifically, contraction of smooth muscle is Norepinephrine: Strong stimulation of ALPHA & BETA-1 RECEPTORS; Weak
thick filament regulated and requires an alteration in myosin before it stimulation of BETA-2 RECEPTORS
can interact with actin, whereas contraction of striated muscle is thin Epinephrine: strong stimulation of ALPHA, BETA-1 & BETA-2 RECEPTORS
filament regulated and requires movement of the troponin-tropomyosin
complex on the actin filament before myosin can bind to actin. 28. Which of the following is present in a patient with atropine
poisoning?
26. A 20 y/o man, who became ill after eating mushrooms, is brought A. Decreased GIT motility
to the emergency room, where he is treated for muscarinic B. Pupillary constriction
poisoning. Which of the following signs is present in the patients? C. Inc. salivation
A. Tachycardia D. Bradycardia
B. Inc. salivation Ratio:
C. Mydriasis Atropine poisoning. Atropine is a parasympatholytic drug which means it
D. Skeletal muscle contacrtures counteracts the effect of cholinergic/ Parasympathetic Nervous system.
Ratio: Mechanism of action:
Muscarinic poisoning—> Cholinergic receptors meaning Parasympathetic. • decrease/inihibit synthesis of Ach
Generally, Parasympathetic is Inhibitory except for: • block release of Ach
Salivary gland- profuse increased in salivation • Block the interaction between Ach and cholinergic receptors
Enteric Nervous System - increase motility • increase inactivation of Ach
Bronchi (airways) - constriction/ contraction
Eyes - pupillary dilation—> MYDRIASIS) 29. Administration of Beta 1 blocker will result in:
Gallbladder and bile ducts - constriction/ contraction A. Relaxation of bronchial smooth muscle
Detrussor muscle of Urinary bladder- contraction B. Slower heart rate
Excitatory effect: Constriction, Contraction C. Vasodilation in the skin and viscera
Inhibitory effect: Dilation, Relaxation D. Shortened AV conduction time in the heart
Ratio:
27. A 12 y/o girl, who is highly allergic, is stung by a bee. Her physician Beta-1 blocker is a Sympatholytic drug which decrease/inhibit/block
gave her a shot of epinephrine. This is explicated to relieve the sympathetic effects
effects of the bee sting by: mechanism of action:
A. Decreasing the heart rate • decreased/inhibit synthesis of NEP
B. Vasoconstriction • block release of NEP
C. Increasing intestinal motility • block interaction between NEP and adrenergic receptors
D. Decreasing the contraction of airway smooth muscle • increase deactivation of NEP

30. Which of the following statements regarding M2 receptors is true?
A. They cause mostly excitatory effects
B. Stimulation increases K conductance
C. Stimulation increases Ca-Na conductance
D. They are located mainly in the visceral smooth muscle
Ratio:
M2 is a cholinergic receptor found in heart. Binding of Ach with M2 causes:
• decreased activation of cAMP
• Increased Potassium conductance (causing hyper polarization— inhibitory) 33. Catecholamines, acting on alpha-1 receptors, will produce:
• inhibitory effect A. Pupillary dilation
• decreased heart rate B. Inc. heart rate
C. Vasodilation
31. Nicotinic receptors in autonomic ganglia are blocked by high doses D. Bronchodilation
of: Ratio:
A. Atropine
B. Curare RULE:
C. Nicotine When Alpha receptors are stimulated, responses are generally EXCITATORY.
D. Succinylcholine • NEP + a-1 receptors (vascular smooth muscle)= vasoconstriction
• NEP + a-1 receptors (radial muscle of the iris)= increased pupillary size
Ratio: (pupillary dilation)
Ganglionic blocking drugs block impulse transmission from the autonomic
preganglionic neurons to the postganglionic neurons. These drugs block Ach when beta receptors are stimulated, responses are generally INHIBITORY.
stimulation of the postganglionic neurons in both sympathetic and • NEP/EP + B-2 receptors= decreased cAMP, increased potassium
parasympathetic systems simultaneously. They are often used for blocking conductance—inihibitory
sympathetic activity but seldom for parasympathetic activity because their • EP + B-2 receptors (bronchial smooth muscle)= bronchodilation
effects of sympathetic blockade usually far overshadow the effects of • EP + B-2 receptors (vascular smooth muscle)= vasodilation
parasympathetic blockade. These drugs include: Tetraethyl ammonium ion, BUT THERE IS AN EXCEPTION TO THIS RULE:
hexamethonium ion, pentolinium, and high doses of nicotine (according to • NEP/EP + Alpha receptors (digestive system, bronchial glands, pancreatic
Doc Valerio recording) islets) — INHIBITORY (decreased GI motility & secretion)
• NEP/EP + B-1 receptors (heart)— EXCITATORY (increased cAMP, Calcium
32. Secretion of epinephrine by the adrenal medulla is increased when conductance,—Increased Heart rate)
Ach binds with:
A. Alpha adrenergic receptors 34. A drug that blocks the reuptake of NEP by nerve terminals will
B. Beta adrenergic receptors decrease:
C. Muscarinic cholinergic receptors A. Salivation
D. Nicotinic cholinergic receptors B. Intestinal motility
Ratio: C. Vascular diameter
There are some sympathetic preganglionic fibers that will synapse directly D. Sweating
to the NN/N2 receptors of adrenal medullary cells (histologically act as
similar to a sympathetic ganglion/peripheral ganglion) Ratio:
Blocking the repute of NEP by nerve terminal is an action of a A. Liver and bone marrow
sympathomimetic drug, therefore increasing the effect of Sympathetic B. Bone marrow and spleen
Nervous system. ** Remember the effects of sympathetic Generally, C. Bone marrow and vertebrae
Sympathetic is Excitatory except: D. Kidneys and liver
Enteric Nervous System - decreased motility Ratio:
Bronchi (airways) - dilation/ relaxation Normally, about 90% of all Erythropoietin (EPO) is formed in the kidneys,
Eyes - pupillary dilation—> MIOSIS) and the remainder is formed mainly in the liver. It is not known exactly
Gallbladder and bile ducts - relaxation where in the kidneys the EPO is formed. Some studies suggest tat EPO is
Detrussor muscle of Urinary bladder- relaxation secreted mainly by fibroblast-like interstitial cells surrounding the tubules
in the cortex and outer medulla, where much of the kidney’s oxygen
35. The following are effects of vagal stimulation, EXCEPT: consumption occurs.
A. Bradycardia
B. Inc. peristalsis 38. What will happen to the RBC if it is incubated in 10% dextrose
C. Urinary bladder distention solution?
D. Inc. acid gastric secretion A. Nothing will happen
Ratio: B. It will swell
Vagus nerve innervates: Heart, Lungs, Esophagus, Stomach, Small C. It will shrink
Intestine, Proximal half of Large Intestine, Liver, Pancreas, and gallbladder. D. It will hemolyze
Sacral-pelvic nerves innervates: distal part of Large intestine, Ratio:
Genitourinary system except kidneys isotonic solution of dextrose is 5%, Anything lower than 5% is hypotonic
*No VAGAL STIMULATION IN THE URINARY BLADDER. causing swelling and bursting of cells; anything higher than 5% is hypertonic
causing shrinkage and crenation of cells.
36. Erythrocytes:
A. Have excessive cell membrane 39. Which is NOT a function of plasma proteins?
B. Transport less than half of the oxygen in the blood A. Coagulation
C. Transport most of the CO2 in the blood B. Transport of oxygen
D. Are the least numerous formed elements C. Immunity
D. Transport of hormones
Ratio: Ratio:
RED BLOOD CELLS FUNCTIONS OF THE PLASMA PROTEINS:
• Biconcave discs 1. Maintenance of water balance between the intravascular compartment
• 2.5 um thick and the extravascular spaces (oncotic pressure)
• 7.5 – 8 um in diameter 2. Imparts viscosity to the blood (mainly by RBCs)
• 1 um at the center (central pallor) 3. Source of antibodies
• Very deformable (Excessive cell membrane) 4. Necessary for coagulation
• Primary function is to carry hemoglobin in the circulation 5. Maintenance of acid-base balance
• Hemogobin carries 4 molecules oxygen 6. Determines the specific gravity of the plasma (1.028) 7. Formation of
• 1g ofHgb~1.34mlofO2 enzymes
• Non-nucleated 8. Transport of hormones and enzymes
*Hemoglobin is not normally found in plasma that’s why Transport of
37. These are sites of erythropoietin synthesis oxygen is not a function of plasma proteins.

