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Mcqs in Physiology: Collected By: Professor Bassam Talib Al-Gailani (M.B.CH.B., PHD)
Mcqs in Physiology: Collected By: Professor Bassam Talib Al-Gailani (M.B.CH.B., PHD)
Physiology
Collected by:
Professor Bassam Talib Al-Gailani
(M.B.Ch.B., PhD)
First edition
Part 1
This part includes:
Cell & Body fluids Physiology 1-35
Blood Physiology 36-92
Nerves & Muscles Physiology 93-151
Digestive System Physiology 152-207
Respiratory System Physiology 208-288
Cardiovascular System Physiology 289-380
Autonomic Nervous System Physiology 381-415
These MCQ collections are absolutely free. Your remarks, corrections, and
comments are highly appreciated. Contact to: Dr Bassam Talib Al-Gailani at
feedbackmcq@yahoo.com. More questions suggested by you are more than
welcome.
It has been a pleasure to be a staff member of the Department of Physiology / Al-Mustansiriya College
of Medicine. These questions were collected from various sources.
Every effort has been made in preparing this publication to provide accurate information. Nevertheless,
I can make no warranties that the information contained herein is totally free from error. I, therefore,
disclaim all liability for direct or consequential resulting from the use of material contained in this book.
Readers are strongly advised to pay careful attention to information provided herein.
My sincere thanks to Assistant Professor Ismail Ibrahim ALkaraghulli (M.B.Ch.B., PhD) / Department of
Physiology / Al-Mustansiriya College of Medicine, for revising MCQs in Cardiovascular Physiology section
of this book.
MCQs are used to assess the student`s cognitive domain of educational objectives (Knowledge,
Comprehension, Application, Analysis, Synthesis, Evaluation). Yet, they are an important tool to promote
students for learning new information beyond the concept of their classical lectures. Accordingly, these
MCQs were collected from extensive sources to help medical students and their teachers to achieve
these goals.
MCQs in
Cell & Body Fluids Physiology
2
Cell & Body Fluids Physiology
1. The cell membrane proteins function as all of the following EXCEPT:
A. Transporter B. Ligand C. Receptor D. Channels
2. The carbohydrate attachment to the peripheral proteins on the outer surface of the plasma
membrane shows all of the following EXCEPT:
A. Antigenicity C. Intercellular connections
B. Surface electrical charge D. Carrier
5. Which of the following cell organelles is responsible for producing adenosine triphosphate (ATP), the
energy currency of the cell?
A. Endoplasmic reticulum C. Lysosomes E. Peroxisomes
B. Mitochondria D. Golgi apparatus F. Ribosomes
6. The protein which is attached to the basal lamina and between cells include:
A. Microfilaments C. Microtubules
B. Cell adhesion molecules D. Molecular motors
7. The process of pinocytosis does not include the entry of which of the following into the cell?
A. Viruses B. Growth factors C. Bacteria D. Insulin
8. Which of the following does not require a channel protein for its transport?
A. Oxygen B. Sodium C. Water D. Chloride
9. Which of the following would decrease the rate of diffusion of substance across cell membrane?
A. Increase in temperature C. Decrease in molecular size
B. Increase in membrane permeability D. Decrease in concentration gradient
10. In the experiment illustrated in part A of the figure 2, equal volumes of solutions X, Y, and Z are
placed into the compartments of the two U-shaped vessels shown. The two compartments of each vessel
are separated by semipermeable membranes (i.e., impermeable to ions and large polar molecules). Part
B illustrates the fluid distribution across the membranes at equilibration. Assuming complete
dissociation, identify each of the solutions shown.
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Cell & Body Fluids Physiology
12. Which one of the following is an example of transport against electrochemical gradient?
A. Diffusion C. Active transport
B. Facilitated diffusion D. Secondary active transport
18. Simple diffusion and facilitated diffusion share which of the following characteristics?
A. Can be blocked by specific inhibitors D. Saturation kinetics
B. Do not require adenosine triphosphate (ATP) E. Transport solute against concentration
C. Require transport protein gradient
19. What is the osmolarity of a solution containing 10 mM NaCl, 5 mM KCl, and 10 mM CaCl2 (in
mOsm/L)?
A. 20 B. 40 C. 60 D. 80 E. 100
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Cell & Body Fluids Physiology
20. The increase in the intracellular Ca++ level can occur due to release of Ca++ from all of the following
EXCEPT:
A. Sarcoplasmic reticulum C. Calmodulin
B. Mitochondria B. Endoplasmic reticulum
21. If the intracellular concentration of a membrane permeant substance doubles from 10 to 20 mM and
the extracellular concentration remains at 5 mM, the rate of diffusion of that substance across the
plasma membrane will increase by a factor of how much?
A. 2 B. 3 C. 4 D. 5 E. 6
25. The hair-like processes on the surface of a cell that beat in waves to help propel materials across its
surface are called:
A. Microvilli B. Flagella C. Cilia D. Centrioles
28. If red blood cells are immersed in a hypertonic solution, the cells will:
A. Remain normal in size and water content
B. Lose fluid and shrink
C. Swell and possibly burst
D. Diffuse through capillary walls
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Cell & Body Fluids Physiology
30. What is the process by which large molecules can leave the cell even though they are too large to
move through the plasma membrane?
A. Exocytosis B. Endocytosis C. Phagocytosis D. Pinocytosis
31. Which of the following best describes the changes in cell volume that will occur when red blood cells
(previously equilibrated in a 280-milliosmolar solution of NaCl are placed in a solution of 140-mM NaCl
containing 20-mM urea, a relatively large but permeant molecule?
A. Shrink, then swell and lyse D. Swell, then return to original volume
B. Shrink, then return to original volume E. No change in cell volume
C. Swell and lyse
32. A clinical study is conducted to determine the actions of an unknown test solution on red blood cell
volume. One milliliter of heparinized human blood is pipetted into 100 milliliters of test solution and
mixed. Samples are taken and analyzed immediately before and at 1-second intervals after mixing. The
results show that red blood cells placed into the test solution immediately swell and burst. Which of the
following best describes the tonicity and osmolarity of the test solution?
A. Hypertonic; could be hyperosmotic, hypo-osmotic, or iso-osmotic
B. Hypertonic; must be hyperosmotic or hypo-osmotic
C. Hypertonic; must be iso-osmotic
D. Hypotonic; could be hyperosmotic, hypo-osmotic, or iso-osmotic
E. Hypotonic; must be hyperosmotic or hypo-osmotic
F. Hypotonic; must be iso-osmotic
33. In the figure 1, two compartments (X and Y) are separated by a typical biological membrane (lipid
bilayer). The concentrations of glucose in compartments X and Y at time zero are shown. There are no
transporters for glucose in the membrane, and the membrane is impermeable to glucose. Which of the
figures best represent the volumes of compartments X and Y when the system reaches equilibrium?
A. A B. B C. C D. D E. E
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Cell & Body Fluids Physiology
34. The primary force moving water molecules from the blood plasma to the interstitial fluid is
A. Active transport D. Cotransport with Na+
B. Cotransport with H+ E. Filtration
C. Facilitated diffusion
35. A neurotransmitter activates its receptor on an ion channel of a neuron, which causes the water-
filled channel to open. Once the channel is open, ions move through the channel down their respective
electrochemical gradients. A change in membrane potential follows. Which of the following best
describes the type of channel and mechanism of ion transport?
Type of Channel Mechanism of Transport
A. Ligand gated Facilitated diffusion
B. Ligand gated Simple diffusion
C. Ligand gated Secondary active transport
D. Voltage gated Facilitated diffusion
E. Voltage gated Simple diffusion
F. Voltage gated Secondary active transport
36. Which of the following is most directly involved in the regulation of apoptosis?
A. Glucose-6-phosphatase D. Aquaporin 2
B. Adenylyl cyclase E. Cytochrome c
C. Nitric oxide synthase
39. Compared with the intracellular fluid, the extracellular fluid has __________ sodium ion
concentration,
__________ potassium ion concentration, __________ chloride ion concentration, and __________
phosphate ion concentration.
A. Lower, lower, lower, lower D. Higher, lower, higher, lower
B. Lower, higher, lower, lower E. Higher, higher, lower, higher
C. Lower, higher, higher, lower F. Higher, higher, higher, higher
43. Which of the following is not a major function of the endoplasmic reticulum (ER)?
A. Synthesis of lipids
B. Synthesis of proteins
C. Providing enzymes that control glycogen breakdown
D. Providing enzymes that detoxify substances that could damage the cell
E. Secretion of proteins synthesized in the cell
47. Which factor determines the amount and direction of fluid that flows between body compartments?
A. The volume of fluid in one of the compartments C. The pH of the fluid
B. The concentration of solutes D. The concentration of hydrogen ions in the fluid
50. Listed below are the hydrostatic and oncotic pressures within a microcirculatory bed.
Plasma colloid osmotic pressure = 25 mm Hg,
Capillary hydrostatic pressure = 25 mm Hg,
Venous hydrostatic pressure = 5 mm Hg,
Arterial pressure = 80 mm Hg,
Interstitial fluid hydrostatic pressure = −5 mm Hg,
Interstitial colloid osmotic pressure = 10 mm Hg,
Capillary filtration coefficient = 10 ml/min/mm Hg
What is the rate of net fluid movement across the capillary wall?
A. 25 ml/min C. 100 ml/min E. 200 ml/min
B. 50 ml/min D. 150 ml/min
51. A twofold increase in which of the following would result in the greatest increase in the transport of
oxygen across the capillary wall?
A. Capillary hydrostatic pressure D. Plasma colloid osmotic pressure
B. Intercellular clefts in the capillary wall E. Capillary wall hydraulic permeability
C. Oxygen concentration gradient
52. Which of the following tends to increase the net movement of glucose across a capillary wall?
A. Increase in plasma sodium concentration
B. Increase in the concentration difference of glucose across the wall
C. Decrease in wall permeability to glucose
D. Decrease in wall surface area without an increase in the number of pores
E. Decrease in plasma potassium concentration
53. The intercellular connections having high permeability for ions are:
A. Desmosomes C. Hemidesmosomes E. Tight junctions
B. Focal adhesions D. Gap junctions
56. The volume of distribution of intravenously administered sucrose (distributed throughout plasma +
interstitial fluid) in a healthy 70-kg man is about
A. 3.5 L B. 10.5 L C. 13.3 L D. 28 L
61. Normal red blood cells were placed in the following solutions and observations made after 1 hour.
Cells would have lysed when placed in:
A. 0.3% NaCl B. 0.9% NaCl C. 35% NaCl D. 5% dextrose
63. 2 liters of 0.9% NaCl is administered to a 12-year old boy with moderate isotonic dehydration. What
will be the change in ICF volume after NaCl administration?
A. No change C. Increases by 0.5 liter
B. Increases by 2 liters D. Decreases by 0.5 liter
65. In a patient who has become dehydrated, body water should be replaced by intravenous infusion of:
A. distilled water D. hyperoncotic albumin
B. 0.9% NaCl E. 10% glucose solution
C. 5% dextrose solution
66. Which of the following exerts the greatest plasma colloid osmotic effect on a mole-mole basis?
A. Glucose B. Globulin C. Albumin D. Fibrinogen
68. Which intercellular junctions allow the passage of small molecules and ions from one cell to another?
A. Gap junctions C. Zonula occludens
B. Focal adhesions D. Desmosomes
70. Of the following substances, the lipid bilayer is most permeable to:
A. sodium B. urea C. glucose D. water
73. Most of the ATP generated in nerve cells is utilized to energize the:
A. Na-Ca exchanger C. Na-K ATPase
B. H-ATPase in the cell membrane D. synthesis of proteins
79. A red blood cell will swell the most when it is placed in a solution containing
A. 100 mM calcium chloride D. 250 mM urea
B. 150 mM sodium chloride E. 300 mM mannitol
C. 200 mM potassium chloride
81. Listed below are the hydrostatic and oncotic pressures within a microcirculatory bed.
Plasma colloid osmotic pressure = 25 mm Hg
Capillary hydrostatic pressure = 25 mm Hg
Venous hydrostatic pressure = 5 mm Hg
Arterial pressure = 80 mm Hg
Interstitial fluid hydrostatic pressure = −5 mm Hg
Interstitial colloid osmotic pressure = 10 mm Hg
Capillary filtration coefficient = 10 ml/min/mm Hg
What is the rate of net fluid movement across the capillary wall?
A. 25 ml/min C. 100 ml/min E. 200 ml/min
B. 50 ml/min D. 150 ml/min
The diagram in figure 3 below illustrates the concentration of a substance in two chambers. If the
concentration of the substance in chamber A doubles, the diffusion of the substance will change from 10
mg/h to:
82. The characteristic of a water-insoluble substance most important in governing its diffusibility through
a cell membrane is its:
A. Hydrated diameter D. Lipid solubility
B. Molecular weight E. Three-dimensional shape
C. Electrical charge
85. Which of the following statements best characterizes a molecule whose osmolality is zero?
A. It will not permeate the membrane
B. It can only cross the membrane through the lipid bilayer
C. It causes water to flow across the membrane
D. It is as diffusible through the membrane as water
E. It is transported across the membrane by a carrier
86. Which of the following causes the rate of diffusion of a particle across a membrane to increase?
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Cell & Body Fluids Physiology
A. The area of the membrane increases
B. The thickness of the membrane increases
C. The size of the particle increases
D. The concentration gradient of the particle decreases
E. The lipid solubility of the particle decreases
87. Female patient had consumed a lot of water in a short period of time. His Laboratory data reveal a
serum sodium concentration of 125 mM/L. Assuming that the reduction in osmolarity is entirely due to
water consumption, that her initial weight was 60 kg, and that her initial osmolarity was 300 mOsm/L,
which of the following is approximately how much water she would have had to drink to produce the
observed hyponatremia?
A. 2.5 L B. 3.5 L C. 5 L D. 6 L E. 7 L
91. Which fluid compartment contains about 67% (by volume) of all body water?
A. intracellular fluid B. plasma C. lymph D. extracellular fluid
92. The fluid secreted into the stomach by the stomach lining is part of which fluid compartment?
A. Transcellular B. Intracellular C. Interstitial D. Lymph
93. In which choice are the major body fluid compartments ranked correctly in order of decreasing
volume?
A. Intracellular, plasma, interstitial C. Intracellular, interstitial, plasma
B. Plasma, interstitial, intracellular D. Plasma, intracellular, interstitial
94. About what percent of a young adult’s body weight is due to water?
A. 4 to 5% B. 10 to 12% C. 50 to 60% D. 98 to 99%
95. In which choice would the person on the left be most likely to have lower body water content (by
percent of body weight) than the person on the right?
A. Person with 15% body fat / person with 5% body fat
B. Male / female
C. Baby / elderly person
D. Normal / dehydrated
13
Cell & Body Fluids Physiology
96. Which of these body fluid compartments contains the highest concentration of proteins?
A. Lymph B. Interstitial fluid C. Cerebrospinal fluid D. Intracellular
97. Various tissues in the body have different levels of water content. Which of these has the lowest
water content by volume?
A. Skin C. Skeletal muscle tissue
B. Cardiac muscle tissue D. Adipose tissue
99. Which factor would cause a shift of water from the plasma to the interstitial fluid?
A. Increased interstitial fluid hydrostatic pressure C. Decreased blood (hydrostatic) pressure
B. Increased blood plasma colloid osmotic pressure D. Increased blood (hydrostatic) pressure
100. Which of these events will occur when a normal person is given isotonic fluids intravenously?
A. There is a net shift of fluid from plasma into interstitial fluid
B. There is a net shift of fluid from interstitial fluid into plasma
C. There is a net shift of fluid from the ECF into the cells
D. There is a net shift of fluid from the ICF out of the cells
101. These are primarily responsible for the movement of fluid between plasma and interstitial fluids.
A. Hydrostatic pressure and osmotic pressure C. Primary and secondary active transport
B. osmosis and active transport D. Membrane channels
102. The interstitial fluid, plasma and lymph are part of which larger fluid compartment?
A. Synovial fluid B. Transcellular fluid C. Intracellular fluid D. Extracellular fluid
107. When there is an abnormally high or low level of sodium in the ECF,
A. Sodium shifts into or out of the cells to balance ICF and ECF osmolarity
B. Water shifts into or out of the cells to balance ICF and ECF osmolarity
C. Water shifts into or out of the capillaries to balance plasma and interstitial fluid osmolarity
D. Sodium shifts into or out of the capillaries to balance plasma and interstitial fluid osmolarity
14
Cell & Body Fluids Physiology
108. Water and electrolytes can move directly from the intracellular fluid into the
A. Plasma B. Interstitial fluid C. Lymph D. Capillaries
112. __________ accounts for about 40% of the total body weight.
A. Extracellular fluid C. Intracellular fluid
B. Interstitial fluid D. Plasma
114. Approximately 90-95% of the osmotic pressure of the extracellular fluid is caused
by ______ and the negative ions associated with them.
A. Ca2+ ions B. K+ ions C. Mg2+ ions D. Na+ ions
115. Loss of a large volume of sweat results in the body fluids becoming __________
which causes __________ in plasma volume.
A. Hypertonic, a decrease D. Hypotonic, a decrease
B. Hypertonic, an increase E. Hypotonic, an increase
C. Isotonic, no change
117. Of the following cellular structures, which is not involved in protein synthesis
A. Ribosomes C. Lysosomes
B. Golgi apparatus D. Smooth endoplasmic reticulum
120. Extracellular edema may result from all of the following EXCEPT:
A. Increased plasma colloid osmotic pressure
B. Lymphatic blockage
C. Increased capillary permeability
D. Increased capillary pressure
E. Increased interstitial fluid colloid osmotic pressure
123. Assuming complete dissociation of all solutes, which of the following solutions would be
hyperosmotic to 1 mM NaCI?
A. 1 Mm glucose C. 1 mM CaCl2 E. 1 mM KCI
B. 5 Mm glucose D. 1 mM sucrose
125. Which of the following substances use a protein-carrier molecule to traverse the cell membrane?
A. Water C. Glucose E. Glycerol
B. Oxygen D. Alcohol
127. All of the following substances are found in higher concentrations in the extracellular fluid
compared to the intracellular fluid EXCEPT:
A. Sodium B. Oxygen C. Potassium D. Calcium
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Cell & Body Fluids Physiology
128. Which of the following Starling forces tend to move fluid from interstitial spaces into blood
capillaries?
A. Plasma colloid osmotic pressure C. Subatmospheric interstitial fluid pressure
B. Capillary hydrostatic pressure D. Interstitial fluid colloid osmotic pressure
129. Net fluid loss from blood capillaries is attributed mainly to:
A. Diffusion B. Filtration C. Absorption D. Active transport
132. In error, a patient is infused with large volumes of a solution that causes lysis of his red blood cells
(RBCs). The solution was most likely:
A. Isotonic NaCl C. Hypertonic mannitol
B. Isotonic mannitol D. Hypotonic urea
E. Hypertonic urea
133. The permeability of a solute in a lipid bilayer will be increased by an increase in the:
A. Molecular radius of the solute
B. Lipid/water partition coefficient of the solute
C. Thickness of the bilayer
D. Concentration difference of the solute across the bilayer
134. Which of the following would occur as a result of the inhibition of Na+- K+ - ATPase?
A. Increased intracellular Na+ concentration C. Decreased intracellular Na+
+
B. Increased intracellular K concentration D. Increased Na+ - cotransport system
137. Which of the following changes tend to cause accumulation of fluid (edema) in the tissue:
A. Increased precapillary vascular resistance
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Cell & Body Fluids Physiology
B. Decreased postcapillary vascular resistance
C. Increased plasma colloid osmotic pressure
D. Increased venous pressure
138. Which of the following changes would probably occur as a result of a twofold increase in the net
filtration of fluid into the tissues?
A. A marked increase in lymph flow rate
B. An increase in interstitial fluid volume
C. A decrease in interstitial fluid colloid osmotic pressure
D. Both (A) and (B)
E. Both (A) and (C)
139. A woman runs a marathon in 90o F weather and replaces all volume lost in sweat by drinking
distilled water. After the marathon, she will have:
A. Decreased total body water (TBW)
B. decreased hematocrit
C. Decreased intracellular fluid (ICF) volume
D. Decreased plasma osmolarity
E. Increased intracellular osmolarity
140. Ion specific channels can be opened or closed by all of the following EXCEPT:
A. Alterations in membrane potential
B. The direct action of G proteins
C. Binding of specific ligands
D. The direct action of adenylate cyclase
142. Factors that prevent or mitigate dependent edema (edema of the feet) include
A. A locally low extravascular colloid osmotic pressure
B. A locally reduced interstitial fluid pressure
C. Reduced leg lymph flow
D. A rise in local peripheral vascular resistance
E. The calf muscle pump
143. The direct action of cyclic AMP in the mammalian cell is to:
A. activate adenylate cyclase
B. activate a protein kinase
C. activate a phosphodiesterase
D. bind to chromatin to alter the rate of transcription
144. The steady state concentration of cyclic AMP within the cell depends on all of the following EXCEPT:
A. the concentration of calmodulin C. the activity of a phosphodiesterase
B. the activity of adenylate cyclase D. the activity of a G protein
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Cell & Body Fluids Physiology
145. The synthesis of cyclic AMP is catalyzed by:
A. a cell surface receptor C. cyclic nucleotide phosphodiesterase
B. adenylate (adenylyl) cyclase D. protein kinase
147. Communication between cells occurs when chemical messengers from one cell bind to _______ on
another cell.
A. Channel proteins C. Receptor molecules
B. Marker molecules D. Second messengers
148. Which one among the following describes the function of the cell membrane or plasma membrane?
A. Cell membrane separates the cell from its external environment
B. Plasma membrane gives the cell a definite size and shape
C. Plasma membrane controls the movement of molecules from one side of the cell to the other
D. All of the above are the functions of cell membrane
149. Proteins of the plasma membrane serve all of the following functions EXCEPT
A. Pumping water out of the cell
B. Breaking down hormones
C. Serving as carriers for large molecule transportation
D. Binding to neurotransmitters
153. The second most abundant of the lipids in the plasma membrane is
A. Glycolipids B. Saturated fats C. Cholesterol D. Phospholipids
156. When molecules move from the area of lower concentration to the area of higher Concentration
and energy is used, it is called
A. Filtration C. Active transport
B. Osmosis D. Passive transport
157. The aroma of a cake baking in the kitchen reaches the living room. The distribution of this odor
throughout the house is an example of
A. Simple diffusion B. Dialysis C. Osmosis D. Active transport
158. Which of the following will increase the rate of diffusion? An increase in the
A. Viscosity of the solvent C. Molecular weight of the diffusing particles
B. The distance the molecules have to travel D. Temperature
159. The movement of a solution across a plasma membrane because of a pressure gradient is called
A. Diffusion C. Facilitated diffusion
B. Filtration D. Active transport
160. The movement of oxygen from a higher concentration in the lungs to a lower concentration in the
blood stream is an example of
A. Diffusion C. Active transport
B. Osmosis D. Bulk transport
161. The greater the concentration of a solute in a solution, the greater the
A. Tendency for water to diffuse from the solution C. Number of carrier molecules present
B. Osmotic pressure of the solution D. Rate of the active transport
162. Cyanide stops the production of ATP. Which of the following processes would be affected?
A. Simple diffusion C. Active transport
B. Osmosis D. Facilitated diffusion
164. If a carrier protein were to move both hydrogen and chloride ions from the inside of a cell to the
extracellular fluid, and consume ATP in the process, it would be considered a(n)
A. Symport system C. Facilitated diffusion system
B. Voltage-gated ion channel D. Antiport system
165. All of the following processes can move substances out of a cell EXCEPT
A. Exocytosis B. Simple diffusion
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Cell & Body Fluids Physiology
C. Active transport D. Phagocytosis
166. Although the basic structure of the plasma membrane is determined mainly by its __________, the
functions of the plasma membrane are determined mainly by its __________ .
A. Carbohydrates, lipids C. Lipids, proteins E. Proteins, lipids
B. Carbohydrates, proteins D. Nucleic acids, lipids
169. Formation of a secretory vesicle, fusion of the secretory vesicle to the cell membrane, and release
of the contents of the secretory vesicles outside the cell describes
A. Diffusion C. Active transport E. Exocytosis
B. Facilitated diffusion D. Phagocytosis
170. In the plasma membrane, _____________ form(s) the lipid bilayer, _____________ determine(s) the
fluid nature of the membrane, and _____________ mainly determine(s) the function of the membrane.
A. Phospholipids, cholesterol, proteins D. Cholesterol, phospholipids, proteins
B. Phospholipids, proteins, cholesterol E. Cholesterol, proteins, phospholipids
C. Proteins, cholesterol, phospholipids
171. Which of the following are functions of the proteins found in the plasma membrane?
A. Channel proteins C. Receptor molecules E. All of the above
B. Marker molecules D. Enzymes
172. In general, lipid-soluble molecules diffuse through the _____________; small, water-soluble
molecules diffuse through the _____________.
A. Membrane channels, membrane channels D. Lipid bilayer, membrane channels
B. Membrane channels, lipid bilayer E. Carrier proteins, membrane channels
C. Lipid bilayer, carrier molecules
173. Small pieces of matter, and even whole cells, can be transported across the plasma membrane in
A. Membrane channels C. Receptor molecules E. Vesicles
B. Carrier molecules D. Marker molecules
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Cell & Body Fluids Physiology
174. Suppose that a woman ran a long-distance race in the summer. During the race she lost a large
amount of hyposmotic sweat. You would expect her cells to
A. Shrink B. Swell C. Stay the same
175. Suppose that a man is doing heavy exercise in the hot summer sun. He sweats profusely. He then
drinks a large amount of distilled water. After he drank the water, you would expect his tissue cells to
A. Shrink B. Swell C. Remain the same
176. Unlike diffusion and osmosis, filtration depends on a _____________ on the two sides of the
partition.
A. Concentration gradient D. Difference in osmotic pressure
B. Pressure difference E. Hyposmotic solution
C. Difference in electric charge
178. Which of these statements concerning cotransport of glucose into cells is true?
A. The sodium-potassium exchange pump moves Na+ into cells
B. The concentration of Na+ outside cells is less than inside cells
C. A carrier protein moves Na+ into cells and glucose out of cells
D. The concentration of glucose can be greater inside cells than outside cells
E. As Na+ is actively transported into the cell, glucose is carried along
179. A white blood cell ingests solid particles by forming vesicles. This describes the process of
A. Exocytosis C. Secondary active transport E. Pinocytosis
B. Facilitated diffusion D. Phagocytosis
182. Which of the following characteristics is shared by simple and facilitated diffusion of glucose?
A. Occurs down an electrochemical gradient D. Requires a sodium gradient
B. Is saturable E. Is inhibited by the presence of galactose
C. Requires metabolic energy
183. Which of the following would occur as a result of the inhibition of Na+ K+ ATPase?
A. Decrease intracellular sodium concentration C. Increase intracellular K+ concentration
B. Increase intracellular calcium concentration D. Increase Na+ - glucose co-transport
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Cell & Body Fluids Physiology
E. Increase Na+ - Ca2+ exchange
185. While studying the effect of varying the extracellular concentration on the transport rate of a
substance, the graph below was obtained. This finding would suggest that this substance is transported
by:
186. Which of the following statements about transport through ion channels is not true?
A. Generally have higher flux rates than transport by facilitated diffusion
B. Can depend on the activation state of the channel
C. Can only occur down an electrochemical gradient
D. Are not selective for the particular ion transported
187. The rate of movement of an ion through an ion specific channel depends on all of the following
EXCEPT:
A. The membrane potential C. The ATP concentration of the cell
B. The concentration gradient of the ion D. The activation state of the channel
189. Which of the following transport processes requires the direct hydrolysis of ATP?
A. Ion selective channels C. Secondary active transport
B. Primary active transport D. Facilitated diffusion
191. Which of the following properties is characteristic of active transport but not of facilitated
diffusion?
A. can transport substances against a concentration gradient
B. Energy is not required
C. can be inhibited by substances structurally similar to the transported substance
D. is highly specific for the substance transported
192. While studying the rate of transport of aspartic acid into muscle cells the above graphs were
obtained. These graphs are consistent with which of the following transport mechanisms?
193. Assuming complete dissociation, which of the following solutions will have the greatest osmolarity?
A. 150 mM glucose B. 80 mM NaCl
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Cell & Body Fluids Physiology
C. 90 mM Na2SO4 D. 210 mM urea
194. If the cell membrane of the red blood cell is permeable to glycerol, and the osmolarity of the
contents of red blood cells is 286 mOsm /L, what would happen to red blood cells if they were placed in a
solution of 286 mM glycerol? The cells would:
A. Shrink and stabilize at a reduced volume (crenate)
B. Shrink for a while and then return to their original volume
C. Neither shrinks nor swells
D. Swell and eventually burst (hemolyze)
195. Given that the cell membrane is freely permeable to glycerol, and that the osmolarity of the
contents of red blood cells is 300 mOsm/L, a solution of 300 mM glycerol is:
A. Isotonic and isosmotic to red cells C. Isosmotic but not isotonic to red cells
B. Isotonic but not isosmotic to red cells D. Neither isotonic nor isosmotic to red cells
196. Given that the cell membrane is effectively impermeable to NaCl but freely permeable to urea, and
that the osmolarity of the contents of red blood cells is 300 mOsm/L, a solution containing 100 mM NaCl
and 100 mM urea is:
A. Isotonic and isosmotic to red cells C. Isosmotic but not isotonic to red cells
B. Isotonic but not isosmotic to red cells D. Neither isotonic nor isosmotic to red cells
197. Given that the cell membrane is effectively impermeable to NaCl but freely permeable to urea, and
that the osmolality of the contents of red blood cells is 300 mOsm/kg water, a solution containing 100
mM NaCl and 100 mM urea is:
A. Hypotonic and isosmotic to red cells C. Isosmotic and hypertonic to red cells
B. Isotonic and isosmotic to red cells D. Neither isotonic nor isosmotic to red cells
198. Which of the following is the t accurate definition of a solution which is isotonic to red blood cells?
A. A solution which has a molarity equal to the molarity of the cell contents
B. A solution which has an osmolarity equal to the osmolarity of the cell contents
C. A solution in which red blood cells neither swell nor shrink
D. None of the above descriptions are accurate
199. Assuming complete dissociation, the osmolality of a solution containing 100 mM NaCl, 100 mM
glucose, and 20 mM cacl2 is:
A. 240 mOsm/kg water C. 320 mOsm/kg water
B. 260 mOsm/kg water D. 360 mOsm/kg water
204. Intravenous infusion of 1 liter of which of the following solutions will lead to the largest increase in
ECF volume?
A. Distilled water D. Hypertonic NaCl
B. Isotonic NaCl E. Isotonic urea
C. Hypotonic NaCl
206. Excessive tissue fluid (edema) in the legs may be due to the following EXCEPT:
A. Be associated with a raised extracellular fluid volume
B. Result from hepatic disease
C. Result from blockage of pelvic lymphatics
D. Increase local interstitial fluid pressure
E. Result from a high arterial blood pressure in the absence of heart failure
207. Which of the following solutions, when infused intravenously, would result in an increase in
extracellular fluid volume, a decrease in intracellular fluid volume, and an increase in total body water
after osmotic equilibrium?
A. 1 Liter of 0.9% sodium chloride (NaCl) solution D. 1 Liter of 5% dextrose solution
B. 1 Liter of 0.45% NaCl solution E. 1 Liter of pure water
C. 1 Liter of 3% NaCl solution
208. Partial obstruction of a major vein draining a tissue would tend to __________ lymph flow rate,
__________ interstitial fluid hydrostatic pressure, and __________ interstitial fluid protein concentration
in the tissue drained by that vein.
A. Increase, increase, increase C. Increase, decrease, decrease E. Decrease, increase, increase
B. Increase, increase, decrease D. Decrease, decrease, decrease F. Decrease, increase, decrease
211. What percentage of osmolality of plasma in a healthy, well hydrated individual is attributable to
sodium and its accompanying anions?
A. 30 % B. 50 % C. 70 % D. 90 %
213. In a healthy adult, ECF volume constitutes what fraction of body weight?
A. 10% B. 20% C. 30% D. 40%
214. In a healthy adult male weighing 70 kg, the total volume of fluid present in the transcellular
compartment does not normally exceed:
A. 1 liter B. 3 liters C. 5 liters D. 7 liters
215. The volume of RBC placed in a NaCl solution with an osmolality of 280 mOsm/Kg H2O is 100
femtoliters. What will be the steady state volume when they are placed in a NaCl solution with an
osmolality of 350 mOsm/Kg H2O?
A. 120 fL B. 80 fL C. 50 fL D. Data inadequate
217. Two liters of 0.9% NaCl is administered to a 12-year old boy with moderate isotonic dehydration.
What is the expected change in ICF volume after NaCl administration?
A. No change C. Increase by 2 liters E. Decrease by 2 liters
B. Increase by 0.5 liter D. Decrease by 0.5 liter
219. Cell volume and pressure is mainly dependent upon activity of:
A. Na glucose cotransporter C. glucose transporter
B. Na-K pump D. Na-Ca exchanger
220. The rate of diffusion of a substance across the cell membrane is inversely proportional to:
A. concentration gradient for the substance C. surface area available for diffusion
B. diffusion coefficient D. thickness of the membrane
27
Cell & Body Fluids Physiology
221. Amongst plasma proteins, albumin makes the greatest contribution to the colloid osmotic pressure
of plasma proteins because, relative to most plasma proteins, albumin:
A. is the most abundant plasma protein C. has the lowest molar mass
B. has the longest half-life D. exits the capillary fastest
222. Osmotic pressure of crystalloids is not included in the Starling’s equation describing fluid exchange
across capillaries because:
A. they were discovered after Starling described the forces
B. crystalloids carry electric charges
C. crystalloids diffuse freely across the capillary endothelium
D. the quantity of crystalloids in plasma is negligible compared to plasma proteins
223. The term oncotic pressure is applied to osmotic pressure exerted by:
A. albumin and other plasma proteins across the capillary wall
B. crystalloids across the cell membrane
C. hemoglobin across the capillary wall
D. substances such as urea, lactate, glucose across the cell membrane
224. Which of the following processes does not exhibit 'saturation kinetics'?
A. Facilitated diffusion C. Simple diffusion
B. Na+ -Ca2+ exchanger D. Na+ coupled active transport
225. Figures A and B given below depict the relationship between transport rates (in Y-axis, in arbitrary
units) and concentration gradients (in X-axis, in arbitrary units) of two substances A and B respectively.
229. Which of the following stimulates the release of calcium from the endoplasmic reticulum?
A. IP3 B. PTH C. 1,25(OH)2 D3 D. DA
231. Which of the following is not a second messenger in a signal transduction pathway?
A. cAMP
B. Guanylyl cyclase
C. Inositol triphosphate
D. Diacylglycerol
E. Steroid hormone – receptor complex
232. Which of the following characteristics is shared by simple and facilitated diffusion of glucose?
A. Occurs down an electrochemical gradient D. Is inhibited by the presence of galactose
B. Is saturable E. Requires a Na+ gradient
C. Requires metabolic energy
233. Solutions A and B are separated by a semipermeable membrane that is permeable to K+ , but not to
Cl-. Solution A is 100 mM KCl, and solution B is 1 mM KCl. Which of the following statements about
solution A and solution B is true?
A. K+ ions will diffuse from solution A to solution B until the K+ of both solutions is 50.5 mM
B. K+ ions will diffuse from solution B to solution A until the K+ of both solutions is 50.5 mM
C. KCl will diffuse from solution A to solution B until the KCl of both solutions is 50.5 mM
D. K+ will diffuse from solution A to solution B until a membrane potential develops with solution A negative
with respect to solution B
E. K+ will diffuse from solution A to solution B until a membrane potential develops with solution A positive
with respect to solution B
234. Solutions A and B are separated by a membrane that is permeable to urea. Solution A is 10 mM
urea, and solution B is 5 mM urea. If the concentration of urea in solution A is doubled, the flux of urea
across the membrane will
A. Double C. Be unchanged E. Decrease to one-third
B. Triple D. Decrease to one-half
235. Solutions A and B are separated by a semipermeable membrane. Solution A contains 1 mM sucrose
and 1 mM urea. Solution B contains 1 mM sucrose. The reflection coefficient for sucrose is one and the
reflection coefficient for urea is zero. Which of the following statements about these solutions is correct?
A. Solution A has a higher effective osmotic pressure than solution B
B. Solution A has a lower effective osmotic pressure than solution B
C. Solutions A and B are isosmotic
D. Solution A is hyperosmotic with respect to solution B, and the solutions are isotonic
E. Solution A is hyposmotic with respect to solution B, and the solutions are isotonic
236. Transport of D- and L-glucose proceeds at the same rate down an electrochemical gradient by which
of the following processes?
A. Simple diffusion D. Cotransport
B. Facilitated diffusion E. Countertransport
C. Primary active transport
237. Which of the following will double the permeability of a solute in a lipid bilayer?
A. Doubling the molecular radius of the solute
29
Cell & Body Fluids Physiology
B. Doubling the oil/water partition coefficient of the solute
C. Doubling the thickness of the bilayer
D. Doubling the concentration difference of the solute across the bilayer
238. Which of the following transport processes is involved if transport of glucose from the intestinal
lumen into a small intestinal cell is inhibited by abolishing the usual Na+ gradient across the cell
membrane?
A. Simple diffusion D. Cotransport
B. Facilitated diffusion E. Countertransport
C. Primary active transport
239. Adenosine triphosphate (ATP) is used indirectly for which of the following processes?
A. Accumulation of Ca2+ by the sarcoplasmic reticulum (SR)
B. Transport of Na+ from intracellular to extracellular fluid
C. Transport of K+ from extracellular to intracellular fluid
D. Transport of H+ from parietal cells into the lumen of the stomach
E. Absorption of glucose by intestinal epithelial cells
240. Assuming complete dissociation of all solutes, which of the following solutions would be
hyperosmotic to 1 mM NaCl?
A. 1 mM glucose D. 1 mM sucrose
B. 1.5 mM glucose E. 1 mM KCl
C. 1 mM CaCl2
241. A new drug is developed that blocks the transporter for H+ secretion in gastric parietal cells. Which
of the following transport processes is being inhibited?
A. Simple diffusion D. Cotransport
B. Facilitated diffusion E. Countertransport
C. Primary active transport
242. A 19-year-old man sustains a full-thickness burn over 60% of his body surface area. A systemic
Pseudomonas aeruginosa infection occurs, and severe pulmonary edema follows 7 days later. The
following data are collected from the patient: plasma colloid osmotic pressure, 19 mm Hg; pulmonary
capillary hydrostatic pressure, 7 mm Hg; and interstitial fluid hydrostatic pressure, 1 mm Hg. Which set of
changes has occurred in the lungs of this patient as a result of the burn and subsequent infection?
244. Regarding the permeation of different solutes across the wall of a continuous capillary,
A. General anesthetics permeate rapidly, because they are lipid soluble
B. Glucose is generally carried across the wall chiefly by plasma ultrafiltration
C. Urea enters the capillary chiefly by diffusion down a concentration gradient
D. Oxygen permeation is more than 1000 times faster than glucose permeation
E. Net water transport depends on diffusion down the water concentration gradient
F. Plasma proteins do not cross the capillary wall
245. When a solute diffuses from the capillary bloodstream into a tissue,
A. The mass transported per unit time is proportional to the concentration gradient
B. Doubling the endothelial surface area will double the mass transported per unit time, for a given
concentration gradient
C. The diffusion rate is inversely proportional to the solute diffusion coefficient
D. The diffusion coefficient of a solute increases in proportion to its molecular mass
E. The mean oxygen concentration along the capillary increases with blood flow
248. The diffusive transfer of glucose from blood to skeletal muscle is increased many fold during
exercise by
A. An increase in endothelial exchange area due to capillary recruitment
B. A rise in interstitial glucose concentration
C. An increase in capillary permeability to glucose
D. A fall in the glucose concentration gradient
249. The transfer of fluid across the capillary wall contributes importantly to
A. The regulation of interstitial fluid volume
B. Antigen transport to lymph nodes
C. The transport of glucose into the tissues
D. The formation of urine
E. The enhancement of plasma volume after a hemorrhage
251. Regarding the forces that influence transcapillary fluid movement in a healthy human,
A. Mid-capillary pressure at heart level is 25–30 mmHg
B. Globulins contribute more than albumin to plasma colloid osmotic pressure
C. Plasma colloid osmotic pressure is 15 mmHg
D. Interstitial fluid pressure is subatmospheric
258. Which of the following can form an almost impermeable seal between two adjacent epithelial cells?
A. Desmosomes C. Integral reductive proteins E. Collagen
B. Gap junctions D. Tight junctions
Use the lettered items in the following diagram for following six questions
266. Which of the following structures can link adjacent cells in such a way that ions can flow directly
from the interior of one cell to the interior of the other cell?
A. Desmosomes C. Gap junctions E. Cholesterol
B. Tight junctions D. Micelles
274. Each of the following statements about sinusoidal capillaries is correct EXCEPT:
A. They have unusually wide lumens
B. They have abundant fenestrations
C. They are not found in skeletal muscle
D. They are the least permeable capillary type
E. They often have phagocytic cells inserted between the endothelial cells of their lining
275. Large diameter capillaries found primarily in the liver, spleen, and bone marrow are called:
A. Continuous capillaries C. Sinusoidal capillaries E. Megacapillaries
B. Fenestrated capillaries D. Metarterioles
1 B 21 B 41 B 61 A 81 D 101 A 121 B
2 D 22 C 42 A 62 C 82 D 102 D 122 A
3 B 23 A 43 E 63 A 83 A 103 C 123 C
4 C 24 D 44 A 64 B 84 C 104 D 124 B
5 B 25 C 45 B 65 C 85 D 105 A 125 C
6 B 26 C 46 A 66 C 86 A 106 B 126 B
7 C 27 D 47 B 67 D 87 E 107 B 127 C
8 A 28 B 48 B 68 A 88 C 108 B 128 A
9 D 29 C 48 A 69 A 89 C 109 B 129 B
10 B 30 A 50 D 70 D 90 D 110 A 130 B
11 B 31 B 51 C 71 B 91 A 111 B 131 D
12 C 32 D 52 B 72 C 92 A 112 C 132 D
13 B 33 B 52 D 73 C 93 C 113 A 133 B
14 D 34 E 54 C 74 D 94 C 114 D 134 A
15 C 35 B 55 D 75 A 95 A 115 A 135 C
16 D 36 E 56 C 76 C 96 D 116 D 136 B
17 A 37 C 57 D 77 A 97 D 117 D 137 D
18 B 38 D 58 A 78 E 98 B 118 C 138 D
19 E 39 D 59 B 79 D 99 D 119 B 139 A
A, E
142 162 C 182 A 202 C 222 C 242 C 262
D, E
143 B 163 B 183 B 203 D 223 A 243 B, C, E 263 A, B, E
MCQs in
Blood Physiology
37
Blood Physiology
1. A fall in plasma albumin concentration would produce increased:
A. Fluid exit from capillaries C. Blood volume
B. Colloidal osmotic pressure D. Fluid entry into the capillaries
14. Chronic blood loss in a person can result in which type of anemia?
A. Hemolytic anemia B. Hypochromic anemia
38
Blood Physiology
C. Megaloblastic anemia D. Aplastic anemia
15. The protein present in the vascular endothelium that combines with thrombin and prevents
intravascular clotting?
A. Plasminogen B. Thrombomodulin C. Thrombosthenin D. Heparin
17. The activation of which clotting factor is crucial for the extrinsic mechanism of blood coagulation?
A. V B. VII C. VIII D. X
18. The rejection of foreign transplanted tissue is caused by:
A. B lymphocyte B. T lymphocyte C. Macrophage D. Natural killer cells
20. Which of the following regulates immune system by the release of cytokines?
A. Plasma cell B. Cytotoxic T cell C. Helper T cell D. B lymphocyte
23. A move to high altitude would trigger which change in the blood?
A. An increased number of reticulocytes C. An increased number of neutrophils
B. A decreased number of reticulocytes D. A decreased number of neutrophils
25. When an infecting organism pierces the skin, which of the following WBCs would quickly migrate out
of the blood vessels and into the tissues to ingest the foreign invader?
A. Basophils B. Eosinophils C. Lymphocytes D. Neutrophils
26. Which of the following WBCs have the longest life span?
A. Neutrophils B. Eosinophils C. Basophils D. Monocytes
28. How would someone experiencing a heart attack caused by a blood clot benefit from a drug that
stimulates the conversion of plasminogen into plasmin?
39
Blood Physiology
A. Plasmin encourages the growth of new blood vessels that can bypass the clot
B. Plasmin increases the oxygen-carrying capacity of RBCs.
C. Plasmin inhibits the formation of new blood clots.
D. Plasmin dissolves the fibrin meshwork around blood clots.
29. What substance, carried by each red blood cell, determines blood type?
A. Antibody B. Antigen C. Hemoglobin D. Globin
30. Which of the following will occur if someone with type A blood receives a transfusion with type B
blood?
A. Leukocytosis B. Polycythemia C. Agglutination D. Fibrinolysis
32. During intrauterine life, formation of the red blood cells begins in:
A. Bone marrow C. Lymph nodes. E. Spleen
B. Liver D. Mesoderm of the yolk sac
36. The white blood cells having receptors for IgE on their membrane are:
A. Basophils. C. Lymphocytes. E. Monocytes.
B. Eosinophils. D. Neutrophils.
38. A blood transfusion reaction is likely to occur if a patient with blood group A+ is transfused with
blood of group:
40
Blood Physiology
A. A+ B. A- C. O+ D. O- E. AB-
39. The hormonal stimulus that prompts red blood cell formation is
A. Serotonin, B. Heparin, C. Erythropoietin, D. Thrombopoietin
42. The white blood cell that releases histamine and other inflammatory chemicals is the
A. Basophil, B. Neutrophil, C. Monocyte, D. Eosinophil
43. Suppose your blood was found to be AB positive. This means that
A. Agglutinogens A and B are present on your red blood cells,
B. There are no anti-A or anti-B agglutinins in your plasma,
C. Your blood is Rh+,
D. All of the above
44. Regarding blood group antigens (agglutinogens), all are false EXCEPT:
A. Carried on the hemoglobin molecule C. Present in fetal blood
B. Beta globulins. D. Inherited as recessive Mendelian characteristics.
45. Regarding breakdown of erythrocytes in the body, all are true EXCEPT:
A. Occurs when they are 17 weeks old
B. Takes place in the reticulo-endothelial system
C. Yields iron, most of which is retained for further use
D. Yields bilirubin which is carried by plasma protein to the liver
E. Is required for the synthesis of bile salts.
62. The appearance of centrifuged blood may suggest the following EXCEPT
A. Anemia is present if there is more plasma than packed cells
B. The plasma lipid level is high
C. The patient has jaundice
D. Hemolysis has occurred
E. The patient has leukemia
65. The hematocrit (packed cell volume), all are true EXCEPT:
A. May be obtained by centrifugation of blood
B. May be calculated by multiplying the mean cell volume by the red cell count
C. Rises in a patient who sustains widespread burns
D. Rises in macrocytic megaloblastic anemia such as pernicious (B12 deficiency) anemia
68. A 40-year-old woman visits the clinic complaining of fatigue. She had recently been treated for an
infection. Her laboratory values are as follows: red blood cell (RBC. count, 1.8 × 10 6 /μl; hemoglobin
(HB., 5.2 g/dL; hematocrit (Hct), 15; white blood cell (WBC. count, 7.6 × 10 3 /μl; platelet count,
320,000/μl; mean corpuscular volume (MCV), 92 fL; and reticulocyte count, 24%. What is the most likely
explanation for this presentation?
A. Aplastic anemia C. Hereditary spherocytosis
B. Hemolytic anemia D. B12 deficiency
70. How many oxygen atoms can be transported by each hemoglobin molecule?
A. 2 B. 4 C. 8 D. 16
71. During the second trimester of pregnancy, where is the predominant site of RBC production?
A. Yolk sac B. Bone marrow C. Lymph nodes D. Liver
72. What function do vitamin B12 and folic acid perform that is critical to hematopoiesis?
A. Support porphyrin production
B. Serve as cofactors for iron uptake
C. Support terminal differentiation of erythroid and myeloid cells
D. Support production of thymidine triphosphate
73. Which phagocytes can extrude digestion products and continue to survive and function for many
months?
44
Blood Physiology
A. Neutrophils B. Basophils C. Macrophages D. Eosinophils
74. During an inflammatory response, what is the correct order of cellular events?
A. Filtration of monocytes from blood increased production of neutrophils activation of tissue
macrophages infiltration of neutrophils from the blood
B. Activation of tissue macrophages infiltration of neutrophils from the blood infiltration of monocytes
from blood increased production of neutrophils
C. Increased production of neutrophils activation of tissue macrophages infiltration of neutrophils
from the blood infiltration of monocytes from blood
D. Infiltration of neutrophils from the blood activation of tissue macrophages infiltration of monocytes
from blood increased production of neutrophils
75. A 45-year-old man presents to the emergency department with a 2-week history of diarrhea that has
gotten progressively worse during the past several days. He has minimal urine output and is admitted to
the hospital for dehydration. His stool specimen is positive for parasitic eggs. Which type of WBC would
have an elevated number?
A. Eosinophils C. T lymphocytes E. Monocytes
B. Neutrophils D. B lymphocytes
76. A 24-year-old man came to the emergency department with a broken leg. A blood test revealed his
WBC count to be 22 × 103 /μl. Five hours later, a second blood test revealed values of 7 × 103 /μl. What is
the cause of the increased WBC count in the first test?
A. Increased production of WBCs by the bone marrow
B. Release of pre-formed, mature WBCs into the circulation
C. Decreased destruction of WBCs
D. Increased production of selectins
77. Where does the transmigration of WBCs occur in response to infectious agents?
A. Arterioles C. Capillaries and venules
B. Lymphatic ducts D. Inflamed arteries
78. An 8-year-old boy frequently comes to the clinic for persistent skin infections that do not heal within
a normal time frame. He had a normal recovery from the measles. A check of his antibodies after
immunizations yielded normal antibody responses. A defect in which of the following cells would most
likely be the cause of the continual infections?
A. B lymphocytes C. Neutrophils E. T lymphocytes
B. Plasma cells D. Macrophages
79. Which cell type in the inflammatory sites can clean up necrotic tissue and direct tissue remodeling?
A. Neutrophil B. Macrophage C. Dendritic cell D. Eosinophil
80. Fluid exudation into the tissue in an acute inflammatory reaction is due to which of the following?
A. Decreased blood pressure D. Increased clotting factors
B. Decreased protein in the interstitium E. Increased vascular permeability
C. Obstruction of the lymph vessels
81. Which statement is true concerning erythroblastosis fetalis (hemolytic disease of the newborn)?
A. HDN occurs when an Rh-positive mother has an Rh-negative child
B. HDN is prevented by giving the mother a blood transfusion
45
Blood Physiology
C. A complete blood transfusion after the first birth will prevent HDN
D. The father of the child must be Rh positive
83. A woman whose blood type is A, Rh positive, and a man whose blood type is B, Rh positive, come to
the clinic with a 3-year-old girl whose blood type is O, Rh negative. What can be said about the
relationship of these two adults to this child?
A. The woman can be the child’s natural mother, but the man cannot be the natural father
B. The man can be the child’s natural father, but the woman cannot be the natural mother
C. Neither adult can be the natural parent of this child
D. This couple can be the natural parents of this child
84. What is the appropriate treatment for an infant born with severe erythroblastosis fetalis?
A. Passive immunization with anti-Rh(D) immunoglobulin
B. Immunization with Rh(D) antigen
C. Exchange transfusion with Rh(D)-positive blood
D. Exchange transfusion with Rh(D)-negative blood
85. Which of the following transfusions will result in an immediate transfusion reaction?
A. O Rh-negative whole blood to an O Rh-positive patient
B. A Rh-negative whole blood to a B Rh-negative patient
C. AB Rh-negative whole blood to an AB Rh-positive patient
D. B Rh-negative whole blood to a B Rh-negative patient
86. Which blood unit carries the least risks for inducing an immediate transfusion reaction into a B-
positive (B, rhesus positive) recipient?
A. Whole blood A positive D. Packed red blood cells O positive
B. Whole blood O positive E. Packed red blood cells AB negative
C. Whole blood AB positive
87. What condition leads to a deficiency in factor IX that can be corrected by an intravenous injection of
vitamin K?
A. Classic hemophilia C. Bile duct obstruction
B. Hepatitis B D. Genetic deficiency in antithrombin III
88. Which transfusion will result in a transfusion reaction? Assume that the patient has never had a
transfusion.
A. Type O Rh-negative packed cells to an AB Rh-positive patient
B. Type A Rh-positive packed cells to an A Rh-negative patient
C. Type AB Rh-positive packed cells to an AB Rh-positive patient
D. Type A Rh-positive packed cells to an O Rh-positive patient
46
Blood Physiology
89. A 55-year-old man who has been undergoing stable and successful anticoagulation with warfarin for
recurrent deep vein thrombosis is treated for pneumonia, and 8 days later he presents with lower
intestinal bleeding. His prothrombin time is quite prolonged. What is the appropriate therapy?
A. Treatment with tissue plasminogen activator
B. Infusion of calcium citrate
C. Treatment with fresh frozen plasma and vitamin K
D. Rapid infusion of protamine (antidote for heparin overdose)
90. A woman whose blood type is A positive and who has always been healthy just delivered her second
child. The father’s blood type is O negative. Because the child’s blood type is O negative (O, Rh negative),
what would you expect to find in this child?
A. Erythroblastosis fetalis due to rhesus incompatibility
B. Erythroblastosis fetalis due to ABO blood group incompatibility
C. Both A and B
D. The child would not be expected to have erythroblastosis fetalis
91. A 2-year-old boy bleeds excessively from minor injuries and has previously had bleeding gums. The
maternal grandfather has a bleeding disorder. The child’s physical examination shows slight tenderness
of his knee with fluid accumulation in the knee joint. You suspect this patient is deficient in which
coagulation factor?
A. Prothrombin activator C. Factor VIII
B. Factor II D. Factor X
92. A patient has a congenital deficiency in factor XIII (fibrin-stabilizing factor). What would analysis of
his blood reveal?
A. Prolonged prothrombin time C. Prolonged partial thromboplastin time
B. Prolonged whole blood clotting time D. Easily breakable clot
94. What would most likely be used for prophylaxis of an ischemic heart attack?
A. Heparin B. Warfarin C. Aspirin D. Streptokinase
95. A 63-year-old woman returned to work after a vacation in New Zealand. Several days after returning
home, she awoke with swelling and pain in her right leg, which was blue. She immediately went to the
emergency department, where examination showed an extensive deep vein thrombosis involving the
femoral and iliac veins on the right side. After resolution of the clot, this patient will require which
treatment in the future?
A. Continual heparin infusion C. Aspirin
B. Warfarin D. Vitamin K
98. Which of the following is appropriate therapy for a massive pulmonary embolism?
A. Heparin C. Aspirin
B. Warfarin D. Tissue plasminogen activator
99. What is the primary mechanism by which heparin prevents blood coagulation?
A. Antithrombin III activation C. Binding available calcium
B. Binding and inhibition of tissue factor D. Inhibition of platelet-activating factor
101. Bleeding from a small cut in the skin, all are true EXCEPT:
A. Is normally diminished by local vascular spasm
B. Ceases within about five minutes in normal people
C. Is prolonged in severe factor VIII (antihemophilic globulin) deficiency
D. Is greater from warm skin than from cold skin
E. Is reduced if the affected limb is elevated
104. The amount of hemoglobin present in 100 ml of red blood cells is called:
A. MCH C. Hb index
B. MCHC D. Price Jones index
115. Red blood cell antigens A and B are also present in:
A. Saliva, and semen B. Amniotic fluid C. Pancreas D. All of the above
120. The protein content of lymph draining from the _______ is highest.
A. Choroid plexus C. Liver
B. Skeletal muscle D. Gastrointestinal tract
122. When a serum sample is electrophoresed, which one of the following bands is absent?
A. Albumin
B. Α1 globulin C. Α2 globulin D. Fibrinogen E. λ-globulin
127. The first cell that can be identified as belongings to RBC series is:
A. Basophil erythroblast C Reticulocyte E. CFU-S.
B. Proerythroblast D. Megaloblast
128. Mast cells and basophils play important role in some types of:
A. Allergic reactions D. Chronic inflammatory diseases
B. Parasitic infections E. Polycythemia
C. Acute infections
132. A 52-year-old man is brought to the Emergency Department with severe chest pain. Angiography
demonstrates a severe coronary occlusion. A thrombolytic agent is administered to reestablish perfusion.
Which of the following does the thrombolytic agent activate?
A. Heparin C. Thrombin E. Prothrombin
B. Plasminogen D. Kininogen
133. A 42-year-old patient with a rare blood type is scheduled for surgery that will likely require a
transfusion. Because the patient has a rare blood type, an autologous blood transfusion is planneD. Prior
to surgery, 1500 mL of blood is collected. The collection tubes contain calcium citrate, which prevents
coagulation by which of the following actions?
A. Blocking thrombin C. Binding vitamin K E. Activating plasminogen
B. Binding factor XII D. Chelating calcium
134. Prior to having his first colonoscopy, a 50-year-old male undergoes a bleeding time test to rule out
any clotting disorders. Bleeding time is determined by nicking the skin superficially with a scalpel blade
and measuring the time required for hemostasis. It will be markedly abnormal (prolonged) in a person
who has which of the following?
A. Anemia C. Thrombocytopenia E. Hemophilia
B. Vitamin K deficiency D. Leukopenia
135. A 67-year-old woman with a history of venous thromboembolism is placed on warfarin (Coumadin)
prophylactically. The blood concentration of Coumadin becomes too high and bleeding occurs. The
bleeding can best be treated by the administration of which of the following?
A. Fibrinogen
B. Thrombin C. Platelets D. Protein C E. Vitamin K
136. A 61-year-old male presents to his family physician with the chief complaint of frequent diarrhea
accompanied by weight loss. He reports a tendency to bruise easily and laboratory data reveal a
prothrombin time of 19 seconds (normal = 11–14 seconds). The bruising and prolonged prothrombin time
can be explained by a decrease in which of the following vitamins?
A. Vitamin A C. Vitamin D E. Vitamin K
B. Vitamin C D. Vitamin E
146. If you have some blood from which the formed elements have been removed, how can you tell if it
is plasma or serum?
A. Plasma contains hemoglobin; serum does not
B. Serum is yellow; plasma has no color
C. Serum contains antibodies; plasma does not
D. Plasma contains clotting proteins; serum does not
148. In which choice are the major groups of plasma proteins listed in order from highest to lowest
percent?
A. Fibrinogen, globulins, albumins C. Albumins, globulins, fibrinogen
B. Globulins, fibrinogen, albumins D. Albumins, fibrinogen, globulins
149. In which choice is the plasma protein correctly matched with one of its functions?
A. Albumin - antibodies involved in immune response
B. Fibrinogen - attacks and destroys pathogens
C. Globulins - transport minerals, lipids, hormones and vitamins
D. Globulins - colloid osmotic pressure
150. The benefit of the biconcave shape of red blood cells is that it
A. Decreases the distance between the cell membrane and hemoglobin molecules, facilitating oxygen
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Blood Physiology
Uptake
B. Allows the cells to hold more hemoglobin
C. Gives more room for the nucleus and organelles
D. Keeps them from leaking out through the walls of capillaries
151. Blood cells all develop from a common stem cell in bone marrow, but early in development they
split into separate lineages. Which three of these cells develop from the myeloblast lineage?
A. Basophil, eosinophil, neutrophil C. Thrombocyte, erythrocyte, lymphocyte
B. Lymphocyte, monocyte, erythrocyte D. Monocyte, erythrocyte, neutrophil
153. Damaged red blood cells are phagocytized by macrophages in the spleen or liver and their
components are Recycled, EXCEPT for the
A. Iron atom from the heme group, which is excreted in bile
B. Globin peptide chains, which are sent to the kidneys for excretion
C. Globin peptide chains, which are converted into bilirubin
D. Heme group (minus the iron atom), which is converted into a green pigment called biliverdin
154. What would you suspect to find if someone has high blood erythropoietin levels?
A. Blood oxygen deficiency C. A high red blood cell count
B. High blood oxygen levels D. A high hemoglobin level
157. The lower the total amount of iron stored in the body,
A. The higher the rate of red blood cell formation
B. The higher the absorption of ingested iron in the intestine
C. The lower the level of transferrin in the blood
D. The higher the level of ferritin in the liver
158. Which blood component is NOT correctly matched with its function?
A. Erythrocytes - transport oxygen
B. Leukocytes - protect against disease
C. Platelets - phagocytize bacteria
D. Plasma proteins - maintain blood osmotic pressure; involved in clotting
159. In which choice are the formed elements arranged in order of increasing size?
A. Red blood cell, neutrophil, platelet C. Neutrophil, platelet, red blood cell
B. Platelet, red blood cell, neutrophil D. Platelet, neutrophil, red blood cell
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Blood Physiology
160. In adults, red blood cells are made in one place, spend most of their lifespan in another, and most
are finally destroyed in yet another place. Which choice lists these locations in chronological order?
A. Bone marrow; blood vessels; spleen C. Spleen; blood vessels; spleen
B. Bone marrow; spleen; blood vessels D. Blood vessels; spleen; bone marrow
162. Joe had to have both of his kidneys removed and is now kept alive only by dialysis machines that
remove waste molecules from his blood and adjust electrolyte levels. Because Joe has no remaining
kidney tissue, he may also need
A. Clotting proteins C. Erythropoietin to stimulate RBC production
B. Vitamin B12 to stimulate RBC production D. A bone marrow transplant
165. What is the role of the nitric oxide (NO) carried by hemoglobin?
A. NO stimulates the formation of more red blood cells
B. NO relaxes blood vessels and decreases blood pressure
C. NO helps the hemoglobin binds to oxygen
D. NO prevents the hemoglobin from picking up carbon monoxide
171. Immature erythrocytes that contain a network of endoplasmic reticulum and normally make up
about 1 - 3% of circulating blood are called
A. Granulocytes C. Proerythroblasts
B. Basophilic erythroblasts D. Reticulocytes
173. In which choice are the leukocytes correctly arranged in order from most common to least
common?
A. Monocytes, lymphocytes, neutrophils, eosinophils, basophils
B. Lymphocytes, neutrophils, monocytes, eosinophils, basophils
C. Neutrophils, monocytes, lymphocytes, basophils, eosinophils
D. Neutrophils, lymphocytes, monocytes, eosinophils, basophils
174. Once released from the bone marrow into the circulation, the average life span of a red blood cell is
about
A. 72 hours B. One week C. 4 months D. 2 years
178. Red blood cells do not use any of the oxygen that they carry, because
A. Oxygen is bound to heme and cannot be removed
B. They lack mitochondria to use oxygen for aerobic respiration
C. They do not need ATP
D. They use carbon dioxide instead of oxygen for energy production
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Blood Physiology
179. In which choice are the proteins listed in the order in which they are activated?
A. Prothrombin activator, thrombin, fibrin
B. Fibrin, thrombin, prothrombin activator
C. Thrombin, fibrin, prothrombin activator
D. Thrombin, prothrombin activator, fibrin
180. Platelet plug formation is initiated when platelets come into contact with
A. Undamaged endothelial cells C. Subendothelial collagen fibers
B. Fibrinogen D. Antithrombin
183. After preliminary testing, a man who had had a stroke was given tissue plasminogen activator (tPA)
at the hospital. The reason for this treatment is that tPA
A. Activates an enzyme that dissolves clots
B. Prevents the formation of clots by removing calcium from the blood
C. Prevents the formation of thrombin
D. Initiates repair in damaged blood vessels
184. A blood clot that forms in an undamaged vessel is called a(n) _______, and if it breaks loose and
travels through the bloodstream it is called a(n) __________.
A. Hematoma; thrombosis C. Thrombus; embolus
B. Thrombus; hematoma D. Embolus; thrombus
189. During platelet plug formation, platelets release these substances, which cause more platelets to
adhere to the plug.
A. Prostacyclin and NO C. Heparin and plasmin
B. Erythropoietin and bilirubin D. ADP and thromboxane
191. During platelet plug formation, platelets release these substances, which cause more platelets to
adhere to the plug.
A. Prostacyclin and NO C. Heparin and plasmin
B. Erythropoietin and bilirubin D. ADP and thromboxane
193. The term that refers to the percentage of packed erythrocytes per unit volume of blood is the:
A. Differential Count B. Hemoglobin C. Hematocrit D. Hemopoiesis
194. Which of the following is a circulating blood cell that is capable of differentiating into a plasma cell?
A. Neutrophil C. B lymphocyte E. Monocyte
B. Basophil D. T lymphocyte
195. The component of plasma responsible for maintaining the osmotic pressure of blood is:
A. Plasmin C. Fibrinogen E. Plasminogen activator
B. Albumin D. Gamma globulin
196. Erythrocytes:
A. Enter the circulation only after becoming fully mature
B. Undergo mitosis in the circulation in response to erythropoietin
C. Are removed from the circulation after about 120 days by macrophages in the spleen, liver, and bone
marrow
D. Have mitochondria and are capable of oxidative respiration
E. None of the above
200. During hemoglobin recycling in the spleen, heme is initially converted into:
A. Bilirubin B. Stercobilin C. Urobilin D. Urobilinogen
207. The phase of coagulation that begins with exposed endothelial collagen is the:
A. Extrinsic pathway C. Common pathway
B. Intrinsic pathway D. Fibrin stabilization phase
208. An individual with type B+ blood has which of the following antibodies in their blood?
A. anti-A and anti-O C. anti-A E. anti-Rh
B. anti-B and anti-Rh D. anti-B
209. Which of the following blood cells have some properties similar to connective tissue mast cells?
A. Basophils B. Neutrophils C. Eosinophils
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Blood Physiology
D. Lymphocytes E. Monocytes
210. Examples of erythrocytes can be found in almost all histological sections. Therefore, knowledge of
the approximate diameter of a red blood cell is useful because it can serve as a built-in ruler on the tissue
section. Which of the following best describes the diameter of red cells?
A. 5-6um C. 7-8um E. 9-10um
B. 6-7um D. 8-9um
216. Platelets:
A. Stick to the damaged area of a blood vessel and help to seal the break
B. Have a lifespan of about 120 days
C. Are the precursors of leukocytes
D. Have multiple nuclei
E. Two of the above
217. Fred's blood type was determined to be AB+. Which of the following is true of Fred's blood?
A. There are no antibodies to antigens A, B, or Rh in the plasma
B. The RBCs contain the A and B antigens on their nuclei
C. The blood totally lacks the Rh factor
D. He cannot receive blood from someone who is type O negative
221. The plasma component that forms the fibrous skeleton of a clot is:
A. Platelets B. Fibrinogen C. Thromboplastin D. Thrombin
223. If Jack has type O+ blood, then which of the following is true?
A. He has no agglutinins at all C. He has no Rh agglutinogens
B. He has no A agglutinogens D. None of the above
226. Which of the following people would have the most anti-B antibodies?
A. An adult male with B+ blood C. An adult female with B-blood
B. An adult male with O- blood D. A female child with AB+ blood
227. If a newborn was blood type O+, which of the following would his blood not contain?
A. Anti-B antibodies
B. Anti-A antibodies
C. Anti-Rh antibodies
D. Erythrocytes which express neither the A nor the B antigen
229. In a sample of centrifuged blood, the layer immediately beneath the plasma:
A. Can contain neutrophils C. Is called the buffy coat
B. Can contain platelets D. All of the above
231. If you observed a white blood cell with a light microscope and noticed the presence of granules,
how would you classify it?
A. Granulocyte C. It could be either of the above
B. Agranulocyte D. It could be neither of the above
235. The stem cells that give rise to all red blood cells, white blood cells, and platelets are known as:
A. Hemocytoblasts C. Hemophilioblasts
B. Reticulocytes D. Myeloid stem cells
239. Which of the following females does not have to be concerned with erythroblastosis fetalis?
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Blood Physiology
A. A female with blood type OB. A female with blood type B+
A female with blood type O+ E. More than one of the above
C. A female with blood type ABD.
240. Which of the following is the most important function of plasma albumin:
A. acting as antibodies
B. contributing to the clotting process
C. contributing to the effective osmotic pressure of plasma
D. acting as binding proteins for thyroid and steroid hormones
241. Which of the following substances makes the greatest contribution to the osmolarity of plasma
(normally about 290 mOsm/L)?
A. protein C. electrolytes (E.g. Na+, Cl−, HCO3−)
B. glucose D. red blood cells
242. Which of the following substances comprise the greatest amount of solute in plasma by weight?
A. electrolytes (E.g. Na+, Cl−, HCO3−) C. glucose
B. protein D. amino acids
243. The hematocrit is a rough measure of the proportion of which of these components of blood?
A. plasma proteins B. deoxyhemoglobin C. red blood cells D. osmotic pressure
244. Which of the following substances is present in plasma but not in serum?
A. globulins B. fibrinogen C. erythrocytes D. inorganic ions
245. Although most of the dissolved solute in plasma by weight is proteins, most of the osmolality of
plasma is provided by its content of inorganic ions. This is because:
A. inorganic ions are charged particles
B. the molarity of inorganic ions in plasma is much greater than the molarity of the proteins
C. inorganic ions cannot pass through capillary walls
D. inorganic ions tend to hydrogen bond with adjacent water molecules
246. When analyzing the osmotic forces acting across the wall of the capillary, plasma albumin is the
greatest contributor even though inorganic ions make the most important contribution to plasma
smolality. This is because:
A. the weight of protein in plasma is greater than the weight of inorganic ions
B. the molecular weights of proteins is greater than the molecular weights of inorganic ions
C. proteins do not carry an electrical charge
D. the capillary wall is not permeable to protein
248. Which of the following conditions would stimulate the synthesis and release of erythropoietin?
A. breathing 100% oxygen C. increasing the dietary intake of iron
B. living at high altitude D. giving an infusion of 500 ml of whole blood
249. Erythropoietin:
A. is secreted by red bone marrow B. stimulates erythrocyte synthesis
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Blood Physiology
C. is a component of hemoglobin D. all of the above
250. The synthesis and release of erythropoietin is increased in a person who goes to live at high altitude
because the:
A. cardiac output is increased C. partial pressure of oxygen in blood is less
B. hematocrit is increased D. alveolar ventilation rate is increased
252. Erythrocytes:
A. Synthesizes and release erythropoietin
B. have about a 7 day survival time after release into the blood
C. have an abundant supply of mitochondria
D. have a higher cellular concentration of potassium than is in plasma
253. Erythropoietin:
A. is a paracrine C. acts on the spleen
B. is synthesized by the spleen D. is elevated in persons living at high altitude
257. Plasmin;
A. Dissolves fibrin C. Is inhibited by protein C.
B. Is converted to plasminogen D. None of the above is true
261. Thrombin;
A. Is activated by thrombomodulin C. Inhibits platelet aggregation
B. Activates factors V, VIII, and XIII D. Is inhibited by warfarin
262. Polycythemia;
A. Increases the viscosity of blood
B. Can result from increased erythropoietin production
C. Can occur in someone who goes to live at high altitude
D. All of the above are true
267. Concerning white blood cells, all the following are False EXCEPT;
A. Monocytes after entering the tissues become macrophages
B. Eosinophil count is increased in viral infections
C. B. lymphocytes are responsible for cellular immunity
D. Helper T- cells suppress humoral immunity
268. The intrinsic pathway of blood coagulation begins with the activation of;
A. Factor VII B. Factor XII C. Prothrombin D. Fibrinogen
272. For blood clotting to occur normally, which of the following is False?
A. Calcium ions must be present
B. The liver must have an adequate supply of vitamin K.
C. There must be a sufficient dietary intake of vitamin C.
D. The liver must be functioning properly
273. Leukocytosis:
A. Is always due to pathological causes
B. Can be caused by exercise
C. Occurs when total white blood cell count is less than 4000/ microliter of blood
D. None of the above is true
274. Increased amounts of erythropoietin might be released from kidney EXCEPT when the:
A. Arterial PO2 is normal and the arterial O2 content is reduced
B. Arterial PO2 and arterial O2 content are reduced
C. Arterial PO2 is low and the saturation of hemoglobin with oxygen is much reduced
D. Tissue PO2 and renal blood flow are both increased
276. Related to hemostasis and blood coagulation, all the following are true EXCEPT:
A. Thrombin decreases platelets aggregation
B. The coagulation mechanism can be initiated through the intrinsic or extrinsic pathway
C. Platelets are necessary for clot retraction to occur
D. Protein C has anticoagulant and fibrinolytic effects
277. Related to the plasma proteins, all of the following are true EXCEPT:
A. They include certain clotting factors
B. They can act as a source for rapid replacement of the tissue proteins
C. They are manufactured only in the liver,
D. They participate in the buffering capacity of the blood
280. Factor XIII and another plasma factor are necessary for the:
A. Activation of prothrombin C. Stabilization of fibrin
B. Conversion of fibrinogen into fibrin monomer D. Conversion of prothrombin into thrombin
281. Microcytic hypochromic type of anemia is most probably caused by a deficiency of:
A. Vitamin B12 B. Intrinsic factor C. Folic acid D. Iron
285. Normal platelets count and life span in the blood are:
A. 100000/cu.mm - 40 days C. 500000/cu.mm – 129 days
B. 150000/cu.mm – 60 days D. 250000/cu mm – 10 days
286. The most commonly used clinical index of erythropoietic activity in the blood is:
A. RBC level C. Reticulocytes level
B. Hb concentration D. Iron level
287. Fetal hemoglobin has more affinity to O2 than adult hemoglobin because:
A. HbF binds less avidly to 2,3 DPG.
B. HbA binds less avidly to 2,3 DPG.
C. HbF has its alpha chain replaced by S chain
D. HbF has its beta chain replaced by Epsilon chain
288. When MCV is 110 µm3 and MCHC is 20% the cells are:
A. Microcytic hypochromic C. Macrocytic hyperchromic
B. Macrocytic hypochromic D. Normocytic normochromic
289. The common pathway of intrinsic and extrinsic mechanisms of blood coagulation is started with the
activation of:
A. Factor IX B. Factor XI C. Factor VII D. Factor X
293. The stored iron in the body which can be used again on demand is in a form of:
A. Transferrin B. Hemosiderin C. Ferritin D. Protoporphyrin
295. what is the MCV of RBCs for the following given data? PCV = 45%, RBC count = 5,340,000/ul, Hb =
15.6 gm/dL.
A. 84.2 fl B. B. 85.2 fl C. C. 86.2 fl D. D. 87.2 fl
296. what is the MCHC of RBCs for the following given data: PCV = 45%, RBC count = 5,340,000/ul, Hb =
15.6 gm/dL.
A. 30.1%. C. 32.9%. E. 34.7%.
B. 31.6%. D. 33.4%.
300. A 24 year old African American man comes to the emergency room 3 hours after the onset of severe
back and chest pain which started when he was climbing up a mountain. He had an episode of same
symptoms five years ago. His values are Hb: 11 g/dL, Total WBC count: 12,000/mm3, Reticulocyte count:
25%. What is the diagnosis of this patient?
A. Acute blood loss D. End stage kidney disease
B. Sickle cell anemia E. Chronic blood loss
C. Anemia of chronic disease
304. Which of the following blood units carries the least risk of inducing an immediate reaction in a type
B, Rh+ patient?
A. Type A +ive whole blood D. Type O +ive packed red cells
B. Type O +ive whole blood E. Type AB –ive packed red cells
C. Type AB +ive whole blood
307. A 30 years old male is brought to the hospital with history of gastrectomy. His skin appears lemon-
yellow. Investigations reveal hemoglobin 10 g/dL, odd shaped RBCs and Serum Vitamin B12 is low. He is
likely to be suffering from:
A. Blood Loss Anemia C. Megaloblastic Anemia E. Aplastic Anemia
B. Pernicious Anemia D. Hemolytic Anemia
309. Ahmad`s blood picture revealed macrocytic anemia of the following type:
A. Sickle cell anemia D. Bone marrow aplasia
B. Hereditary spherocytosis E. Pernicious anemia
C. Blood loss anemia
310. Ghazala was diagnosed as a case of classic hemophilia. The best possibility is that:
A. One of her X chromosomes code for deficiency of Factor VIII
B. Her mother was a hemophilia carrier
C. Her autosomes carry the mutant gene for hemophilia
D. She is suffering from von Willebrand’s disease
E. Her father had hemophilia & mother was a hemophilia carrier
311. A young boy was brought to hospital emergency with complaint of acute pain in right iliac fossa. On
history, examination & clinical investigation, he was diagnosed to have acute appendicitis. His Total WBC
count (per µL) is likely to be:
A. 4,000 C. 8,000 E. 14,000
B. 6,000 D. 10,000
312. A 34-year-old man with schizophrenia has chronic fatigue for 6 months. He has a good appetite but
has developed a dislike for vegetables since last 1 year because he hears voices that tell him that the
vegetables are poisoned. His physical and neurological examinations are normal. His hemoglobin level is
9.1 g/dL, leukocyte count is 10,000/mm and Mean Corpuscular Volume is 122 fl (normal 77-93 fl). Which
of the following is the most likely diagnosis?