40. All are naturally occurring anticoagulants EXCEPT: Ratio:
A. Fibrin
Autoimmune Autoantibodies
B. Heparin disorders
C. Warfarin
D. Thrombomodulin Myasthenia Gravis anti-acetylcholine receptors antibody
Ratio: Rheumatoid Rheumatoid factor(IgG antibody against IgM)

Fibrin: produced upon stimulation of fibrinogen by thrombin arthritis
Heparin: produced largely by mast cells Systemic lupus anti nuclear antibodies
Thrombomodulin: a protein bound with the endothelial membrane which erythematous
binds thrombin causing slowing of the clotting process
Warfarin: a synthetic drug affecting Vitamin K-dependent coagulation multiple myeloma cancer of the plasma cells
factors. Warfarin causes this effect by inbiting the enzyme VKOR c1 which 43. This antibody class is attached to B cells and is involved in their
converts the inactive/oxidized form of vitamin k to its active/reduced activation?
form. A. IgA
B. IgD
41. Which class of antibodies is bound to antigens stimulating basophils C. IgG
and mast cells and releases chemicals to stimulate inflammation? D. IgM
A. IgA
B. IgG Ratio:
C. IgM *refer to #41
D. IgE 44. Breastfeeding is highly suggestive to newborn as compared to
commercially available milk products. One reason of which is
Ratio: because of the colostrum. In this way, what type of immunity is
IgG: first to appear in chronic infection/ secondary antigen stimulus; able being given?
to cross the placenta; monomer; activates complement A. Natural active
IgA: main antibody found in secretions; swhen found in secretions: Dimer; B. Artificial active
if in plasma: monomer C. Natural passive
IgM: first antibody to appear in primary antigen stimulus/ acute infection; D. Artificial active
largest antibody (pentamaer); activates complement
IgD: found in the surface of B lymphocytes; dimer Ratio:
IgE: mediates certain allergic reactions; monomer; attached to basophils Passive immunity is the transfer of active immunity, in the form of
and mast cells readymade antibodies, from one individual to another. Passive immunity
can occur naturally, when maternal antibodies are transferred to the fetus
42. This disease is a result of autoantibodies against Ach receptors through the placenta or when breastfeeding, Colostrum which composed
which lead to ineffective nerve muscle junctions and weakness? primarily of IgA is passed. Passive immunization is used when there is a high
A. Myasthenia Gravis risk of infection and insufficient time for the body to develop its own
B. Rheumatoid arthritis immune response, or to reduce the symptoms of ongoing or
C. Systemic lupus erythematosus immunosuppressive diseases. Passive immunity provides immediate
D. Multiple myeloma protection, but the body does not develop memory, therefore the patient is
at risk of being infected by the same pathogen later.
45. The antibodies inactivate the invading agent by covering the toxic The process by which the action potential of the cardiac myocyte leads to
sites of the antigenic agents. This process is called: contraction is termed excitation-contraction coupling. Cardiac muscle is
A. Neutralization excited when a wave of excitation spreads rapidly along the myocardial
B. Lysis sarcolemma from cell to cell via gap junctions. Excitation also spreads into
C. Agglutination the interior of the cells via the T tubules, which invaginate the cardiac
D. Precipitation fibers at the Z lines. Electrical stimulation at the Z line or the application
of Ca++ to the Z lines in a skinned (sarcolemma removed) cardiac fiber
Ratio: elicits localized contraction of the adjacent myofibrils.
Neutralization: antibodies inactivate the invading agent by covering the During the plateau (phase 2) of the action potential, permeability of the
toxic sites of the antigenic agent sarcolemma to Ca++ increases.
Lysis: destruction of a infecting substance through antibody or complement Ca++ flows down its electrochemical gradient and enters the cell through
Agglutination: The clumping of cells such as bacteria or red blood cells in Ca++ channels in the sarcolemma and in the T tubules.
the presence of an antibody or complement.
Precipitation: Soluble Ag & Ab interact and form a lattice that develops into
a visible precipitate.
46. Active transport of calcium across the cardiac sarcolemma is best

described as:
A. It is increased by hyponatremia
B. It promotes net movement of calcium into the cell
C. It is decreased by hypernatremia
D. It is increased during diastole
Ratio:
Excitation-Contraction Coupling of Cardiac Muscle
Figure 16-37 Schematic diagram of the movement of calcium in excitation-
The earliest studies on isolated hearts indicated that optimal contraction coupling in cardiac muscle. Influx of Ca++ from interstitial fluid
concentrations of Na+, K+, and Ca++ in extracellular fluid are necessary for during excitation triggers release of Ca++ from the sarcoplasmic reticulum
contraction of cardiac muscle. Without Na+, the heart is not excitable and (SR). The free cytosolic Ca++ activates contraction of the myofilaments
will not beat. As already described, the resting membrane potential is (systole). Relaxation (diastole) occurs as a result of uptake of Ca++ by
independent of the [Na+]o gradient across the membrane, but very much the SR, by extrusion of intracellular Ca++ by the 3Na+-1Ca++ antiporter,
dependent on [K+]o. Decreases or increases in [K+]o, especially if they are and to a limited degree by the Ca++-ATPase pump. βR, β-adrenergic
large or occur quickly, can lead to arrhythmias, loss of excitability of the receptor; cAMP-PK, cAMP-dependent protein kinase.
myocardial cells, and even cardiac arrest. Ca++ is also essential for cardiac During the action potential Ca++ enters the cell via Ca++ channels (e.g., L
contraction. Removal of Ca++ from the extracellular fluid results in type). However, the amount of Ca++ that enters the cell interior from the
decreased contractile force and eventual arrest in diastole. Conversely, an extracellular/interstitial fluid is not sufficient to induce contraction of the
increase in [Ca++]o enhances contractile force, and very high [Ca++]o myofibrils. Instead, it acts as a trigger (trigger Ca++) to release Ca++ from
induces cardiac arrest in systole (rigor). The free intracellular [Ca++] is the the SR, where the intracellular Ca++ is stored (Fig. 16-37). Ca++ leaves the
factor principally responsible for the contractile state of the myocardium. SR through Ca++ release channels, which are called ryanodine receptors
because the channel protein, also called foot protein or junctional
processes, binds ryanodine avidly. Cytoplasmic [Ca++] increases from a