A. Acute blood loss C. Hemolytic anemia E. Sickle cell anemia
B. Aplastic anemia D. Folic acid deficiency
313. By the age of 7 months, the primary site of hematopoiesis in a fetus is:
A. Thymus C. Spleen E. Red marrow
B. Liver D. Reticuloendothelial system
315. Polycythemia:
A. Is associated with decrease in blood viscosity
B. May cause an increase in the mass of RBCs in blood
C. Is seen with increase in ESR.
D. Is a contagious disease
320. A lady presented with shock due to post-partum hemorrhage, her blood group was unknown but
became coagulated when mixed with serum containing anti-A antibodies and similarly her serum
coagulated with B positive blood. The most suitable blood group to be transfused in this case is:
A. O negative C. A positive E. B positive
B. O positive D. AB positive
321. A blood smear shows hypochromic, microcytic RBCs with moderate poikilocytosis. Most likely
diagnosis is:
A. Anemia of chronic disease D. Iron deficiency anemia
B. Autoimmune hemolytic anemia E. Microangiopathic hemolytic anemia
C. Folate deficiency anemia
322. A young boy complaining of tiredness and shortness of breath is diagnosed with anemia. His blood
picture shows microcytic and hypochromic anemia with normal count of WBCs & platelets & normal
shape of RBCs. This picture is seen in:
A. Aplastic anemia C. Megaloblastic anemia E. Thalassemia
B. Sickle cell anemia D. Blood loss anemia
323. A survivor of the Hiroshima blast during the Second World War presented to hospital with pale look
and purplish patches on the thin skin area. His hemoglobin is below normal. He is most likely suffering
from:
A. iron deficiency anemia C. megaloblastic anemia E. aplastic anemia
B. sickle cell anemia D. hereditary spherocytosis
324. Nori, a pure vegetarian comes to doctor with complaint of exertional dyspnea. On examination he
has pallor. Initial lab tests show Hb 7.4 g/dL, MCV is 115 fL. What is the most probable cause of
megaloblastic anemia in this patient?
A. Folic acid deficiency C. Iron deficiency E. G6PD deficiency
B. Vitamin B12 deficiency D. Hemolysis
325. Asim, a 5 years old boy falls from his bicycle and receives a cut over the knee. His tissue
macrophages & fibroblasts will move to the site of injury for repair by:
A. Ciliary movement C. Chemotaxis E. Whip- like movement
B. Ameboid movement D. Margination
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Blood Physiology
326. Long term hypoxia may serve as a growth inducer of the following blood cells:
A. Basophils C. Macrophages E. Platelets
B. Monocytes D. Red blood cells
327. Red blood cells can pass from bone marrow to blood capillaries by diapedesis during:
A. Basophil erythroblast stage D. Proerythroblast stage
B. Mature erythrocyte stage E. Orthochromatic erythroblast stage
C. Reticulocyte stage
329. This is a process which removes unneeded cloth when healing has occurred. Without this, blood
vessels would gradually become completely blocked.
A. Hematopoiesis D. Leukopenia
B. Fibrinolysis E. Thrombocytopenia
C. Leukopoiesis
330. This blood disease where hemoglobin becomes spiky and sharp due to a change in just one of the
287 amino acids in a beta chain of a globin molecule. These wrongly shaped blood cells tend to rupture
easily and dam up blood vessels, preventing accurate oxygen flow to the body.
A. Infectious Mononucleosis C. Thrombocytopenia E. Hemophilia
B. Leukemia D. Sickle-Cell Anemia
332. This type of lymphocyte functions in the immune response by acting directly against virus-infected
cells and tumor cells.
A. Neutrophils C. Monocytes E. Lymphoblasts
B. T-cells D. B-cells
334. This type of lymphocyte gives rise to plasma cells, which produce antibodies that are released into
the blood.
A. Neutrophils C. Monocytes E. Lymphoblasts
B. B cells D. T cell
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Blood Physiology
340. Meaning "leaping across," this term refers to the ability of WBCs to slip out of capillary blood
vessels.
A. Thrombocytopenia C. Leukopoiesis E. Diapedesis
B. Leukopenia D. Fibrinolysis
341. This is a bleeding disorder where the number of circulating platelets is deficient, causing
spontaneous bleeding from small blood vessels all over the body.
A. Erythropenia C. Leukemia E. Diapedesis
B. Leukopenia D. Thrombocytopenia
342. This term refers to several different hereditary bleeding disorders that involve prolonged bleeding
into tissues from even minor tissue trauma, which can be life threatening.
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Blood Physiology
A. Anemia C. Hemophilia E. Diapedesis
B. Leukemia D. Thrombocytopenia
343. The percentage of a blood's individual formed elements in comparison to the blood as a whole is
known as:
A. An embolism C. An embolus E. A thrombus
B. The hematocrit D. The heparin
344. This is composed largely of a soft network of reticular connective tissue bordering on wide blood
capillaries. It produces different numbers of each blood type as needed in response to body needs and
regulatory factors.
A. Kidneys C. Liver E. Leukocyte
B. White bone Marrow D. Red Bone marrow
345. This is a drug that inhibits thromboxane A2 formation. Studies show that, over several years, men
taking low doses of this showed a 50% reduction in incidences of heart attack.
A. Embolus C. Protein C E. Vitamin C
B. Thromboxan D. Aspirin
347. This type of agranulocyte contains a "U" shaped nucleus. They differentiate into macrophages
which protect against viruses, certain intracellular bacterial parasites, and chronic infections.
A. Lymphocyte C. Neutrophil E. Eosinophil
B. Monocyte D. Basophil
351. Which of the following is most likely to give rise to a megaloblastic type of anemia?
A. Dietary deficiency of iron D. Excessive red cell destruction
B. Surgical removal of ileum E. Irradiation of bone marrow
C. Chronic blood loss
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Blood Physiology
352. Which of the following is best applicable to normal erythrocytes?
A. They are rigid biconcave disks
B. About 10% contain nuclear material
C. They contain carbonic anhydrase
D. They release erythropoietin when destructed
E. They are larger than white cells
353. A WBC count 16000 mm3 with 72% polymorphonuclear leucocytes indicates
A. Normal state C. A chronic illness E. Dehydration
B. Acute infection D. Bone marrow failure
355. Which of the following plasma proteins is synthesized outside the liver?
A. Albumin C. α and β globulin E. prothrombin
B. Fibrinogen D. γ globulin
356. What would happen to red blood cells if the heme group were removed from hemoglobin?
A. Red blood cells would not be able to bind oxygen
B. Red blood cells would not be able to reproduce
C. White blood cells would not be able to reproduce
D. Blood clot formation would be inhibited
360. The process of coagulation is classically divided into how many pathways?
A. 3 B. 5 C. 2 D. 4
361. Select the statement about red blood cells that is incorrect.
A. Mature red blood cells lack nuclei C. Deoxyhemoglobin carries oxygen
B. Red blood cells contain hemoglobin D. Red blood cells lack mitochondria
363. When red blood cells are worn out, part of their components are recycled while others are
disposed. Select the incorrect statement about destruction of red blood cells.
A. The greenish pigment, biliverdin, is recycled to the bone marrow
B. Iron is carried to the bone marrow by a protein called transferrin
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Blood Physiology
C. Biliverdin and bilirubin impart color to bile
D. Macrophages in the liver and spleen destroy worn out red blood cells
364. Which dietary component(s) is/are needed for DNA synthesis, and thus greatly influence the
production of red blood cells?
A. Calcium C. Vitamin B12 and folic acid
B. Iron D. Protein
365. The type of anemia that is fairly common and caused by insufficient dietary iron is ______________.
A. Aplastic anemia C. Hemolytic anemia
B. Pernicious anemia D. Iron deficiency anemia
366. The type of white blood cell that is often the first to arrive at the site of infection is a granulocyte,
and the member of this group that stains light purple is a _______________.
A. Basophil B. Eosinophil C. Neutrophil D. Monocyte
367. The largest cells in the blood that leave the bloodstream to become macrophages are the
_______________.
A. Eosinophils B. Monocyte C. Basophil D. Neutrophil
368. A person with eosinophilia, or greater than normal numbers of eosinophils, is most likely suffering
from ____________.
A. Allergies or internal parasites C. An autoimmune disease
B. Anemia D. Diabetes
372. Which clotting factor is released from damaged tissue, and initiates a chain of clotting events?
A. Prothrombin C. Fibrin
B. Thrombin D. Tissue thromboplastin
373. A person with type AB blood would have ____________ antigens on red blood cells, and
___________ antibodies carried in the plasma.
A. A and B; neither anti-A or anti-B C. B; anti-A
B. Neither A nor B; both anti-A and anti-B D. A; anti-B
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Blood Physiology
374. Erythroblastosis fetalis, also known as hemolytic disease of the newborn, most often occurs in
______________ mothers carrying ______________ fetuses.
A. Rh+; Rh- C. Type A; type O
B. Rh-; Rh+ D. Type B; Type A
378. In a young female having iron deficiency, her blood tests show hemoglobin=8 g/dL, MCV=75 fl,
MCH=26 pg, MCHC= 28 g/dL. The type of anemia she is suffering from:
A. Hypochromic normocytic D. Normochromic microcytic
B. Hypochromic microcytic E. Normochromic macrocytic
C. Normochromic normocytic
383. ____________________ are activated by antigen fragments complexed with MHC II proteins.
A. CD8 T cells B. CD4 T cells C. CD8 B cells D. CD4 B cells
384. ____________________ are activated by antigen fragments complexed with MHC I proteins.
A. CD8 T cells B. CD4 T cells C. CD8 B cells D. CD4 B cells
385. Which of the following antibodies is able to confer natural passive immunity?
A. IgD B. IgE C. IgG D. IgM
393. In situation A, you have the body cells displaying class I MHC proteins. In situation B, you have the
body cells displaying class II MHC proteins.
A. in A > in B B. in A < in B C. in A = in B
395. T cells bearing the CD4 surface glycoprotein are known as Helper T cells and only bind to antigens
linked to class II MHC proteins.
A. This statement is true
B. This statement is false because helper T cells display the CD8 glycoprotein
C. This statement is false because helper T cells only bind to antigens linked to class I MHC proteins
399. Which of the following is the typical site of T and B cell activation?
A. Red marrow C. Lymph nodes E. All of the above
B. Thymus D. Lymph vessels
401. Complement:
A. Interferes with viral replication C. Aids in antigen presentation
B. Is involved in antibody production D. Causes cell lysis
402. Regarding IgG and IgM, all the following are true EXCEPT:
A. IgM is a pentamer while IgG is a monomer D. IgG has 2 antigen-binding sites while IgM has 10
B. IgM is found in lower amounts in the serum E. IgG is made by plasma cells while IgM is not
C. IgG can cross the placenta while IgM cannot
404. The following may be found in normal adult venous blood EXCEPT:
A. 0.5% carboxyhemoglobin C. 70% oxyhemoglobin
B. 1% methemoglobin D. 5% fetal hemoglobin
444. Which of the following is NOT correctly matched with its function?
A. Albumin – maintains plasma osmotic pressure D. Thrombin – involved in fibrin production
B. Transferrin – transports heme within the plasma E. Ferritin – storage of iron in the liver
C. Hemoglobin – transports oxygen
445. Which of the following would be the greatest source of blood viscosity?
A. Basophils C. Reticulocytes E. Lymphocytes
B. Erythrocytes D. Thrombocytes
447. Which of the following contains granules filled with histamine and heparin?
A. Erythrocyte C. Eosinophil E. None of the above
B. Basophil D. Thrombocyte
450. If an individual’s intact endothelial cells were unable to secrete prostacyclin, his platelet plugs
would most likely be:
A. Larger than normal D. Composed primarily of leukocytes
B. Smaller than normal E. Both C and D are correct
C. Still normal
451. Which of the following is LEAST involved in the normal coagulation process?
A. Calcium chelators C. Prothrombin activator E. Fibrinogen
B. Vitamin K D. Calcium
454. Which of the following would cause a rise in plasma bilirubin levels?
A. Inability to secrete bile
B. Excessive destruction of white blood cells
C. The presence of vitamin K producing bacteria in the colon
D. Deficiency of erythropoietin
455. A deficiency in _________ could cause clotting problems, while a deficiency in ________ could
cause anemia.
A. Iron: Cobalt C. Copper: Manganese E. Calcium: Iron
B. Calcium: Ferrenium D. Sodium: Iron
458. The movement of white blood cells towards a chemical known as LPS would be an example of
________________________.
A. Diapedesis C. Amoebeosis E. None of the above
B. Positive chemotaxis D. Amphoteris
459. Which of the following WBCs contains granules filled with chemicals involved in the inflammatory
process?
A. Basophils C. Platelets E. Eosinophils
B. Lymphocytes D. Neutrophils
460. _______ is produced quickly by the _______ clotting mechanism and slowly by the __________
clotting mechanism.
A. Prothrombin activator – extrinsic – intrinsic D. Thrombin – intrinsic – extrinsic
B. Prothrombin activator – intrinsic – extrinsic E. Plasmin – intrinsic – extrinsic
C. Thrombin – extrinsic – intrinsic
461. Which of the following events associated with coagulation occurs LAST?
A. Clot retraction D. Formation of prothrombin activator
B. Fibrinolysis E. Formation of thrombin
C. Formation of fibrin
462. Which of the following leukocytes exerts the most control over the immune system?
A. Neutrophils C. Granulocytes E. Monocytes
B. Basophils D. Lymphocytes
463. Which of the following is NOT a site of erythropoiesis in the adult male?
A. Liver D. Ribs
B. Proximal epiphysis of the humerus E. Proximal epiphysis of the femur
C. Sternum
466. Art vanDelay has a blood volume of 5 L. 59% of his blood is composed of RBCs. 1% of his blood is
composed of WBCs and platelets. How many liters of water does his blood contain?
A. 1 L B. 1.8 L C. 2 L D. 2.4 L E. 2.7 L
469. Hematocrit:
A. Would be expected to decrease in polycythemia
B. Would be expected to increase due to hemolytic anemia
C. Is typically between 28% and 48% in normal adult males
D. Could be increased due to an increase in erythropoietin release by the kidney
E. Is defined as the percentage of plasma that is occupied by packed red blood cells
477. Erythropoiesis:
A. Occurs in the yellow bone marrow
B. Is stimulated only by the hormone thrombopoietin
C. Includes cells known as hemocytoblasts, reticulocytes, and erythrocytes
D. Is always stimulated when blood oxygen content is increased
E. None of the above
478. Leukocytes:
A. Are also known as lymphocytes and function in immunity
B. Are capable of moving toward chemicals released by pathogens
C. Are normally found in blood at a count of 5,000-10,000 per 10ml of blood
D. Are formed in the red bone marrow from stem cells known as erythroblasts
E. Are primarily found within the bloodstream and rarely found in connective tissue
481. Blood:
A. Is classified as a combination of epithelial and connective tissues
B. Has an average pH of 7.4, making it very acidic
C. Is 90% water
D. Has an average temperature of 30.9°C
E. None of the above is correct
486. Hemoglobin:
A. Transports oxygen but not carbon dioxide D. Can bind both oxygen and carbon monoxide
B. Is contained within the nucleus of the mature RBC E. 2 of the above are true
C. Contains no metals
494. The shape of a red blood cell can best be described as _____________. One advantage of that
shape is that _______________________.
A. Biconcave: it makes the red blood cell more flexible
B. Spherical: it allows the red blood cell to maximize its organelle content
C. Biconcave: it compresses the red blood cell’s nucleus to allow for more frequent DNA transcription
D. Stellate: it increases the red blood cell’s surface area
E. None of the above is correct
495. Suppose a red blood cell contains 1 million molecules of hemoglobin. How many molecules of iron
does it contain?
A. 250,000 B. 1 million C. 4 million D. 10 million E. 1 billion
500. All of the following would be considered normal pH values for blood EXCEPT:
A. 7.35 C. 7.86 E. 2 of the above
B. 7.44 D. 7.02
503. Which of the following indicates the relative number of formed elements in a microliter of blood?
A. RBCs > WBCs > Platelets D. Platelets > RBCs > WBCs
B. RBCs > Platelets > WBCs E. None of the above is correct
C. WBCs > Platelets > RBCs
510. Globulins produced by plasma cells function as __________, while albumin is important for
__________.
A. Clotting factors; osmotic pressure D. Clotting factors; heat transport
B. Antibodies; oxygen transport E. Leukocytes; clotting
C. Antibodies; osmotic pressure
511. During hemoglobin recycling, iron is transported to the liver by ___________ and stored there as
____________.
A. Transferrin – ferritin D. Transferrin – albumin
B. Ferritin - transferrin E. Basophils – hemoglobin
C. Albumin – transferrin
512. Prostacyclin is released by ____________ cells lining a blood vessel and it functions by __________
platelets.
A. Healthy – repelling D. Damaged – attracting
B. Damaged – repelling E. Damaged – destroying
C. Healthy – attracting
513. During the vascular spasm phase of hemostasis, the __________ muscles in the wall of the
damaged blood vessel will __________. This causes blood vessel diameter to _________.
A. Skeletal – contract – increase D. Smooth – relax – increase
B. Skeletal – relax – decrease E. Smooth – contract – increase
C. Smooth – contract – decrease
516. Which of the following organs produces most of the plasma proteins?
A. Spleen C. Kidney E. White bone marrow
B. Liver D. Red bone marrow
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Blood Physiology
517. Which of the following is most necessary for coagulation?
A. Vitamin A C. Vitamin E E. Vitamin Z
B. Vitamin D D. Vitamin K
519. The following are true about the ABO and rhesus (Rh) system:
A. A person of group O is a universal donor
B. A person who is group AB has anti-A and anti-B antibodies
C. The presence of the D antigen means that the subject is Rh positive
D. Rhesus antibodies occur naturally
E. The second rhesus positive baby of a Rh negative mother is at a greater risk than the first
521. When neutrophils and macrophages squeeze out of capillaries to fight off infection it is called:
A. Phagocytosis C. Interleukin E. Folliculitis
B. Hemolysis D. Diapedesis
522. During a great battle between your WBC's and an aggressive microbe, an inflammatory response
has been initiated redness and edema has kicked in what else does the body do to protect itself?
A. Histamine cause vasodilation D. Living and dead WBC and bacteria accumulate
B. Hypothalamus raises the thermostat E. All of the above
C. Neutrophils engulf and destroy the microbe
523. Specificity and memory are associated with which body defense mechanism?
A. Inflammatory response
B. Phagocytosis by macrophages and neutrophils
C. Interferon
D. T cell and B cell responses
E. Anatomical barriers in the body
529. A foreign substance, usually a protein that stimulates the immune system to react, such as by
producing antibodies is a ______________.
A. Allergen C. Histamine E. Interferon
B. Antigen D. Mast cell
530. When a macrophage ingests invading bacteria and takes the antigen to a lymph node, what
happens next?
A. The macrophage will present it to the first B-cell it encounters, and the B-cell will in turn change its
surface receptors to match the antigen
B. A b-cell will only become activated if it already has a match for the antigen
C. A matching B-cell will become activated into a cytotoxic T-cell
D. The cells of the lymph node will release histamine
E. The lymph node will increase production of neutrophils
531. What is the most common portal of entry for diseases, into the body?
A. Respiratory system C. Hematocrit system
B. Endocrine system D. Any opening into the body
532. This gland shrinks in size during adulthood, and has hormones that function in maturation of T-
lymphocytes:
A. Lymph nodes B. Thymus C. Spleen D. Tonsils
533. Which of the following is not a mechanical factor to protect the skin and mucous membranes from
infection?
A. Layers of cells B. Tears C. Saliva D. Lysozyme
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Blood Physiology
1 A 21 C 41 B 61 E 81 D 101 C 121 E
2 A 22 D 42 D 62 A 82 D 102 C 122 D
3 C 23 A 43 D 63 A 83 D 103 C 123 A
4 B 24 A 44 C 64 A 84 D 104 B 124 A
5 B 25 D 45 E 65 D 85 B 105 C 125 C
6 A 26 D 46 C 66 A 86 D 106 C 126 E
7 A 27 C 47 D 67 A 87 C 107 D 127 B
8 D 28 D 48 D 68 B 88 D 108 C 128 A
9 C 29 B 48 B 69 B 89 C 109 B 129 D
10 B 30 C 50 C 70 C 90 D 110 B 130 A
11 B 31 D 51 C 71 D 91 C 111 D 131 D
12 D 32 D 52 A 72 D 92 D 112 C 132 B
13 D 33 D 52 C 73 C 93 B 113 A 133 D
14 B 34 E 54 B 74 B 94 C 114 B 134 C
15 B 35 D 55 C 75 A 95 B 115 D 135 E
16 B 36 A 56 C 76 B 96 A 116 A 136 B
17 B 37 D 57 C 77 C 97 C 117 C 137 A
18 B 38 E 58 C 78 C 98 D 118 A 138 B
19 D 39 C 59 C 79 B 99 A 119 A 139 B
MCQs in
Nerves & Muscles Physiology
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Nerves & Muscles Physiology
1. In the resting state the conductance of membrane is more for which of the ions?
A. Na+ B. Ca++ C. K+ D. Cl-
EXCEPT
2. Hyperpolarization in the action potential is caused by:
A. Increased exit of K+ from the cell C. Delay in sodium pump
-
B. Entry of Cl into the cell D. Increased exit of Na+ from the cell
3. Which of the following would carry the membrane potential closer to firing level?
A. Anodal current (negative electrode) C. Cathodal current (positive electrode)
B. Exit of K+ D. Accommodation
5. What would be the effect of decrease in ECF Na+ on the resting membrane potential?
A. Not much effect C. Increase in membrane potential
B. Decrease in membrane potential D. Accommodation
9. Conductance of membrane for chloride ion in the excitable tissue indicates which of the following?
A. Hyperpolarization C. No effect in the membrane potential
B. Depolarization D. Repolarization
10. Which one of the following nerve fibers is more susceptible to mechanical pressure?
A. A α B. Aγ C. B D. C
11. In ECF, the rise in the concentration of which of the ion can cause decrease in membrane potential?
A. Ca++ B. K+ C. Na+ D. Cl−
12. The ATPase activity to cleave ATP and utilize energy for the contraction of muscle is present in the:
A. Actin B. Myosin C. Troponin D. Tropomyosin
14. Regarding isotonic muscle contraction all of the following are true EXCEPT:
A. Muscle is allowed to shorten C. Length of the muscle remains constant
B. Tension remains constant D. External work is done
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Nerves & Muscles Physiology
15. The protein that is involved in skeletal muscle contraction but not in smooth muscle contraction is:
A. Troponin B. Actin C. Myosin D. ATPase
18. Relaxation of muscle occurs by involving all of the following mechanisms EXCEPT:
A. Hydrolysis of ATP in the myosin C. Attachment of ATP to myosin head
++
B. Removal of Ca from troponin C D. Active pumping of Ca++ into the cisternae
19. All of the following would lead to contraction of skeletal muscle EXCEPT:
A. Depolarization of T tubules C. Ca++ release from cisternae
++
B. Ca release from troponin C D. Depolarization of sarcolemma
20. During muscle shortening, decrease in width of all of the following occurs EXCEPT:
A. A band B. I band C. H zone D. Sarcomere
21. Which one of the following would increase acetylcholine concentration at the neuromuscular
junction when administered?
A. Curare B. Neostigmine C. Botulinum toxin D. Succinylcholine
24. Hyperpolarization results if in the extracellular fluid, there is decreased concentration of:
A. Calcium C. Magnesium E. Sodium
B. Chloride D. Potassium
26. The muscle protein which covers the active sites on the actin filament at rest is:
A. Actin C. Tropomyosin E. Troponin-I
B. Myosin D. Troponin-T
29. During the neuromuscular transmission, end plate potential is produced. It is:
A. Due to Ca++ influx D. Obeys all or none law
B. Having a refractory period E. Of low amplitude in myasthenia gravis
C. Localized hyperpolarization
34. In skeletal muscle neuromuscular junctions, all the following are false EXCEPT:
A. The motor end plate is the motor nerve terminal
B. Spontaneous (miniature) potentials may be recorded in the motor nerve terminal
C. Motor nerve terminals have vesicles containing norepinephrine
D. There is a high concentration of acetylcholinesterase
E. Transmission is facilitated by botulinum toxin
35. A skeletal muscle fiber, all the following are true EXCEPT:
A. Membrane is negatively charged on the inside with respect to the outside at rest
B. Contains intracellular stores of calcium ions
C. Is normally innervated by one motor neuron
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Nerves & Muscles Physiology
D. Becomes more excitable as its resting membrane potential falls
E. Becomes less excitable as the extracellular ionized calcium levels fall
36. An excitatory post-synaptic potential, all the following are false EXCEPT
A. It is the depolarization of a post-synaptic nerve cell membrane that occurs when a presynaptic neuron is
stimulated
B. Involves reversal of polarity across the post-synaptic nerve cell membrane
C. Is propagated at the same rate as an action potential
D. Is caused by the electrical field induced by activity in the pre-synaptic nerve terminals
41. When a nerve cell membrane is depolarized by 5 mV, all the following are true EXCEPT
A. Its permeability to sodium increases
B. Sodium ions move into the cell to cause further depolarization
C. Potassium ions move outwards down their electrochemical gradient
D. Chloride ions move inwards down their electrochemical gradient
E. An action potential is generated
42. An action potential in a nerve fiber, all the fallowing are false EXCEPT
A. Occurs when its membrane potential is hyperpolarized to a critical level
B. Is associated with a transient decrease in membrane permeability to sodium
C. Is associated with a transient decrease in membrane permeability to potassium
D. Induces local electrical currents in adjacent segments of the fiber
E. Has amplitude which varies directly with the strength of stimulus
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Nerves & Muscles Physiology
43. Non-myelinated axons differ from myelinated axons in that they are
A. Not sheathed in Schwann cells
B. Not capable of regeneration after section
C. Found only in the autonomic nervous system
D. More excitable
E. Refractory for a longer period after excitation
45. All the following are true for the differences of visceral smooth muscle from skeletal muscle EXCEPT
A. It contracts when stretched
B. It is not paralyzed when its motor nerve supply is cut
C. Its cells have unstable resting membrane potentials
D. It contains no Actin or myosin
E. Excitation depends more on influx of extracellular calcium than release of calcium from endoplasmic
reticulum
47. Histological and physiological study of skeletal muscle shows that the
A. Distance between two Z lines remains constant during contraction
B. Width of the A band is constant during contraction
C. Tension developed is maximal when actin and myosin molecules just fail to overlap
D. The T system of transverse tubules opens into the terminal cisterns of the sarcoplasmic reticulum
51. A single contraction of skeletal muscle is most likely to be terminated by which of the following
actions?
A. Closure of the postsynaptic nicotinic acetylcholine receptor
B. Removal of acetylcholine from the neuromuscular junction
C. Removal of Ca++ from the terminal of the motor neuron
D. Removal of sarcoplasmic Ca++
E. Return of the dihydropyridine receptor to its resting conformation
52. Which of the following best describes an attribute of visceral smooth muscle not shared by skeletal
muscle?
A. Contraction is ATP dependent D. High rate of cross-bridge cycling
B. Contracts in response to stretch E. Low maximal force of contraction
C. Does not contain actin filaments
53. The resting potential of a myelinated nerve fiber is primarily dependent on the concentration
gradient of which of the following ions?
A. Ca++ B. Cl− C. HCO3− D. K+ E. Na+
54. Calmodulin is most closely related, both structurally and functionally, to which of the following
proteins?
A. G-actin B. Myosin light chain C. Tropomyosin D. Troponin C
55. During a demonstration for medical students, a neurologist uses magnetic cortical stimulation to
trigger firing of the ulnar nerve in a volunteer. At relatively low-amplitude stimulation, action potentials
are recorded only from muscle fibers in the index finger. As the amplitude of the stimulation is increased,
action potentials are recorded from muscle fibers in both the index finger and the biceps muscle. What is
the fundamental principle underlying this amplitude-dependent response?
A. Large motor neurons that innervate large motor units require a larger depolarizing stimulus
B. Recruitment of multiple motor units requires a larger depolarizing stimulus
C. The biceps muscle is innervated by more motor neurons
D. The motor units in the biceps are smaller than those in the muscles of the fingers
E. The muscles in the fingers are innervated only by the ulnar nerve
56. A neurotransmitter activates its receptor on an ion channel of a neuron, which causes the water-
filled channel to open. Once the channel is open, ions move through the channel down their respective
electrochemical gradients. A change in membrane potential follows. Which of the following best
describes the type of channel and mechanism of ion transport?
Type of Channel : Mechanism of Transport
A. Ligand gated : Facilitated diffusion
B. Ligand gated : Simple diffusion
C. Ligand gated : Secondary active transport
D. Voltage gated : Facilitated diffusion
E. Voltage gated : Simple diffusion
F. Voltage gated : Secondary active transport
57. Which of the following decreases in length during the contraction of a skeletal muscle fiber?
A. A band of the sarcomere B. I band of the sarcomere C. Thick filaments
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Nerves & Muscles Physiology
D. Thin filaments E. Z disks of the sarcomere
58. Tetanic contraction of a skeletal muscle fiber results from a cumulative increase in the intracellular
concentration of which of the following?
A. ATP B. Ca++ C. K+ D. Na+ E. Troponin
59. Weight lifting can result in a dramatic increase in skeletal muscle mass. This increase in muscle mass
is primarily attributable to which of the following?
A. Fusion of sarcomeres between adjacent myofibrils
B. Hypertrophy of individual muscle fibers
C. Increase in skeletal muscle blood supply
D. Increase in the number of motor neurons
E. Increase in the number of neuromuscular junctions
62. The figure shows the change in membrane potential during an action potential in a giant squid axon.
Which of the following is primarily responsible for the change in membrane potential between points A
and B?
A. Inhibition of the Na+ - K+-ATPase D. Movement of Na+ into the cell
B. Movement of K+ into the cell E. Movement of Na+ out of the cell
+
C. Movement of K out of the cell
63. The figure shows the change in membrane potential during an action potential in a giant squid axon.
Which of the following is primarily responsible for the change in membrane potential between points F
and G?
A. Inhibition of the Na+ - K+-ATPase D. Movement of Na+ into the cell
+
B. Movement of K into the cell E. Movement of Na+ out of the cell
C. Movement of K+ out of the cell
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Nerves & Muscles Physiology
64. The axon of a neuron is stimulated experimentally with a 25-millivolt pulse, which initiates an action
potential with a velocity of 50 meters per second. The axon is then stimulated with a 100-millivolt pulse.
What is the action potential velocity after the 100-millivolt stimulation pulse (in meters per second)?
A. 25 B. 50 C. 100 D. 150 E. 200
65. The delayed onset and prolonged duration of smooth muscle contraction, as well as the greater force
generated by smooth muscle compared with skeletal muscle, are all consequences of which of the
following?
A. Greater amount of myosin filaments present in smooth muscle
B. Higher energy requirement of smooth muscle
C. Physical arrangement of actin and myosin filaments
D. Slower cycling rate of the smooth muscle myosin cross-bridges
E. Slower uptake of Ca++ ions after contraction
66. An experimental drug is being tested as a potential therapeutic treatment for asthma. Preclinical
studies have shown that this drug induces the relaxation of cultured porcine tracheal smooth muscle cells
pre-contracted with acetylcholine. Which of the following mechanisms of action is most likely to induce
this effect?
A. Decreased affinity of troponin C for Ca++
B. Decreased plasma membrane K+ permeability
C. Increased plasma membrane Na+ permeability
D. Inhibition of the sarcoplasmic reticulum Ca++-ATPase
E. Stimulation of adenylate cyclase
A 55-year-old woman visits her physician because of double vision, eyelid droop, difficulty chewing and
swallowing, and general weakness in her limbs. All these symptoms worsen with exercise and occur more
frequently late in the day. The physician suspects myasthenia gravis and orders a Tensilon test. The test
is positive. Use this information when answering Questions 67–68.
67. The increased muscle strength observed during the Tensilon test is due to an increase in which of the
following?
A. Amount of acetylcholine (ACh) released from the motor nerves
B. Levels of ACh at the muscle end plates
C. Number of ACh receptors on the muscle end plates
D. Synthesis of norepinephrine
68. What is the most likely basis for the symptoms described in this patient?
A. Autoimmune response
B. Botulinum toxicity
C. Depletion of voltage-gated Ca++ channels in certain motor neurons
D. Development of macro motor units after recovery from poliomyelitis
E. Overexertion
69. Which of the following drugs would likely alleviate this patient’s symptoms?
A. Atropine B. Botulinum toxin antiserum C. Curare D. Halothane E. Neostigmine
A 56-year-old man sees a neurologist because of weakness in his legs that improves over the course of
the day or with exercise. Extracellular electrical recordings from a single skeletal muscle fiber reveal
normal miniature end plate potentials. Low-frequency electrical stimulation of the motor neuron,
however, elicits an abnormally small depolarization of the muscle fibers. The amplitude of the
depolarization is increased after exercise. Use this information to answer Questions 71–73.
71. Based on these findings, which of the following is the most likely cause of this patient’s leg
weakness?
A. Acetylcholinesterase deficiency
B. Blockade of postsynaptic acetylcholine receptors
C. Impaired presynaptic voltage-sensitive Ca++ influx
D. Inhibition of Ca++ re-uptake into the sarcoplasmic reticulum
E. Reduced acetylcholine synthesis
73. The molecular mechanism underlying these symptoms is most similar to which of the following?
A. Acetylcholine C. Curare E. Tetrodotoxin
B. Botulinum toxin D. Neostigmine
74. Trace A in the above figure represents a typical action potential recorded under control conditions
from a normal nerve cell in response to a
depolarizing stimulus. Which of the
following perturbations would explain the
conversion of the response shown in trace
A to the action potential shown in trace
B?
A. Blockade of voltage-sensitive Na+
channels
B. Blockade of voltage-sensitive K+
channels
C. Blockade of Na-K “leak” channels
D. Replacement of the voltage-sensitive K+
channels with “slow” Ca++ channels
E. Replacement of the voltage-sensitive Na+ channels with “slow” Ca++ channels
75. Which of the following perturbations would account for the failure of the same stimulus to elicit an
action potential in trace C?
A. Blockade of voltage-sensitive Na+ channels
B. Blockade of voltage-sensitive K+ channels
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Nerves & Muscles Physiology
C. Blockade of Na-K “leak” channels
D. Replacement of the voltage-sensitive K+ channels with “slow” Ca++ channels
E. Replacement of the voltage-sensitive Na+ channels with “slow” Ca++ channels
76. A 17-year-old soccer player sustained a fracture to the left tibia. After her lower leg has been in a
cast for 8 weeks, she is surprised to find that the left gastrocnemius muscle is significantly smaller in
circumference than it was before the fracture. What is the most likely explanation?
A. Decrease in the number of individual muscle fibers in the left gastrocnemius
B. Decrease in blood flow to the muscle caused by constriction from the cast
C. Temporary reduction in actin and myosin protein synthesis
D. Increase in glycolytic activity in the affected muscle
E. Progressive denervation
77. Smooth muscle that exhibits rhythmical contraction in the absence of external stimuli also
necessarily exhibits which of the following?
A. “Slow” voltage-sensitive Ca++ channels
B. Intrinsic pacemaker wave activity D. Hyperpolarized membrane potential
C. Higher resting cytosolic Ca++ concentration E. Action potentials with “plateaus”
79. Which of the following best describes the correct temporal order of events for skeletal muscle?
A. Muscle action potential Muscle contraction Nerve action potential
B. Muscle action potential Nerve action potential Muscle contraction
C. Muscle contraction Muscle action potential Nerve action potential
D. Muscle contraction Nerve action potential Muscle action potential
E. Nerve action potential Muscle action potential Muscle contraction
F. Nerve action potential Muscle contraction Muscle action potential
80. Which of the following best describes a physiological difference between the contraction of smooth
muscle compared with the contraction of cardiac muscle and skeletal muscle?
A. Ca++ independent C. Requires more energy
B. Does not require an action potential D. Shorter in duration
82. The membrane potential of cardiac muscle cells is most affected by even a small change in plasma
concentration of:
A. Na B. K C. Cl D. Ca
84. The number of Na channels per square micrometer of membrane in myelinated mammalian neurons
is maximum in the:
A. Cell body B. Dendritic zone C. Initial segment D. Node of Ranvier
86. In motor neurons, the portion of the cell with the lowest threshold for the production of a full-
fledged action potential is:
A. Initial segment B. Soma C. Dendritic zone D. Node of Ranvier
88. In the CNS, the membranes that wrap around myelinated neurons are those of:
A. Schwann cells B. Oligodendroglia C. Endothelial cells D. Astrocytes
90. When heart rate is about 75 beats per minute, what is the mean duration of action potential in
ventricular muscle cells?
A. 5 ms B. 25 ms C. 200 ms D. 250 ms
91. Regarding the force of muscle contraction, all the fallowing are true EXCEPT:
A. increasing the frequency of activation of motor units
B. increasing the number of motor units activated
C. increasing the amplitude of action potentials in motor neurons
D. recruiting larger motor units
92. An excitable cell has an RMP of -70 mV and a firing level of - 50 mV. This cell would be unexcitable
when its membrane potential is:
A. - 30 mV B. - 55 mV C. - 70 mV D. - 90 mV
93. An excitable cell has an RMP of -70 mV and a firing level of - 50 mV. This cell would be most excitable
when its membrane potential is:
A. - 30 mV B. - 55 mV C. - 70 mV D. - 90 mV
94. Which one of the following statements about graded potential is incorrect?
A. They are graded responses C. They may be depolarizing or hyperpolarizing
B. They are local (non-propagated) responses D. They are produced by a threshold stimulus
97. The activity of which contractile protein is altered to regulate smooth muscle contraction?
A. Actin B. Myosin C. Calmodulin D. Tropomyosin
99. The major source of calcium for contraction of skeletal muscle is:
A. ECF B. cytosol C. mitochondria D. sarcoplasmic reticulum (SR)
104. Regarding the ionic basis of action potential in cardiac muscle cells, which one of the following is
incorrect?
A. Phase 0: Na influx B. Phase 1: K influx C. Phase 2: Ca influx D. Phase 3: K efflux
105. When heart rate is about 75 beats/min, the duration of absolute refractory period of cardiac muscle
is:
A. 50 ms B. 100 ms C. 200 ms D. 300 ms
115. Which of the following characteristics of an axon is most dependent on its diameter?
A. The magnitude of its resting potential D. The overshoot of its action potential
B. The duration of its refractory period E. The activity of its sodium-potassium pump
C. The conduction velocity of its action potential
119. The resting potential of a nerve membrane is primarily dependent on the concentration gradient of
A. Potassium B. Sodium C. Calcium D. Chloride E. Bicarbonate
120. Which one of the following muscle proteins plays an important role in contraction of both smooth
and striated muscle?
A. Calmodulin B. Troponin C. Tropomyosin D. Actin E. Myosin light chains
121. Which of the following words or phrases is most closely associated with an end-plate potential at
the neuromuscular junction?
A. “All-or-none response” C. Hyperpolarization E. Electrically excitable gates
B. Depolarization D. Action potential
122. In a nerve, the magnitude of the action potential overshoot is normally a function of the
A. Magnitude of the stimulus D. Resting membrane potential
B. Intracellular potassium concentration E. Diameter of the axon
C. Extracellular sodium concentration
124. Which of the following statements about synaptic transmission at the neuromuscular junction is
true?
A. It is enhanced by high levels of cholinesterase
B. It is caused by an influx of potassium ions through the muscle membrane
C. It is depressed by abnormally low levels of magnesium
D. It is depressed by increased parasympathetic nerve activity
E. It is produced by the release of acetylcholine from the alpha motoneuron
125. When comparing the contractile responses in smooth and skeletal muscle, which of the following is
most different?
A. The source of activator calcium
B. The role of calcium in initiating contraction
C. The mechanism of force generation
D. The source of energy used during contraction
E. The nature of the contractile proteins
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126. The amount of force produced by a skeletal muscle can be increased by
A. Increasing extracellular Mg2+ D. Decreasing the interval between contractions
++
B. Decreasing extracellular Ca E. Increasing the preload beyond 2.2 µm
C. Increasing the activity of acetylcholine esterase
128. Periodic hyperkalemic paralysis is characterized by high potassium concentration and muscle
weakness. Which of the following is likely to cause muscle weakness as a result of increased extracellular
potassium concentration?
A. Hyperpolarization of muscle cells
B. Inactivation of sodium channels in muscle cells
C. Increased release of neurotransmitters from alpha motoneurons
D. Decreased potassium conductance in muscle cells
E. Increased duration of action potentials produced by alpha motoneurons
129. The flow of calcium into the cell is an important component of the upstroke phase of action
potentials in
A. Cardiac ventricular muscle D. Nerve cell bodies
B. Intestinal smooth muscle E. Presynaptic nerve terminals
C. Skeletal muscle fibers
130. The membrane potential will depolarize by the greatest amount if the membrane permeability
increases for
A. K B. Na and K C. Cl D. K and Cl E. Na
135. Which of the following would cause an immediate reduction in the amount of potassium leaking
out of a cell?
A. Increasing the permeability of the membrane to potassium
B. Increasing the intracellular potassium concentration
C. Increasing (hyperpolarizing) the membrane potential
D. Reducing the activity of the sodium-potassium pump
E. Decreasing the potassium equilibrium potential
137. Synaptic transmission between pain fibers from the skin and spinal cord neurons is mediated by
A. Acetylcholine B. Substance P C. Endorphins D. Somatostatin E. Serotonin
140. When skeletal muscle is in its resting state, myosin cross-bridges are prevented from binding to
actin molecules by
A. Calmodulin D. Titin
B. Troponin E. Phospholamban
C. Tropomyosin
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142. Which one of the steps in the diagram is responsible for the formation of latch bridges?
A. Step 1 B. Step 2 C. Step 3 D. Step 4 E. Step 5
148. The cross bridges of the sarcomere in skeletal muscle are components of
A. Actin B. Myosin C. Troponin D. Tropomyosin
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149. The likely mechanism through which neostigmine acts in improving muscular weakness is
A. It blocks action of acetylcholine C. It enhances the action of catecholamines
B. It interferes with action of mono-amine D. It blocks the action of acetyl choline esterase
oxidase
152. Regarding the release of neurotransmitter from synaptic vesicles, all the following are true EXCEPT
A. Takes place by exocytosis C. Is quantal
B. Is controlled by neuronal calcium influx D. Requires neuronal sodium ions influx
154. The effect of calcium ions on neurotransmitter release at synapses include the following EXCEPT:
A. Vesicular fusion
B. Tonic depolarization of the presynaptic neuron
C. Post-tetanic potentiation
D. Transport of synaptic vesicles to the presynaptic active zone of release
E. Reuptake of noradrenaline
155. Regarding the neuronal resting membrane of the human brain is, all the following are true, EXCEPT:
A. Maintained by the sodium pump
B. Around -70mV
C. Maintained by using ATP for energy
D. Achieved by active extrusion of potassium ions out of the neuron
158. The portion of the nervous system that directly controls skeletal muscles is the
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A. Somatic motor division D. Autonomic system
B. Visceral nervous system E. Peripheral nervous system
C. Central nervous system
159. The part of the peripheral nervous system which brings information to the central nervous system is
A. The motor C. Somatic E. Afferent
B. Efferent D. Autonomic
160. Nerve and muscle cells are classified as excitable tissues because they
A. Generate electrical signals and propagate electrical signals
B. Generate electrical signals, propagate electrical signals, and store electrical capacity
C. Generate electrical signals
D. Propagate electrical signals
E. Store electrical capacity
161. Interneurons
A. Carry only sensory impulses
B. Are found between neurons, synapsing with their effectors
C. Carry only motor impulses
D. Are found only in the central nervous system
E. Only connect motor neurons to other motor neurons
162. Axonal transport refers to ______________ down the length of the axon.
A. Sodium and potassium movement D. Mitochondrial transport
B. Movement of proteins packaged in vesicles E. None of the above are true
C. Impulse transmission
164. Each of these is a true statement EXCEPT one. Identify the exception.
A. EPSP's can make action potentials more likely to occur
B. IPSP's depolarize the membrane
C. EPSP's that reach threshold can initiate an action potential
D. The trigger zone is the integrating part of the neuron
E. All of the above are true statements
165. The ion that plays a key role in initiating electrical signals in neurons is
A. K+ B. Ca++ C. Na+ D. Cl−
167. Application of the poison tetrodotoxin (TTX) to a neuron blocks voltage-gated Na+ channels. What
effect will this have on an action potential in the neuron?
A. TTX will lengthen the depolarization phase of the action potential
B. TTX will not affect action potentials because voltage-gated Na+ channels have no role in them
C. TTX will diminish or abolish the depolarization phase of the action potential
D. TTX will increase the amplitude of the action potential
168. Action potentials are non-directional. Why do they only travel from the cell body of a neuron to the
terminal and never go backward?
A. This statement is false They do travel backwards
B. Both sodium gates and potassium gates are closed once an action potential passes
C. The sodium channel is at normal resting state once an action potential passes
D. The membrane behind the region of action potential is at refractory period once an action potential
passes
E. Too much of a depolarization would inhibit the action potential, so it doesn't travel backwards so that it
won't open up more sodium channels
171. Which of the following does not describe skeletal muscle fibers?
A. Striated B. Typically voluntary C. Multinucleate D. Branched
176. Acetylcholinesterase:
A. Produces acetylcholine
B. Is the acetylcholine receptor in muscle tissue
C. Is responsible for smooth but not skeletal muscle contraction
D. Degrades the neurotransmitter which is found in the neuromuscular junction
178. A person suffering from nerve gas exposure is given atropine to counter the effects because:
A. Atropine will bind to and electrophilically inactivate the nerve gas
B. Atropine blocks the nerve gas receptor
C. Atropine blocks the acetylcholine receptor which prevents the lingering excess ach from having adverse
effects
D. Atropine inactivates acetylcholinesterase
180. The walls of hollow organs and some blood vessels contain this type of muscle tissue.
A. Striated B. Skeletal C. Cardiac D. Voluntary E. Smooth
182. The energy of muscle contraction is derived from the following EXCEPT:
A. ATP B. muscle glycogen C. lactic acid D. Creatine phosphate
183. Depolarization:
A. is associated with increase in membrane permeability to Na+
B. is terminated with closure of voltage activated K+ channels
C. is followed by muscle relaxation
D. is caused by K+ efflux
192. Repolarization:
A. Occurs at first gradual then becomes fast
B. Results from closure of sodium gates and opening of potassium gates
C. is represented by the ascending limb of the spike
D. is followed by appearance of response
210. The release of the neurotransmitter from the synaptic vesicles depends mainly on:
A. Ca++ B. K+ C. Na+ D. Mg2+
214. Which characteristic or component is shared by skeletal muscle and smooth muscle?
A. Thick and thin filaments arranged in sarcomeres
B. Troponin
C. Elevation of intracellular Ca+2 concentration for excitation-contraction coupling
D. Spontaneous depolarization of the membrane potential
E. High degree of electrical coupling between cells
215. Repeated stimulation of a skeletal muscle fiber causes tetanic contraction because the intracellular
concentration of which solute increases and remains at high levels?
A. Na+ D. Mg+2 G. Calmodulin
+ ++
B. K E. Ca H. ATP
C. Cl− F. Troponin
216. During a nerve action potential, a second stimulus is delivered as indicated by the arrow shown in
figure 1. In response to the stimulus, a second action potential:
217. The rate of conduction of action potentials along a nerve will be increased by:
A. Stimulating the Na+ - K+ pump
B. inhibiting the Na+ - K+ pump
C. Decreasing the diameter of the nerve
D. Myelinating the nerve
E. Lengthening the nerve fiber
218. A drug completely blocks Na+ channels in nerves. Which of following effects on the action potential
would it be expected to produce?
A. Block the occurrence of action potentials
B. Increase the rate of increase of the upstroke of the action potential
C. Shorten the absolute refractory period
D. Abolish the hyperpolarizing after-potential
E. Increase the Na+ equilibrium potential
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219. In figure 2, at which labeled point on the action potential the relative refractory period is located?
A. 1 & 2. B. 3. C. 4. D. 4 & 5 E. 5.
220. In figure 2, what process is responsible for the change in membrane potential that occurs between
point 1 and point 3?
A. Movement of Na+ into the cell D. Movement of K+ out the cell
+
B. Movement of Na out of the cell E. Activation of the Na+ - K+ pump
+
C. Movement of K into the cell F. Inhibition of the Na+ - K+ pump
221. In figure 2, what process is responsible for the change in membrane potential that occurs between
point 3 and point 4?
A. Movement of Na+ into the cell D. Movement of K+ out of the cell
+
B. Movement of Na out the cell E. Activation of the Na+ - K+ pump
+
C. Movement of K into the cell F. Inhibition of the Na+ - K+ pump
222. In figure 2, what process is responsible for the change in membrane potential that occurs at area 5?
A. Movement of Na+ into the cell D. Movement of K+ out of the cell
+
B. Movement of Na out the cell E. Activation of the Na+ - K+ pump
+
C. Movement of K into the cell F. Inhibition of the Na+ - K+ pump
223. In figure 2, at which labeled point on the action potential the absolute refractory period is located?
A. 1 & 2. B. 2 & 3. C. 4. D. 4 & 5 E. 5.
225. Which of the following sequence of events is correct for excitation – contraction coupling in skeletal
muscle?
A. Increased intracellular Ca 2+ concentration action potential in the muscle membrane cross- bridge
formation
B. Action potential in the muscle membrane depolarization of the T tubules release of Ca++ from the
sarcoplasmic reticulum (SR)
C. Action potential in the muscle membrane splitting of adenosine triphosphate (ATP) binding of Ca 2+
to troponin C.
D. Release of Ca++ from the SR depolarization of the T tubules binding of Ca 2+ to troponin C.
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226. Which of the following events occurs before depolarization of the T tubules in skeletal muscle in the
mechanism of excitation – contraction coupling?
A. Depolarization of the sarcolemmal membrane
B. Opening of Ca 2+ release channels on the sarcoplasmic reticulum (SR)
C. Uptake of Ca++ into the SR by Ca 2+ - adenosine triphosphatase (ATP) ase
D. Binding of Ca++ to troponin C.
E. Binding of actin and myosin
227. Which of the following is always an inhibitory neurotransmitter in the central nervous system
(CNS)?
A. Norepinephrine D. Serotonin
B. Glutamate E. Histamine
C. Gamma-aminobutyric acid (GABA)
228. Which of the following statements is not correct? If the sodium-potassium pump were suddenly
poisoned:
A. The resting membrane potential would become less negative
B. No further transmission of nerve impulses could occur
C. The intracellular potassium concentration would decrease
D. The intracellular sodium concentration would increase
229. Which of the following statements is not correct? Release of acetylcholine at the neuromuscular
junction:
A. Produces an endplate potential
B. Increases sodium movement into the muscle fiber
C. Always causes the muscle fiber to contract
D. Is followed by rapid destruction of acetylcholine
232. The _________ portion of the motor division of the nervous system conducts action potentials from
the central nervous system to skeletal muscle fibers.
A. Afferent B. Autonomic C. Somatic D. Sympathetic
233. The _________ division of the nervous system conducts actions potentials from the central nervous
system to cardiac muscle.
A. Afferent B. Autonomic C. Sensory D. Somatic
234. Which of the following effectors in NOT innervated by the autonomic nervous system?
A. Cardiac muscle B. Glands C. Skeletal muscle D. Smooth muscle
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235. Which of the following types of neurons has a single process extending from the cell body which
later divides a short distance away into central and peripheral processes?
A. Unipolar B. Bipolar C. Multipolar D. None of the above
236. Collections of neuron cell bodies in the central nervous system are called
A. Myelin B. Axons C. Dendrites D. Nuclei
237. Which of the following is involved in the myelination of axons of the central nervous system?
A. Microglia B. Astrocytes C. Oligodendrocytes D. Schwann cells
241. Which of the following statements is NOT true concerning the resting membrane potential?
A. The membrane is relatively more permeable to potassium ions than to sodium ions
B. Potassium ions are constantly moving out of the cell down their concentration gradient
C. Sodium ions are in relatively higher concentration inside the cell than outside
D. The membrane is relatively permeable to chloride ions
242. During the repolarization phase of an action potential, which of the following is the primary
activity?
A. Sodium ions are flowing out of the cell C. Potassium ions are flowing into the cell
B. Sodium ions are flowing into the cell D. Potassium ions are flowing out of the cell
244. During the depolarization phase of an action potential, which of the following situations exists?
A. The membrane is becoming less permeable to all ions
B. The inside of the membrane is becoming more negative with respect to the outside
C. The membrane potential remains constant
D. The inside of the membrane is becoming more positive with respect to the outside
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245. Local potentials (graded potential) have ALL of the following characteristics EXCEPT
A. Propagation C. Comparatively long duration
B. Variation of amplitude D. No refractory period
246. The one-way nature of action potential propagation down an axon is primarily due to
A. Sodium ion depletion C. The refractory period
B. Potassium ion depletion D. ATP loss
247. In the resting state of the membrane, which of the following situations exists for voltage-gated
sodium ion channels?
A. The activation and inactivation gates alternate being closed and open
B. The inactivation gate is open and the activation gate is closed
C. The activation and inactivation gates are both closed
D. The activation gate is open and the inactivation gate is closed
250. Which of the following stimuli produces a depolarization that propagates from one end of the
membrane to the other?
A. Supramaximal B. Threshold C. Maximal D. All of the Above
251. Release of which neurotransmitter leads to the excitation and contraction of skeletal muscles?
A. Acetylcholine B. Epinephrine C. Glutamate D. Serotonin
253. When a depolarization wave reaches the synaptic end bulb of a presynaptic neuron, the NEXT event
is
A. Uptake of neurotransmitter from the synaptic cleft
B. Active transport of calcium ions out of the cell
C. Diffusion of calcium ions into the cell
D. Immediate release of neurotransmitter
254. A neurotransmitter that allows sodium ions to leak into a postsynaptic neuron causes
A. No changes in the resting potential
B. Damage to the myelin sheath
C. Excitatory postsynaptic potentials
D. An alteration of the membrane threshold
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255. The voltage across a neuron's membrane has changed from its resting potential of -70 mv to -80 mv.
Which of the following is most likely to be TRUE regarding this situation?
A. The neuron has bound a neurotransmitter that increases membrane permeability to sodium ions
B. Large pores have opened in the membrane to allow release of large intracellular anions
C. The neuron has bound a neurotransmitter that increases the permeability to chloride ions
D. Additional myelin has been added to the membrane to provide greater electrical insulation
257. Neurons have cytoplasmic extensions that connect one neuron to another neuron. Given these
structures:
1. Axon
2. Dendrite
3. Dendritic spine
4. Presynaptic terminal
Choose the arrangement that lists the structures in the order they are found between two neurons.
A. 1,4,2,3 B. 1,4,3,2 C. 4,1,2,3 D. 4,1,3,2 E. 4,3,2,1
258. a neuron with many short dendrites and a single long axon is a ______________ neuron.
A. Multipolar B. Unipolar C. Bipolar
259. unmyelinated axons within nerves may have which of these associated with them?
A. Schwann cells B. Nodes of Ranvier C. Oligodendrocytes D. All of the above
261. concerning concentration difference across the plasma membrane of muscle fiber, there are
A. More K+ and Na+ outside the cell than inside
B. More K+ and Na+ inside the cell than outside
C. More K+ outside the cell than inside and more Na+ inside the cell than outside
D. More K+ inside the cell than outside and more Na+ outside the cell than inside
262. compared to the inside of the resting plasma membrane, the outside surface of the membrane is
A. Positively charged
B. Electrically neutral
C. Negatively charged
D. Continuously reversing so that it is positive one second and negative the next
E. Negatively charged whenever the Na+ –K+ pump is operating
264. the resting membrane potential results when the tendency for _____________ to diffuse out
Of the cell is balanced by their attraction to opposite charges inside the cell.
A. Na+ B. K+ C. Cl− D. Negatively charged proteins
265. if the permeability of the plasma membrane to K+ increases, resting membrane potential
_____________. This is called _____________.
A. Increases, hyperpolarization C. Decreases, hyperpolarization
B. Increases, depolarization D. Decreases, depolarization
266. decreasing the extracellular concentration of K+ affects the resting membrane potential by causing
A. Hyperpolarization B. Depolarization C. No change
267. which of these terms are correctly matched with their definition or description?
A. Depolarization: membrane potential becomes more negative
B. Hyperpolarization: membrane potential becomes more negative
C. Hypopolarization: membrane potential becomes more negative
269. during the depolarization phase of an action potential, the permeability of the membrane
A. To K+ is greatly increased C. To Ca++ is greatly increased
+
B. To Na is greatly increased D. Is unchanged
270. during the repolarization phase of an action potential, the permeability of the membrane
A. To K+ is greatly increased C. To Ca++ is greatly increased
+
B. To Na is greatly increased D. Is unchanged
275. summation
A. Is caused by combining two or more local potentials
B. Occurs at the trigger zone of the postsynaptic neuron
C. Results in an action potential if it reaches the threshold potential
D. Can occur when two action potentials arrive in close succession at a single Presynaptic terminal
E. All of the above
277. one of the characteristics of muscle tissue is that is has conductivity. Which of the following best
describes this characteristic?
A. Muscles contract when stimulated
B. Muscles have local electrical charges that are capable of moving along the muscle fiber
C. Muscles only pull; they cannot push
D. Muscles can stretch when needed
278. one of the characteristics of muscle tissue is that is has extensibility. Which of the following best
describes this characteristic?
A. Muscles contract when stimulated
B. Muscles have local electrical charges that move along the muscle fiber
C. Muscles only pull; they cannot push
D. Muscles can stretch when needed
279. one of the characteristics of muscle tissue is that is has excitability. Which of the following best
describes this characteristic?
A. Muscles contract when stimulated
B. Muscles have local electrical charges that move along the muscle fiber
C. Muscles only pull; they cannot push
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D. Muscles can stretch when needed
280. which of the following groups are considered to be parts of the series-elastic components of
muscle?
A. Actin and myosin
B. Ligaments and tendons
C. Thick and thin filaments
D. Endomysium, perimysium, epimysium, fascia, and tendons
281. which of the following best describes the function of the series-elastic component of muscle?
A. These components help the muscle contract
B. The components help maintain muscle tone
C. These are not excitable or contractile, but are extensible and elastic
D. These assist the thick and thin filaments to contract
283. the molecule within the cytoplasm of a muscle fiber that supplies quick energy for contraction is
A. Fructose B. Glycogen C. Sucrose D. ADP
287. which of the following tissues has the greatest ability to repair itself?
A. Skeletal muscle B. Cardiac muscle C. Smooth muscle D. All have about the same ability
288. of the following muscles types, which one has long, cylindrical-shaped cells?
A. Skeletal muscle B. Cardiac muscle C. Smooth muscle D. All are about the same
289. of the following muscle types, which one has only one nucleus?
A. Skeletal muscle B. Cardiac muscle C. Smooth muscle D. All of the above
290. the recovery stroke in muscle contraction involves which of the following?
A. Movement of the myosin molecule while the cross-bridge is attached
B. Return of the myosin head to its original position after the cross bridge releases
C. Actin slides on myosin
D. Myosin slides on actin
291. the striations in striated muscle correspond with actual molecular structures. Which of the
following is the I band?
A. The band where only actin molecules are found
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B. The band where only myosin molecules are found
C. An attachment point for actin molecules
D. An attachment point for myosin molecules
292. the striations in striated muscle correspond with actual molecular structures. Which of the
following is the h band?
A. The band where only actin molecules are found
B. The band where only myosin molecules are found
C. An attachment point for actin molecules
D. An attachment point for myosin molecules
293. during an action potential, calcium is released into the sarcoplasm, near the actin and myosin
molecules. Which of the following is the best explanation of what the calcium does?
A. The calcium binds to the actin and myosin and makes them work together
B. The calcium breaks apart ATP to ADP and P.
C. The calcium removes the tropomyosin block
D. The calcium causes the release of acetylcholine
294. when the myosin head (of the thick filament) flexes into a bend, while releasing ADP and inorganic
phosphate, pulling the thin filament along with it, this is called the
A. Action reaction B. Power stroke C. Recovery stroke D. Muscle tone
298. When the neuron stimulates a muscle fiber, what molecule diffuses across the gap between them?
A. Calcium B. Acetylcholine C. Sodium D. Sodium and potassium
299. Muscle fibers and neurons are called electrically excitable cells because
A. Their membranes respond to electricity
B. Their plasma membranes exhibit voltage changes in response to stimulation
C. Their surfaces respond to the release of acetylcholine
D. They have junctional folds in the membranes that can trap electrical charges
300. Movement of which of the following proteins causes exposure of the active sites on the actin
molecule?
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A. Troponin B. Tropomyosin C. Myosin D. Acetylcholine
304. Which of the following assures quick removal of neurotransmitter at the junction between a nerve
and a muscle?
A. Acetylcholine B. Dopamine C. Acetylcholinesterase D. PABA
305. A buildup of acetylcholine in the synaptic cleft without breakdown may cause which of the
following?
A. Spastic paralysis B. Treppe C. Myasthenia gravis D. Flaccid paralysis
306. In a muscle twitch, which of the following represents the time between application of a stimulus
and the beginning of contraction?
A. Treppe B. Tetany C. Lag (latent) D. Relaxation
307. Which of the following determines the height of the peaks in multiple motor unit summation?
A. The speed of stimuli
B. The amount of tension produced by the number of motor units responding
C. The strength of each stimulus
D. None of the above
309. Which of the following explains why treppe takes place in muscle contractions?
A. Decreased calcium levels around the myofibrils
B. Increased sodium around the myofibrils
C. Increased calcium levels around the myofibrils
D. Decreased potassium around the myofibrils
312. Which of the following energy storages source is most commonly used during the first 10 seconds of
exercise?
A. ATP B. Creatine phosphate C. Lactic acid D. None of the above
313. During anaerobic respiration, what is the net amount of ATP produced?
A. 4 ATP B. 6 ATP C. 20 ATP D. 2 ATP
315. All of the following are true about fast-twitch fibers EXCEPT
A. High amount of myoglobin C. Break down ATP rapidly
B. Rapid contraction D. Fewer mitochondria than slow-twitch fibers
316. Which of the following is true about distribution of fast and slow-twitch fibers in the body?
A. Fast-twitch fibers are primarily found in long distance runners
B. Slow-twitch fibers are usually more resistant to fatigue
C. There is a clear separation of slow- and fast-twitch fibers in individual muscles
D. Training does not influence the balance of fast- and slow-twitch fibers
317. Unitary smooth muscle is found in all of the following locations in the body EXCEPT?
A. Digestive tract B. Reproductive tract C. Urinary tract D. Iris of the eye
319. Which of the following are the most common neurotransmitters in smooth muscle?
A. Dopamine and epinephrine C. Acetylcholine and norepinephrine
B. Acetylcholine and epinephrine D. Acetylcholine and dopamine
320. All of the following are properties of cardiac muscle cells EXCEPT
A. Intercalated discs
B. Involuntary
C. Branching fibers
D. Shorter in duration of contraction than skeletal muscles
327. If the permeability of the plasma membrane to Na+ ions increases, the result is
A. Depolarization of the plasma membrane
B. Repolarization of the plasma membrane
C. Little, if any, change in the resting membrane potential of the plasma membrane
331. The drug atropine blocks neurotransmitter receptors on the postsynaptic terminal of the
neuromuscular junction. This cause
A. Flaccid paralysis B. Spastic paralysis C. No change in muscle function
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332. The enlarged areas of the sarcoplasmic reticulum near the T tubules are the
A. Sarcolemma C. Terminal cisternae E. Tropomyosin molecules
B. Sarcomeres D. Troponin molecules
334. Cross bridges form during muscle contraction when myosin comes in contact with active sites on
A. Troponin molecules C. Calcium ions E. Actin molecules
B. Tropomyosin molecules D. Acetylcholine molecules
336. For cross bridge release, it is necessary for __________ to attach to the myosin head.
A. A tropomyosin molecule C. Ca++ ions E. The sarcolemma
B. ATP D. A troponin molecule
337. Which of these is (are) required for the relaxation of a muscle fiber?
A. ATP D. No additional stimulation of the neuron
B. Ca++ ion uptake into the sarcoplasmic reticulum E. All of these
C. Acetylcholinesterase activity
338. Even though each muscle fiber responds in all-or-none fashion, a whole muscle can contract with
varying force because of
A. Different threshold values of each fiber D. Rigor mortis
B. Total tetanus of the muscle E. The latent phase of contraction
C. Multiple motor unit summation
339. Which of these processes results in an increase in the force of contraction of a whole muscle?
A. Multiple motor unit summation C. Treppe
B. Multiple wave summation D. All of these
340. A muscle contraction in which the muscle produces an increasing tension, but the length remains
constant is a(n)
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A. Isometric contraction C. Concentric contraction
B. Isotonic contraction D. Eccentric contraction
349. Which of these statements about the molecular structure of myofilaments is true?
A. Tropomyosin has a binding site for Ca++
B. The head of the myosin molecule binds to an active site on G actin
C. ATPase is found on troponin
D. Troponin binds to the rodlike portion of myosin
E. Actin molecules have a hingelike portion that bends and straightens during contraction
350. The part of the sarcolemma that invaginates into the interior of the skeletal muscle cells is the
A. T tubule system D. Terminal cisternae
B. Sarcoplasmic reticulum E. Mitochondria
C. Myofibrils
355. With stimuli of increasing strength, which of these is capable of a graded response?
A. Nerve axon B. Muscle fiber C. Motor unit D. Whole muscle
356. Jerry Jogger’s 3 mile run every morning takes about 30 minutes. Which of these sources provides
most of the energy for his run?
A. Aerobic respiration C. Creatine phosphate
B. Anaerobic respiration D. Stored ATP
358. Which of these conditions would one expect to find within the leg muscle cells of a world-class
marathon runner?
A. Myoglobin-poor C. Primarily anaerobic E. Large deposits of glycogen
B. Contract very quickly D. Numerous mitochondria
360. The ______ is a depression in the sarcolemma that receives a motor nerve ending.
A. T tubule B. Terminal cisterna C. Sarcomere D. Motor end plate E. Synapse
362. Smooth muscle cells have______, whereas skeletal muscle fibers do not.
A. Sarcoplasmic reticulum C. Calmodulin E. Myosin ATPase
B. Tropomyosin D. Z discs
363. Single-unit smooth muscle cells can stimulate each other because they have
A. A latch-bridge C. Gap junctions E. Calcium pumps
B. Diffuse junctions D. Tight junctions
364. Warm-up exercises take advantage of ______ to enable muscles to perform at peak strength.
A. The stress-relaxation response D. Oxygen debt
B. The length-tension relationship E. Treppe
C. Excitatory junction potentials
373. During an action potential the repolarization phase is the result of:
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A. passive transport of Na+ out of the cell
B. passive transport of K+ out of the cell
C. active transport of Na+ out of the cell
D. active transport of K+ out of the cell
374. When an action potential occurs in a neuron, the after hyperpolarization is caused by:
A. a burst of activity of the Na+ /K+ pump
B. inhibition of the Na+ /K+ pump
C. increased permeability of the cell membrane to K+
D. increased permeability of the cell membrane to Na+
375. All other things being equal, which of the following axons will have the fastest conduction velocity?
A. a thick unmyelinated fiber
B. a thin unmyelinated fiber
C. a thick myelinated fiber
D. a thin myelinated fiber
384. Which of the following statements about the axon hillock (initial segment) is true?
A. Is the site on the neuron where summation can occur
B. Is the site where a graded potential can be transformed into one or more action potentials
C. Does not exist in neurons which have myelinated axons
D. Is the site of storage of synaptic vesicles
385. Where in the membrane of a nerve cell would you expect to find the highest concentration of
voltage regulated Na+ channels?
A. Cell body B. Dendrites C. Presynaptic membrane D. Axon hillock (initial segment)
386. The axon membrane propagates action potentials whereas the dendrite membrane only propagates
post synaptic (graded) potentials because the axon membrane:
A. Has a more negative resting membrane potential
B. Is mostly covered by a layer of myelin
C. Contains ligand regulated ion channels
D. Contains voltage regulated ion channels
388. At steady state all of the following processes are occurring in the unexcited nerve cell EXCEPT:
A. K+ is leaving the cell down its electrochemical gradient
B. K+ is being actively transported into the cell
C. The cell membrane is more permeable to K+ than to Na+
D. Na+ is leaving the cell down its electrochemical gradient
389. If a neuron was treated with a chemical that blocked the passive movement of K+, the resting
membrane potential of the cell would:
A. Change to the threshold potential of the neuron
B. Change to the K+ equilibrium potential
C. Change to the Na+ equilibrium potential
D. Change to zero (i.e. No membrane potential)
390. Which of the following changes will cause the membrane potential of a neuron to hyperpolarize
(become more negative)?
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A. Reducing the extracellular concentration of K+
B. Increasing the permeability of the cell membrane to Na+
C. Increasing the extracellular concentration of Na+
D. Treating the cell with ouabain
391. If the concentration of KCl outside a nerve cell were increased, the resting membrane potential of
the cell would:
A. Not be affected because the cell membrane is relatively impermeable to K+
B. Not be affected because K+ is pumped out of the cell
C. Hyperpolarize (become more negative)
D. Depolarize (become less negative)
392. Which of the following actions would reduce the resting membrane potential of the nerve cell (i.e.
make it less negative)?
A. Increase the extracellular concentration of K+
B. Decrease the extracellular concentration of Na+
C. Increase the permeability of the membrane to K+
D. None of the above would reduce the resting membrane potential
393. If the permeability of a nerve cell to K+ were increased, the resting membrane potential of the cell
would:
A. becomes more negative (hyperpolarize)
B. becomes less negative (depolarize)
C. briefly becomes less negative and then returns to its original value
D. not change because the membrane is virtually impermeable to K+
395. Which of the following statements about chemical synapses is not true?
A. They always have acetyl choline as a neurotransmitter
B. They allow transmission of nerve impulses in only one direction
C. They can be inhibitory or excitatory
D. They can be found inside the spinal cord
397. Removal of a neurotransmitter from the synaptic cleft can occur by:
A. Reuptake of the neurotransmitter by the pre-synaptic neuron
B. Diffusion of the neurotransmitter away from the synaptic cleft
C. Destruction of the neurotransmitter by enzymes located on the post-synaptic membrane
D. Any of the above mechanisms
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398. The function of the initial segment (axon hillock) of a neuron is to:
A. Convert graded post synaptic potentials into action potentials
B. Synthesize the neurotransmitter of the neuron
C. Receive incoming impulses from other neurons
D. Release neurotransmitter when depolarized
399. An inhibitory neuron could affect the neuron with which it synapses by:
A. Producing an IPSP within the neuron D. Increasing Cl− influx into the neuron
B. Hyperpolarizing the neuron E. All of the above
C. Increasing K+ efflux from the neuron F. 2 of the above
400. Summation:
A. Is caused by a combining of several local potentials
B. Can occur when 2 action potentials arrive simultaneously at 2 different presynaptic terminals
C. Can occur when 2 action potentials arrive in very close succession at a single presynaptic terminal
D. All of the above
401. Following production of ADP during contraction of skeletal muscle, the most rapid way of
regenerating ATP is:
A. Phosphorylation of ADP by creatine phosphate
B. Anaerobic glycolysis of cell stores of glycogen
C. Anaerobic glycolysis of glucose from the blood
D. Oxidative phosphorylation of fatty acids from the blood
402. The cytoplasmic Ca++ concentration of skeletal muscle would be expected to be highest in:
A. Relaxed muscle
B. During unfused tetanus
C. During fused tetanus
D. At the point during a single twitch when maximum muscle tension is developed
403. A skeletal muscle contracting isometrically generates the greatest tension at its normal resting
length because at that length:
A. The cellular concentration of ATP is highest
B. Sarcoplasmic reticulum is most precisely aligned with the thick filaments
C. The rate of conduction of the action potential across the cell membrane is most rapid
D. The greatest number of cross bridges is aligned with actin binding sites
404. When contracting isometrically, a skeletal muscle will develop its greatest tension:
A. At its normal resting length
B. At 60% of its normal resting length
C. At 150% of its normal resting length
D. The tension developed is constant, irrespective of its length
405. The force of contraction of a skeletal muscle depends on all of the following factors EXCEPT:
A. Its initial length C. The type of muscle fiber it contains
B. The number of motor units activated D. The extracellular Ca++ concentration
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406. Most of the energy for a skeletal muscle functioning for 20 minutes at 25% of its maximum output is
supplied by:
A. Stored ATP C. Anaerobic metabolism of glycogen
B. Stored creatine phosphate D. Aerobic metabolism of fatty acids
408. Which of the following statements about the motor unit is not true?
A. Motor units in the coulometer muscles are the smallest in the body
B. The muscle fibers of a motor unit tend to be located next to each other
C. When the motor nerve fires an action potential, all muscle fibers in the motor unit contract
D. Smaller motor units tend to fire earliest as muscle tension is increased
409. When compared with oxidative slow muscle fibers, fast glycolytic fibers would have:
A. Glycogen as their most important energy source C. Smaller motor units
B. A higher myoglobin content D. A richer capillary blood supply
410. Which of the following types of motor unit would be the first to contract if a skeletal muscle were
given progressively more powerful stimuli?
A. Those containing slow oxidative fibers C. Those with the largest diameter fibers
B. The largest motor units D. Those with the greatest glycogen content
411. An exercise regimen which includes running and swimming long distances will promote an increase
in the:
A. Number of fast glycolytic fibers in skeletal muscle
B. Size of existing fast glycolytic fibers in skeletal muscle
C. Number of slow oxidative fibers in skeletal muscle
D. Mitochondrial content and blood supply of slow oxidative fibers in skeletal muscle
412. An exercise regimen which consisted of a daily 90 minute leisurely swim would be expected to have
all of the following effects EXCEPT:
A. An increased number of fast glycolytic fibers
B. An increased blood supply to muscles
C. A lowered resistance to blood flow
D. An increased concentration of myoglobin within muscle cells
414. The neuromuscular junction of skeletal muscle has all of the following properties EXCEPT:
A. Has acetyl choline as its neurotransmitter
B. Has an enzyme in its post-synaptic membrane which degrades the neurotransmitter
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C. The neurotransmitter causes receptor-operated Cl− channels to open in the post-synaptic membrane
D. The end plate potential is an excitatory post synaptic potential
415. Which of these statements about the neuromuscular junction in skeletal muscle is true?
A. The neurotransmitter could be norepinephrine
B. A single muscle cell can be supplied by a number of different motor neurons
C. The neurotransmitter causes opening of voltage gated ion channels on the motor end plate
D. The neurotransmitter can be hydrolyzed by an enzyme on the post-synaptic membrane
416. Binding of the neurotransmitter to the post-synaptic membrane at the neuromuscular junction of
skeletal muscle has which of the following effects?
A. Opening of voltage gated Na+ channels C. Opening of ligand gated cation channels
B. Opening of voltage gated K+ channels D. Opening of ligand gated Cl− channels
417. A cross section of a relaxed skeletal muscle made immediately adjacent to the Z line of the
sarcomere would be expected to show:
A. Thin filaments only C. Thin filaments and thick filaments
B. Thick filaments only D. Neither thin filaments nor thick filaments
418. Troponin has a binding site for all of the following substances EXCEPT:
A. Tropomyosin B. Actin C. ATP D. Calcium
419. The function of tropomyosin in skeletal muscle during contraction or relaxation is to:
A. Bind Ca++ during contraction
B. Bind Ca++ during relaxation
C. Block the cross bridge binding sites on actin
D. Conduct action potentials to the sarcoplasmic reticulum
420. The function of the transverse tubules in the skeletal muscle cell is to:
A. Conduct the action potential to the central part of the cell
B. Conduct nutrients to the central part of the cell
C. Store Ca++ during muscle relaxation
D. Form a docking site for synaptic vesicles at the neuromuscular junction
421. Which of the following proteins has the enzymatic ability to hydrolyze ATP?
A. Myosin B. Actin C. Troponin D. Tropomyosin
422. Which of the following proteins contains a binding site for Ca++?
A. Actin B. Myosin C. Troponin D. Tropomyosin
423. In the relaxed skeletal muscle the highest concentration of Ca++ is to be found:
A. In synaptic vesicles C. Bound to troponin
B. Within the sarcoplasmic reticulum D. In the cytoplasm of the myofibrils
424. The following events occur as part of the process of skeletal muscle contraction:
A. Depolarization of the transverse tubules
B. Ca++ release by the sarcoplasmic reticulum
C. Increased permeability of the muscle cell membrane to Na+ and K+
D. Binding of acetyl choline to the muscle cell membrane
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These events occur in which of the following sequences?
A. A,D,B,C B. D,A,C,B C. D,C,A,B D. D,C,B,A
425. During skeletal muscle contraction and relaxation the function of ATP is to:
A. Energize the transport of Ca++ from the cytoplasm of the cell into sarcoplasmic reticulum
B. Separate myosin and actin by binding to the myosin cross bridge
C. Energize the myosin cross bridge when hydrolyzed
D. All of the above
426. Contraction of smooth muscle can be caused by a variety of stimuli. All of these stimulatory
processes involve:
A. Movement of Ca++ into the cytoplasm of the cell from extracellular fluid
B. Activation of the sympathetic nervous system
C. An extracellular chemical stimulus (neurotransmitter or hormone)
D. Activation of troponin
427. Contraction of smooth muscle involves all of the following processes EXCEPT:
A. Movement of Ca++ into the cytoplasm from sarcoplasmic reticulum and extracellular fluid
B. Binding of Ca++ to troponin
C. Phosphorylation of myosin
D. Interaction of myosin cross bridges with binding sites on actin
428. Which of the following properties is possessed by smooth muscle but not by skeletal muscle?
A. Contains both actin and myosin
B. Its contraction is triggered by an increase in cytoplasmic Ca++ concentration
C. The thick filament consists of myosin
D. Ca++ action is mediated by its binding to calmodulin
429. Contraction of smooth muscle can be caused by all of the following EXCEPT:
A. Stimulation by the sympathetic nervous system
B. Stimulation by the somatic nervous system
C. Stretch of the muscle
D. Contraction can be spontaneous (without outside stimulation)
430. The direct action of Ca++ during smooth muscle contraction is to:
A. Bind to calmodulin
B. Stimulate release of Ca++ from sarcoplasmic reticulum
C. Bind to troponin
D. Stimulate the activation of a G protein
431. The correct temporal sequence for events at the neuromuscular junction is
A. Action potential in the motor nerve; depolarization of the muscle end plate; uptake of Ca++ into the
presynaptic nerve terminal
B. Uptake of Ca++ into the presynaptic terminal; release of acetylcholine (ACh); depolarization of the muscle
end plate
C. Release of ach; action potential in the motor nerve; action potential in the muscle
D. Uptake of Ca++ into the motor end plate; action potential in the motor end plate; action potential in the
muscle
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E. Release of ach; action potential in the muscle end plate; action potential in the muscle
432. Repeated stimulation of a skeletal muscle fiber causes a sustained contraction (tetanus).
Accumulation of which solute in intracellular fluid is responsible for the tetanus?