resting level of about 10-7 M to levels of about 10-5 M during excitation. C. Phase 3 is due to inc. K conductance
This Ca++ then binds to the protein troponin C. The Ca++-troponin complex D. The duration is 250-300 millisecs.
interacts with tropomyosin to unblock active sites between the actin and
myosin filaments. This unblocking initiates cross-bridge cycling and hence Ratio:
contraction of the myofibrils. SA Node action potential
Mechanisms that raise cytosolic [Ca++] increase the force developed, and Phase 4: slow rise in membrane potential and is unstable. the slow rise in
those that lower cytosolic [Ca++] decrease the force developed. For membrane potential is called the pre-potential or slow diastolic
example, catecholamines increase the movement of Ca++ into the cell by depolarization. There is more Na leak channels, membrane potential
phosphorylation of the sarcolemmal Ca++ channels via a cAMP-dependent increases. Na leakage, decrease K
protein Phase 0: depolarization. somewhat inclined, depolarization occurs slowly.
into the cell by phosphorylation of the sarcolemmal Ca++ channels via a Activation of Slow (inclined) voltage gated long lasting Calcium channels
cAMP-dependent protein kinase. This in turn releases more Ca++ from the allowing Ca influx with some Na influx—> Membrane potential become less
SR, and as a result contractile force increases. Increasing [Ca++]o will negative
increase the amount of Ca++ that enters the cell via the Ca++ channels and Phase 1: voltage gated K channels will open allowing K efflux. But
will thereby increase contractile force as just described. Reducing the Na+ repolarization cannot occur rapidly because of the long lasting Ca channels
gradient across the sarcolemma will also increase contractile force, an are still open. Calcium influx, Potassium efflux
effect mediated by the 3Na+-1Ca++ antiporter that normally extrudes Ca++ Phase 2: midway of repo: Calcium channels close, K channels open
from the cell (Fig. 16-37). For example, reducing [Na+]o causes less Na+ to Phase 3: Hyperpolarized: prolonged opening of K channels
enter the cell in exchange for Ca++, which results in an increase in [Ca++]i
and thus contractile force. 48. In complete heart block:
Raising [Na+]i will have a similar effect. Indeed, this is the mechanism by A. Fainting may occur because the atria are unable to pump blood
which cardiac glycosides increase contractile force. Cardiac glycosides into the ventricles
inhibit Na+,K+-ATPase and thereby raise [Na+]i in the cells. The elevated B. Ventricular fibrillation is common
cytosolic [Na+] reverses the direction of the 3Na+-1Ca++ antiporter, and C. Atrial rate is lower than ventricular rate
therefore less Ca++ is removed from the cell. The increase in [Ca++]i D. Fainting may occur because of prolonged periods during which
results in an increase in contractile force. the ventricles fail to contract
Finally, contractile force is diminished when [Ca++]i is decreased by a Ratio:
reduction in [Ca++]o, by an increase in the Na+ gradient across the Third-degree heart block – With this condition, also called complete heart
sarcolemma, or by the administration of a Ca++ channel antagonist that block. Initially, the ventricles will not contract because no impulses will
prevents Ca++ from entering the myocardial cell. reach the ventricles but there are pacemaker cells in the ventricles-
At the end of systole, the influx of Ca++ stops, and the SR is no longer bundle of His and Purkinje fibers. The two are latent pacemakers and
stimulated to release Ca++. In fact, the SR avidly takes up Ca++ by means they are also automatic cells. For 20 seconds, there will be no impulse
of a Ca++-ATPase. This SR Ca++-ATPase is similar to but distinct from the Ca coming from the SA node, the latent pacemakers in ventricle specifically
++-ATPase found in the sarcolemma. Cytosolic [Ca++] is also reduced during the parking fibers will be activated, it will escape from the overdrive
diastole through the action of the 3Na+-1Ca++ antiporter in the suppression and this is called ventricular escape. When activated, the
sarcolemma, as well as by a sarcolemmal Ca++-ATPase (Fig. 16-37). parking fibers will generate its own AP causing ventricles to contract at a
rate that is dictated by parking fibers. If atria contraction is 75 beats per
47. One difference between the ventricular muscle and action minute, in the ventricle, it is 30-40 beats/minute. Fainting (syncope) is a
potential and the SA node action potential is that in the latter: transient effect of complete heart block, it occurs because of decreased
A. Phase 4 is due to inc. K conductance and dec. Na leakage blood flow in the brain caused by the 20 sec lack of ventricular
B. Phase 0 is due to inc. Ca conductance contraction.

49. Slope of the prepotential in SA node after vagal stimulation is
______ slope of the prepotential in SA node after sympathetic
stimulation:
A. Greater than
B. The same as
C. Less than
Ratio:
Vagal stimulation(Parasympathetic) is inhibitory to the heart, causing
decreased slope of pre potential in SA node.
Sympathetic stimulation is excitatory
50. The work performed by the left ventricle is greater than that
performed by the right ventricle, because in the left ventricle:
A. The wall is thicker
B. The preload is greater 52. During the middle of systole:
C. The afterload is greater A. A ventricular volume is increasing
D. All of these B. Aortic pressure starts to decrease
Ratio: C. The QRS complex in the ECG is occurring
Preload refers to the force that stretches the relaxed muscle fibers. In the D. Ventricular pressure starts to increase
left ventricle, for example, the blood filling and thus stretching the wall Ratio:
during diastole represents the preload. Afterload refers to the force
against which the contracting muscle must act. Again from the perspective
of the left ventricle, afterload is the pressure in the aorta that must be
overcome by the contracting left ventricular muscle to open the aortic
valve and eject the blood. WORK performed by the left ventricle is greater
than the right ventricle because of the After load. why? because aortic
pressure is around 70-130 mmHg compare to that of pulmonic pressure
which is around 4-25 mmHg.
51. Just before atrial depolarization and contraction:

A. A period of diastasis occur
B. The mitral valve is closed
53. A 75 y/o woman went to see her cardiologist because of exertional
C. Left ventricular pressure >20 mmHg
dyspnea and an episode of syncope while dancing. A systolic
D. The heart is repolarizing
ejection murmur is auscultated that radiates to the carotid
arteries. Her signs and symptoms are most likely due to:
Ratio:
A. Mitral stenosis
B. Aortic stenosis
C. Mitral regurgitation
D. Aortic regurgitation
Ratio:

55. Given: EDV=130mL; ESV=45mL
A. 50%
B. 65%
C. 75%
D. 90%
Aortic stenosis is heard during Systole. Episode of syncope occur because Ratio:
there is a decreased ejection of blood from the left ventricle to the aorta SV= EDV-ESV
causing pooling of blood in left ventricle and decreased cardiac SV= 130-45 = 85
output(resulting to decreased blood flow to peripheral organs including the
brain) 56. EDV increases with a decrease in:
54. Which of the following curves shows the regurgitation between A. Myocardial compliance
cardiac output and heart rate? B. Duration of diastole
C. Venous capacitance
D. Negativity of the intrathoracic pressure
Ratio:
Factors affecting EDV include
• Effective Filling time= directly proportional
• Effective filling pressure= directly proportional EDV
• Myocardial compliance= directly proportional to EDV
• Venous return= directly proportional to EDV
***Decreasing venous compliance reduces the capacitance of the veins,
Answer: B increasing venous return and therefore end-diastolic volume.
Ratio:
In the formula CO= SV x HR. If the HR increases, there will be an increase 57. During isovolumic relaxation, the V wave appears in the atrial
in the frequency of depolarization on the sarcolemma of the cardiac pressure curve. This is due to:
muscle cell. So the more the cardiac muscle is depolarized, the more Ca++
A. Backflow of blood to the vena cava during atrial systole
enters the cell and if more Ca++ enters the cell, the greater the force of B. Beginning of atrial filling
contraction, the more the stroke volume increases, increased cardiac
C. Eversion of the AV valves into the atria because of increased
output. That is how an increase in HR will increase the CO. intraventricular pressure
D. Increased atrial filling
Effective filling time refers to the duration of the diastolic or relaxation Ratio: A wave- increase atrial pressure during atrial systole
phase because that is when the ventricles are filled with blood. So C wave- high pressure during ventricular systole push the AV valves
Increased in Filling time would also increase EDV, SV, and CO. to bulge into the atria causing slight increase in atrial pressure
V wave- increase atrial pressure during isovolumic relaxation where
However, Heart rate affects Filling time(FT), an increased in HR would it is simultaneous with the increase in atrial filling
shorten the duration of Action Potential including the duration of diastole
thereby decreasing the FT, EDV, SV, and CO. But there is a specific
58. Ventricular pressure is greater than aortic pressure during:
increased in HR that is considered to be able to affect the filling time. A. Isovolumic contraction
60-180 HR= normal level of CO because filling time is not affected yet
B. Rapid ejection
>180 HR= the duration of FT is severely compromised resulting to
C. Reduced ejection
decreased CO D. Rapid ventricular filling