A. Na+ C. Cl– E. Ca++ G. Calmodulin
+ 2+
B. K D. Mg F. Troponin H. ATP
433. A 42-year-old man with myasthenia gravis notes increased muscle strength when he is treated with
an acetylcholinesterase (AChE) inhibitor. The basis for his improvement is increased
A. Amount of acetylcholine (ACh) released from motor nerves
B. Levels of ACh at the muscle end plates C. number of ACh receptors on the muscle end plates
D. Amount of norepinephrine released from motor nerves
E. Synthesis of norepinephrine in motor nerves
434. The velocity of conduction of action potentials along a nerve will be increased by
A. Stimulating the Na+ –K+ pump D. Myelinating the nerve
+ +
B. Inhibiting the Na –K pump E. Lengthening the nerve fiber
C. Decreasing the diameter of the nerve
435. A newly developed local anesthetic blocks Na+ channels in nerves. Which of the following effects on
the action potential would it be expected to produce?
A. Decrease the rate of rise of the upstroke of the action potential
B. Shorten the absolute refractory period
C. Abolish the hyperpolarizing after - potential
D. Increase the Na+ equilibrium potential
E. Decrease the Na+ equilibrium potential
436. At the muscle end plate, acetylcholine (ACh) causes the opening of
A. Na+ channels and depolarization toward the Na+ equilibrium potential
B. K+ channels and depolarization toward the K+ equilibrium potential
C. Ca++ channels and depolarization toward the Ca++ equilibrium potential
D. Na+ and K+ channels and depolarization to a value halfway between the Na+ and K+ equilibrium potentials
E. Na+ and K+ channels and hyperpolarization to a value halfway between the Na+ and K+ equilibrium
potentials
438. Which of the following temporal sequences is correct for excitation– contraction coupling in skeletal
muscle?
A. Increased intracellular Ca++; action potential in the muscle membrane; cross-bridge formation
B. Action potential in the muscle membrane; depolarization of the T tubules; release of Ca++ from the
sarcoplasmic reticulum (SR)
C. Action potential in the muscle membrane; splitting of adenosine triphosphate (ATP); binding of Ca++ to
troponin C
D. Release of Ca++ from the SR; depolarization of the T tubules; binding of Ca++ to troponin C
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439. In skeletal muscle, which of the following events occurs before depolarization of the T tubules in
the mechanism of excitation–contraction coupling?
A. Depolarization of the sarcolemmal membrane
B. Opening of Ca++ release channels on the sarcoplasmic reticulum (SR)
C. Uptake of Ca++ into the SR by Ca++-adenosine triphosphatase (ATPase)
D. Binding of Ca++ to troponin C
E. Binding of actin and myosin
440. Adenosine triphosphate (ATP) is used indirectly for which of the following processes?
A. Accumulation of Ca++ by the sarcoplasmic reticulum (SR)
B. Transport of Na+ from intracellular to extracellular fluid
C. Transport of K+ from extracellular to intracellular fluid
D. Transport of H+ from parietal cells into the lumen of the stomach
E. Absorption of glucose by intestinal epithelial cells
442. A 56-year-old woman with severe muscle weakness is hospitalized. The only abnormality in her
laboratory values is an elevated serum K+ concentration. The elevated serum K+ causes muscle weakness
because
A. the resting membrane potential is hyperpolarized
B. the K+ equilibrium potential is hyperpolarized
C. the Na+ equilibrium potential is hyperpolarized
D. K+ channels are closed by depolarization
E. K+ channels are opened by depolarization
F. Na+ channels are closed by depolarization
G. Na+ channels are opened by depolarization
446. The sequence of events in muscle contraction, all the following are true EXCEPT:
A. Action potential depolarize the T-tubules
B. Depolarization of T-tubules release calcium from sarcoplasmic reticulum
C. Calcium binds to the troponin-tropomyosin complex
D. Actin combines with myosin ATP leading to crossbridge activation
E. Calcium moves back into sarcoplasmic reticulum by passive transport
447. What activity should be taking place at the postsynaptic membrane, if its membrane potential
changes from – 65 mv to – 50 mv?
A. EPSP B. IPSP C. End plate potential D. Graded potentials
448. Electrical response to subminimal stimuli in the excitable tissue would produce all of the following
except:
A. Temporal summation B. Spatial summation C. Action potential D. Graded potentials
450. The release of neurotransmitter at a chemical synapse in the central nervous system is dependent
upon which of the following?
A. Synthesis of acetylcholinesterase
B. Hyperpolarization of the synaptic terminal
C. Opening of ligand-gated ion calcium channels
D. Influx of calcium into the presynaptic terminal
451. The excitatory or inhibitory action of a neurotransmitter is determined by which of the following?
A. The function of its postsynaptic receptor
B. Its molecular composition
C. The shape of the synaptic vesicle in which it is contained
D. The distance between the pre- and postsynaptic membranes
452. Which of the following is characteristic of the events occurring at an excitatory synapse?
A. There is a massive efflux of calcium from the presynaptic terminal
B. Synaptic vesicles bind to the postsynaptic membrane
C. Voltage-gated potassium channels are closed
D. Ligand-gated channels are opened to allow sodium entry into the postsynaptic neuron
455. Prolonged changes in neuronal activity are usually achieved through the activation of which of the
following?
A. Voltage-gated chloride channels
B. Transmitter-gated sodium channels
C. G-protein–coupled channels
D. Voltage-gated potassium channels
458. Which of the following types of cells work as scavenger cells in the CNS?
A. Microglia B. Oligodendroglia C. Ependymal cells D. Astrocytes
462. The minimum time for transmission across one synapse is:
A. 0.5 ms B. 1 ms C. 1.5 ms D. 2 ms
471. Which of the following neurotransmitters has both excitatory and inhibitory effects?
A. Glycine
B. GABA
C. Aspartate
D. Glutamate
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1 C 21 B 41 E 61 C 81 B 101 D 121 B
2 A 22 B 42 D 62 D 82 B 102 A 122 C
3 C 23 A 43 E 63 C 83 B 103 C 123 A
4 A 24 D 44 E 64 B 84 D 104 B 124 E
5 A 25 C 45 D 65 D 85 B 105 C 125 B
6 C 26 C 46 E 66 E 86 A 106 A 126 D
7 B 27 D 47 B 67 B 87 D 107 D 127 C
8 D 28 E 48 E 68 A 88 B 108 B 128 B
9 A 29 E 48 D 69 E 89 A 109 B 129 B
10 A 30 E 50 B 70 B 90 D 110 C 130 E
11 B 31 C 51 D 71 C 91 C 111 A 131 C
12 B 32 D 52 B 72 B 92 A 112 C 132 E
13 D 33 B 52 D 73 B 93 B 113 D 133 C
14 C 34 D 54 D 74 E 94 D 114 E 134 A
15 A 35 E 55 A 75 A 95 B 115 C 135 C
16 B 36 A 56 B 76 C 96 B 116 C 136 B
17 C 37 D 57 B 77 B 97 B 117 A 137 B
18 A 38 D 58 B 78 D 98 C 118 D 138 D
19 B 39 B 59 B 79 E 99 D 119 A 139 A
MCQs in
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1. Receptive relaxation of stomach facilitates:
A. Mixing B. Storage C. Propulsion D. Emptying
11. In which phase of digestion do enzymes break down food into particles cells can absorb?
A. Mechanical digestion C. Chemical digestion
B. Absorption D. Ingestion
12. The layer of the digestive tract that contracts and relaxes to propel food forward is the:
A. Mucosa B. Muscularis C. Submucosa D. Serosa
13. Which enzyme acts in the mouth to begin the breakdown of starch?
A. Amylase B. Pepsin C. Trypsin D. Sucrase
16. Which of the following acts as an initial trigger to the stomach to begin secreting gastric juice?
A. The smell of food C. The movement of chyme into the duodenum
B. The stretching of the stomach as it fills with food D. Contractions within the stomach
22. The event not likely to occur during the pharyngeal stage of swallowing is:
A. Deglutition apnea D. Opening of the glottis
B. Closure of the posterior nares E. Upward movement of the larynx
C. Narrowing the palatopharyngeal folds
23. Contraction of the gall bladder and stimulation of enzyme rich pancreatic secretion are the function
of:
A. Cholecystokinin D. Secretin
B. Gastrin E. Vasoactive intestinal peptide
C. Motilin
24. Bile
A. Contains enzymes required for the digestion of fat
B. Contains unconjugated bilirubin
C. Bile salts make cholesterol more water−soluble
D. Bile pigments contain iron
E. Becomes more alkaline during storage in the gallbladder
25. Saliva
A. From different salivary glands has a similar composition
B. Contains enzymes essential for the digestion of proteins
C. Has less than half the ionic calcium level of plasma
D. Has more than twice the iodide level of plasma
E. Has a pH between 5 and 6.
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Digestive System Physiology
26. Swallowing is a reflex which has all the following EXCEPT
A. Has its reflex centers in the cervical segments of the spinal cord
B. Includes inhibition of respiration
C. Is initiated by a voluntary act
D. Is dependent on intrinsic nerve networks in the esophagus
E. Is more effective when the person is standing rather than when lying down
29. Regarding the defecation reflex, all the following are true EXCEPT
A. That is coordinated by reflex centers in the sacral cord
B. Whose afferent limb carries impulses from stretch receptors in the rectal wall
C. Whose efferent limb travels mainly in sympathetic autonomic nerves
D. Which is more likely to be initiated just after a meal than just before it
E. Which can be voluntarily inhibited or facilitated
38. The normally innervated stomach, all the following are true EXCEPT
A. Is stimulated to secrete gastric juice when food is chewed, even if it is not swallowed
B. Cannot secrete HCl when its H2 histamine receptors are blocked
C. And the denervated stomach can secrete gastric juice after a meal is ingested
D. Empties more quickly than the denervated stomach
E. Is stimulated to secrete gastric juice by the hormone secretin
39. The passage of gastric contents to the duodenum may cause all the following EXCEPT
A. Copious secretion of pancreatic juice rich in bicarbonate
B. Decreased gastric motility
C. Contraction of the gallbladder
D. Contraction of the sphincter of Oddi
41. For the absorption of the following, all are true EXCEPT
A. Fat is impaired if either bile or pancreatic juice is not available
B. Undigested protein molecules can occur in the newborn
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Digestive System Physiology
C. Iron is at a rate proportional to body needs
D. Sodium is at a rate proportional to body needs
42. For the secretion of gastric juice, all the following are true EXCEPT
A. Increases when food stimulates mucosal cells in the pyloric region
B. Is associated with an increase in the pH of venous blood draining the stomach
C. In response to food is reduced after vagotomy
D. Is essential for protein digestion
E. Is essential for absorption of vitamin B12.
43. In the small intestine, all the following are true EXCEPT
A. The enzyme concentration in intestinal juice is lower in the ileum than in the jejunum
B. Vitamin B12 is absorbed mainly in the terminal ileum
C. Water absorption is dependent on the active absorption of sodium and glucose
D. Absorption of calcium occurs mainly in the terminal ileum
E. Glucose absorption is dependent on sodium absorption
44. The cells of the liver, all the following are true EXCEPT
A. Help to maintain the normal blood glucose level
B. Deaminate amino acids to form NH4+ which is converted into urea and excreted in the urine
C. Synthesize Vitamin D3 (cholecalciferol)
D. Manufacture most of the plasma proteins EXCEPT immune globulins
E. Inactivate steroid hormones manufactured in the gonads
45. Absorption of dietary fat, all the following are true EXCEPT
A. Can only occur after the neutral fat has been split into glycerol and fatty acids
B. Involves fat uptake by both the lymphatic and blood capillaries
C. Is impaired following gastrectomy
D. Is required for normal bone development
E. Is required for normal blood clotting
47. Modifying gastric function, all the following are true EXCEPT
A. By cutting vagal fibers to the pylorus increases the emptying rate
B. By enlarging the pyloric orifice increases the emptying rate
C. By making a side−to−side anastomosis between the stomach and jejunum may cause peptic ulceration in
the jejunum
D. To allow rapid gastric emptying may lead to low blood glucose levels after a meal
E. To allow rapid gastric emptying may lead to a fall in blood volume and blood pressure after a large meal
48. Impaired intestinal absorption of, all the following are true EXCEPT
A. Iron occurs frequently following removal of most of the stomach
B. Water occurs in infants who cannot digest disaccharides
C. Calcium may occur following removal of the terminal ileum
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D. Bile salts may occur following removal of the terminal ileum
51. Complications that may arise after total gastrectomy include all the following EXCEPT
A. Inadequate food intake
B. Depletion of vitamin B12 stores in the liver
C. Malabsorption of fat due to rapid intestinal transit
D. Impaired defecation due to loss of the gastrocolic reflex
E. Pancreatic enzymes can make up for the loss of gastric pepsin
53. Diminished liver function may result in an increase in all the following EXCEPT
A. Albumin to globulin ratio in the blood
B. Size of male breasts
C. Level of unconjugated bilirubin in the blood
D. Tendency to bleed
E. Variability of the blood glucose level
54. Peptic ulceration tends to heal after all the following EXCEPT
A. Division of the vagal nerve supply to the stomach
B. Surgical removal of the pyloric antrum
C. Glucocorticoid drug treatment
D. Elimination of the bacterium Helicobacter pylori from the stomach
E. Treatment with histamine H2 blocking drugs
56. Surgical removal of 90 per cent of the small intestine may cause a the following EXCEPT
A. An increase the fat content of the stools
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Digestive System Physiology
B. A decrease in the bone mineralization (osteomalacia)
C. A decrease in the extracellular fluid volume
D. A decrease in the blood hemoglobin level
E. A decrease in the body weight
57. Lack of pancreatic juice in the duodenum may lead to the following EXCEPT
A. The presence of undigested meat fibers in the stools
B. An increase in the fat content of the feces
C. A tendency for the feces to putrefy
D. A high prothrombin level in blood
59. Gastric
A. Acid secretion in response to a lowered blood sugar is mediated by the hormone gastrin
B. Emptying is facilitated by sympathetic nerve activity
C. Acid secretion increases when histamine H2, muscarinic M1 or gastrin receptors are activated
D. Acid secretion is inhibited by the presence of food in the mouth
62. Absorption of glucose by intestinal mucosal cells, all the following are true EXCEPT
A. Relies on a carrier mechanism in the cell membrane
B. Is blocked by the same agents that block renal reabsorption of glucose
C. Is enhanced by blockade of active sodium transport in the cells
D. Involves the same carriers that are used for the absorption of galactose
E. Takes place mainly in the duodenum and jejunum
64. Muscle tone in the lower esophagus, all the following are true EXCEPT
A. Greater than tone in the middle esophagus
B. A major factor in preventing heartburn
C. Decrease in pregnancy
D. Increased by gastrin
E. Increased by anticholinergic drugs
65. A 43−year−old man eats a meal consisting of 40 percent protein, 10 percent fat, and 50 percent
carbohydrate. Thirty minutes later the man feels the urge to defecate. Which reflex results in the urge to
defecate when the duodenum is stretched?
A. Duodenocolic
B. Enterogastric
C. Intestino−intestinal
D. Rectosphincteric
68. Which ion has the highest actual concentration in saliva under basal conditions?
A. Bicarbonate B. Chloride C. Potassium D. Sodium
69. Relative to plasma concentration, which ion has the highest concentration in saliva under basal
conditions?
A. Bicarbonate B. Chloride C. Potassium D. Sodium
70. A 10−year−old boy consumes a cheeseburger, fries, and chocolate shake (fat, carbohydrate, and
protein). The meal stimulates the release of several gastrointestinal hormones. Which of the following
hormone can be released from duodenum mucosa in response to all of the above food ingredients?
A. Cholecystokinin (CCK) D. Motilin
B. Gastric inhibitory polypeptide E. Secretin
C. Gastrin
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71. A clinical experiment is conducted in which one group of subjects is given 50 grams of glucose
intravenously and another group is given 50 grams of glucose orally. Which factor can explain why the
oral glucose load is cleared from the blood at a faster rate compared with the intravenous glucose load?
A. CCK−induced insulin release
B. CCK−induced vasoactive intestinal peptide (VIP) release
C. Gastric inhibitory polypeptide−induced glucagon release
D. Gastric inhibitory polypeptide −induced insulin release
E. VIP−induced Gastric inhibitory polypeptide release
72. Digestion of which of the following is impaired to the greatest extent in patients with achlorhydria?
A. Carbohydrate B. Fat C. Protein
73. Gastric emptying is tightly regulated to ensure that chyme enters the duodenum at an appropriate
rate. Which event promotes gastric emptying under normal physiological conditions in a healthy person?
(Note: Orad region of the stomach includes the fundus and upper half of the body of the stomach)
Tone of Orad Stomach Segmentation Contractions in Tone of Pyloric Sphincter
Small Intestine
A. Decrease Decrease Decrease
B. Decrease Increase Decrease
C. Increase Decrease Decrease
D. Increase Decrease Increase
E. Increase Increase Increase
Direction: A tropical hurricane hits a Caribbean island, and the people living there are forced to drink
unclean water. Within the next several days, a large number of people experience severe diarrhea, and
about half of these people die. Samples of drinking water are positive for the bacterium Vibrio cholerae.
Use this information to answer Questions 74–76.
74. A toxin from V. cholerae is most likely to stimulate an increase in which of the following in the
epithelial cells of the crypts of Lieberkühn in these people?
A. Cyclic adenosine monophosphate (cAMP) C. Chloride absorption
B. Cyclic guanosine monophosphate (cGMP) D. Sodium absorption
75. Which type of ion channel is most likely to be irreversibly opened in the intestinal epithelial cells of
these people?
A. Calcium B. Chloride C. Magnesium D. Potassium E. Sodium
76. Which range best describes the life span (in days) of an intestinal enterocyte infected with V.
cholerae in a person who survives?
A. 1 to 3 B. 3 to 6 C. 6 to 9 D. 9 to 12 E. 12 to 15
77. The gastrointestinal hormones have physiological effects that can be elicited at normal
concentrations as well as pharmacological effects that require higher than normal concentrations. What
is the physiological effect of the various hormones on gastric emptying?
Gastrin Secretin Cholecystokinin Gastric inhibitory polypeptide Motilin
78. Swallowing is a complex process that involves signaling between the pharynx and swallowing center
in the brain stem. Which structure is critical for determining whether a bolus of food is small enough to
be swallowed?
A. Epiglottis D. Soft palate
B. Larynx E. Upper esophageal sphincter
C. Palatopharyngeal folds
79. The spinal cord of a 60−year−old woman is severed at T6 in an automobile accident. She devises a
method to distend the rectum to initiate the rectosphincteric reflex. Rectal distention causes which of
the following responses in this woman?
A No No No
B No No Yes
C No Yes Yes
D Yes No Yes
E Yes Yes No
F Yes Yes Yes
80. An 82−year−old woman with upper abdominal pain and blood in the stool has been taking
nonsteroidal anti−inflammatory drugs (NSAIDs) for arthritis. Endoscopy reveals patchy gastritis
throughout the stomach. Biopsies were negative for Helicobacter pylori. Pentagastrin administered
intravenously would lead to a less than normal increase in which of the following?
(Pentagastrin is a synthetic polypeptide that has effects like gastrin when given parenterally. It stimulates
the secretion of gastric acid, pepsin, and intrinsic factor).
A. Duodenal mucosal growth D. Pancreatic enzyme secretion
B. Gastric acid secretion E. Pancreatic growth
C. Gastrin secretion
81. Which substances have a physiological role in stimulating the release of hormones or stimulating
nervous reflexes, which in turn can inhibit gastric acid secretion?
Acid Fatty Hyperosmotic Isotonic
Acids Solutions Solutions
A No No Yes No
B No No Yes Yes
C Yes Yes No Yes
D Yes Yes Yes Yes
E Yes Yes Yes No
82. A clinical study is conducted to determine the time course of gastric acid secretion and gastric pH in
healthy volunteers after a meal consisting of 10 percent fat, 30 percent protein, and 60 percent
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Digestive System Physiology
carbohydrate. The results show an immediate increase in the pH of the gastric juice after the meal, which
is followed several minutes later by a secondary increase in the rate of acid secretion. A decrease in
which substance is most likely to facilitate the secondary increase in the rate of acid secretion in these
volunteers?
A. Gastrin C. Somatostatin
B. Cholecystokinin D. Vasoactive intestinal peptide
83. Vomiting is a complex process that requires coordination of numerous components by the vomiting
center located in the medulla. Which of the following occurs during the vomiting act?
LES Upper Abdominal Diaphragm
Esophageal Muscles
Sphincter
84. Various proteolytic enzymes are secreted in an inactive form into the lumen of the gastrointestinal
tract. Which of the following substances are important for activating one or more proteolytic enzymes,
converting them to an active form?
Trypsin Enterokinase Pepsin
A No No No
B No No Yes
C No Yes No
D Yes Yes No
E Yes Yes Yes
85. A clinical study is conducted in which gastric acid secretion is stimulated using pentagastrin before
and after treatment with a histamine H2 blocker. Which rates of gastric acid secretion (in mEq/hr) are
most likely to have occurred in this experiment? (Pentagastrin is a synthetic polypeptide that has effects
like gastrin when given parenterally. It stimulates the secretion of gastric acid, pepsin, and intrinsic
factor)
Pentagastrin Pentagastrin
Alone + H2 Blocker
A 15 15
B 15 25
C 25 15
D 26 28
E 40 45
86. A 23−year−old medical student consumes a cheeseburger, fries, and chocolate shake (proteins, fats,
and carbohydrates). Which of the following hormones produce physiological effects at some point during
the next several hours?
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Digestive System Physiology
Gastrin Secretin Cholecystokinin GIP
87. A 68−year−old woman with hematemesis has heartburn and stomach pain. An endoscopy shows
inflammation involving the gastric body and antrum as well as a small gastric ulcer. Biopsies were
positive for H. pylori. H. pylori damages the gastric mucosa primarily by increasing mucosal levels of
which of the following?
A. Ammonium C. Gastrin E. Pepsin
B. Bile salts D. NSAIDs
88. A healthy 21−year−old woman eats a big meal and then takes a 3−hour ride on a bus that does not
have a bathroom. Twenty minutes after eating, the woman feels a strong urge to defecate, but manages
to hold it. Which mechanisms have occurred in this woman?
Relaxation of the Contraction of the Contraction of the Rectum
Internal Anal External Anal Sphincter
Sphincter
A No No No
B No Yes Yes
C Yes No Yes
D Yes No No
E Yes Yes Yes
89. A 65−year−old man eats a healthy meal. Approximately 40 minutes later the ileocecal sphincter
relaxes and chyme moves into the cecum. Gastric distention leads to relaxation of the ileocecal sphincter
by way of which reflex?
A. Enterogastric C. Gastrocolic E. Rectosphincteric
B. Gastroileal D. Intestino−intestinal
90. The gastric mucosal barrier has a physiological and an anatomical basis to prevent back−leak of
hydrogen ions into the mucosa. Some factors are known to strengthen the integrity of the gastric
mucosal barrier, whereas other factors can weaken the barrier. Which factors strengthen or weaken the
barrier?
Bile Salts Mucous Aspirin NSAIDs Gastrin Ethanol
92. A 62−year−old man with dyspepsia and a history of chronic gastric ulcer has abdominal pain.
Endoscopy shows a large ulcer in the proximal gastric body. Biopsies were positive for H. pylori. Which
substances are used clinically for treatment of gastric ulcers of various etiologies?
Antibiotics NSAIDs H2 Blockers Proton Pump
Inhibitors
A No No Yes Yes
B Yes No No Yes
C Yes No Yes Yes
D Yes Yes Yes Yes
E No Yes Yes Yes
93. Cystic fibrosis (CF) is an inherited disorder of the exocrine glands affecting children and young
people. Mucus in the exocrine glands becomes thick and sticky and eventually blocks the ducts of these
glands (especially in the pancreas, lungs, and liver), forming cysts. A primary disruption in the transfer of
which ion across cell membranes occurs in CF, leading to decreased secretion of fluid?
A. Calcium B. Chloride C. Phosphate D. Potassium E. Sodium
94. A 10−year−old boy consumes a glass of milk and two cookies. His LES and fundus relax while the food
is still in the esophagus. Which substance is most likely to cause relaxation of the LES and fundus in this
boy?
A. Gastrin C. Motilin E. Norepinephrine
B. Histamine D. Nitric oxide
95. A 19−year−old man is fed intravenously for several weeks after a severe automobile accident. The
intravenous feeding leads to atrophy of the gastrointestinal mucosa, most likely because the blood level
of which of the following hormones is reduced?
A. Cholecystokinin only D. Gastrin and cholecystokinin
B. Gastrin only E. Gastrin and secretin
C. Secretin only F. Secretin and cholecystokinin
96. Mass movements are often stimulated after a meal by distention of the stomach (gastrocolic reflex)
and distention of the duodenum (duodenocolic reflex). Mass movements often lead to which of the
following?
A. Bowel movements D. Esophageal contractions
B. Gastric movements E. Pharyngeal peristalsis
C. Haustrations
97. A 45−year−old woman with type 1 diabetes has an early feeling of fullness when eating. She is often
nauseous after a meal and vomits about once each week after eating. Glucose−induced damage to which
structure is most likely to explain her gastrointestinal problem?
A. Celiac ganglia B. Enteric nervous system C. Esophagus D. Stomach E. Vagus nerve
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Digestive System Physiology
98. Which stimulus−mediator pair normally inhibits gastrin release?
Stimulus Mediator
A Acid CCK
B Acid GLIP
C Acid Somatostatin
D Fatty acid Motilin
E Fatty acid Somatostatin
99. A 55−year−old man consumes a meal consisting of 20 percent fat, 50 percent carbohydrate, and 30
percent protein. The following gastrointestinal hormones are released at various times during the next 6
hours: gastrin, secretin, motilin, GIP, and cholecystokinin. Which structure is most likely to release all five
hormones in this man?
A. Antrum B. Colon C. Duodenum D. Esophagus E. Ileum
100. An 89−year−old man has a cerebrovascular accident (stroke) in the medulla and pons that
completely eliminates all vagal output to the gastrointestinal tract. Which function is most likely to be
totally eliminated in this man?
A. Gastric acid secretion D. Primary esophageal peristalsis
B. Gastrin release E. Secondary esophageal peristalsis
C. Pancreatic bicarbonate secretion F. None of the above
101. An 84−year−old man with hematemesis and melena is diagnosed with a duodenal ulcer. A patient
diagnosed with a duodenal ulcer is likely to exhibit which of the following?
Parietal Cell Acid Secretion Plasma Gastrin
Density
A Decreased Decreased Decreased
B Decreased Increased Decreased
C Increased Decreased Increased
D Increased Increased Decreased
E Increased Increased Increased
102. A 71−year−old man with upper abdominal pain and blood in the stool takes NSAIDs for the pain and
washes it down with whiskey. Pentagastrin administration produced lower than predicted levels of
gastric acid secretion. Secretion of which substance is most likely to be diminished in this patient with
gastritis?
A. Intrinsic factor B. Ptyalin C. Rennin D. Saliva E. Trypsin
103. The control of gastric acid secretion in response to a meal involves several events that take place
over a 4−or 5−hour period after the meal. These events include (1) a decrease in the pH of the gastric
contents, (2) an increase in the rate of acid secretion, (3) a decrease in the rate of acid secretion, and (4)
an increase in the pH of the gastric contents. Which sequence best describes the correct temporal order
of events over a 4−or 5−hour period after a meal?
A. 4, 3, 2, 1 C. 3, 4, 1, 2 E. 4, 2, 1, 3 G. 2, 3, 1, 4
B. 3, 1, 4, 2 D. 2, 1, 4, 3 F. 1, 2, 3, 4
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Digestive System Physiology
104. Which mechanism for transport of substances across the luminal cell membrane of an enterocyte is
present in newborns and infants but not in adults?
A. Endocytosis D. Primary active transport
B. Facilitated diffusion E. Secondary active transport
C. Passive diffusion
105. CF is the most common cause of pancreatitis in children. Which option best explains the mechanism
of CF−induced pancreatitis?
A. Activation of enterokinase D. Excessive secretion of CCK
B. Activation of trypsin inhibitor E. Gallstone obstruction
C. Autodigestion of pancreas
107. Postganglionic parasympathetic neurons innervating the gastrointestinal smooth muscle are
located in:
A. Myenteric plexus C. Paravertebral ganglia
B. Submucosal plexus D. Prevertebral ganglia
110. Which one of the following is not a prominent stimulator of gastric acid secretion?
A. Prostaglandin E2 B. Gastrin C. Acetylcholine D. Histamine
111. Vagotomy does not prevent gastric acid secretion occurring in response to:
A. Injection of histamine C. Sight and smell of food
B. Injection of insulin D. Emotions
112. Enterocytes are replenished by mitotically active undifferentiated cells located in:
A. Brunner’s glands C. Peyer’s patches
B. Crypts of Lieberkühn D. Gut associated lymphoid tissue
114. The pattern of electrical and motor activity in the gastrointestinal tract during periods of fasting is
called:
A. Basic electrical rhythm C. Peristalsis
B. Migrating motor complex (MMC) D. Segmentation
115. The major humoral mediator of pancreatic duct cell secretion of bicarbonate rich juice is:
A. Secretin B. CCK C. Somatostatin D. Pancreozymin
116. The most potent stimulus for secretin release from the duodenum is:
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Digestive System Physiology
A. Acid load C. Fatty acid with > 8 carbons
B. Peptide D. Carbohydrate
117. The major humoral mediator of gall bladder contraction in response to a fat meal is:
A. CCK B. Gastrin C. Secretin D. Somatostatin
119. Bile salts are essential for absorption of fat because they:
A. Solubilize dietary lipids in micelles C. Are hydrophobic
B. Increase surface tension D. Contain cholesterol
123. The type of contraction that normally occurs only in the colon is:
A. Peristalsis B. Segmentation C. Mass action contraction D. Migratory motor complex
124. The type of intestinal contraction that hastens transit in the GIT in the digestive state is:
A. Peristalsis B. Segmentation C. Tonic contraction D. Migrating motor complex
621. Motor neurons in the myenteric plexus that stimulate the contraction of visceral smooth muscle in
the gastrointestinal tract release:
A. Acetylcholine D. Somatostatin
B. Vasoactive intestinal polypeptide E. Enkephalins
C. Nitric oxide
128. Which of the following inhibits gastric acid secretion by an action on the parietal cell?
A. Acetylcholine C. Gastrin E. Prostaglandin E
B. Epinephrine D. Histamine
129. Vagally mediated increase in gastric acid secretion is partly mediated by:
A. Gastrin releasing peptide (GRP) C. Vasoactive intestinal polypeptide (VIP)
B. Gastric inhibitory peptide (GIP) D. Somatostatin
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Digestive System Physiology
130. The release of gastrin from G cells in the antrum of the stomach is inhibited by:
A. Activation of vagal efferent fibers to the stomach
B. Circulating epinephrine
C. Blood−borne calcium
D. Mechanical distention of the stomach
E. Somatostatin
137. Bile salts are essential for absorption of fat because they:
A. Solubilize dietary lipids in micelles C. Are hydrophobic
B. Increase surface tension D. Contain pancreatic enzymes
142. Most pancreatic zymogens are activated in the duodenal lumen by:
A. Enterokinase (enteropeptidase) B. Trypsin C. Trypsin activator protein
145. Which of the following enzymes is located in the brush border of enterocytes in the small intestine?
A. Lactase B. Colipase C. Cholesterol ester hydrolase D. Lingual lipase
147. Quantitatively, the most important enzyme in the digestion of fat is:
A. Lingual lipase B. Gastric lipase C. Pancreatic lipase D. Lipoprotein lipase
148. Normally, instillation of acid into the duodenum to reduce pH in its lumen to 4 would most likely:
A. Stimulate gastrin release C. Increase secretion of Brunner’s glands
B. Increase output of trypsin D. Relax the pyloric sphincter
149. The major humoral mediator of pancreatic duct cell secretion of bicarbonate rich juice is:
A. Secretin B. CCK C. Somatostatin D. Gastrin
150. The major humoral mediator of gall bladder contraction in response to a fat meal is:
A. CCK B. Gastrin C. Secretin D. Somatostatin
152. In healthy humans, the maximal rate of glucose absorption from the intestine is estimated to be
about:
A. 10 g/hour B. 40 g/hour C. 120 g/hour D. 180 g/hour
153. Intestinal absorption of which of the following does not directly utilize a Na+ gradient?
A. Fructose B. Galactose C. Glucose D. Phenylalanine E. Tyrosine
154. Which of the following mechanisms allows complete absorption of glucose from the intestinal
lumen into the cytosol of the enterocyte?
A. Simple diffusion through GLUT−5 C. Na channels in enterocyte membrane
B. Na−glucose cotransporter−1 (SGLT−1) D. Paracellular uptake via gap junctions
157. In healthy humans, active absorption of bile acids and bile salts occurs mainly in the:
A. Duodenum B. Jejunum C. Terminal ileum D. Colon
158. Select all correct answers. Calcium absorption from the intestine:
A. Is facilitated by vitamin D C. Occurs mainly in the upper small intestine
B. Is decreased by phytates and oxalates D. All of the above
159. In healthy humans, the earliest the first part of a test meal reaches the cecum is in about:
A. 4 hours B. 6 hours C. 9 hours D. 12 hours
166. Chronic administration of which of the following types of drugs would lead to a sustained increase
in serum gastrin levels?
A. H2 receptor antagonist C. Anticholinergic E. Beta blocker
B. Proton pump inhibitor D. Antacid
167. Which one of the following statements about small intestinal motility is correct?
A. Contractile frequency is constant from duodenum to terminal ileum
B. Peristalsis is the major contractile pattern during feeding
C. Migrating motor complexes occur during the digestive period
D. Vagotomy abolishes contractile activity during the digestive period
E. Contractile activity is initiated in response to bowel wall distention
168. Which one of the following statements about gastric emptying is correct?
A. Solids empty more rapidly than liquids
B. Vagotomy accelerates the emptying of solids
C. Indigestible food empties during the digestive period
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Digestive System Physiology
D. Acidification of the antrum decreases gastric emptying
E. Vagotomy decreases accommodation of the proximal stomach
170. The principal paracrine secretion involved in the inhibitory feedback regulation of gastric acid
secretion is
A. Gastrin B. Somatostatin C. Histamine D. Enterogastrone E. Acetylcholine
171. Which one of the following is the putative inhibitory neurotransmitter responsible for relaxation of
gastrointestinal smooth muscle?
A. Dopamine B. Vasoactive intestinal peptide C. Somatostatin D. Substance P E. Acetylcholine
173. Which one of the following statements best describes water and electrolyte absorption in the GI
tract?
A. The small intestine and colon have similar absorptive capacities
B. Osmotic equilibration of chyme occurs in the stomach
C. The majority of absorption occurs in the jejunum
D. Water absorption is independent of Na+ absorption
174. Hypokalemic metabolic acidosis can occur with excess fluid loss from the
A. Stomach B. Ileum C. Colon D. Pancreas E. Liver
176. The hormone involved in the initiation of the migrating motor complex is
A. Gastrin B. Motilin C. Secretin D. Cholecystokinin E. Enterogastrone
179. Which one of the following processes applies to the proximal stomach?
A. Accommodation B. Peristalsis C. Retropulsion D. Segmentation
180. After secretion of trypsinogen into the duodenum, the enzyme is converted into its active form,
trypsin, by
A. Enteropeptidase C. Pancreatic lipase E. An alkaline pH
B. Procarboxypeptidase D. Previously secreted trypsin
181. The major mechanism for absorption of sodium from the small intestine is
A. Na+−H+ exchange C. Electrogenic transport E. Solvent drag
B. Cotransport with potassium D. Neutral NaCl absorption
184. Dietary fat, after being processed, is extruded from the mucosal cells of the gastrointestinal tract
into the lymphatic ducts in the form of
A. Monoglycerides B. Diglycerides C. Triglycerides D. Chylomicrons E. Free fatty acids
185. Acute obstruction of the common bile duct produced experimentally will incur which of the
following changes in plasma and urinary levels of Bilirubin?
Unconjugated Bilirubin in Plasma Conjugated bilirubin in plasma Conjugated bilirubin in urine
A Increase No change Increase
B No change Increase Increase
C Decrease Decrease Decrease
D Increase Decrease Increase
E Decrease No change Increase
186. Gas within the colon is primarily derived from which one of the following sources?
A. CO2 liberated by the interaction of HCO3− and H+
B. Diffusion from the blood
C. Fermentation of undigested oligosaccharides by bacteria
D. Swallowed atmospheric air
E. Air pockets within foodstuffs
189. Vitamins synthesized by intestinal bacteria and absorbed in significant quantities include
A. Vitamin B6 B. Vitamin K C. Thiamine D. Riboflavin E. Folic acid
190. Which one of the following statements about the colon is correct?
A. Absorption of Na+ in the colon is under hormonal (aldosterone) control
B. Bile acids enhance absorption of water from the colon
C. Net absorption of HCO3− occurs in the colon
D. Net absorption of K+ occurs in the colon
E. The luminal potential in the colon is positive
193. Which one of the following statements about small intestine crypt Cells is correct?
A. They evidence well−developed microvilli
B. They are responsible for net NaCl and water absorption
C. They contain significant quantities of brush border hydrolases
D. They are responsible for net NaCl and water secretion
E. They demonstrate little or no proliferative activity
196. Which of the following sugars is absorbed from the small intestine by Facilitated diffusion?
A. Glucose B. Galactose C. Fructose D. Sucrose E. Lactose
197. Nearly all binding of cobalamin (vitamin B12) to intrinsic factor occurs in the
A. Stomach B. Duodenum C. Jejunum D. Ileum E. Colon
199. At concentrations present in the diet, which vitamin is absorbed primarily by diffusion?
A. Vitamin C B. Folate C. Vitamin D D. Niacin E. Vitamin B12
202. Which one of the following statements about the process of vitamin
B12 absorption is correct?
A. In humans, intrinsic factor is secreted from chief cells of the gastric gland
B. Vitamin B12 binds preferentially to intrinsic factor in the stomach
C. In adults, vitamin B12 absorption occurs along the length of the small intestine
D. Absorption may be reduced in a patient with pancreatic insufficiency
E. Absorption occurs via passive diffusion into the enterocyte
203. Patients may experience nausea and a sense of early satiety following
A. Surgical resection of the proximal small bowel D. Surgical removal of the gastric antrum
B. A vagotomy of the distal stomach E. A vagotomy of the orad stomach
C. Surgical resection of the proximal stomach
204. The origin of electrical slow wave activity in gastrointestinal tract Smooth muscle is
A. The interstitial cells of Cajal
B. The smooth muscle of the circular muscle layer
C. The smooth muscle of the longitudinal muscle layer
D. The smooth muscle of the muscularis mucosa
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Digestive System Physiology
E. The myenteric plexus
206. The major factor that protects the duodenal mucosa from damage by
Gastric acid is
A. Pancreatic bicarbonate secretion
B. The endogenous mucosal barrier of the duodenum
C. Duodenal bicarbonate secretion
D. Hepatic bicarbonate secretion
E. Bicarbonate contained in bile
207. Bicarbonate absorption from the upper small intestine is closely coupled with
A. Na−glucose absorption D. Electrogenic Na absorption
B. Neutral NaCl absorption E. Na–vitamin B12 absorption
C. Na/H exchange
208. Which one of the following statements about bile acids is correct?
A. Conjugation with glycine enhances passive absorption of bile acids
B. Bile acids constitute approximately 80% of the total solutes in bile
C. Deoxycholic acid and lithocholic acid are examples of primary bile acids
D. Bile acid synthesis is catalyzed by the microsomal enzyme 7α−hydroxylase
E. Bile acids are essentially water−insoluble
211. The delivery of chyme into the proximal small intestine will
A. Increase gastric acid secretion
B. Decrease pancreatic bicarbonate secretion
C. Increase gastric emptying of solids
D. Decrease circulating CCK levels
E. Increase small intestine segmentation
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Digestive System Physiology
212. A person is found to have increased basal and maximal acid outputs, Decreased serum calcium
levels, and microcytic anemia. Inflammation in Which area of the gastrointestinal tract would explain
these findings?
A. Colon B. Jejunum C. Duodenum D. Gallbladder E. Stomach
213. Which one of the following statements best describes water and electrolyte absorption in the
gastrointestinal tract?
A. Most water and electrolytes derive from the oral intake of fluids
B. The small and large intestines have similar absorptive capacities
C. Net secretion of potassium occurs from the ileum
D. Osmotic equilibration of chyme occurs in the duodenum
E. Cholera toxin inhibits sodium−coupled nutrient transport
214. The paracrine secretion responsible for inhibiting gastric acid secretion is
A. Histamine B. Enterogastrone C. Somatostatin D. Pepsin E. Enterooxyntin
215. A medical student presents to the emergency room with a two−day History of severe vomiting and
orthostatic hypotension. What kind of metabolic abnormalities would you expect?
A. Hypokalemia, hypochloremia, and metabolic acidosis
B. Hyperkalemia, hyperchloremia, and metabolic alkalosis
C. Normal serum electrolytes and metabolic acidosis
D. Normal serum electrolytes and metabolic alkalosis
E. Hypokalemic, hypochloremic, metabolic alkalosis
217. Which one of the following statements about bile acids is correct?
A. They are essentially water−insoluble
B. The majority of bile acids is absorbed by passive diffusion
C. Glycine conjugates are more soluble than taurine conjugates
D. The amount lost in the stool each day represents the daily loss of cholesterol
E. The bile acid dependent fraction of bile is stimulated by the hormone secretin
219. The macrolide antibiotic erythromycin is associated with gastrointestinal disturbances related to
increased motility. The antibiotic works by Binding to receptors on nerves and smooth muscle that
recognize the gastrointestinal hormone
A. Gastrin B. Motilin C. Secretin D. Cholecystokinin E. Enteroglucagon
220. The transport protein responsible for entry of glucose into the intestinal enterocyte is called
A. Glut−2 B. Glut−5 C. SGLT1 D. SGLT2 E. SGLT5
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Digestive System Physiology
221. Short−chain fatty acid absorption occurs almost exclusively from the
A. Stomach B. Duodenum C. Jejunum D. Ileum E. Colon
222. Which one of the following statements about medium−chain fatty Acids is correct?
A. They are more water−soluble than long−chain fatty acids
B. Within the enterocyte, they are used for triglyceride resynthesis
C. They are packaged into chylomicrons
D. They are transported in the lymph
E. They require emulsification prior to enterocyte uptake
222. A patient with diabetes mellitus presents with gastroesophageal reflux disease accompanying
gastroparesis. Which of the following statements about gastric emptying is correct?
A. Solids empty more rapidly than liquids
B. Meals containing fat empty faster than carbohydrate−rich food
C. Hyperosmolality of duodenal contents initiates a decrease in gastric emptying
D. Acidification of the antrum increases gastric emptying
E. Vagal stimulation decreases receptive relaxation in the upper portion of the stomach
222. A 27−year−old female medical student with irritable bowel syndrome (IBS) has an alteration in
intestinal motility resulting in fluctuating constipation and diarrhea. Her condition has worsened in the
past month as the date she has scheduled for her licensure examination approaches. Which of the
following statements about small intestinal motility is correct?
A. Contractile frequency is constant from duodenum to terminal ileum
B. Peristalsis is the only contractile activity that occurs during feeding
C. Migrating motor complexes occur during the digestive period
D. Vagotomy abolishes contractile activity during the digestive period
E. Contractile activity is initiated in response to bowel wall distention
225. An 18−year−old male with pernicious anemia lacks intrinsic factor, which is necessary for the
absorption of cyanocobalamin. Vitamin B12 is absorbed primarily in which portion of the GI tract?
A. Stomach B. Duodenum C. Jejunum D. Ileum E. Colon
226. A 57−year−old man undergoes resection of the distal 100 cm of the terminal ileum as part of
treatment for Crohn’s disease. The patient likely will develop malabsorption of which of the following?
A. Iron B. Folate C. Lactose D. Bile salts E. Protein
227. A 42−year−old salesman presents with the chief complaint of intermittent midepigastric pain that is
relieved by antacids or eating. Gastric analysis reveals that basal and maximal acid output exceeds
normal values. The gastric acid hypersecretion can be explained by an increase in the plasma
concentration of which of the following?
A. Somatostatin B. Histamine C. Gastrin D. Secretin E. Enterogastrone
228. A 27−year−old female comes to the emergency room because of a 2−day bout of profuse watery
diarrhea. Physical examination reveals dry lips and oropharynx. The patient is diagnosed with acute
secretory diarrhea and dehydration, likely due to Escherichia coli. Which of the following sodium
reabsorptive pathways is inhibited by the enterotoxin?
A. Sodium−glucose−coupled cotransport D. Sodium−hydrogen countertransport
B. Electroneutral NaCl transport E. Sodium−bile salt cotransport
C. Electrogenic sodium diffusion
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Digestive System Physiology
229. A 37−year−old male presents with dehydration and hypokalemic metabolic acidosis. This acid−base
and electrolyte disorder can occur with excess fluid loss from which of the following organs?
A. Stomach B. Ileum C. Colon D. Pancreas E. Liver
230. A 49−year−old man undergoes vagotomy for his peptic ulcer disease. As a result, which of the
following gastrointestinal motor activities will be affected most?
A. Secondary esophageal peristalsis
B. Distention−induced intestinal segmentation
C. Orad stomach accommodation (proximal part of the stomach)
D. Caudal stomach peristalsis (distal part of the stomach)
E. Migrating motor complexes
231. A 35−year−old male smoker presents with burning epigastric pain that is most pronounced on an
empty stomach and was diagnosed as Zollinger−Ellison syndrome. Normally, basal acid output is
increased by which of the following?
A. Acidification of the antrum D. Alkalinization of the antrum
B. Administration of an H2−receptor antagonist E. Acidification of the duodenum
C. Vagotomy
232. A 42−year−old male develops a gastric carcinoma affecting the proximal third of his stomach. He is
scheduled for a partial gastrectomy of the affected region, which will primarily affect which of the
following processes?
A. Accommodation B. Peristalsis C. Retropulsion D. Segmentation
233. A 68−year−old woman with rheumatoid arthritis, who has been taking nonsteroidal
anti−inflammatory drugs (NSAIDS) for the past 10 years, complains of burning epigastric pain that is
relieved by antacids, but worsened with food. Her doctor discontinues the NSAIDS and starts her on
cimetidine. Which of the following is true regarding the pharmacological blockade of histamine H2
receptors in the gastric mucosa?
A. It inhibits both gastrin− and acetylcholine−mediated secretion of acid
B. It inhibits gastrin−induced but not meal−stimulated secretion of acid
C. It has no effect on either gastrin−induced or meal−stimulated secretion of acid
D. It prevents activation of adenyl cyclase by gastrin
E. It causes an increase in potassium transport by gastric parietal (oxyntic) cells
234. A 37−year−old male with AIDS presents with a fever, anorexia, weight loss, and GI bleeding.
Physical examination reveals a palpable abdominal mass. Endoscopy and biopsy reveal a small−bowel
malignancy, indicating surgical resection. Removal of proximal segments of the small intestine would
most likely result in a decrease in which of the following?
A. Basal acid output D. Gastric emptying of solids
B. Maximal acid output E. Pancreatic enzyme secretion
C. Gastric emptying of liquids
235. A 63−year−old female is diagnosed with an intractable duodenal ulcer. After consultation with a
surgeon, it is recommended that she undergoes a parietal cell vagotomy. Subsequently the patient
experiences nausea and vomiting after ingestion of a mixed meal. Which of the following best explains
her symptoms?
A. Increased gastric emptying of solids C. Increased gastric emptying of liquids
B. Decreased gastric emptying of solids D. Decreased gastric emptying of liquids
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Digestive System Physiology
E. Increased emptying of liquids and solids
236. A 17−year−old male who is being treated with the macrolide antibiotic erythromycin complains of
nausea, intestinal cramping, and diarrhea. The side effects are the result of the antibiotic binding to
receptors on GI tract enteric nerves and smooth−muscle cells that recognize which gastrointestinal
hormone?
A. Gastrin B. Secretin C. Cholecystokinin D. Motilin E. Enterogastrone
237. A 23−year−old woman complains of abdominal cramps and bloating that are relieved by defecation.
Subsequent clinical evaluation reveals an increased maximal acid output, decreased serum calcium and
iron concentrations, and microcytic anemia. Inflammation in which area of the GI tract best explains
these findings?
A. Stomach B. Duodenum C. Jejunum D. Ileum E. Colon
238. Gastric emptying studies performed on a 49−year−old female reveal a time to one−half emptying of
liquids of 18 min (normal <20 min) and a time to one−half emptying of solids to be 150 min (normal <120
min). Which of the following best explains the data?
A. Increased amplitude of antral contractions D. Sectioning of the vagus nerves to the stomach
B. Decreased orad stomach compliance E. Inflammation of the proximal small intestine
C. Pyloric stenosis
239. A 67−year−old male with a history of alcohol abuse presents to the emergency room with severe
epigastric pain, hypotension, abdominal distension, and diarrhea with steatorrhea. Serum amylase and
lipase are found to be greater than normal, leading to a diagnosis of pancreatitis. The steatorrhea can be
accounted for by a decrease in the intraluminal concentration of which of the following pancreatic
enzymes?
A. Amylase B. Trypsin C. Chymotrypsin D. Lipase E. Colipase
240. A 42−year−old male is referred to a gastroenterologist for evaluation of refractory peptic ulcer
disease. Subsequent endoscopic and laboratory data are suggestive of Zollinger−Ellison syndrome. The
increased basal acid output and maximal acid output of the patient is best explained by an increase in the
plasma concentration of which of the following?
A. Gastrin−releasing peptide B. Secretin C. Somatostatin D. Gastrin E. Histamine
241. A 63−year−old woman presents with diarrhea, abdominal pain, and flushing. The urinary excretion
of the serotonin metabolite, 5−hydroxyindoleacetic acid (5−HIAA) is elevated. Abdominal CT reveals a
tumor in the terminal ileum. Surgical resection of the terminal ileum will most likely result in which of
the following?
A. A decrease in absorption of amino acids
B. An increase in the water content of the feces
C. An increase in the concentration of bile acid in the enterohepatic circulation
D. A decrease in the fat content of the feces
E. An increase in the absorption of iron
242. Which of the following vitamins is both synthesized by intestinal bacteria and absorbed in
significant quantities?
A. Vitamin B6 B. Vitamin K C. Thiamine D. Riboflavin E. Folic acid
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Digestive System Physiology
243. A 70−year old woman presents with abdominal pain, microcytic anemia, and weight loss.
Colonoscopy with biopsy confirms colon cancer. Which of the following statements about the colon is
correct?
A. Absorption of Na+ in the colon is under hormonal (aldosterone) control
B. Bile acids enhance absorption of water from the colon
C. Net absorption of HCO3− occurs in the colon
D. Net absorption of K+ occurs in the colon
E. The luminal potential in the colon is positive
244. A patient’s abdominal pain is subdued after eating. Which of the following is true regarding
contraction of the gallbladder following a meal?
A. It is inhibited by a fat−rich meal
B. It is inhibited by the presence of amino acids in the duodenum
C. It is stimulated by atropine
D. It occurs in response to cholecystokinin
E. It occurs simultaneously with the contraction of the sphincter of Oddi
245. A 42−year−old airline pilot presents to his family physician with a chief complaint of midepigastric
pain that is relieved by antacids or eating. Endoscopic evaluation reveals the presence of a duodenal
ulcer. Based on the diagnosis, which of the following also would be expected?
A. Decreased basal acid output D. Increased frequency of antral contractions
B. Increased maximal acid output E. Decreased orad stomach compliance
C. Decreased gastric emptying of liquids
246. A 26−year−old male presents to the emergency room with a 48−hour bout of diarrhea with
steatorrhea. Which of the following best accounts for the appearance of excess fat in the stool?
A. Decreased bile salt pool size D. Decreased secretion of intrinsic factor
B. Delayed gastric emptying E. Decreased gastric accommodation
C. Decreased gastric acid secretion
247. A 43−year−old female presents with chief complaints of bulky and frequent diarrhea and weight
loss. She experiences recurrent episodes of abdominal distension terminated by passage of stools.
Laboratory data reveals a microcytic anemia, decreased serum calcium, and decreased serum albumin.
After additional tests she is diagnosed with gluten−sensitive enteropathy. Her generalized decrease in
intestinal absorption can be attributed to which of the following?
A. Decreased intestinal motility D. Increased enterohepatic circulation of bile
B. Increased migrating motor complexes E. Decreased gastric emptying
C. Decreased intestinal surface area
248. A 32−year−old woman presents to the Emergency Department with abdominal pain and diarrhea
accompanied by steatorrhea. Gastric analysis reveals a basal acid output (12 mM/h) greater than normal
(<5 mmol/h). The steatorrhea is most likely due to which of the following?
A. Inactivation of pancreatic lipase due to low C. Decreased gastric acid secretion
duodenal pH D. Decreased secretion of intrinsic factor
B. Delayed gastric emptying E. Decreased pyloric sphincter tone
249. A patient presents with severe inflammation of the ileum. Clinical findings include which of the
following?
A. Increased vitamin B12 absorption C. Increased colon absorption of water
B. Decreased bile acid pool size D. Decreased release of secretin
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Digestive System Physiology
E. Increased absorption of dietary fats
250. A patient undergoes surgery for their GI symptoms. Which of the following procedures may result in
nausea and a sense of early satiety?
A. Surgical resection of the proximal small bowel D. Surgical removal of the gastric antrum
B. A vagotomy of the distal stomach E. A vagotomy of the orad stomach
C. Surgical resection of the proximal stomach
251. A patient with peptic ulcer disease is taken off their medication because of undesirable side effects.
As a result, the patient has rebound gastric acid hypersecretion. Which of the following drugs best
accounts for the observed result?
A. An H1−receptor antagonist D. An antacid
B. A proton pump inhibitor E. A CCKB receptor antagonist
C. A cholinergic receptor antagonist
252. A 49−year−old female is referred to surgery for removal of a tumor from the fundic region of the
stomach. Resection of the fundus is likely result in which of the following outcomes?
A. A decrease in the contractile frequency of the stomach
B. An increase in the gastric emptying rate of liquids
C. A decrease in the gastric emptying of solids
D. An increase in maximal acid output
E. A decreased gastrin release in response to ingestion of a meal
253. An 18−year−old college student reports that she experiences severe abdominal bloating and
diarrhea within 1 hour of consuming dairy products. A subsequent H2−breath test is abnormal. The
diarrhea and bloating can best be explained by which of the following?
A. A deficiency in the brush border enzyme lactase D. Decreased carbohydrate absorption
B. Carbohydrate−induced secretory diarrhea E. A decrease in exocrine pancreatic secretion
C. Decreased intestinal surface area
254. A 31−year−old male presents to the Emergency Department with the symptoms of heartburn and
difficulty swallowing. Esophageal manometry reveals an inflamed esophageal mucosa and a hypotensive
lower esophageal sphincter. A diagnosis of gastroesophageal reflux disease is made and the patient is
subsequently treated with an H2−receptor antagonist. Normally, which of the following is true regarding
reflux of gastric acid into the esophagus?
A. It initiates primary esophageal peristalsis D. It inhibits esophageal bicarbonate secretion
B. It inhibits gastric acid secretion E. It inhibits gastric motility
C. It initiates secondary esophageal peristalsis
255. A 42−year−old obese female presents to the Emergency Department with right upper quadrant
pain, nausea, and vomiting. The pain is not related to food intake and lasts for several hours before
resolving slowly. Ultrasound images are suggestive of gallstones with cystic duct obstruction. Which of
the following is the primary physiological stimulus of gallbladder contraction in the digestive period?
A. Acid−induced release of secretin from the small intestine
B. Fat−induced release of cholecystokinin from the small intestine
C. Calorie−induced release of enterogastrone from the small intestine
D. Distension−induced release of glucagon from the small intestine
E. Amino acid−induced release of motilin from the small intestine
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Digestive System Physiology
256. A 56−year−old male presents with postprandial diarrhea persisting since an ileal resection. The
gastric surgeon suspects bile acid malabsorption. Which of the following statements about bile acids is
correct?
A. They are essentially water−insoluble
B. The majority of bile acids are absorbed by passive diffusion
C. Glycine conjugates are more soluble than taurine conjugates
D. The amount lost in the stool each day represents the daily loss of cholesterol
E. The bile acid−dependent fraction of bile is stimulated by the hormone secretin
257. A newborn with severe diarrhea is found to have an inherited defect in a glucose transporter
resulting in glucose/galactose malabsorption, necessitating a glucose− and galactose−free diet. Which of
the following is the transport protein responsible for entry of glucose into the intestinal enterocyte?
A. Glut−2 B. Glut−5 C. SGLT 1 D. SGLT 2 E. SGLT 5
258. A patient with alcoholic cirrhosis comes in vomiting blood. After stabilizing him with IV fluids, the
next step should be administration of an agonist/analog of which of the following agents to inhibit
gastric acid secretion and visceral blood flow?
A. Gastrin B. Somatostatin C. Histamine D. Pepsin E. Acetylcholine
259. A 56−year−old man presents with weight loss, cough, and diffuse chest pain. A chest x−ray reveals
normal heart and lungs, but the radiologist detects a “bird’s beak” narrowing of the terminal esophagus,
which is also seen with a barium swallow. Follow−up history indicates that the patient also has dysphagia
and regurgitation. Manometry shows increased lower esophageal sphincter (LES) pressure with no
relaxation upon swallowing, indicating a diagnosis of achalasia. Which of the following is the putative
inhibitory neurotransmitter responsible for relaxation of gastrointestinal smooth muscle?
A. Dopamine B. Vasoactive intestinal peptide C. Somatostatin D. Substance P E. Acetylcholine
260. A patient has vomiting and severe watery diarrhea after eating spoiled shellfish. Intravenous fluid
and electrolyte replacement was started, and a stool specimen was taken, which came back positive for
Vibrio Cholerae. Which of the following statements best describes water and electrolyte absorption in
the GI tract?
A. Most water and electrolytes come from ingested fluids
B. The small intestine and colon have similar absorptive capacities
C. Osmotic equilibration of chyme occurs in the stomach
D. The majority of absorption occurs in the jejunum
E. Cholera toxin inhibits sodium−coupled nutrient transport
261. After secretion of trypsinogen into the duodenum, the enzyme is converted into its active form,
trypsin, by which of the following?
A. Enteropeptidase B. Procarboxypeptidase C. Pancreatic lipase D. Chymotrypsin E. An alkaline pH
262. A patient with cirrhosis undergoes a total colectomy. Removal of the entire colon would be
expected to cause which of the following?
A. Decreased urinary urobilinogen D. Severe malnutrition
B. An increase in blood ammonia E. Death
C. Megaloblastic anemia
263. An 18−year−old female decides to get a tattoo for her birthday. Two months later she presents with
a fever, right upper quadrant pain, nausea, vomiting, and jaundice. Which of the following lab values
would most likely be found in a patient with infectious hepatitis?
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Digestive System Physiology
A. An increase in plasma alkaline phosphatase
B. An increase in plasma bile acids
C. An increase in both direct and indirect plasma bilirubin
D. An increase in direct bilirubin, and a decrease in indirect bilirubin in the plasma
E. An decrease in both direct and indirect plasma bilirubin
264. A patient presents with a chief complaint of flatulence. Gas within the colon is primarily derived
from which of the following sources?
A. CO2 liberated by the interaction of HCO3– and H+
B. Diffusion from the blood
C. Fermentation of undigested oligosaccharides by bacteria
D. Swallowed atmospheric air
E. Air pockets within foodstuffs
265. Nearly all binding of cobalamin (vitamin B12) to intrinsic factor occurs in which of the following
organs?
A. Stomach B. Duodenum C. Jejunum D. Ileum E. Colon
266. The rate of gastric emptying increases with an increase in which of the following?
A. Intragastric volume C. Fat content of duodenum E. Acidity of duodenum
B. Intraduodenal volume D. Osmolality of duodenum
267. Following an anastomosis of the jejunum to the stomach, a patient presents with discomfort after
meals, including weakness, dizziness, and sweating. The symptoms of dumping syndrome are caused in
part by which of the following?
A. Increased blood pressure D. Hypoglycemia
B. Increased secretion of glucagon E. Hyperglycemia
C. Increased secretion of cholecystokinin
268. A 52−year−old woman who has been dieting for several weeks breaks down and eats half a pan of
frosted brownies. Insulin secretion following a carbohydrate−rich meal is stimulated by which of the
following?
A. Gastrin B. CCK C. Serotonin D. VIP E. GIP
269. A new mother calls the pediatrician because she is concerned that her infant defecates after every
meal. Which of the following is the cause of these normal bowel movements in newborns?
A. The gastroileal reflex D. The defecation reflex
B. The gastrocolic reflex E. Peristaltic rushes
C. The intestino−intestinal reflex
270. A patient is found to have elevated levels of direct−acting plasma bilirubin. Which of the following
is the most likely diagnosis?
A. Bile reflux gastropathy C. Pancreatitis
B. Terminal ileal bypass D. Obstruction of the common bile duct
271. Which of the following is the major mechanism for absorption of sodium from the small intestine?
A. Na+−H+ exchange C. Electrogenic transport E. Solvent drag
B. Cotransport with potassium D. Neutral NaCl absorption
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Digestive System Physiology
272. A morbidly obese male presents with hypertension, hyperlipidemia, and Type II diabetes mellitus.
Dietary fat, after being processed, is extruded from the mucosal cells of the gastrointestinal tract into the
lymphatic ducts in the form of which of the following?
A. Monoglycerides B. Diglycerides C. Triglycerides D. Chylomicrons E. Free fatty acids
274. A 33−year−old female, who has been taking large doses of NSAIDs for her menstrual cramps,
presents with burning epigastric pain. The pain improves after eating a meal, suggesting a duodenal
versus a gastric ulcer. Which of the following is the major factor that protects the duodenal mucosa from
damage by gastric acid?
A. Pancreatic bicarbonate secretion C. Duodenal bicarbonate secretion
B. The endogenous mucosal barrier of the D. Hepatic bicarbonate secretion
duodenum E. Bicarbonate contained in bile
277. In infants, defecation often follows a meal. The cause of colonic contractions in this situation is
A. Gastro−ileal reflex C. Gastrocolic reflex
B. Increased circulating levels of CCK D. Enterogastric reflex
290. The muscular contractions, which move material through the digestive tract, are called:
A. Peristalsis B. Deglutition C. Mass movements D. Segmental contractions
291. The nervous system or systems that can control peristalsis in the inferior esophagus, stomach, small
intestine and large intestine is (are) the
A. Somatic motor nervous system
B. Sympathetic nervous system
C. Sympathetic and parasympathetic nervous systems
D. Autonomic and somatic motor nervous systems
292. Stimulation by the sympathetic nervous system will cause which one of the following effects in the
inferior esophagus, stomach, small intestine and large intestine?
A. Nothing, because skeletal muscle is found in the walls of these areas
B. Increases peristalsis by stimulation of smooth muscle
C. Decreases peristalsis by inhibition of smooth muscle
D. Decreases peristalsis by stimulation of smooth muscle
293. Contractions that mix material in the small intestine are called
A. Peristalsis B. Deglutition C. Mass movements D. Segmental contractions
294. The secretions that lubricate the food so it moves easily through the digestive tract and also
protects the epithelium are called
A. Mucus B. Water C. Enzymes D. Hormones
295. Which one of the following is absorbed in the GI tract without being digested?
A. Starch B. Proteins C. Vitamins D. Triglycerides
296. Contractions of the smooth muscles in the tunica muscularis in the GI tract causes ___________ and
is stimulated by ____________ plexus.
A. Local secretions, Meissner's or submucosal C. Peristalsis, Meissner's or submucosal
B. Peristalsis, Auerbach's or myenteric D. Local secretions, Auerbach's or myenteric
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Digestive System Physiology
297. The enteric plexus in the tunica submucosa is called the_____________ plexus.
A. Meissner's B. Auerbach's C. Myenteric D. Solar
298. Stimulation of the parasympathetic neurons in the GI tract from Auerbach's or myenteric plexus will
cause
A. Inhibition of local secretions C. Stimulation of local secretions
B. Inhibition of peristalsis D. Stimulation of peristalsis
299. Which of the following is FALSE about the enteric nervous system?
A. It works through local control
B. It consists of enteric sensory and motor neurons
C. Enteric interneurons connect sensory and motor neurons together
D. The enteric neurons are incapable of controlling digestive tract functions without the central nervous
system (CNS)
300. Which of the following cranial nerves carries sensation from the digestive tract to the CNS?
A. Gastric B. Vagus C. Spinal accessory D. None of the above
301. Which one of the following is most easily absorbed in the oral cavity?
A. Glucose B. Water C. Fatty acids D. Peptides
302. If you suck on a plain piece of bread, it will begin to taste sweet after a few moments. Saliva
contains the digestive enzyme ________________, which breaks down starch into ________________.
A. Amylase; glucose B. Pepsin; maltose C. Amylase, maltose D. Maltase, glucose
303. Saliva decreases gingivitis and caries because it contains immunoglobulin A and
A. Lysozymes B. Mucus C. Salivary amylase D. Water
305. The esophagus is different from the GI tract because the esophagus has
A. Skeletal muscles at the superior end and smooth muscles at the inferior end
B. No tunica submucosa
C. Villi and microvilli to increase surface area
D. No tunica mucosa
307. The pharyngeal phase of swallowing is ___________, which is controlled by __________ muscle.
A. Involuntary; smooth B. Voluntary; smooth C. Involuntary; skeletal D. Voluntary; skeletal
310. The hydrogen ions that form hydrochloric acid of the stomach come from
A. Pyruvic acid B. Lactic acid C. Carbonic acid D. Citric acid
311. The low ph of the stomach activates enzymes that digest _____________ while inactivating
enzymes that digest ______________.
A. Lipids; proteins B. Proteins; starch C. Starch; proteins D. Nucleic acids; starch
312. The stomach produces acids, which denature protein, and pepsin that digests protein. The cell
membranes of the epithelial cells lining the stomach contain protein. The protein in the epithelial cells
are not denatured or digested because
A. The membranes contain a different type of protein that resists denaturation and digestion
B. Mucus coats the epithelium
C. Cell membranes are destroyed but mitotic activity replaces cells with new ones every few hours
D. Hormones produced by the endocrine cells protect the cell membranes and neutralize the acid pH.
313. Parasympathetic stimulation causes endocrine cells in the stomach to release the hormone
A. Gastrin B. Pepsinogen C. CCK D. Secretin
315. In the regulation of stomach secretions, distension of the stomach activates local reflexes and a
parasympathetic reflex. This is called the _____________ phase.
A. Cephalic B. Gastric C. Intestinal D. Enterogastric
316. Cells in duodenum monitor chyme coming from the stomach that has a ph of 1. You would expect
the duodenal cells to
A. Release gastric inhibitory polypeptide and cholecystokinin, which inhibits gastric secretions
B. Initiate the enterogastric reflex, which increases gastric secretions
C. Release secretin, which inhibits gastric secretions
D. Release enterogastrone, which inhibits gastric secretions
317. Which one of the following hormones is released by both the stomach and small intestine?
A. Gastrin B. Secretin C. Cholecystokinin D. Gastric inhibitory polypeptide
318. You take a deep breath; you raise your larynx and hyoid bone; your epiglottis closes off the larynx;
the soft palate closes off the nasopharynx; the diaphragm and abdominal muscles contract and the lower
esophageal sphincter relaxes. What has just happened?
A. Low blood glucose levels caused these hunger pangs
B. Irritation in the GI tract caused the vomiting reflex
C. Bolus has entered the larynx and stimulated the gagging reflex
D. Bolus has entered the oropharynx, which initiated the swallowing reflex
319. The small intestine contains fingerlike projections called ____________, whose function is to
___________.
A. Villi; secret mucus
B. Rugae; allow for expansion
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Digestive System Physiology
C. Crypts of Lieberkühn; produce mucus, digestive enzymes and hormones
D. Villi; increase surface area
320. Brunner's glands produce __________ and are found in the _____________.
A. Hormones; duodenum B. Mucus; duodenum C. Enzymes; ileum D. Mucus; ileum
321. You have a situation where the hepatopancreatic ampullar sphincter or sphincter of Oddi will not
relax. You would expect
A. Chyme not to be released into the stomach
B. The feces to contain a much higher percentage of fat than normal
C. The feces to contain a much higher percentage of starch and protein than normal
D. Chyme not to be released into the large intestine
324. The liver is a major storehouse for all of the following EXCEPT one. Which one of the following
substance or substances are not stored in the liver.
A. Copper and iron B. Calcium C. Vitamins A, B12, D, E and K D. Glycogen
325. Which one of the following functions best describes the effects of the hormone cholecystokinin?
A. Inhibits gastric secretions
B. Increases gastric secretions
C. Inhibits gastric secretions, stimulates pancreatic secretions (high in enzymes), stimulates contraction of
the gall bladder and relaxation of the sphincter of Oddi
D. Inhibits gastric secretions, stimulates pancreatic secretions (high in bicarbonate ions) and increases the
Secretions of bile, intestinal juice and mucus
327. The major part of the aqueous component (other than water) of pancreatic juice is
A. Mucus
B. Trypsinogen, chymotrypsinogen, and procarboxypeptidase
C. Bicarbonate ions
D. Secretin
328. Trypsinogen when activated by ___________ will break down proteins in the ___________.
A. Enterokinase; pancreatic ducts C. Secretin; pancreatic ducts
B. Trypsin; small intestine D. Enterokinase; small intestine
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Digestive System Physiology
329. Which one of the following enzymes is not part of the enzymatic component of the pancreatic
juice?
A. Amylase B. Lipase C. Nucleases D. Chymotrypsin
330. In the production of the aqueous component of pancreatic juice, _________ ions are actively
transported into the intercalated duct and sodium ions are exchanged for _________ ions.
A. Bicarbonate; hydrogen C. Bicarbonate; potassium
B. Sodium; potassium D. Hydrogen; potassium
331. Secretion of the enzymatic component of pancreatic juice is stimulated by the hormone
A. Gastric inhibitory polypeptide C. Gastrin
B. Secretin D. Cholecystokinin
332. Stimulation by the parasympathetic nervous system will cause the __________ anal sphincter to
_____________.
A. External; relax B. External; contract C. Internal; contract D. Internal; relax
334. These contractions occur 3 to 4 times a day and involve large parts of the transverse and descending
colon. These contractions are called
A. Mass movements C. The defecation reflex
B. Haustral churning D. Teniae coli waves
335. Stimulation of the internal anal sphincters by the sympathetic nervous system or stimulation of the
external anal sphincter by the somatic motor nervous system would
A. Stimulate the defecation reflex C. Stimulate mass movements
B. Inhibit the defecation reflex D. Inhibit mass movements
337. Disaccharides like sucrose, lactose, and maltose are digested primarily in the
A. Stomach C. Brush border of the small intestine
B. Lumen of the small intestine D. Colon
338. After eating or drinking dairy products like cheese and milk, you have intestinal cramps, bloating
and diarrhea. You most likely have
A. Lactose intolerance B. Diabetes mellitus, Type I C. Heartburn D. Peritonitis
339. Glucose and galactose in the small intestine are taken into the epithelial cell by __________ and
passed into the interstitial fluid by ___________.
A. Diffusion; facilitated diffusion C. Cotransport; active transport
B. Facilitated diffusion; cotransport D. Cotransport; facilitated diffusion
342. The lipids that can be absorbed across the epithelial wall of the small intestine are hydrophobic and
would have a difficult time in the watery lumen to come in contact with the epithelial membrane. These
lipids are able to move easily in the watery lumen because of interaction with
A. Bile salts B. Lipase C. Micelles D. Chylomicrons
343. Once absorbed into the epithelial cell of the small intestine, free fatty acids and glycerol are
recombined and a protein coat is added to form a
A. Chylomicron B. Micelle C. Lipoprotein D. Fatty droplet
344. Once chylomicrons leave the simple columnar epithelium of the small intestine, they diffuse into
A. Capillaries B. Lacteals C. Arterioles D. Venules
347. Calcium is actively absorbed by the small intestine and this is accelerated by
A. Sodium B. The intrinsic factor C. Vitamin D D. Vitamin K
352. The __________ secretes peptidases and disaccharidases, whereas the __________ secretes trypsin,
chymotrypsin, amylase, lipase, and nucleases
A. Stomach, liver B. Stomach, small intestine
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Digestive System Physiology
C. Liver, small intestine E. Small intestine, pancreas
D. Liver, pancreas
354. Arrange these events in the order in which they occur during fat digestion, Absorption, and
transport:
1. Chylomicrons enter lacteals
2. Triglycerides, phospholipids and cholesterol coated with protein
3. Fatty acids and glycerol packaged into micelles
4. Bile salts emulsify fats
5. Lipase digests fat
A. 1,2,4,5,3 B. 2,5,4,3,1 C. 3,5,4,1,2 D. 4,5,3,2,1 E. 5,3,4,1,2
356. Which of these stomach cell types is not correctly matched with its function?
A. Surface mucous cells: produce mucus
B. Parietal cells: produce hydrochloric acid
C. Chief cells: produce intrinsic factor
D. Endocrine cells: produce regulatory hormones
359. Defecation
A. Can be initiated by stretch of the rectum
B. Can occur as a result of mass movements
C. Involves local reflexes
D. Involves parasympathetic reflexes mediated by the spinal cord
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Digestive System Physiology
E. All of the above
361. Bile
A. Is an important enzyme for the digestion of fats D. Emulsifies fats
B. Is made by the gallbladder E. Both C and D
C. Contains breakdown products from hemoglobin
363. If the thoracic duct were tied off, which of these classes of nutrients would not enter The circulatory
system at their normal rate?
A. Amino acids B. Glucose C. Lipids D. Fructose E. Nucleotides
367. High doses of antibiotics can destroy the bacterial flora of the large intestine. This can result in
impaired:
A. Absorption of protein B. Blood coagulation C. Bone resorption D. Respiratory control
368. The gastric gland cell whose absence could lead to pernicious anemia is the:
A. Chief cell B. Goblet cell C. Mucous neck cell D. Parietal cell E. Enteroendocrine cell
370. A baby is admitted into the hospital with a history of projectile vomiting after each feeding. On
examination, it is found that the pyloric sphincter is thickened and does not open readily. Because of the
baby's loss of gastric juice, his blood probably indicates:
A. Acidosis B. Leukocytosis C. Alkalosis
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Digestive System Physiology
D. An excessively low pH E. Excessive proteinuria
373. Which of the following cell types is NOT present in the stomach?
A. Mucous neck cells B. Chief cells C. Parietal cells D. Epithelial cells E. Alpha cells
379. Which of the following pairs of hormones are mainly involved in controlling pancreatic exocrine
secretions?
A. Insulin and glucagon D. Motilin and serotonin
B. Cholecystokinin and secretin E. Glucagon and somatostatin
C. Somatostatin and gastrin
380. Which of the following organs does not have both endocrine and exocrine function?
A. Stomach B. Small Intestine C. Gallbladder D. Liver E. Pancreas
381. If you eat a meal of French fries, buttered toast, ice cream, and whole milk, which of the following
glands would secrete the most enzymes that would be involved in digesting all this food?
A. Liver B. Exocrine pancreas C. Endocrine pancreas D. Ileum E. Buccal glands
382. If you compared the blood entering the liver and the blood leaving the liver, you find that:
A. Blood leaving the liver has more glucose
B. Blood leaving the liver contains more oxygen
C. Blood leaving the liver contains fewer amino acids
D. Blood leaving the liver contains more toxins and less carbon dioxide
386. Each of the following statements about Brunner's glands is correct EXCEPT:
A. They are a characteristic component of the duodenal wall
B. They produce a serous secretion rich in digestive enzymes
C. They lie in the submucosal layer
D. They empty their secretions into the crypts of Lieberkühn
388. In which test tube would protein digestion occur at the highest rate?
A. Tube containing pepsinogen and salivary amylase
B. Tube containing pepsinogen
C. Tube containing HCl
D. Tube containing HCl and intestinal amylase
E. Tube containing HCl and pepsinogen
391. Which of the following is transported in intestinal epithelial cells by a Na+ − dependent cotransport
process?
A. Fatty acids B. Triglycerides C. Frutose D. Alanine E. Oligopeptides
392. A patient with severe Crohn`s disease has been unresponsive to drug therapy and undergoes ileal
resection. After the surgery, he will have steatorrhea because:
A. The liver bile acid pool increases
B. Chylomicrons do not form in the intestinal lumen
C. Micelles do not form in the intestinal lumen
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Digestive System Physiology
D. Dietary triglycerides cannot be digested
E. The pancreas does not secrete lipase
393. Which of the following abolishes “receptive relaxation “of the stomach?
A. Parasympathetic stimulation
B. Sympathetic stimulation
C. Vagotomy
D. Administration of gastrin
E. Administration of vasoactive intestinal peptide (VIP)
F. Administration of cholecystokinin (CCK)
395. A patient with Zollinger−Ellison syndrome (gastrin−producing pancreatic tumor) would be expected
to have which of the following changes?