Ratio: B. Renal circulation
Ventricular pressure is initially low. it will increased slightly during atrial C. Arteries of the head and neck
systole because of the additional volume of blood that will be ejected by D. Right and left sides of the heart
the atria to the ventricles. Ventricular pressure will be greater than aortic Ratio:
pressure during opening of SL valves which occurs at the start of Rapid Blood leaves the heart through the aorta from which it is distributed to
ejection. major organs by large arteries, each of which originates from the aorta.
Therefore, these major distributing arteries (e.g., carotid, brachial,
59. A 65 y/o man being treated with a beta blocker and ACE inhibitor superior mesenteric, iliac) are in-parallel with each other. This further
for his heart failure complains of fatigue, weakness, shortness of means that the vascular networks of most individual organs are in-parallel
breath and an irregular heartbeat. ECG reveals atrial fibrillation. with other organ networks. For example, the circulations of the head,
His cardiologist adds digoxin to his treatment regimen, but tells the arms, and legs are all parallel circulations.
patient to have his blood K level checked regularly. Hypokalemia
will increase the risk and severityof digitalis toxicity because of: 62. Velocity of blood flow is fastest in what type of vessel?
A. Hypopolarization of the cardiac muscle membrane A. Aorta
B. Stimulation of the Na/K pump B. Arteriole
C. Inhibition of Na/K pump C. Capillary
D. Increased removal of cardiac cystolic Ca via the Na-Ca D. Vena cava
exchanger.
Ratio: Ratio:
Digoxin is classified as cardiac glycosides that binds to the alpa subunit of
NA-K-ATPase specifically inhibits the enzyme. The interrelationships among velocity, flow, and area are shown in Figure
17-1. Because conservation of mass requires that the fluid flowing through
60. The patient (referring to #59) is being given an ACE inhibitor for his a rigid tube be constant, the velocity of the fluid will vary inversely with
heart failure to: the cross-sectional area. Thus, fluid flow velocity is greatest in the
A. Decrease the afterload section of the tube with the smallest cross-sectional area and slowest in
B. Increase the preload the section of the tube with the greatest cross- sectional area. (Aorta
C. Increase myocardial contractility has the smallest cross-sectional area while Capillary has the greatest cross-
D. Decrease the heart rate sectional area)
Ratio: 63. Which factor will produce laminar flow?

ACE inhibitors are a standard in the treatment of heart failure. Numerous A. Normal hematocrit
studies have shown that ACE inhibitors impart a beneficial effect on heart B. Increased velocity of flow
failure patients regarding cardiovascular morbidity and mortality. C. Anemia
ACE inhibitor benefits to the patient with heart failure include afterload D. Rough surface of the endothelium
and preload reduction (via blood pressure lowering), preserving serum Ratio:
potassium levels, and their effects on endothelial function. Overwhelming Increased velocity of flow causes turbulent flow, as well as when there is a
evidence shows that ACE inhibitors should be utilized in all heart failure rough surface of the endothelium. Anemia also causes turbulent flow
patients unless contraindicated. because there is a deficiency of rbcs in the circulation thereby allowing the
blood to flow faster than normal. All causes turbulent blood flow except
61. In which of the following areas in the CVS is blood flow parallel? Normal Laminar flow
A. Pulmonary circulation

64. What is the primary factor for determining blood flow? Atherosclerotic blood vessel: seen throughout because of obstructions
A. Vessel diameter caused fat deposition in the tunica intima
B. Tissue’s need for oxygen Aortic arch: because of sudden turn and bifurcations
C. pO2 of the blood 66. Which blood vessel gives the highest resistance?
D. number of RBC A. Aorta
Ratio: B. Capillaries
Poiseuille's law describes the flow of fluids through cylindrical tubes in C. Vena cava
terms of flow, pressure, the dimensions of the tube, and the viscosity of D. Terminal arterioles
liquid. Ratio:
It is apparent that the greatest drop in pressure occurs in the very small
arteries and arterioles. However, capillaries, which have a mean diameter
of about 7 µm, have the greatest resistance to blood flow. Nevertheless, it
where: is the arterioles, not the capillaries, that have the greatest resistance of
Q=flow all the different varieties of blood vessels that lie in series with one
Pi-Po = pressure gradient from the inlet (i) of the tube to the outlet (o) another . This seeming paradox is related to the relative numbers of
r =radius of the tube parallel capillaries and parallel arterioles.
l = length of the tube Most simply, there are far more capillaries than arterioles in the systemic
η =viscosity of the fluid circulation, and total resistance across the many capillaries arranged in
As is clear from the equation, flow through the tube will increase as the parallel is much less than total resistance across the fewer arterioles
pressure gradient is increased, and it will decrease as either the viscosity arranged in parallel. In addition, arterioles have a thick coat of circularly
of the fluid or the length of the tube increases. The radius of the tube is a arranged smooth muscle fibers that can vary the lumen radius. Even
critical factor in determining flow because it is raised to the fourth small changes in radius alter resistance greatly, as can be seen from the
power. As described later, the radius of a tube is a major determinant of hydraulic resistance equation, wherein R varies inversely with r4.
the resistance to flow.
67. What statement DOES NOT describe a vein?
65. Eddy currents in the blood flow are expected in the following A. It’s high elastin content causes venous return
EXCEPT: B. A reservoir of blood volume
A. Carotid artery C. The transmural pressure is low
B. Mitral valve D. It’s collagen content confers structural integrity
C. Arch of aorta Ratio:
D. Atherosclerotic blood vessel Veins
• any blood vessel that returns blood from the tissues to the heart
Ratio: • diameter is larger than artery
Turbulent flow means that the blood flows crosswise in the vessel and along • more distensible (ability of blood vessels to expand) -contain more blood
the vessel, usually forming whorls in the blood, called eddy currents. These than arteries
eddy currents are similar to the whirlpools that one frequently sees in a • they are not elastic. They contain smooth muscles which contract causing
rapid flowing river at a point of obstruction. blood to be transported back to heart.
Carotid artery: Eddy current and back flows were observed at bifurcation • contain valves
and the lateral part of the proximal internal carotid arteries (ICA) and • classified as capacitance vessel
external carotid arteries (ECA) • reservoir of blood volume
• low transmural pressure

Matching type: 72. The normal direction of the overall vector of the electrical activity
of the heart is:
68. Increased metabolism releases adenosine A. Downward and to the right
Ratio: Vasodilation theory- If the rate of metabolism is increase, it is B. Upward and to the left
accompanied by an immediate increase in blood flow. This is because when C. Downward and to the left
a tissue is highly metabolic, it is excreting a lot of metabolites and by- D. Leftward only
products which cause the vessels to dilate. The most commonly associated
by- product is adenosine. Ratio:
Normal: move form right going down to the apex (Cardiac Vector)
69. Vasodilation in cyanide poisoning
Ratio: O2 lack theory/Nutrient Lack Theory- Oxygen and nutrients are 73. Which of the following is a unipolar limb lead?
required for the smooth muscles to contract. Therefore, the absence of A. Lead III
oxygen would cause the smooth muscle to relax and dilate the vessel. We B. Lead II
must then recall that dilation of blood vessels will cause an increase in C. V1
blood flow to the 4th power (Poiseuille’s Law) D. aVF
Cyanide Poisoning is another condition which prevents O2 utilization (ETC).
The ultimate effect is that oxygen perfusion to organs will decrease, and Ratio:
the vessels will dilate causing the reddish discoloration. Bipolar/Extremity limb leads: Lead I, Lead II, Lead III
Unipolar limb lead/ Unipolar extremity leads/Augmented: aVR, aVL, aVF
70. Prolonged application of the tourniquet results to vasodilation Unipolar Chest Leads/Pre-Cordial Leads: V1-V8
Ratio: Reactive hyperemia- is appreciated when applying tourniquet.
Blocking the blood for a prolonged period of time will cause a momentary 74. Abnormality in the right ventricle (ie. Enlargement or hypertrophy)
hypoxia to the tissues initiating vessel dilation. Release of the tourniquet is best seen in which chest lead?
would then cause blood to flow back to the dilated vessels at a more rapid A. V1
rate because of its dilation. There is a compensation of the blood B. V3
oxygenation lost during the time of blockage. C. V4
D. aVF
71. What is the direction of the ECG when a repolarizing current is
going from the negative to positive potential of the ECG lead? Ratio:
A. Positive deflection (upward) V1 & V2- right anterior portion of the heart
B. Negative deflection (downward) V3 & V4- left anterior portion of the heart
C. Isoelectric V2 & V3- middle portion of the heart
D. None of the above V5 & V6- lateral portion of the heart
Ratio: V7 & V8- posterior aspect/wall of the heart
*For depolarizing current
a. Upward deflection (+)- flow of the electrical current is going to the 75. Compute for the axis and determine the axis deviation
positive side Lead I: (+)8mm Lead aVF: (-)12mm
b. Downward deflection (-)-away from the positive side A. Normal axis
*For repolarizing current B. Left axis deviation
a. Downward deflection- going to positive C. Right axis deviation
b. Upward deflection- away from positive D. Intermediate