A. Decreased serum gastrin levels D. Decreased parietal cell mass
B. Increased serum insulin levels E. Peptic ulcer disease
C. increased absorption of dietary lipids
398. A patient with a duodenal ulcer is treated successfully with the drug cimetidine. The basis for
cimetidine` s inhibition of gastric H+ secretion is that, it:
A. Blocks muscarinic receptors on parietal cells
B. Blocks H2 receptors on parietal cells
C. Increases intracellular cyclic adenosine monophosphate (cAMP) levels
D. Blocks H+−K+− adenosine triphosphatase (ATPase)
E. Enhances the action of acetylcholine (Ach) on parietal cells
−
399. Which of the following is true about the secretion from the exocrine pancreas?
A. It has a higher CI− concentration than does plasma
B. It is stimulated by the presence of HCO3− in the duodenum
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Digestive System Physiology
C. Pancreatic HCO3− secretion is increased by gastrin
D. Pancreatic enzyme secretion is increased by cholecystokinin (CCK)
E. It is hypotonic
400. Which of the following substances must be further digested before it can be absorbed by specific
carriers in intestinal cells?
A. Fructose B. Sucrose C. Alanine D. Dipeptides E. Tripeptides
402. The major stimulus for primary peristalsis in the esophagus is:
A. Presence of food in the esophagus
B. Swallowing
C. Reguritation of food from the stomach
D. Closing of the upper esophageal sphincter (UES)
E. Opening of the lower esophageal sphincter (LES)
404. Gastric acid secretion increases when food enters the stomach because:
A. Protein digestion products directly stimulate the parietal cells to release hydrochloric acid (HCl)
B. Food raises the pH of the stomach, allowing more acid to be released
C. Both
D. Neither
406. Which of the following can occur without brain stem coordination?
A. Chewing D. Vomiting
B. Swallowing E. Gastric emptying
C. Primary esophageal peristalsis
407. The major stimulus for gastric acid (HCl) secretion during the cephalic phase is:
A. Histamine B. Gastrin C. Secretin D. Somatostatin E. Ach
409. Fats are transported from intestinal cells to blood plasma primary in the form of:
A. Micelles B. Chylomicrons C. Triglycerides D. Fatty acids E. Monoglycerides
413. The major factor controlling the secretion of bile salts from the liver is the amount of:
A. Secretin released during a meal D. Bile reabsorbed from the intestine
B. Fat entering the small intestine E. Cholecystokinin (CCK) released during a meal
C. Bile acids produced by the liver
416. Na+−dependent transport is responsible for the absorption of all of the following EXCEPT:
A. Vitamin E B. Amino acids C. Glucose D. Bile salts
418. A Na+ dependent active transport system is necessary for the intestinal absorption of all of the
following EXCEPT:
A. Dipeptides B. Bile salts C. Fructose D. Vitamin C E. Glucose
426. Which of these statements about the submucosal & myenteric nerve plexuses is not true?
A. the plexuses regulate the activity of smooth muscle cells
B. the plexuses regulate the activity of endocrine and exocrine cells
C. the intrinsic plexuses are under the influence of extrinsic nerves
D. the myenteric plexus is located in the submucosal layer
434. Which of the following substances is released from neurons in the GI tract and produces smooth
muscle relaxation?
A. Secretin B. Gastrin C. CCK D. VIP E. GIP
441. Which of the following is true about the secretion from the exocrine pancreas?
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Digestive System Physiology
A. It has a higher CI− concentration than does plasma
B. It is stimulated by the presence of HCO3− in the duodenum
C. Pancreatic HCO3− secretion is increased by gastrin
D. Pancreatic enzyme secretion is increased by cholecystokinin (CCK)
E. It is hypotonic
445. Cholecystokinin (CCK) has some gastrin like properties because both CCK and gastrin
A. are released from G cells in the stomach
B. are released from I cells in the duodenum
C. are members of the secretin−homologous family
D. have five identical C−terminal amino acids
E. have 90% homology of their amino acids
449. In infants; defecation of ten follows a meal. The cause of colonic contractions in this situation is
A. the gastroileal reflex D. increased circulating levels of somatostatin
B. increased circulating levels of CCK E. the enterogastric reflex
C. the gastrocolic reflex
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Digestive System Physiology
450. Water is absorbed in the jejunum,ileum,and colon and excreted in the feces. Arrange these in
order of the amount of water absorbed or excreted from greatest to smallest
A. colon,jejunum,ileum,feces D. colon,ileum,jejunum,feces
B. feces,colon,ileum,jejunum E. feces,jejunum,ileum,colon
C. jejunum,ileum,colon,feces
451. The pathway from the intestinal lumen to the circulating blood for short−chain fatty acid(<10
carbon atoms) is
A. intestinal mucosal cell→chylomicrons→lymphatic duct→systemic venous blood
B. intestinal mucosal cell→hepatic portal vein blood→systemic venous blood
C. space between mucosal cells→lymphatic duct→systemic venous blood
D. space between mucosal cells→chylomicrons→lymphatic duct→systemic venous blood
E. intestinal mucosal cell→LDL→hepatic portal vein blood→systemic venous blood
452. A 49−year−old male patient with severe Crohn’s disease has been unresponsive to drug therapy and
undergoes ileal resection. After the surgery, he will have steatorrhea. Because
A. The liver bile acid pool increases
B. Chylomicrons do not form in the intestinal lumen
C. Micelles do not form in the intestinal lumen
D. Dietary triglycerides cannot be digested
E. The pancreas does not secrete lipase
456. Which of the following substances is secreted in response to an oral glucose load?
A. Secretin
B. Gastrin
C. Cholecystokinin CCK.
D. Vasoactive intestinal peptide VIP.
E. Glucose−dependent insulinotropic peptide GIP.
457. A 24−year−old male graduate student participates in a clinical research study on intestinal motility.
Peristalsis of the small intestine
A. mixes the food bolus
B. is coordinated by the central nervous system CNS.
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Digestive System Physiology
C. involves contraction of smooth muscle behind and in front of the food bolus
D. involves contraction of smooth muscle behind the food bolus and relaxation of smooth muscle in front of
the bolus
E. involves relaxation of smooth muscle simultaneously throughout the small intestine
458. A patient with Zollinger–Ellison syndrome would be expected to have which of the following
changes?
A. Decreased serum gastrin levels D. Decreased parietal cell mass
B. Increased serum insulin levels E. Peptic ulcer disease
C. Increased absorption of dietary lipids
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Digestive System Physiology
1 B 21 D 41 D 61 E 81 E 101 D 121 B
2 B 22 D 42 D 62 C 82 C 102 A 122 B
3 C 23 A 43 D 63 C 83 D 103 E 123 B
4 A 24 C 44 C 64 E 84 E 104 A 124 A
5 D 25 D 45 A 65 A 85 C 105 C 125 A
6 B 26 A 46 C 66 D 86 E 106 A 126 A
7 C 27 D 47 A 67 E 87 A 107 A 127 A
8 B 28 C 48 C 68 A 88 E 108 B 128 E
9 A 29 C 48 D 69 C 89 B 109 A 129 A
10 D 30 A 50 A 70 B 90 D 110 A 130 E
11 C 31 B 51 D 71 D 91 B 111 A 131 B
12 B 32 C 52 D 72 C 92 C 112 D 132 A
13 A 33 D 52 D 73 C 93 B 113 C 133 B
14 B 34 E 54 C 74 A 94 D 114 B 134 B
15 C 35 A 55 E 75 B 95 B 115 A 135 A
16 A 36 C 56 C 76 B 96 A 116 A 136 A
17 A 37 D 57 D 77 B 97 E 117 A 137 A
18 B 38 E 58 C 78 C 98 C 118 B 138 B
19 C 39 D 59 C 79 D 99 C 119 A 139 C
MCQs in
Respiratory System Physiology
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Respiratory System Physiology
1. Which of the following is a function of the nasopharynx?
A. Filter dust
B. Warm and moisten inspired air
C. Provide openings for the right and left Eustachian tubes
D. Contain olfactory receptors responsible for the sense of smell
2. Which structure is responsible for directing food and liquids into the esophagus during swallowing?
A. Glottis B. Epiglottis C. Adam’s apple D. Conchae
4. Inhaled food or foreign objects are most likely to lodge in which part of the respiratory system?
A. Pharynx B. Right bronchus C. Left bronchus D. Bronchioles
9. When pressure in the lungs drops lower than atmospheric pressure, what occurs?
A. Air flows out of the lungs
B. Air flows into the lungs
C. A pneumothorax forms, collapsing the lungs
D. The bronchioles constrict, causing respiratory distress
11. Which of the following lung volumes or capacities can be measured by spirometry?
A. Functional residual capacity FRC. C. Residual volume RV.
B. Physiologic dead space D. Total lung capacity TLC.
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Respiratory System Physiology
E. Vital capacity VC.
12. An infant born prematurely in gestational week 25 has neonatal respiratory distress syndrome.
Which of the following would be expected in this infant?
A. Arterial PO2 of 100 mm Hg D. Normal breathing rate
B. Collapse of the small alveoli E. Lecithin/sphingomyelin ratio of greater than
C. Increased lung compliance 2:1 in amniotic fluid
Questions 14 and 15
A 12−year−old boy has a severe asthmatic attack with wheezing. He experiences rapid breathing and
becomes cyanotic. His arterial PO2 is 60 mm Hg and his PCO2 is 30 mm Hg.
14. Which of the following statements about this patient is most likely to be true?
A. Forced expiratory volume/forced vital capacity (FEV1/FVC) is increased
B. Ventilation/perfusion (V/Q) ratio is increased in the affected areas of his lungs
C. His arterial PCO2 is higher than normal because of inadequate gas exchange
D. His arterial PCO2 is lower than normal because hypoxemia is causing him to hyperventilate
E. His residual volume (RV) is decreased
17. Which volume remains in the lungs after a tidal volume (TV) is expired?
A. Tidal volume (TV) E. Functional residual capacity (FRC)
B. Vital capacity (VC) F. Inspiratory capacity
C. Expiratory reserve volume (ERV) G. Total lung capacity
D. Residual volume (RV)
18. A 35−year−old man has a vital capacity (VC) of 5 L, a tidal volume (TV) of 0.5 L, an inspiratory capacity
of 3.5 L, and a functional residual capacity (FRC) of 2.5 L. What is his expiratory reserve volume (ERV)?
A. 4.5 L B. 3.9 L C. 3.6 L D. 3.0 L E. 2.5 L F. 2.0 L G. 1.5 L
22. A 49−year−old man has a pulmonary embolism that completely blocks blood flow to his left lung. As
a result, which of the following will occur?
A. Ventilation/perfusion (V/Q) ratio in the left lung will be zero
B. Systemic arterial PO2 will be elevated
C. V/Q ratio in the left lung will be lower than in the right lung
D. Alveolar PO2 in the left lung will be approximately equal to the PO2 in inspired air
E. Alveolar PO2 in the right lung will be approximately equal to the PO2 in venous blood
Questions 23 and 24
23. In the hemoglobin–O2 dissociation curves shown, the shift from curve A to curve B could be caused
by
A. increased pH D. HbF
B. decreased 2,3−DPG concentration E. CO poisoning
C. strenuous exercise
26. Compared with the systemic circulation, the pulmonary circulation has a
A. higher blood flow D. higher capillary pressure
B. lower resistance E. higher cardiac output
C. higher arterial pressure
27. A healthy 65−year−old man with a tidal volume (TV) of 0.45 L has a breathing frequency of 16
breaths/min. His arterial PCO2 is 41 mm Hg, and the PCO2 of his expired air is 35 mm Hg. What is his
alveolar ventilation?
A. 0.066 L/min B. 0.38 L/min C. 5.0 L/min D. 6.14 L/min E. 8.25 L/min
28. Compared with the apex of the lung, the base of the lung has
A. a higher pulmonary capillary PO2 C. a higher ventilation/perfusion (V/Q) ratio
B. a higher pulmonary capillary PCO2 D. the same V/Q ratio
31. If an area of the lung is not ventilated because of bronchial obstruction, the pulmonary capillary
blood serving that area will have a PO2 that is
A. equal to atmospheric PO2 D. higher than inspired PO2
B. equal to mixed venous PO2 E. lower than mixed venous PO2
C. equal to normal systemic arterial PO2
32. In the transport of CO2 from the tissues to the lungs, which of the following occurs in venous blood?
A. Conversion of CO2 and H2O to H+ and HCO3– in the red blood cells RBCs
B. Buffering of H+ by oxyhemoglobin
C. Shifting of HCO3– into the RBCs from plasma in exchange for Cl–
D. Binding of HCO3– to hemoglobin
E. Alkalinization of the RBCs
33. Which of the following causes of hypoxia is characterized by a decreased arterial PO2 and an
increased difference between alveolar PO2 and arterial PO2?
A. Hypoventilation D. Carbon monoxide poisoning
B. Right−to−left cardiac shunt E. Ascent to high altitude
C. Anemia
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Respiratory System Physiology
34. A 42−year−old woman with severe pulmonary fibrosis is evaluated by her physician and has the
following arterial blood gases: pH = 7.48, PO2 = 55 mm Hg, and PCO2 = 32 mm Hg. Which statement best
explains the observed value of PCO2?
A. The increased pH stimulates breathing via peripheral chemoreceptors
B. The increased pH stimulates breathing via central chemoreceptors
C. The decreased PCO2 inhibits breathing via peripheral chemoreceptors
D. The decreased PCO2 stimulates breathing via peripheral chemoreceptors
E. The decreased PCO2 stimulates breathing via central chemoreceptors
35. A 38−year−old woman moves with her family from New York City sea level to Leadville Colorado
(10,200 feet above sea level). Which of the following will occur as a result of residing at high altitude?
A. Hypoventilation E. Pulmonary vasodilation
B. Arterial PO2 greater than 100 mm Hg F. Hypertrophy of the left ventricle
C. Decreased 2,3−DPG concentration G. Respiratory acidosis
D. Right shift of the Hb–O2 dissociation curve
36. The pH of venous blood is only slightly more acidic than the pH of arterial blood because
A. CO2 is a weak base
B. There is no carbonic anhydrase in venous blood
C. The H+ generated from CO2 and H2O is buffered by HCO3– in venous blood
D. The H+ generated from CO2 and H2O is buffered by deoxyhemoglobin in venous blood
E. Oxyhemoglobin is a better buffer for H+ than is deoxyhemoglobin
38. A person with a ventilation/perfusion V/Q. defect has hypoxemia and is treated with supplemental
O2. The supplemental O2 will be most helpful if the person’s predominant V/Q defect is
A. Dead space B. Shunt C. High V/Q D. Low V/Q E. V/Q = 0
39. Which person would be expected to have the largest difference between alveolar PO2 and arterial
PO2?
A. Person with pulmonary fibrosis
B. Person who is hypoventilating due to morphine overdose
C. Person at 12,000 feet above sea level
D. Person with normal lungs breathing 50% O2
E. Person with normal lungs breathing 100% O2
43. At what level of alveolar oxygen pressure the peripheral chemoreceptors are activated? (Pressure in
mmHg)
A. 150 B. 100 C. 90 D. 60
44. The affinity of hemoglobin for oxygen is increased if there is an increase in:
A. pH B. temperature C. 2,3 DPG D. PCO2
48. If the Intrapleural pressure becomes atmospheric, the changes in the lungs would include:
A. Increased compliance C. Decreased air way resistance
B. Decreased work of breathing D. Collapse of alveoli
49. Rise in capillary hydrostatic pressure at the base of lungs can result in:
A. Pulmonary embolism B. Pulmonary edema C. Dyspnea D. B and C
52. The volume of air that is present in the lungs after a forceful expiration is called:
A. Tidal volume C. Expiratory reserve volume
B. Residual volume D. Functional residual capacity
56. In chronic obstructive pulmonary disease an increase in which of the following cannot occur?
A. Work of breathing B. Air way resistance C. Vital capacity D. Residual volume of lungs
59. Pulmonary edema mostly occurs at the base of the lungs because of:
A. Less PO2 at the base
B. More PCO2 at the apex
C. Increased capillary hydrostatic pressure at the base
D. Increased vascular resistance at the base
64. During the inspiration, the vertical dimension of the thoracic cavity is increased due to contraction
of:
A. Diaphragm D. Serritus anterior
B. External intercostals E. Sternocleidomastoid
C. Scalene
66. The difference of total lung capacity and vital capacity is:
A. Expiratory reserve volume D. Residual volume
B. Functional residual capacity E. Tidal volume
C. Inspiratory reserve volume
67. The rate of diffusion of gases through the respiratory membrane is inversely proportional to:
A. Diffusion capacity of the respiratory membrane for the gas
B. Pressure gradient across the respiratory membrane
C. Surface area of the respiratory membrane
D. Solubility of the gas
E. Thickness of the respiratory membrane
69. The rate and duration of inspiratory ramp signals from the dorsal respiratory medullary neurons is
controlled by impulses from:
A. Cerebral cortex D. Pneumotaxic center
B. Hypothalamus E. Ventral respiratory neurons
C. Peripheral chemoreceptors
70. A patient having hypoxia shows his arterial PO2 – 60 mmHg and hemoglobin concentration 15 g/dl.
He is most likely suffering from:
A. Anemic hypoxia D. Hypoxic hypoxia
B. Carbon monoxide poisoning E. Stagnant hypoxia
C. Histologic hypoxia
71. During the acclimatization at high altitude, the change not likely to occur is:
A. Accelerated erythropoiesis
B. Increased hemoglobin concentration
C. Increased rate of pulmonary ventilation
D. Increased concentration of 2:3 diphosphoglycerate
E. Respiratory acidosis
72. In a person breathing normally at rest with an environmental temperature of 25°C, regarding the
partial pressure, all the following are true EXCEPT
A. Of CO2 in alveolar air is about 40 mm Hg
B. Of water vapor in alveolar air is less than half the alveolar PCO2 level
C. Of water vapor in alveolar air is greater than that in room air even at 100 per cent humidity
D. Of O2 in expired air is greater than in alveolar air
E. Of CO2 in mixed venous blood is greater than in alveolar air
73. As blood passes through systemic capillaries, all the following are true EXCEPT
A. pH falls
B. HCO3− ions pass from red cells to plasma
C. Cl− ion concentration in red cells falls
D. Its oxygen dissociation curve shifts to the right
E. Its ability to deliver oxygen to the tissues is enhanced
74. Regarding the respiratory center, all the following are true EXCEPT
A. Is in the medulla oblongata
B. Sends impulses to inspiratory muscles during quiet breathing
C. Sends impulses to expiratory muscles during quiet breathing
D. Is involved in the swallowing reflex
E. Is involved in the vomiting reflex
75. Regarding the carotid bodies, all the following are true EXCEPT
A. Are stretch receptors in the walls of the internal carotid arteries
B. Have the greatest flow rate/unit volume in the body
C. Are influenced more by blood PO2 than by its oxygen content
D. Generate more afferent impulses when blood H+ ion concentration rises
E. And the aortic bodies are mainly responsible for the increased ventilation in hypoxia
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Respiratory System Physiology
80. Regarding the normal lungs, all the following are true EXCEPT
A. The rate of alveolar ventilation at rest exceeds the rate of alveolar capillary perfusion
B. The ventilation/perfusion (V/P) ratio exceeds 1.0 during maximal exercise
C. The V/P ratio is higher at the apex than at the base of the lungs when a person is standing
D. Oxygen transfer can be explained by passive diffusion
E. Dead space increases during inspiration
88. A rise in arterial PCO2 leads to an increase in all the following EXCEPT
A. Ventilation due to stimulation of peripheral baroreceptors
B. Ventilation due to stimulation of central chemoreceptors
C. Arterial pressure
D. Cerebral blood flow
E. The plasma bicarbonate level
92. Pulmonary
A. Arterial mean pressure is about one−sixth systemic mean arterial pressure
B. Blood flow/minute is similar to systemic blood flow/minute
C. Vascular resistance is about 50 per cent that of systemic vascular resistance
D. Vascular capacity is similar to systemic vascular capacity
E. Arterial pressure increases by about 50 per cent when cardiac output rises by 50 per cent
93. Carbon dioxide is carried in the blood in the following forms EXCEPT
A. Combination with the hemoglobin molecule
B. Combination with plasma proteins
C. Physical solution in plasma
D. Greater quantity in red blood cells than in plasma
E. Greater quantity as HCO3− ions than as other forms
94. A shift of the oxygen dissociation curve of blood to the right EXCEPT
A. Occurs in the pulmonary capillaries
B. Occurs if blood temperature rises
C. Favors oxygen delivery to the tissues
D. Favors oxygen uptake from the lungs by alveolar capillary blood
E. Increases the P
100. Regarding Oxygen debt, all the following are true, EXCEPT
A. It is the amount of O2 consumed after cessation of exercise
B. It is incurred because the pulmonary capillary walls limit O2 uptake during exercise
C. It is possible since skeletal muscle can function temporarily without oxygen
D. It is associated with a rise in blood lactate
E. It is associated with metabolic acidosis
101. The CO2 dissociation curve for whole blood shows that
A. Its shape is sigmoid
B. Blood saturates with CO2 when PCO2 exceeds normal alveolar levels
C. Blood contains some CO2 even when the PCO2 is zero
D. Oxygenation of the blood drives CO2 out of the blood
E. Adding CO2 to the blood drives O2 out of the blood
102. The oxygen content of mixed venous blood can be all the following EXCEPT
A. Measured using blood sampled from the right atrium
B. Increased during generalized muscular exercise
C. Increased in a warm environment
D. Increased in cyanide poisoning
E. Decreased in circulatory failure
104. Regarding air in the pleural cavity (pneumothorax), all the following are true EXCEPT
A. Allows intrapleural pressure to rise to atmospheric pressure
B. Causes the underlying lung to collapse by compressing it
C. Increases the functional residual capacity
D. Leads to a slight outward movement of the chest wall
E. Reduces vital capacity
107. A healthy, 25−year−old medical student participates in a 10−kilometer charity run for the American
Heart Association. Which muscles does the student use (contract) during expiration?
A. Diaphragm and external intercostals D. Internal intercostals and abdominal recti
B. Diaphragm and internal intercostals E. Scaleni
C. Diaphragm only F. Sternocleidomastoid muscles
108. Which of the following would be expected to increase the measured airway resistance?
A. Stimulation of parasympathetic nerves to the lungs
B. Low lung volumes D. Forced expirations
C. Release of histamine by mast cells E. All of the above
109. Several students are trying to see who can generate the highest expiratory flow. Which muscle is
most effective at producing a maximal effort?
A. Diaphragm D. Rectus abdominis
B. Internal intercostals E. Sternocleidomastoid
C. External intercostals
110. The figure on the right shows three different compliance curves (S, T, and U) for isolated lungs
subjected to various transpulmonary pressures. Which of the following best describes the relative
compliances for the three curves?
Direction: Use the figure below to answer the following two questions:
112. A 22−year−old woman inhales as much air as possible and exhales as much air as she can, producing
the spirogram shown in the figure above. A residual volume of 1.0 liter was determined using the helium
dilution technique. What is her FRC (in liters)?
A. 2.0 B. 2.5 C. 3.0 D. 3.5 E. 4.0 F. 5.0
113. With a slow decrease in left heart function, which of the following will minimize the formation of
pulmonary edema?
A. An increase in plasma protein concentration due to fluid loss
B. Increase in the negative interstitial hydrostatic pressure
C. Increased pumping of lymphatics
D. Increase in the concentration of interstitial proteins
114. A 22−year−old woman has a pulmonary compliance of 0.2 L/cm H2O and a pleural pressure of −4 cm
H2O. What is the pleural pressure (in cm H2O) when the woman inhales 1.0 liter of air?
A. −6 B. −7 C. −8 D. −9 E. −10
115. A preterm infant has a surfactant deficiency. Without surfactant, many of the alveoli collapse at the
end of each expiration, which in turn leads to pulmonary failure. Which set of changes is present in the
preterm infant compared with a normal infant?
Alveolar Surface Tension Pulmonary Compliance
A Decreased Decreased
B Decreased Increased
C Decreased No change
D Increased Decreased
E Increased Increased
F Increased No change
G No change No change
116. A patient has a dead space of 150 ml, FRC of 3 liters, tidal volume (VT) of 650 ml, expiratory reserve
volume (ERV) of 1.5 liters, total lung capacity (TLC) of 8 liters, and respiratory rate of 15 breaths/min.
What is the residual volume (RV)?
A. 500 ml B. 1000 ml C. 1500 ml D. 2500 ml E. 6500 ml
117. A patient has a dead space of 150 milliliters, FRC of 3 liters, VT of 650 milliliters, ERV of 1.5 liters,
TLC of 8 liters, and respiratory rate of 15 breaths/min. What is the alveolar ventilation (VA)?
A. 5 L/min B. 7.5 L/min C. 6.0 L/min D. 9.0 L/min
118. The various lung volumes and capacities include the total lung capacity (TLC), vital capacity (VC),
inspiratory capacity (IC), tidal volume (VT), expiratory capacity (EC), expiratory reserve volume (ERV),
inspiratory reserve volume (IRV), functional residual capacity (FRC), and residual volume (RV). Which of
the following lung volumes and capacities can be measured using direct spirometry without additional
methods?
TLC VC IC VT EC ERV IRV FRC RV
A No No Yes No Yes No Yes No No
B No Yes Yes Yes Yes Yes Yes No No
C No Yes Yes Yes Yes Yes Yes Yes No
D Yes Yes Yes Yes Yes Yes Yes No Yes
E Yes Yes Yes Yes Yes Yes Yes Yes Yes
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Respiratory System Physiology
120. A 34−year−old man sustains a bullet wound to the chest that causes a pneumothorax. What best
describes the changes in lung volume and thoracic volume in this man compared with normal?
Lung Volume Thoracic Volume
A Decreased Decreased
B Decreased Increased
C Decreased No change
D Increased Decreased
E Increased Increased
F No change Decreased
121. A healthy 10−year−old boy breathes quietly under resting conditions. His tidal volume is 400
milliliters and his ventilation frequency is 12/min. Which of the following best describes the ventilation
of the upper, middle, and lower lung zones in this boy?
122. An experiment is conducted in two persons (subjects T and V) with identical tidal volume (VTs) of
1000 milliliters, dead space volumes (200 milliliters), and ventilation frequencies of 20 breaths per
minute. Subject T doubles his VT and reduces his ventilation frequency by 50%. Subject V doubles his
ventilation frequency and reduces his VT by 50%. What best describes the total ventilation (also called
minute ventilation) and alveolar ventilation (VA) of subjects T and V?
123. A person with normal lungs has an oxygen (O2) consumption of 750 ml O2/min. The hemoglobin
(HB) concentration is 15 g/dl. The mixed venous saturation is 25%. What is the cardiac output?
A. 2500 ml/min C. 7500 ml/min E. 20,000 ml/min
B. 5000 ml/min D. 10,000 ml/min
124. A cardiac catheterization is performed in a healthy adult. The blood sample withdrawn from the
catheter shows 60% O2 saturation, and the pressure recording shows oscillations from a maximum of 27
mm Hg to a minimum of 12 mm Hg. Where was the catheter tip located?
A. Ductus arteriosus B. Foramen ovale C. Left atrium
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D. Pulmonary artery E. Right atrium
125. If alveolar surface area is decreased 50% and pulmonary edema leads to a doubling of diffusion
distance, how does diffusion of O2 compare with normal?
A. 25% increase C. 25% decrease E. 75% decrease
B. 50% increase D. 50% decrease
126. Which of the following sets of differences best describes the hemodynamics of the pulmonary
circulation when compared with the system circulation?
127. A 67−year−old man is admitted emergently to the hospital because of severe chest pain. A
Swan−Ganz catheter is floated into the pulmonary artery, the balloon is inflated, and the pulmonary
wedge pressure is measured. The pulmonary wedge pressure is used clinically to monitor which
pressure?
A. Left atrial pressure D. Pulmonary artery systolic pressure
B. Left ventricular pressure E. Pulmonary capillary pressure
C. Pulmonary artery diastolic pressure
128. Which diagram in the figure below best illustrates the pulmonary vasculature when the cardiac
output has increased to a maximum extent?
A. A B. B C. C D. D E. E
129. A human experiment is being performed in which forearm blood flow is being measured under a
variety of conditions. The forearm is infused with a vasodilator, resulting in an increase in blood flow.
Which of the following occurs?
A. Tissue interstitial partial pressure of oxygen (PO2) will increase
B. Tissue interstitial partial pressure of carbon dioxide (PCO2) will increase
C. Tissue pH will decrease
130. Blood gas measurements are obtained in a resting patient who is breathing room air. The patient
has an arterial content of 19 ml O2/dl with a PO2 of 95. The mixed venous O2 content is 4 ml O2/dl blood.
Which condition does the patient have?
A. An increase in physiological dead space C. A low Hb concentration
B. Pulmonary edema D. A low cardiac output
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131. A normal male subject has the following initial conditions (in the steady state):
Arterial PO2 = 92 mm Hg Cardiac output = 5600 ml/min
Arterial O2 saturation = 97% O2 consumption = 256 ml/min
Venous O2 saturation = 20% Hb concentration = 12 gm/dl
Venous PO2 = 30 mm Hg
If you ignore the contribution of dissolved O2 to the O2 content, what is the venous O2 content?
A. 2.2 ml O2/100 ml blood E. 6.2 ml O2/100 ml blood
B. 3.2 ml O2/100 ml blood F. 10.8 ml O2/100 ml blood
C. 4 ml O2/100 ml blood G. 16 ml O2/100 ml blood
D. 4.6 ml O2/100 ml blood
132. A man fell asleep in his running car. He was unconscious when he was brought into the emergency
department. With carbon monoxide (CO) poisoning, you would expect his alveolar O2 partial pressure
(PCO2) would be _______, while his arterial O2 content (CaO2) would be ______.
A. Normal, decreased C. Increased, normal
B. Decreased, decreased D. Increased, normal
133. A 30−year−old woman performs a Valsalva maneuver about 30 minutes after eating lunch. Which
option best describes the changes in pulmonary and systemic blood volumes that occur in this woman?
134. A child who is eating round candies approximately 1 and 1.5 cm in diameter inhales one down his
airway, blocking his left bronchiole. Which of the following describes the changes that occur?
135. The forces governing the diffusion of a gas through a biological membrane include the pressure
difference across the membrane (ΔP), the cross−sectional area of the membrane (A), the solubility of the
gas (S), the distance of diffusion (D), and the molecular weight of the gas (MW). Which changes increase
the diffusion of a gas through a biological membrane?
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136. A person’s normal VT is 400 milliliters with a dead space of 100 milliliters. The respiratory rate is 12
breaths/min. The person undergoes ventilation during surgery, and the VT is 700 with a rate of 12. What
is the approximate alveolar PCO2 for this person?
A. 10 B. 20 C. 30 D. 40 E. 45
137. Arterial PO2 is 100 mm Hg and arterial PCO2 is 40 mm Hg. Total blood flow to a muscle is 700
ml/min. There is a sympathetic activation resulting in a decrease in blood flow of this muscle to 350
ml/min. There is no neuromuscular activation, and thus no contraction of the muscle. Which of the
following will occur?
138. A 45−year−old man at sea level has an inspired O2 tension of 149 mm Hg, nitrogen tension of 563
mm Hg, and water vapor pressure of 47 mm Hg. A small tumor pushes against a pulmonary blood vessel,
completely blocking the blood flow to a small group of alveoli. What are the O2 and carbon dioxide (CO2)
tensions of the alveoli that are not perfused (in mm Hg)?
139. In which conditions is alveolar PO2 increased and alveolar PCO2 decreased? (Va = Alveolar
ventilation)?
A. Increased Va and unchanged metabolism C. Increased metabolism and unchanged Va
B. Decreased Va and unchanged metabolism D. Proportional increase in metabolism and Va
140. The diffusing capacity of a gas is the volume of gas that will diffuse through a membrane each
minute for a pressure difference of 1 mm Hg. Which gas is often used to estimate the O2−diffusing
capacity of the lungs?
A. CO2 B. CO C. Cyanide gas D. Nitrogen E. O2
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141. The O2−CO2 diagram below shows a ventilation perfusion (V/Q) ratio line for the normal lung.
Which of the following best describes the effect of decreasing V/Q ratio on the alveolar PO2 and PCO2?
142. A 23−year−old medical student has mixed venous O2 and CO2 tensions of 40 mm Hg and 45 mm Hg,
respectively. A group of alveoli are not ventilated in this student because mucus blocks a local airway.
What are the alveolar O2 and CO2 tensions distal to the mucus block (in mm Hg)?
Questions 41 and 42
143. A 67−year−old man has a solid tumor that pushes against an airway, partially obstructing air flow to
the distal alveoli. Which point on the V/Q line of the O2−CO2 diagram below corresponds to the alveolar
gas of these distal alveoli?
A. A B. B C. C D. D E. E
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144. A 55−year−old man has a pulmonary embolism that completely blocks the blood flow to his right
lung. Which point on the V/Q line of the O2−CO2 diagram above corresponds to the alveolar gas of his
right lung?
A. A B. B C. C D. D E. E
145. The figure below shows two lung units (S and T) with their blood supplies. Lung unit S has an ideal
relationship between blood flow and ventilation. Lung unit T has a compromised blood flow. What is the
relationship between total dead space (TDS), physiologic dead space (PDS) and anatomic dead space
(ADS) for these lung units?
146. A 32−year−old medical student has a fourfold increase in cardiac output during strenuous exercise.
Which curve on the figure below most likely represents the changes in O2 tension that occur as blood
flows from the arterial end to the venous end of the pulmonary capillaries in this student?
A. A B. B C. C D. D E. E
147. The figure below shows changes in the partial pressures of O2 and CO2 as blood flows from the
arterial (Art) end to the venous (Ven) end of the pulmonary capillaries. Which diagram best depicts the
normal relationship between PO2 (red line) and PCO2 (green line) during resting conditions?
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Respiratory System Physiology
A. A B. B C. C D. D E. E
148. Which of the following would be true if the blood lacked red blood cells and just had plasma and
the lungs were functioning normally?
A. The arterial PO2 would be normal
B. The O2 content of arterial blood would be normal
C. Both A and B
D. Neither A nor B
149. The figure below shows a normal O2−Hb dissociation curve. What are the approximate values of Hb
saturation (% Hb−O2), PO2, and O2 content for oxygenated blood leaving the lungs and reduced blood
returning to the lungs from the tissues?
150. A person with anemia has a Hb concentration of 12 g/dl. He starts exercising and uses 12 ml O2/dl.
What is the mixed venous PO2?
A. 0 mm Hg C. 20 mm Hg E. 100 mm Hg
B. 10 mm Hg D. 40 mm Hg
151. Which points on the figure below represent arterial blood in a severely anemic person?
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152. A stroke that destroys the respiratory area of the medulla would be expected to lead to which of
the following?
A. Immediate cessation of breathing
B. Apneustic breathing
C. Ataxic breathing
D. Rapid breathing (hyperpnea)
E. None of the above (breathing would remain normal)
153. Which of the below O2−Hb dissociation curves corresponds to normal blood (red solid line) and
blood containing CO (green dotted line)?
A. A B. B C. C D. D E. E F. F
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154. Using the figure of the previous question, which of the above O2−Hb dissociation curves
corresponds to blood during resting conditions (red solid line) and blood during exercise (green dotted
line)?
A. A B. B C. C D. D E. E F. F
155. Using the figure of the previous question, which of the above O2−Hb dissociation curves
corresponds to blood from an adult (red solid line) and blood from a fetus (green dotted line)?
A. A B. B C. C D. D E. E F. F
156. Arterial PO2 is 100 mm Hg and arterial PCO2 is 40 mm Hg. Total blood flow to all muscle is 700
ml/min. There is a sympathetic activation resulting in a decrease in blood flow to 350 ml/min. What will
occur?
157. What is the most important pathway for the respiratory response to systemic arterial CO2 (PCO2)?
A. CO2 activation of the carotid bodies
B. Hydrogen ion (H+) activation of the carotid bodies
C. CO2 activation of the chemosensitive area of the medulla
D. H+ activation of the chemosensitive area of the medulla
E. CO2 activation of receptors in the lungs
158. The basic rhythm of respiration is generated by neurons located in the medulla. What limits the
duration of inspiration and increases respiratory rate?
A. Apneustic center D. Pneumotaxic center
B. Dorsal respiratory group E. Ventral respiratory group
C. Nucleus of the tractus solitarius
159. When the respiratory drive for increased pulmonary ventilation becomes greater than normal, a
special set of respiratory neurons that are inactive during normal quiet breathing then becomes active,
contributing to the respiratory drive. These neurons are located in which structure?
A. Apneustic center D. Pneumotaxic center
B. Dorsal respiratory group E. Ventral respiratory group
C. Nucleus of the tractus solitarius
160. A 26−year−old medical student on a normal diet has a respiratory exchange ratio of 0.8. How much
O2 and CO2 are transported between the lungs and tissues of this student (in ml gas/100 ml blood?
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161. CO2 is transported from the tissues to the lungs predominantly in the form of bicarbonate ion.
Compared with arterial red blood cells, which of the following options best describes venous red blood
cells?
162. The afferent (sensory) endings for the Hering−Breuer reflex are mechanoreceptors located in the
A. Carotid arteries C. External intercostals E. Diaphragm
B. Alveoli D. Bronchi and bronchioles
163. An anesthetized man is breathing with no assistance. He then undergoes artificial ventilation for 10
minutes at his normal VT but at twice his normal frequency. He undergoes ventilation with a gas mixture
of 60% O2 and 40% nitrogen. The artificial ventilation is stopped and he fails to breathe for several
minutes. This apneic episode is due to which of the following?
A. High arterial PO2 suppressing the activity of the peripheral chemoreceptors
B. Decrease in arterial pH suppressing the activity of the peripheral chemoreceptors
C. Low arterial PCO2 suppressing the activity of the medullary chemoreceptors
D. High arterial PCO2 suppressing the activity of the medullary chemoreceptors
E. Low arterial PCO2 suppressing the activity of the peripheral chemoreceptors
164. Which of the following describes a patient with constricted lungs compared with a normal patient?
165. Which diagram in the figure below best describes the relationship between alveolar ventilation (Va)
and arterial CO2 tension (PCO2) when the PCO2 is changed acutely over a range of 35 to 75 mm Hg?
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Respiratory System Physiology
A. A B. B C. C D. D E. E F. F
166. Which diagram in the figure below best describes the relationship between alveolar ventilation (Va)
and arterial O2 tension (PO2) when the PO2 is changed acutely over a range of 0 to 160 mm Hg and the
arterial PCO2 and H+ concentration remain normal?
A. A B. B C. C D. D E. E F. F
167. At a party, a 17−year−old male places a paper bag over his mouth and breathes in and out of the
bag. As he continues to breathe into this bag, his rate of breathing continues to increase. Which of the
following is responsible for the increased ventilation?
A. Increased alveolar PO2 B. Increased alveolar PCO2 C. Decreased arterial PCO2 D. Increased pH
168. Alveolar ventilation (Va) increases severalfold during strenuous exercise. Which factor is most likely
to stimulate ventilation during strenuous exercise?
A. Collateral impulses from higher brain centers D. Decreased mean venous PO2
B. Decreased mean arterial pH E. Increased mean arterial PCO2
C. Decreased mean arterial PO2
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Respiratory System Physiology
169. During strenuous exercise, O2 consumption and CO2 formation can increase as much as 20−fold.
Alveolar ventilation (Va) increases almost exactly in step with the increase in O2 consumption. Which
option best describes what happens to the mean arterial O2 tension (PO2), CO2 tension (PCO2), and pH in
a healthy athlete during strenuous exercise?