76. The common mean cardiac vector or axis of the heart is:
A. (+)59 degrees
B. (-)30 to (+)59 degrees
C. (-)59 degrees
D. 0 to (+)100 degrees What is the most likely diagnosis?
A. Myocardial ischemia
Ratio: B. Myocardial infarction
Asians: 0 to 90 degrees C. Bundle branch block
Americans: (-)30 to (+)110 degrees D. Hypocalcemia
Common cardiac vector: (+)59 degrees
Ratio:
77. Ventricular enlargement is suspected if the following ECG findings Prominent Q wave = previous infarction
is/are seen: *elevation: ischemia
A. Very tall T waves Depression: infarction
B. Prominent U waves
C. Very deep S waves 79. A 39 y/o male is complaining of loose watery stool for 2 days
D. QRS interval <0.10 sec. accompanied by generalized body weakness and numbness on all
extremities. Electrolyte determination was done which showed
Ratio: hypokalemia. Which of the following ECG finding is associated with
*Cardiac enlargement this electrolyte abnormality?
-Very tall R waves A. Peaked T wave
-Very deep S waves B. Prolonged QT interval
-QRS >0.10 sec C. Prominent U wave
D. Prolonged QRS complex
*Hyperkalemia
-peak/prominent T wave Ratio: *refer to #77
-prolonged QRS
80. Which of the following electrolyte will most likely affect the
*Hypokalemia duration of the QT interval?
-prolonged PR interval A. Potassium
-prominent U wave B. Calcium
-occasionally, late T wave inversion in the precardial leads C. Sodium
D. Chloride
*Hypocalcemia Ratio: *refer to #77
-prolonged ST segment and consequently of the QT interval
81. This is true of the pulmonary circulation
A. It is a high pressure circulation
78. A 68 y/o male came in the emergency room for consult due to B. The mean arterial pressure is 15 mmHg
severe chest pain. ECG done showed the following: C. The arteries are very muscular
D. It contains arterioles
E. None of the above

Ratio: The endothelial cells that line the capillaries of the lungs are exposed to
the total cardiac output. Such exposure provides an ideal environment to
metabolize substances and modify venous blood before its entry into the
systemic circulation. The endothelial cells of the pulmonary capillary bed
Psystolic: 25 have developed a variety of metabolic processing mechanisms and cell
Pdiastolic: 10 surface receptors to carry out their unique role in metabolism. Endothelial
cells within the pulmonary capillary bed, metabolize many substances,
MAP= 10 + 0.33(25-10) including vasoactive amines, cytokines, lipid mediators, and proteins.
MAP= 14.95 mmHg Metabolism occurs through either intracellular or extracellular processing
of substances as they pass through the capillaries or via direct synthesis
82. This is TRUE of the intrapleural pressure and secretion by endothelial cells. For example, circulating inactivated
A. It is above atmospheric during inspiration angiotensin I is activated by extracellular enzymes on the surface of
B. It is equal to 0 cmH2O at rest endothelial cells.
C. It is due to the opposing action of the thorax and the lungs Serotonin, a vasoconstrictor, binds to a specific receptor on the surface of
D. It also decreases during expiration the endothelial cell and is internalized and metabolized by intracellular
E. All of the above mechanisms. Approximately 80% of the serotonin entering the lung is
metabolized in a single pass through the pulmonary capillary bed.
Ratio: Endothelial cells also have surface receptors for bradykinin, tumor necrosis
*Intrathoracic/Intrapleural Pressure factor (TNF), components of complement, immunoglobulin Fc fragments,
-pressure of the fluid in the pleural space and adhesion molecules. In addition, endothelial cells synthesize and
-always sub-atmospheric (negative) relative to atmospheric pressure, secrete prostacyclin, endothelin, clotting factors, nitric oxide,
around -5 cmH2O prostaglandins, and cytokines. Vascular endothelial cells, however, lack 5-
-pressure changes during respiration lipoxygenase and are not able to synthesize leukotrienes. Compounds not
a. At the beginning of inspiration, the diameter of the thorax increases metabolized by the pulmonary capillary bed include epinephrine,
causing the intrathoracic pressure to fall, becomes more negative, and dopamine, histamine, isoproterenol, angiotensin II, and substance P.
continues to fall throughout the inspiratory period. It is most negative at ** It is not clear whether leukotrienes are synthesized in lungs, however,
the end of inspiration internet sources(journals) confirmed that leukotrienes are synthesized in
b. During expiration, the diameter pf the thorax decreases, pressure rises lungs when stimulated by various inflammatory or hypersensitivity reaction.
until about the end of expiration where it tends to level off, returning to
normal resting pressure. 84. The following change/s occurs during asthma attack
A. Airflow increases
83. The following substance/s are metabolized in the lungs B. Airway resistance decreases
A. Serotonin C. Vascular resistance decreases
B. Angiotensin I D. Airway resistance increases
C. Leukotrienes
D. Prostaglandin E2 Ratio:
E. All of the above
Asthma- results to bronchoconstriction. Can also cause a decrease in radius
Ratio: resulting to increased resistance and decreased airflow.
METABOLIC FUNCTIONS OF THE LUNG

85. This will decrease pulmonary vascular resistance D. Mid-expiration
A. Recruitment and distention of vessels E. None of the above
B. Nitric oxide inhalation
C. O2 inhalation
D. All of the above
Ratio:
Ratio:
Vasodilators and Distention
Compliance is greater during mid-inspiration
of vessels increase radius;
Compliance is lowest during the beginning and late respiration
remember the formula for
resistance, resistance and
88. In the distribution of blood flow in the lungs, Zone 1 is
radius are inversely proportional. Slight increase in radius causes
A. Alveolar > Arterial > Venous pressure
significant decreased in resistance because radius is raised to 4th power.
B. Alveolar = Arterial = Venous pressure
C. Arterial > Alveolar > Venous pressure
86. This is TRUE of lung compliance
D. Alveolar > Venous > Arterial pressure
A. Decreased in emphysematous individuals
E. Arterial > Venous > Alveolar pressure
B. Increased in severely premature babies
C. Decreased in individuals with lung fibrosis
Ratio:
D. None of the above
Zone 1: Alveolar > Arterial > Venous
E.
Zone 2: Arterial > Alveolar > Venous
Ratio:
Zone 3: Arterial > Venous > Alveolar
Pulmonary fibrosis- a restrictive lung disease associated with increased
collagen fiber deposition in the interstitium, the lung is non-compliant or
Match column A with column B
less compliant. The lungs are very stiff and cannot distend even at higher
pressure
A B
Capacities Volumes
87. Lung compliance is highest during this phase
B 89. Vital Capacity A. ERV + RV
A. Start of inspiration
A 90. Functional residual capacity B. IRV + TV + ERV
B. Start of expiration
D 91. Inspiratory capacity C. IRV + TLC
C. Mid-inspiration
D. IRV + TV
Ratio: Detrussor muscle of Urinary bladder- relaxation
94. At resting state, which of the following parameters is correct

pertaining to the lungs?
A. Cardiac output to the pulmonary circulation is 500ml/min
B. Respiratory membrane surface area is 100m2
C. Blood volume in the pulmonary capillaries is 60mL
D. All of the above
Ratio:
It is estimated that the total surface area of the respiratory membrane is
approximately 50-100m2 in normal adults. Blood involved in exchange of
gases comes directly from the heart thru the pulmonary artery. The total
quantity of blood in the capillaries of the lungs, at any given instant, is
about 60-100mL. spread all over the area of 70m2.
95. Which of the following is true regarding gases present in

atmosphere?
A. O2 has the highest partial pressure
B. O2 has the highest diffusing capacity in the lungs
C. CO2 has the highest diffusion coefficient
D. All of the above
A B Ratio:
A 92. Loss of alveolar interdependence A. increased airway resistance
B 93. Stimulation B2 receptors b. decreased airway resistance
C. both
D. neither
Ratio:
Interdependence of alveolar sacs
-when one polygonal sac expands, it tends to pull other alveolar sacs,
96. Decrease O2 utilization despite normal PaO2 is seen in…
making the whole lungs easier to expand.
A. Anemic hypoxia
Loss of interdependence = harder to expand = increased resistance
B. CN poisoning
C. Shock
Epinephrine—> Sympathetic effect. Generally, Sympathetic is Excitatory
D. All of the above
except:
Ratio:
Enteric Nervous System - decreased motility
Bronchi (airways) - dilation/ relaxation = decreased resistance
Eyes - pupillary dilation—> MIOSIS)
Gallbladder and bile ducts - relaxation

*Hypoxic Hypoxia/ Hypoxemia 98. Transport of O2..
-Low PO2 and O2 in the blood A. Is mainly as oxy-hemoglobin
-due to deficiency of oxygen in the atmosphere; uneven distribution of B. Facilitates Cl shift
alveolar gas and/or pulmonary blood flow C. Makes the plasma alkaline
-Hypoventilation D. All of the above
-Diffusion impairment
-Venous to Arterial Shunt Ratio:
Oxygen is present in the blood in two forms:
*Anemic Hypoxia A. Physically dissolved in the plasma
-blood does not have enough capacity to carry oxygen -about 1-3L of the total oxygen transported is in the dissolved state
-Normal PO2, low O2 content B. Chemically combined with Hgb as HbO2
-Anemia, lack of hemoglobin, is the primary cause -the concentration of Hgb is normally 14-15grams/100mL of blood.
-Carbon Monoxide poisoning One molecule of Hgb is capable of combining with 4 oxygen molecules. One
gram of Hgb combines with 1.34 ml of oxygen and when blood is fully
*Circulatory Hypoxia saturated with oxygen about 20 volumes percent of oxygen are present as
-Due to low blood flow oxyhemoglobin.
-Normal PO2, Normal O2 content
-There is general or localized circulatory insufficiency 99. Transport of CO2..
-Can also be due to tissue edema or abnormal tissue demands A. Is mainly as carboxy-hemoglobin
B. Decreases plasma pH
*Histotoxic Hypoxia/ Anoxia C. Increases affinity of O2 to Hgb
-Due to inability of cells to utilize the oxygen delivered D. All of the above
-Normal PO2 and O2 content
-Can be secondary to poisoning of cellular enzymes making them not able Ratio:
to utilize oxygen (e.g. Cyanide Poisoning) CO2 inside the red cells combines with water to form carbonic acid. The
reaction is rapid in the presence of carbonic anhydrase, an enzyme present
97. An increase in which of the following facilitates Haldane effect? in red cells. The acid dissociates immediately into bicarbonate and
A. Temperature hydrogen ions. Bicarbonate account for the transport of approximately
B. pH 65-70% of CO2 carried from the tissues to the lungs
C. 2,3-DPG
D. All of the above 100.Which of the following maximally stimulates ventilation?
A. Increased plasma pH
Ratio: B. Hypoxemia
A change in the direction of the blood towards the acidic side causes the C. Increased PaCO2
curve to flatten towards the right, wherein the affinity of Hgb to O2 is D. All of the above
reduced. Carbon dioxide and lactic acid liberated during tissue activity will
exert this effect (Bohr effect) promoting oxygen release to the tissues.
When the amount of CO2 is lesser as seen in the lungs, the curve will move
towards the left, allowing oxygen to combine with Hgb. (Haldane effect)

Ratio:
Ventilatory Control:
*PaCO2
-most potent regulator
-40 mmHg
- inc.: 900% inc. ventilation
*pH
-7.4
-dec.: 400% inc. ventilation
*PaO2
-80-100 mmHg
-dec.: 75% Inc. ventilation
103.Due to a failed relationship, RAC, 25 y/o suffers from metabolic

101.Which of the following generates the inspiratory ramp? acidosis secondary to acetylsalicylate overdose. Which of the
A. Nucleus retrofacialis following is true?
B. Pneumotaxic center A. Central chemoreceptors are stimulated
C. Nuclei tractus solitarius B. Carotid bodies increase minute ventilation
D. All of the above C. Aortic bodies inhibit DRG
D. All of the above
Ratio:
*Inspiratory Ramp Ratio:
-Nucleus tractus solitaries RAC suffers from METABOLIC ACIDOSIS. Compensatory mechanism of lungs is
-Rostal nucleus Increased in ventilation or anything that can increase ventilation or minute
-Nucleus paraambiguus ventilation to remove immediately the acidity.
*Exhalation 104.FCB, a 22 y/o does crossfit exercise routine for 30 min. which of
-Nucleus retrofacialis the following is true?
-Caudal nucleus retroambiguus A. Metabolic acidosis occurs due to lactic acid
-Nucleus paraambiguus B. Muscle and joint movement increases alveolar ventilation
C. PaO2 decreases due to increased O2 utilization
102.Which of the following ventilatory disorders produce no change in D. All of the above
intrapleural pressure?
A. Ondin’s curse Ratio:
B. Cheyne-stokes breathing Increase work of muscle in explosive exercise would require recruitment of
C. Obstructive sleep apnea much more Oxygen in the lungs.It is aerobic. Crossfit exercise is under type
D. All of the above 2b which is Fast oxidative. Meaning it would require Oxygen and the
metabolism is fast.
Ratio:

105.GMV, a 35 y/o joins the Philippine team in climbing Mt. Everest. target cell by diffusion through the intestinal space. Example of paracrine
Which of the following is true as she ascends? agents are CCK, secretin, prostaglandin, adenosine, and nitric oxide.
A. PaCO2 levels stimulate DRG.
B. Pulmonary arterial pressure decreases 108.Which activity is NOT happening during the pharyngeal stage of
C. Plasma pH increases swallowing?
D. All of the above A. Movement of the soft palate
B. Movement of the epiglottis
Ratio: C. Contraction of the hard palate
As GMV ascends, Oxygen tension decreases, the compensatory mechanism D. None of these
of the body as it detects decreased oxygen is hyperventilation, wherein Ratio:
Carbon dioxide in the body is decreases as Oxygen increases. Decreased Pharynx – considered an airway and food passageway
Carbon dioxide results to increased Plasma pH. • Once bolus of food is to be pushed to the pharynx, you prepare the
pharynx to function as a passageway by closing all airway
106.Which CN is NOT involved in the swallowing reflex? openings; trachea and posterior nares.
A. Trigeminal nerve • Soft palate move backward touching the posterior pharyngeal wall
B. Abducens nerve closing the posterior nares.
C. Facial nerve • Epiglottis will press down on the glottis, the larynx will elevate and
D. Vagus nerve vocal cords will approximate closing the tracheal opening
• Pharyngeal muscle will push the food towards the esophagus by
Ratio: contraction of pharyngeal constrictors.
Swallowing/ deglutition 109.The interstitial cells of Cajal is responsible for the:
• Afferent fiber- CN V, IX, X A. Continuous generation of “spikes” in the GI smooth muscles
o Center- tractus solitaries/ nucleus ambiguous B. Activation of the secretory activities of the GI cells
• Efferent fiber- CN V, VII, XII C. Direct activation of the GI extrinsic neurons
o Partly voluntary, mostly reflex D. Direct generation of the slow waves in the GI smooth muscles
CN IX – Glossopharyngeal – parotid
CN V – trigeminal – mastication Ratio:
CN VII – Facial – sublingual/submandibular Interstitial call of cajal
CN IX – Vagus - parasympathetic • Origin of slow waves
• Network of cells in close content to the smooth muscles
107.This chemical agent is associated with the paracrine control of GI • The pacemaker of the gut
activity:
A. VIP 110.The effective trituration of gastric contents is mostly dependent on
B. Ach the normal functioning of the:
C. NO A. Proximal stomach
D. Motilin B. Middle stomach
Ratio: C. Distal stomach
Nitric oxide is a component of the endothelium derived relaxing factors, D. Duodenum
stimulated by acetylcholine or other vasodilator agent. Paracrine regulation
describes the process whereby a chemical messenger or regulatory peptide
is released from a sensing cell in the intestinal wall that acts on a nearby Ratio:

Lower stomach Ratio:
• Mixing and regulates emptying Tonicity
• Simultaneous contraction of the lower stomach creates a greater • Hypertonic stomach delays emptying
force that allows the content to go back to the upper stomach • Hypotonic stomach hastens emptying
(mixing movement) and prevents emptying of large amount of o Drinking water after a meal makes the stomach slightly
gastric contents towards the small intestine hypotonic
• Emptying a small amount happen at the early period of lower Acidity
gastric relaxation • Gastric pH close to 5(between 3 to 5) results to normal gastric
emptying of 4-6 hrs.
111.This agent is released by the ECL cells when the stomach is filled • Decrease of gastric pH (less than 3) decreases the rate of gastric
with food: emptying
A. Ghrelin Type of food
B. Serotonin • Carbohydrates are fastest to empty
C. Leptin • Proteins have intermediate rate of emptying
D. Histamine • A diet rich in fat takes longer time to empty
Temperature
Ratio: • Warm food takes longer time to empty
Argentaffin/ entero chromaffin like cells secrete SEROTONIN when the • Cold food takes a shorter time to empty
stomach is full Volume
Parietal cells/ oxyntic cells releases GHRELIN when the stomach is empty • Lesser volume, faster emptying
Different tissues of the body sensing hypoglycemia releases OREXIN that • Greater volume, slower emptying
activates the hunger center
112.This region or part of the hypothalamus is activated by 114.Injuries affecting the enteric neurons leads to abnormalities
adipocytokines: regions of the digestive tract EXCEPT for the:
A. Pre-optic area A. Mouth
B. Ventro-lateral B. Small intestines
C. Ventro-medial C. Large intestines
D. Dorso-medial D. Esophagus
Ratio: Ratio:
Adipocytokine sometimes called LEPTIN inhibits the hunger center (ventro The small intestine, large intestine, and esophagus contains meissner’s
lateral) in the hypothalamus and activates the satiety center (ventro plexus and myenteric plexus which are absent in the mouth.
medial) that can lead to feeling of satisfaction.
115.Which statement is CORRECT?
113.Which condition could lead to slower emptying of gastric contents A. Defecation is highly dependent on the activity of the vagus
to the duodenum? nerve
A. Very hypotonic gastric contents B. Haustration is attributed to activation of the colonic
B. High carbohydrate diet longitudinal muscles
C. Ingestion of cold food C. If a person is constipated, the phrenic nerve is also activated to
D. Gastric pH=2 help remove rectal contents
D. The major movement of the colonic muscles is peristalsis

B. Secondary peristalsis of the esophagus is a part of the
Ratio: swallowing reflex
The parasympathetic response in defecation is governed by pelvic C. Transit time of food in the stomach is about 80-10 hours
splanchnic nerve D. The first part of the ingested meal reaches the cecum within 4
Haustrations are attributed to the activation of the colonic circular muscles hours
Tonic and segmenting contraction is the common movement of the colon
Ratio:
116.In congenital absence of the myenteric plexus in the colon, the Frequency of gastric motor activity is about 3/minute
major problem of the patient is: Transit time of food in the stomach is about 4-6 hrs
A. Decrease in colonic secretions *end result of swallowing (after the swallowing reflex)
B. Frequent food intake • Primary peristalsis – dependent on the function of the extrinsic
C. Ingestion of large volume of food in a single meal nerves (CN V, VII, IX, X) controlling peristalsis
D. Absence of bowel movement • Secondary peristalsis – due to the direct activation of the myenteric
plexus, more powerful movement
Ratio:
The myenteric plexus in the colon is the motor neuron of the GIT 119.If there is activation of the myenteric neurons it leads to the
positioned between muscle layers. This myenteric plexus is the one following activities in the GIT:
responsible for the peristaltic movement in the GIT. This is also associated A. Contraction of the proximal longitudinal muscles with
with mechanoreceptors which are sensitive to stretch or mechanical simultaneous relaxation of the distal longitudinal muscles
distention. The absence of myenteric plexus can lead to the absence of B. Contraction of the distal circular muscles with simultaneous
bowel movements. relaxation of the proximal circular muscles
C. Contraction of the proximal longitudinal muscles with
simultaneous contraction of the distal circular muscles
117.In migrating motor complexes, increase in GI movements: D. Contraction of the proximal circular muscles with simultaneous
A. Is observed if there is frequent food intake relaxation of the distal circular muscles
B. Is seen in the esophagus, stomach, and small intestines Ratio:
C. Is mostly attributed to peristaltic movements Myenteric reflex / Law of intestine
D. Is due to excessive activity of the vagus nerve • Distends a segment --- activates myenteric neurons --- transmits
excitatory impulses on the proximal circular region (muscle
Ratio: contract) and transmits inhibitory impulses on the distal circular
Migrating motor complexes is a modified motor activity occurring during region --- PREFERRENTIAL TRANSMISSION OF IMPULSES
fasting between periods of digestion, migrating from the stomach to the
distal ileum; activity is seen only in stomach and small intestine; increase 120.The high amplitude propagating contraction of the colon is
movement during fasting and observed when the person is sleeping. facilitated mostly by reflexes originating from the:
After meal has been digested and absorbed, it is desirable to clear any A. Ileum
undigested residues from the lumen to prepare the intestine for the next B. Cecum
meal. Such clearance is affected by peristalsis. C. Stomach
D. Rectum
118.Which statement is CORRECT?
A. Frequency of gastric motor activity is about 5/min Ratio:

The “mass movement” of the colonic contraction is greatly facilitated by
the gastroileal reflex, duodenocolic reflex, and gastrocolic reflex. This 123.Which of the following is a common secretion of the different
reflexes are brought about by the contraction primarily of the antrum, regions of the stomach from the fundus to the pyloric area?
pylorus and the proximal duodenum. A. Somatostatin
B. Mucus
121.In the defecation reflex, the release of these agents promotes the C. Histamine
relaxation of the internal anal sphincter: D. Acid
A. Ach and substance-P
B. Serotonin and Ach Ratio:
C. VIP and NO
Cell type Part of stomach Secretion Stimulated by
D. Serotonin and VIP
Parietal cells/ Fundus and HCL Gastrin
Ratio: oxyntic cells Body Intrinsic Factor Acetylcholine
Histamine
Hormone affecting GI motor activity Gastric
secretagouges
INHIBITORY EXCITATORY
Chief cells/ Fundus and Pepsinogen Acetylcholine
VIP – major hormone that inhibit smooth Substance P peptic cells body Gastrin
muscle
Mucous cells Whole stomach Mucus Acetylcholine
CCK (stomach) CCK (small and large intestine) Pepsinogen
Somatostatin Motilin ECL cells Fundus and Histamine
body Serotonin
Nitric Oxide
Endocrine cells
Enkephalins G-cells Antrum Gastrin GRP, Ach
Secretin D-cells Fundus, body & Somatostatin Increase gastric
EC2 cells antrum Motilin acidity
D1 cells Fundus and VIP
A-cells body Glucagon
Fundus and
122.Activation of neurons arising from the superior cervical ganglion body
Antrum
allows the:
A. Salivary glands to secrete a thin watery saliva
B. Submandibular gland to release ptyalin
C. Parotid gland to secrete salivary amylase
D. Release also of VIP to affect the salivary glands 124.The most important secretion of the gastric oxyntic cells essential
to help normalize DNA production is:
Ratio: A. Pepsinogen
Sympathetic fibers to the salivary glands start from the superior cervical B. Ghrelin
ganglion with two distinct receptors mainly the alpha and beta receptors. C. Mucin
• Alpha receptors- release of thick and viscous saliva D. Intrinsic factor
• Beta receptors- release of amylolytic enzyme (salivary amylase)
Ratio: Ratio:
Gastric parietal cells/ Oxyntic cells Composition of Saliva
• HCl- for digestion • Mucin- a slippery glycoprotein making the saliva a good lubricant
• Intrinsic factor- needed for the normal DNA production/normal • IgA- secretory antibody for protection
maturation of human cell • Lysozyme and lactoferrin- for protection
• Ptyalin (salivary amylase)- can digest 20-40% of starch in diet
125.The agent responsible for the increase in gastric acid secretion • Lingual lipase
during the cephalic phase is: • Hypotonic solution of electrolytes
A. GIP • Growth factors
B. GRP
C. GLP 128.CCK-58 is capable of enhancing pancreatic acinar cell activity by:
D. GIF A. Stimulating vagus nerve to release GRP
B. Enhancing the activity of the Cystic Fibrosis Transmembrane
Ratio: Conductance Regulator
*Cephalic phase- 30% C. Stimulating the enteropeptidase
-sight, smell, taste, thought of food D. Stimulating CCK-1 receptors
-neurogenic signals that cause the cephalic phase of gastric secretion Ratio:
originate in the cerebral cortex and in the appetite centers of the Vagal Afferent nerve endings in the wall of the small intestine are
amygdala and hypothalamus. They are transmitted through the dorsal responsive to CCK-58 by virtue of their expression of CCK-1 receptors. The
motor nuclei of the ragi and then through the vagus nerves to the stomach. binding of CCK-58 on the CCK-1 receptors activates a vagovagal reflex that
This will promote the release of GRP to stimulate the release of GASTRIN. can further enhance acinar cell secretion via activation of pancreatic
extrinsic neurons and release of a series of NTA such as Ach, GRP, and VIP.
126.Which chemical agent capable of increasing gastric parietal cell
activity uses cAMP as its second messenger? 129.This liver zone is highly perfused and is the one mostly affected by
A. Ach ingested toxins:
B. Histamine A. Periportal
C. Gastrin B. Midzonal
D. None of the above C. Centrilobular
D. None of these
Ratio:
Agents that can cause release of acids: Ratio:
M3 receptors- Ach (Ca-mediated) *Zone 1 (Periprtal Lobule)
H2 receptors- Histamine (cAMP) -nearest the portal vein; receives most of the oxygen from hepatic artery
CCK B/ CCK 2 receptors- Gastrin (Ca-mediated) -area that first receives blood drained from the intestine (portal vein)
127.The following agents are produced by the salivary glands EXCEPT *Zone 2 (Midzonal Region)
for: -intermediate to the final region of liver
A. Growth factors
B. Antibodies *Zone 3 (Centrilobular Area)
C. Lipase -Adjacent to the Central Vein
D. Proteases -the area most prone to ischemia

130.This region of the digestive tract is NOT affected by the hormone stomach wall and enter portal vein whereas long chain fatty acids dissolve
gastrin: in the fat droplet and pass on the duodenum.
A. Mouth Small intestine is the major site for LIPID DIGESTION
B. Esophagus
C. Small intestine 133.Protein digestion initially happens in the stomach with the help of:
D. Colon A. Enteropeptidases
Ratio: B. Acid
Extra gastric effect of GASTRIN- can affect almost all part of the GIT (from C. Intrinsic factors
esophagus to colon) including the accessory organs (liver, gall bladder, D. Mucus
pancreas); can affect secretory and motor activities and growth of other Ratio:
regions of GIT especially the esophagus; only the mouth to pharynx is not HCl- causes the denaturation of proteins or unfolding, rendering the inner
affected (minimal) peptides of the molecule accessible to enzymatic hydrolysis
Enteropeptidases- stimulates the activation of trypsinogen to trypsin which
131.Absorption of the following vitamins decreases if there is an automatically activates other trypsinogen molecules
absorption problem affecting the terminal ileum: Intrinsic factor- aids in the absorption of Vit. B12
A. Vit. A Mucus- aids in the lubrication of the food particles
B. Vit. B12
C. Both 134.Bile salts are essential for:
D. Neither A. Micelle formation
B. Fat saponification prior to digestion
Ratio: C. Normal absorption of the fat soluble vitmains
Absorption of Vitamins D. All of these
• Fat soluble- included in the micelles and absorbed along with fats Ratio:
• Water soluble- absorbed by Na dependent cotransport mechanism Bile salts have two important action in the intestine:
• Vit B12- absorbed in the distal part of the ileu and requires presence a. they have a detergent action on the fat particles in the food. This
of gastric intrinsic factor action, which decreases the surface tension of the particles and allows
agitation in the intestinal tract to break the fat globules into minute sizes,
Digestion of Fats + Absorption of Vit. ADEK is called emulsifying or detergent function of bile salts.
• 95% are absorbed in the terminal Ileum b. more important than the emulsifying function, bile salts help in
• 5% reaches the colon absorption of fatty acids, monoglycerides, cholesterol, and other lipids
• 1% of colonic bile is reabsorbed from the intestinal tract.
*important for the formation of micelle that aids in thr normal absorption
132.Considerable amount of fats are initially digested in the: of the fat soluble vitamins in the enterocytes.
A. Mouth
B. Stomach 135.The major water absorbing area of the GIT is the:
C. Duodenum A. Stomach
D. Colon B. Small intestine
Ratio: C. Proximal colon
The stomach contains gastric lipase which hydrolyze short or long chain D. Distal colon
fatty acids. Released hydrophilic short chain fatty acids are absorbed via

Ratio:
Total water reabsorbed is 8,800ml. Most reabsorption of water

Is in the JEJUNUM followed by ILEUM. Least absorption is in the COLON.

Promo 2015 Medical Physiology A 2

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FINAL EXAMINATION MEDICAL PHYSIOLOGY A (pancreatic acinar cells). In these cells the secretory product (e.g.

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Ratio: Rheumatoid Rheumatoid factor(IgG antibody against IgM)

46. Active transport of calcium across the cardiac sarcolemma is best

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

51. Just before atrial depolarization and contraction:

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Ratio: 63. Which factor will produce laminar flow?

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

94. At resting state, which of the following parameters is correct

95. Which of the following is true regarding gases present in

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

103.Due to a failed relationship, RAC, 25 y/o suffers from metabolic

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

Total water reabsorbed is 8,800ml. Most reabsorption of water

Mendoza, Eldick ▪ Pacia, Arvin ▪ Sioson, Faith ▪ Toraneo, Christian MD2019

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