170. A 54−year−old woman with advanced emphysema due to long−term cigarette smoking is admitted
to the hospital for shortness of breath. She is diagnosed with pulmonary hypertension. Her arterial blood
gases are
PO2 = 75 mm Hg
PCO2 = 45 mm Hg
pH = 7.35
What is the cause of the pulmonary hypertension in this woman?
A. Increased alveolar PCO2 C. Decreased alveolar PO2
B. Increased sympathetic tone D. Decreased pulmonary capillary number
172. A 45−year−old man inhaled as much air as possible and then expired with a maximum effort until
no more air could be expired. This action produced the maximum expiratory flow−volume (MEF−V) curve
shown in the figure below. What is the forced vital capacity (FVC) of this man (in liters)?
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Respiratory System Physiology
173. The maximum expiratory flow−volume (MEF−V) curve shown in the figure below is used as a
diagnostic tool for identifying obstructive and restrictive lung diseases. At which point on the curve does
airway collapse limit maximum expiratory air flow?
A. A B. B C. C D. D E. E
174. The maximum expiratory flow−volume (MEF−V) curves shown in the figure below were obtained
from a healthy person (red solid curve) and a 57−year−old man with shortness of breath (green dotted
curve). The man with shortness of breath likely has which disorder?
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Respiratory System Physiology
175. A 62−year−old man reports difficulty breathing. The figure below shows an MEFV (maximum
expiratory flow−volume curve from the patient (green solid line) and from a typical healthy individual
(red dotted curve). Which of the following best explains the MEFV curve of the patient?
176. The MEFV (maximum expiratory flow−volume curve) shown in the figure below (red solid line) was
obtained from a 75−year−old man who smoked 40 cigarettes per day for 60 years. The green doted
flow−volume curve was obtained from the man during resting conditions. Which set of changes is most
likely to apply to this man?
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Respiratory System Physiology
177. The figure below shows a forced expiration for a healthy person (curve X) and a person with a
pulmonary disease (curve Z). What is the forced expiratory volume in the first second of expiration
(FEV1)/FVC ratio (as a percent) in these persons?
178. The figure below shows forced expirations from a person with healthy lungs (curve X) and from a
patient (curve Z). The patient most likely has which condition?
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Respiratory System Physiology
179. Which of the following describes blood gases during consolidated pneumonia where the lung is
filled with fluid and cellular debris?
181. The volume–pressure curves in the figure below were obtained from a normal subject and a patient
with a pulmonary disease. Which abnormality is most likely present in the patient?
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Respiratory System Physiology
182. A 34−year−old medical student generates the flow−volume curves shown in the figure below. Curve
W is a normal maximum expiratory flow-volume (MEFV) curve generated when the student was healthy.
Which of the following best explains curve X?
183. Which of the following best describes comparison of the lung compliance and surfactant levels in a
premature infant with respiratory distress syndrome versus a normal full−term infant?
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Respiratory System Physiology
184. Compared with a normal healthy person, how do TLC and maximum expiratory flow (MEF) change
with restrictive lung disease?
185. A 78−year−old man who smoked 60 cigarettes per day for 55 years reports shortness of breath. The
patient is diagnosed with chronic pulmonary emphysema. Which set of changes is present in this man
compared with a healthy nonsmoker?
186. While breathing room air, a patient with chronic obstructive pulmonary disease, has a systemic
arterial PCO2 of 65 mm Hg and a PO2 of 40 mm Hg. Supplemental oxygen is administered at a 40%
fractional concentration of oxygen in inspired gas (FiO2), which resulted in an increase of PO2 to 55 mm
Hg and PCO2 to 70 mm Hg. Which of the following describes the supplemental O2?
A. Restored arterial dissolved O2 to normal
B. Did not change breathing
C. Reduced the hypoxic stimulation of breathing
D. Increased the pulmonary excretion of CO2
188. When he was in his early 40s, a 75−year−old man worked for 5 years in a factory where asbestos
was used as an insulator. The man is diagnosed with asbestosis. Which set of changes is present in this
man compared with a person with healthy lungs?
189. The amount of air present in the lungs at the end of a tidal breath is:
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Respiratory System Physiology
A. Residual volume B. Expiratory reserve volume C. Functional residual capacity
193. A person breathes into and from a spirometer (volume 12 liters) containing 10% helium gas
mixture. After equilibration, helium concentration of expired gas was found to be 6.7%. His vital capacity
is 4.2 liters. What is his residual volume?
A. 1000 ml B. 1200 ml C. 1500 ml D. 1800 ml
194. The maximum amount of gas that can be exhaled after a full inspiration is called:
A. Expiratory reserve volume C. Total lung capacity
B. Vital capacity D. Functional residual capacity
196. The largest volume of gas that can be moved into and out of the lungs in 1 minute by voluntary
effort is called:
A. Respiratory minute volume C. Maximal voluntary ventilation
B. Minute ventilation D. Vital capacity
197. The normal compliance of the human lungs and chest wall is:
A. 0.1 L/cm H2O B. 0.2 L/cm H2O C. 0.3 L/cm H2O D. 0.4 L/cm H2O
206. Peak expiratory flow rate (PEFR), an index of airways resistance, is reduced in:
A. Restrictive lung disease B. Bronchial asthma
207. The most sensitive index of small airways resistance in a patient with bronchial asthma is:
A. vital capacity
B. FEV1
C. FEV1/FVC
D. PEFR
E. Maximal Mid-Expiratory Flow Rate (Forced Expiratory Flow 25%–75%)
211. Under basal conditions, the amount of oxygen consumed per minute is about:
A. 100 ml B. 250 ml C. 350 ml D. 500 ml
212. Under basal conditions, the respiratory quotient (i.e., the volume of CO2 produced / volume of
oxygen consumed) is about:
A. 1 B. 0.8 C. 0.7 D. 1.2
215. At rest, the normal diffusing capacity of the lungs for carbon monoxide is about:
A. 25 ml/min/mm Hg C. 75 ml/min/mm Hg
B. 50 ml/min/mm Hg D. 100 ml/min/mm Hg
216. The mean systemic arterial pressure and the mean pulmonary artery pressure are respectively
90 and 15 mm Hg. Can you tell the ratio of systemic and pulmonary vascular resistances?
A. 1 B. 10 C. 6 D. Data inadequate
219. In the upright position, the V/Q ratio at the lung apex is about:
A. 1 B. 0.7 C. 0.5 D. 3
221. If blood Hb concentration is 15 g/dL, how much oxygen would be transported in blood?
A. Approximately 20 ml/dL B. Approximately 15 ml/dL C. Data inadequate
222. If Hb were completely absent, how much plasma would be required to transport oxygen required
for basal metabolism?
A. 10 liters B. 27 liters C. 52 liters D. 84 liters
223. Which of the following shifts the oxyhemoglobin dissociation curve to the right?
A. CO2 C. Increase in tissue temperature
B. 2, 3-BPG D. Decrease in tissue pH
224. Suppose you administer 100% oxygen at 4 atmospheres, then how much oxygen would be
transported in 100 ml of plasma?
A. 0.3 ml B. 3 ml C. 6 ml D. 9 ml
225. The decrease in oxygen affinity of Hb when the pH of blood falls is:
A. Bohr effect C. Hawthorne effect
B. Haldane effect D. Hamburger effect
226. Which of the following shifts the oxyhemoglobin dissociation curve to the left?
A. CO C. Increase in tissue temperature
B. Increase in 2,3 DPG in RBC D. Decrease in tissue pH
228. Administration of O2 rich gas mixtures improves tissue oxygenation most in:
A. Hypoxic hypoxia C. Hypokinetic hypoxia
B. Anemic hypoxia D. Histotoxic hypoxia
232. Systemic arterial chemoreceptors (commonly called peripheral chemoreceptors) are mainly
stimulated by:
A. A decline in PO2 C. A decrease in blood flow through them
+
B. An increase in H concentration of arterial D. An increase in PCO2
plasma
238. Which of the following statements regarding Cheyne-Stokes respiration are correct?
A. It is characterized by periods of hyperpnea punctuated by apnea
B. It is attributed to increased sensitivity of the respiratory center to CO2
C. It may occur if lung-to-brain circulation time is prolonged
D. It occurs in severe congestive heart failure
239. During mouth-to-mouth resuscitation, what is the oxygen concentration of the resuscitating gas
mixture?
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Respiratory System Physiology
A. 16% B. 21% C. 28% D. 35%
240. Hyperventilating allows one to hold one’s breath for a longer period of time, because
hyperventilation
A. Increases the oxygen reserve of systemic arterial blood
B. Decreases the PCO2 of systemic arterial blood
C. Decreases the pH of systemic arterial blood
D. Increases brain blood flow
E. None of the above, since hyperventilation reduces the time one can voluntarily stop breathing
242. If oxygen is added to inspired air to increase its partial pressure from 150 mm Hg to 450 mm Hg:
A. Dissolved oxygen will increase approximately three-fold
B. The oxygen content of the blood will increase approximately three-fold
C. The PN2 will remain the same
D. The PO2 will increase approximately one-fold
E. Hypercarbia will be prevented
244. The following cause a decrease in the arterial partial pressure of oxygen:
A. Anemia D. A rise in physiological dead-space
B. Carbon monoxide E. Old age
C. Hyperventilation
246. Regarding the surfactant, all the following are true, EXCEPT :
A. Is a mucopolypeptide
B. Causes a decrease in surface tension
D. Causes an increase in compliance
E. Production is reduced after a prolonged reduction in pulmonary blood flow
251. An increase in the 2.3-DPG concentration in red blood cells occurs in the following EXCEPT:
A. Anemia C. Stored blood E. Cyanotic heart disease
B. Acclimatization to altitude D. Trained athletes
252. On ascending to an altitude of 6000 m, changes include all the following EXCEPT:
A. An increase in minute volume D. A fall in arterial PO2
B. An initial increase in plasma pH E. An increase in cerebral blood flow
C. A rise in urine pH
253. Regarding chemoreceptors in the arterial system, all the following EXCEPT:
A. Have a higher rate of oxygen consumption per gram than brain tissue
B. Respond to changes in oxygen tension and not content
C. Respond to changes in pH
D. Conduct afferent information via the glossopharyngeal and vagus nerves
E. Are found in the carotid sinus
256. In a healthy individual breathing spontaneously, which of the following pressures is positive with
reference to atmospheric pressure?
A. Alveolar pressure during inspiration B. Alveolar pressure during expiration
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Respiratory System Physiology
C. Intrapleural pressure during inspiration D. Intrapleural pressure during expiration
258. In a healthy individual with a total lung volume of 6 liters, the amount of oxygen present in the
lungs at the end of a tidal expiration is about:
A. 100 ml B. 210 ml C. 400 ml D. 1000 ml E. 2300 ml
259. A person breathes into and from a spirometer (volume 12 liters) containing 10% helium gas
mixture. After equilibration, helium concentration of expired gas was found to be 6.7%. His vital
capacity is 4.2 liters. What is his residual volume?
A. 1000 ml B. 1200 ml C. 1500 ml D. 1800 ml
260. For a respiratory minute volume of 6 liters, which of the following combinations of breathing rate
and tidal volumes allows for maximum alveolar ventilation in a healthy individual?
A. 10 breaths per minute; and 600 ml C. 20 breaths per minute; and 300 ml
B. 15 breaths per minute; and 400 ml D. 30 breaths per minute; and 200 ml
262. If the PO2 of blood in the pulmonary capillaries is 100 mm Hg and it is 98 mm Hg in the left ventricle,
which of the following is most likely to account for this?
A. Some bronchial venous blood drains into pulmonary veins
B. Some return from the coronary veins occurs into the chambers of the left side of the heart
C. Pulmonary arteriovenous anastomoses
D. Patent foramen ovale
263. In the adult, which of the following is most different between the systemic and pulmonary
circulations?
A. Volume of blood flowing through it C. Capillary hydrostatic pressure
B. Stroke volume D. Oncotic pressure
265. Which of the following is true at functional residual capacity (relaxation volume)?
A. Intrapulmonary pressure = atmospheric pressure
B. Intrapleural pressure > atmospheric pressure
C. Intrapulmonary pressure = intrapleural pressure
D. Transrespiratory pressure is positive
273. If blood Hb is 10 g/dl, PO2 is 100 mm Hg, and hemoglobin is 50% saturated with oxygen, the volume
of oxygen contained in 100 ml of blood is approximately:
A. 5.6 ml B. 6.7 ml C. 9.5 ml D. 19.5 ml
275. The normal value of P50 on the oxyhemoglobin dissociation curve in an adult is:
A. 13.5 mm Hg B. 20.3 mm Hg C. 26 mm Hg D. 33.8 mm Hg
276. What is/are the consequence(s) of a selective lesion of the pneumotaxic center?
A. Respiratory frequency increases D. Tidal volume becomes greater
B. Tidal volume decreases E. Prolonged inspiratory spasms
C. Respiration becomes slower
278. When someone inhales a gas mixture consisting of 10% CO2 for 2 minutes, which of the following is
least likely?
A. PCO2 remains at 40 mm Hg C. Alveolar PO2 decreases
B. Respiratory minute volume increases D. pH of brain interstitial fluid drops
280. Which of the following structures or mechanisms is / are least important in the regulation of
breathing at rest in humans?
A. Medullary chemoreceptors B. Carotid and aortic bodies C. Hering-Breuer reflexes
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Respiratory System Physiology
283. Which one of the following has been recently postulated to function as a sensor of oxygen levels
and a facilitator of oxygen transport in the brain?
A. Myoglobin B. Neuroglobin C. Nitric oxide D. Cytochrome oxidase c
284. Which of the following combinations of arterial blood gas results is most likely in a normal person
after a month’s residence at 4000-meter altitude? Arterial pH, PCO2 and HCO3‒ (mmol/L) respectively
would be:
A. 7.36, 36 mm Hg, 30 C. 7.46, 26 mm Hg, 19
B. 7.4. 40 mmHg, 24 D. 7.6, 20 mm Hg, 40
285. The arterial blood gas values, pH 7.58, PCO2 23 mm Hg, PO2 300 mm Hg and oxygen saturation of
hemoglobin 60% are most consistent with a diagnosis of:
A. Carbon monoxide poisoning C. Voluntary hyperventilation
B. Ventilatory (type 2 respiratory) failure D. Methyl alcohol poisoning
286. Which of the following conditions leads to tissue hypoxia without an alteration of oxygen content
of blood?
A. Carbon monoxide poisoning C. Cyanide poisoning
B. Methemoglobinemia D. Respiratory acidosis
290. 97% of oxygen from lungs to tissues is carried in chemical combination with:
A. Carbon dioxide C. Hemoglobin E. Plasma proteins
B. Hydrogen ions D. Water
291. Reaction between water and carbon dioxide with in Red Blood Cells is catalyzed by the enzymes:
A. Peroxidase B. Catalase C. Collagenase
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Respiratory System Physiology
D. Carbonic anhydrase E. Esterase
296. If the patient’s total lung capacity is 6 L, what is the functional residual capacity?
A. 1 L B. 2 L C. 3 L D. 4 L E. 5 L
300. If the patient doubles his tidal volume without changing his CO2 production, his PCO2 will be
A. 15 mmHg B. 20 mmHg C. 25 mmHg D. 30 mmHg E. 35 mmHg
301. A woman has a respiratory rate of 18, a tidal volume of 350 mL, and a dead space of 100 mL. What
is her alveolar ventilation?
A. 4.0 L B. 4.5 L C. 5.0 L D. 5.5 L E. 6.0 L
302. The woman in the preceding question has a normal PCO2 of 40 mmHg. If she increases her tidal
volume by 75 mL, her PCO2 will become approximately
A. 15 mmHg B. 20 mmHg C. 25 mmHg D. 30 mmHg E. 35 mmHg
303. Which one of the following would increase in obstructive, but not in restrictive, lung disease?
A. Vital capacity C. Functional residual capacity
B. FEV1 D. Breathing frequency
305. Which one of the following will decrease in a person with ventilation-perfusion (V/Q)
abnormalities?
A. Anion gap D. Alveolar-arterial gradient for oxygen
B. Arterial pH E. Alveolar ventilation
C. Arterial carbon dioxide tension
306. Which one of the following is higher at the apex of the lung than at the base when a person is
standing?
A. V/Q ratio C. Ventilation E. Lung compliance
B. Blood flow D. PCO2
307. In areas of the lung with lower than normal V/Q ratios, the
A. Capillary CO2 tension is lower than normal
B. Pulmonary vascular resistance is higher than normal
C. Alveolar O2 tension is higher than normal
D. Water vapor pressure is higher than normal
E. Gas exchange ratio is higher than normal
308. Very small particles are removed from the respiratory system by
A. Bulk flow B. Diffusion C. Expectoration D. Phagocytosis E. Ciliary transport
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309. Which of the following conditions causes a decrease in arterial O2 saturation without a decrease in
O2 tension?
A. Anemia D. Hypoventilation
B. Carbon monoxide poisoning E. Right-to-left shunt
C. A low V/Q ratio
311. The partial pressure of oxygen inhaled from a tank containing 21% O2 by divers at a depth of 100 ft
below sea level (4 atmospheres) is approximately
A. 40 mmHg B. 100 mmHg C. 200 mmHg D. 600 mmHg E. 1200 mmHg
312. The patient’s dead space is (The dead space can be calculated using the Bohr equation: Dead space
volume (VD) = Tidal volume (VT) * (Alveolar PCO2 − Expired PCO2) ÷ Alveolar PCO2]
A. 80 mL B. 90 mL C. 100 mL D. 110 mL E. 120 mL
314. To return the PCO2 value to normal (40 mmHg), the patient would have to increase her alveolar
ventilation to
A. 6.5 L/min B. 7.0 L/min C. 7.5 L/min D. 8.0 L/min E. 8.5 L/min
315. At what point during the tidal breath illustrated below is the alveolar PCO2 at its highest value?
A. A B. B C. C D. D E. E
316. Peripheral and central chemoreceptors may both contribute to the increased ventilation that occurs
as a result of
A. A decrease in arterial oxygen content B. A decrease in arterial blood pressure
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C. An increase in arterial carbon dioxide tension E. An increase in arterial pH
D. A decrease in arterial oxygen tension
320. The following diagram illustrates a flow-volume loop obtained from a normal patient. At which one
of the points on the curve will airflow remain constant despite an increased respiratory effort?
A. A B. B C. C D. D E. E
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322. What is the P50 of the oxyhemoglobin curve labeled A in the diagram?
A. 80 mmHg B. 60 mmHg C. 40 mmHg D. 30 mmHg E. 20 mmHg
323. Which of the following conditions is most likely to shift the above oxyhemoglobin curve from A to
B?
A. Increased temperature D. Hyperventilation
B. Exercise E. Metabolic acidosis
C. Acclimatization to high altitude
324. Which one of the following is higher at total lung capacity than it is at residual volume?
A. Anatomical dead space
B. Lung compliance C. Airway resistance D. Alveolar pressure
325. Which one of the following components of a pulmonary function test will be closest to normal in a
patient with restrictive lung disease?
A. FEV1 B. FVC C. FEV1/FVC D. TLC
326. A man breathing room air at sea level has a PCO2 of 48 mmHg. His alveolar oxygen tension (PO2) is
(can be calculated using the modified alveolar gas equation, Alveolar PO2 = PiO2 − (alveolar PCO2/R),
where R is the respiratory exchange ratio (VCO2 produced /VO2 consumed), which depends on the diet
and is normally 0.8. PiO2 equals the fraction of oxygen in room air (0.21) times the barometric pressure at
sea level (760 mmHg) minus the water vapor pressure (47 mmHg) of saturated tracheal gas at body
temperature (37°C)).
A. 150 mmHg B. 110 mmHg C. 100 mmHg D. 90 mmHg E. 60 mmHg
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Respiratory System Physiology
327. A young skier with normal pulmonary function (minute volume 4 L; pulmonary blood flow 5 L/min)
who is recovering from a tibial fracture suddenly develops right-sided chest pain and tachypnea. Embolic
occlusion of the right pulmonary artery is suspected. Which of the following alveolar gas measurements
would immediately confirm the diagnosis?
PO2 (mmHg) PCO2 (mmHg)
A. 125 60
B. 125 20
C. 100 40
D. 80 20
E. 80 60
329. When the respiratory muscles are relaxed, the lungs are at
A. Residual volume (RV) D. Inspiratory reserve volume (IRV)
B. Expiratory reserve volume (ERV) E. Total lung capacity (TLC)
C. Functional residual capacity (FRC)
330. Which one of the following is the most likely cause of a high arterial PCO2?
A. Increased metabolic activity D. Alveolar capillary block
B. Increased alveolar dead space E. Increased alveolar ventilation
C. Depressed medullary respiratory centers
332. Which of the following would normally be less in the fetus than in the mother?
A. PCO2 D. PO2
B. Pulmonary vascular resistance E. Arterial hydrogen ion concentration
C. Affinity of hemoglobin for oxygen
333. An increase in the P50 of an oxyhemoglobin curve would result from a decrease in
A. Metabolism B. pH C. Temperature D. Oxygen E. 2,3-DPG
336. Pulmonary alveoli are kept dry by factors that include the
A. Phagocytic activity of alveolar macrophages
B. Negative interstitial fluid pressure
C. Low vapor pressure of water in inspired air
D. Lack of surfactant
E. Tight junctions between the alveolar capillary endothelial cells
337. In which one of the following conditions will the diffusing capacity of the lung increase?
A. Formation of pulmonary emboli D. Congestive heart failure
B. Fibrotic lung disease E. COPD
C. Polycythemia
339. Which of the following will return toward normal during acclimatization to high altitude?
A. Arterial hydrogen ion concentration D. Arterial hemoglobin concentration
B. Arterial carbon dioxide tension E. Alveolar ventilation
C. Arterial bicarbonate ion concentration
342. In an acclimatized person at high altitudes, oxygen delivery to the tissues may be adequate at rest
because of
A. An increase in hemoglobin concentration
B. The presence of an acidosis
C. A decrease in the number of tissue capillaries
D. The presence of a normal arterial PO2
E. The presence of a lower-than-normal arterial PCO2
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343. Which of the following will increase as a result of stimulating parasympathetic nerves to the
bronchial smooth muscle?
A. Lung compliance D. Resistive work of breathing
B. Airway diameter E. Anatomic dead space
C. Elastic work of breathing
344. During a normal inspiration, more air goes to the alveoli at the base of the lung than to the alveoli
at the apex of the lung because
A. The alveoli at the base of the lung have more surfactant
B. The alveoli at the base of the lung are more compliant
C. The alveoli at the base of the lung have higher V/Q ratios
D. There is a more negative intrapleural pressure at the base of the lung
E. There is more blood flow to the base of the lung
346. Which of the following conditions is most likely to produce the change from the normal maximum
flow-volume curve illustrated below?
351. Which one of the following will be greater than normal in a patient with an areas of low V/Q ratio?
A. PCO2 D. Oxygen dissolved in blood
B. PO2 E. Oxygen combined with hemoglobin
C. Alveolar-arterial gradient
353. Enzymes within the lung are responsible for the activation of
A. Angiotensin II B. Bradykinin C. Prostaglandins D. Serotonin E. Leukotrienes
354. When a person ascends to a high altitude, alveolar ventilation increases. Alveolar ventilation
continues to increase over the next several days because
A. The central chemoreceptors become more sensitive to low oxygen tensions
B. The peripheral chemoreceptors increase their firing rate
C. The plasma concentration of 2,3-DPG increases
D. Adaptation of central chemoreceptors to low pH of the cerebrospinal fluid
E. The oxygen-carrying capacity of hemoglobin increases
356. Which one of the following gases diffuses across the alveoli-capillary membrane by a diffusion-
limited transport process?
A. Oxygen C. Carbon dioxide E. Nitrous oxide (N2O)
B. Nitrogen D. Carbon monoxide
357. A person ascends to the top of a mountain where the atmospheric pressure is below normal. Which
one of the following blood gases was drawn from the person at the top of the mountain?
PO2 PCO2
A. 50 30
B. 60 40
C. 80 50
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D. 100 40
E. 120 30
359. Patients with chronic lung disease are often divided into “blue bloaters” (those who are cyanotic)
and “pink puffers” (those who are not cyanotic). The presence of cyanosis in blue bloaters but not in pink
puffers results from difference in their
A. V/Q ratios C. Airway resistances E. Expiratory flow rates
B. Vital capacities D. Total lung capacities
360. Which one of the above oxyhemoglobin saturation curves was obtained from fetal blood?
A. A B. B C. C D. D E. E
361. Which one of the above oxyhemoglobin saturation curves was obtained from blood exposed to
carbon monoxide?
A. A B. B C. C D. D E. E
362. Which one of the above changes in arterial blood gas values was obtained from a patient with a
large intrapulmonary shunt?
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Respiratory System Physiology
A. A B. B C. C D. D E. E
363. Which one of the above changes in arterial blood gas values was obtained from a patient with
metabolic acidosis?
A. A B. B C. C D. D E. E
364. A patient with reduced VC, FRC, and RV is found to have a normal pH. A tentative diagnosis of
diffuse interstitial fibrosis is made. Which of the following characteristics are consistent with this
disease?
A. An increase in lung compliance D. A decrease in PCO2
B. A decrease in respiratory rate E. An increase in the FEV1/FVC ratio
C. An increase in the V/Q ratio
371. As one ascends to higher than 3000 meters above sea level changes in alveolar PO2 and PCO2 are as
follows
A. Decrease in PO2, increase in PCO2 C. Increase in both PO2 and PCO2
B. Decrease in PO2, decrease in PCO2 D. Increase in PO2, decrease in PCO2
378. Total vital capacity is decreased but timed vital capacity is normal in
A. Bronchial asthma B. Scoliosis C. Chronic bronchitis D. All the above
380. Figure 3–13 shows the oxyhemoglobin dissociation curves for a healthy patient and for an anemic
patient. Which of the following statements concerning these patients is true?
A. Patient A is anemic
B. Arterial PO2 is likely to be similar for both subjects
C. Venous PO2 of the anemic subject will be greater than that of the normal subject at rest or during
exercise
D. If cardiac output is identical, then oxygen delivery will be identical in subjects A and B.
381. A 25-year-old, 70-kg man broke several ribs as a result of a fall from a ladder. His treatment at a
nearby hospital included stabilizing his chest with bandages. The bandages were tied in a way that
reduced his tidal volume by 50%. To compensate, he doubled his respiratory rate. Two hours later, an
arterial blood sample was taken. Which of the following conditions would have been observed?
A. Increased PO2 and decreased PCO2 C. Decreased PO2 and increased PCO2
B. No change in PO2 or PCO2 D. Increased PO2 and increased PCO2
382. An individual’s total lung capacity (TLC) is 6.5 L, and her inspiratory capacity (FRC −TLC) is 3.55 L. At
the end of a normal expiration, her lung volume is 4.45 L. The individual’s tidal volume (VT) is
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A. 1.50 L B. 3.00 L C. 0.500 L D. 0.750 L E. 0.900 L
383. Following infusion of lactic acid into the blood of a healthy subject, arterial pH falls to 7.35. Which
of the following would be expected to occur?
A. A decrease in ventilation D. A rise in arterial PCO2
B. A rise in the pH of the cerebrospinal fluid E. A decrease in the ratio
C. A decrease in arterial PO2
384. Which of the following causes of brain hypoxia would most strongly stimulate the aortic and carotid
chemoreceptors?
A. Carbon monoxide poisoning
B. Severe anemia
C. Formation of methemoglobin
D. A marked decrease in pulmonary diffusing capacity
E. Acute respiratory alkalosis
386. Which of the following is in the correct path of CO2 from the tissue to the atmosphere?
A. Reaction with H2O to make H2CO3, dissociation to H+ and HCO3-, H+ combines with imidazole side chain of
hemoglobin, carried back to lungs as HHb+ and HCO3-, reverse reaction forms CO2
B. O2 is metabolized to CO2, reaction with H2O to make H2CO3, H2CO3 combines with imidazole side chain of
hemoglobin, H2CO3-Hb+ is carried back to the lungs, reverse reaction forms CO2
C. Reaction with H2O to make H2CO3, dissociation to H+ and HCO3-, HCO3- combines with imidazole side
chain of hemoglobin, carried back to the lungs as HCO3--Hb+ and H+, reverse reaction forms CO2
D. O2 is metabolized to CO2, reaction with H2O to make H2CO3, dissociation to H+ and HCO3-, carried back to
lungs in this form, reverse reaction forms CO2
387. Which of the following is the first branching of the bronchial tree that has gas exchanging
capabilities?
A. Terminal bronchioles C. Alveoli E. Alveolar ducts
B. Respiratory bronchioles D. Segmental bronchi
389. If you increased the left atrial pressure from 5 mmHg to 15 mmHg, what effect would that have on
pulmonary circulation?
A. It would force blood the opposite direction
B. It would increase the speed at which blood moves through the pulmonary circulation
C. No change
D. Blood flow would almost or completely stop
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390. Which of the following concerning average lung volumes and capacities of a person at rest is TRUE?
A. TLC>VC>TV>FRC C. TLC>VC>FRC>TV
B. TLC>FRC>VC>TV D. TLC>FRC>TV>VC
391. Which of the following is NOT a normal occurrence with increasing age?
A. Vital capacity of the lung decreases D. Inspiratory capacity decreases
B. Residual volume increases E. Expiratory reserve volume increases
C. Functional residual capacity increases
392. Which of the following spirometry measurements has the greatest sensitivity for detecting early air
flow obstruction?
A. FVC B. FEV1 C. FFE D. FEF25-75
394. During inspiration, how does alveolar pressure compare to atmospheric pressure?
A. Alveolar pressure is greater than atmospheric
B. Alveolar pressure is less than atmospheric
C. Alveolar pressure is the same as atmospheric
D. Alveolar pressure is one of the few pressures where the reference pressure is not atmospheric
395. Which of the following represents the pressure difference that acts to distend the lungs?
A. Alveolar pressure C. Transthoracic pressure E. Esophageal pressure
B. Airway opening pressure D. Transpulmonary pressure
396. If a patient had a progressive lung disease that required an ever increasing pressure to fill the same
volume of lung, how would the lung's compliance be affected?
A. It would increase it
B. It would stay the same
C. It would decrease it
D. These variables do not affect lung compliance
397. An asthma sufferer finds she has to breathe at twice her normal rate. How does that affect her
dynamic compliance?
A. It stays the same
B. It decreases
C. It increases
D. Static compliance, not dynamic, is the variable affected by asthma
398. According to the Law of Laplace, air should flow from the smaller alveoli to the larger, collapsing
them. In the lungs, several factors counter that tendency, and stabilize the alveolar structures. Which of
the following is NOT one of them?
A. Surfactant lowers surface tension to a greater degree when it is on a smaller surface area, allowing the
smaller alveoli to stay open
B. Mechanical stability is given by surrounding alveoli
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C. Transpulmonary pressure is lower for smaller alveoli, allowing them to stabilize in comparison to the
bigger ones
D. Without surfactant, surface tension at the gas-liquid interface increases as alveolar surface area
decreases
399. Which of the following is FALSE concerning the production and role of lung surfactant?
A. It is part of a lipoprotein called dipalmitoyl phosphatidyl-choline
B. It is synthesized by alveolar type I cells
C. As the alveolar surface area decreases during the compression curve, the surfactant decreases the
surface tension at a constant rate
D. When surfactant density is decreased during expansion, surface tension initially rises rapidly, and then
slows down until it reaches the starting point
400. Which of the following is NOT true concerning respiratory distress syndrome in premature infants?
A. Their ability to synthesize dipalmitoyl phosphatidyl-choline is limited
B. Higher pressures are required to ventilate the lungs
C. Lung compliance is low
D. Positive pressure respirators are often used to assist them in breathing
E. Alveoli tend to overexpand and sometimes burst at the end of inspiration
402. If the lung were punctured, which of the following would happen?
A. The lung would collapse on the side of the puncture
B. Both the lung and the chest wall would collapse on the side of the puncture
C. The relaxation pressure of the chest wall would increase until it surpassed the atmospheric
D. The relaxation pressure of the chest wall would increase, but stop before it reached atmospheric
pressure
403. Which of the following is FALSE concerning the airflow in the lungs?
A. During inspiration and expiration, the flow in the trachea and larger bronchi is turbulent
B. Towards the middle of the bronchial tree, the flow is turbulent at the branches and laminar in between
C. Near the end of the bronchial tree, the flow is laminar
D. The acini have very small radii which significantly increases the total air flow resistance of the bronchial
tree
405. Which of the following does NOT apply to the alveoli at the base of the lungs?
A. They are less elastic than the alveoli at the apex
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B. The pleural pressure is lower
C. At FRC they are less inflated than the alveoli at the apex
D. They are closed at RV.
E. They have a greater volume change than alveoli at the apex during inspiration from FRC.
406. Which of the following is TRUE if a patient breathes slower than normal with increased tidal
volumes?
A. More resistive work is done C. More elastic work is done
B. The total work done decreases D. Compliance is decreased
407. Which of the following is INCORRECT concerning the efficiency of breathing and the oxygen
consumption of the respiratory muscles?
A. Efficiency is defined as the ratio of mechanical work done to move air to the amount of metabolic energy
used by the respiratory muscles
B. The respiratory system uses less than 3% of the body's total oxygen consumption at rest
C. Respiratory muscles are more efficient than large muscle groups
D. Emphysema increases the oxygen requirement for respiratory muscles
E. Hyperventilation can increase the oxygen consumption of respiratory muscles to 30%.
408. If the FIO2 is 0.21, the FEO2 is 0.16, the VT is 0.5 L, and the frequency of breathing is 12. What is the
VO2? The equations are VO2=VI * (FIO2 - FEO2) and VI = VT * f.
VO2 = oxygen consumption, FIO2 = Percent Oxygen in Inspired Air, FEO2 = Percent Oxygen in Expired Air,
VT = Tidal volume, VI = Volume of expired air = TV * F (frequency)
A. 3.0 L/min B. 0.75 L/min C. -0.75 L/min D. 0.3 L/min
409. How do you calculate how much inspired air actually ventilates the alveoli during one minute?
A. Subtract the volume of dead space from the tidal volume
B. Subtract both the dead space volume that was already in the lungs plus the dead space of the inspired air
that won't reach the alveoli from the tidal volume
C. Subtract the volume of dead space from the tidal volume and multiply it by the number of breaths per
minute
D. It is equal to the tidal volume times the frequency of breathing
412. If a patient's blood carries 10 grams of Hb per deciliter, what is the O2 carrying capacity of his
blood?
A. 18 ml per deciliter C. 10 ml per deciliter
B. 20 ml per deciliter D. 13 ml per deciliter
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413. Which of the following definitions is FALSE?
A. O2 content of blood is the actual amount of O2 in one deciliter of blood
B. O2 saturation of blood is the ratio of O2 content to its O2 capacity
C. The O2 uptake curve of blood is the functional relationship between O2 content and PO2
D. The O2 content of blood depends completely on the amount of Hb in the blood
415. Which of the following is NOT a form by which CO2 can be transported in the blood?
A. As bicarbonate C. Bound to the amino end groups in proteins
B. Dissolved in the blood D. Bound to the imidazole ring of glutamate
416. Which of the following pairs is NOT a pulmonary mechanoreceptor paired to a possible stimulus?
A. Stretch receptor: inflation
B. Irritant receptor: inhaled dust
C. Juxtacapillary receptors: decreases interstitial fluid volume in alveolar walls
D. Bronchial C receptors: large inflations
417. Which of the following is INCORRECT concerning the O2 / CO2 movement and processing through
the lungs and tissues?
A. Binding of O2 to Hb changes its configuration so that CO2 and H+ ions are more likely to dissociate
B. When CO2 diffused into the alveoli, the arterial PCO2 is lowered
C. Carbonic acid is an intermediate in the reaction combining H+ with HCO3- to form H2O and CO2
D. Arterial blood flows to the tissues where H+ ions combine with HCO3- to form H2O and CO2
419. If you blocked the blood supply to an alveolus, which of the following would NOT occur as a result?
A. The ventilation perfusion ratio would be 0.
B. The alveolar PO2 would be greater than normal
C. The alveolar PCO2 would be 0.
D. All of the above are true
420. Which of the following is FALSE concerning the ventilation and perfusion of different regions of the
lung?
A. Alveoli at the top of the lung have a smaller dynamic compliance
B. The Hb moving through the base of the lung is less saturated than that at the apex of the lung
C. Alveolar PO2 at the apex of the lung is higher than that at the base of the lung
D. Regional variation in ventilation-perfusion is more efficient for oxygenating blood than is uniform
ventilation-perfusion
421. Which of the following is FALSE concerning the relationships of the variables in diffusion of O2
across a membrane?
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A. Doubling the thickness of the membrane would cut the total flow of O2 in half
B. Doubling the area of the membrane would double the total flow of O2
C. If you increased the alveolar concentration of O2, you would increase the total flow of O2 across the
alveolar membrane
D. The lower the diffusion coefficient, the higher the total flow
E. Increasing the arterial concentration of O2 would decrease the total flow of O2
422. If the blood moved slower than normal through the alveolar capillaries, which of the following
would have an increased uptake?
A. Carbon dioxide C. Oxygen
B. Carbon monoxide D. None of the above
424. Which of the following pairs is INCORRECT concerning central nervous systems and a factor they
respond to by affecting respiration?
A. Cerebellum: Mechanoreceptor input
B. Limbic system: emotional states
C. Cerebral cortex: voluntary control
D. Cerebral motor cortex: exercise
425. Which of the following will NOT increase the minute ventilation?
A. An increase in arterial pH.
B. An increase in arterial partial pressure of carbon dioxide
C. Increase in alveolar pressure of carbon dioxide
D. Exercise
E. Hypoxia
426. Which of the following is the primary regulating variable of the central chemoreceptors?
A. Arterial PO2 C. arterial pH
B. Arterial PCO2 D. Input from stretch receptors
427. Which of the following is FALSE concerning chemoreceptor input to the respiratory centers?
A. CSF is a poor buffer and a drop in PCO2 produces a large change in pH initiating a change in respiration
B. The body can adjust to chronic hypercapnea by using an active HCO3- transport process in the choroid
plexus
C. The carotid and aortic bodies detect increases in arterial PCO2 and pH, and decreases in arterial PO2
D. 75% of ventilatory response is regulated by chemoreceptors in the CSF and 25% by the carotid and aortic
bodies
E. Central chemoreceptors tend to respond slowly over time, while carotid bodies react quickly to
immediate needs
428. Considering the events associated with inspiration, all the fallowing are true EXCEPT
A. In order to fill the lungs with air, the alveolar pressure must be decreased relative to the atmospheric
pressure
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B. The contraction of the respiratory diaphragm increases the vertical dimension of the thorax, increasing
the volume of the thorax
C. The internal intercostal muscles contract during inspiration
D. Inspiration is dependent upon the contraction of the inspiratory muscles
431. Which of the following statements regarding the bronchial tree is TRUE?
A. The epithelium decreases in height as you proceed from the trachea toward the terminal bronchioles
B. Cartilage gradually replaces smooth muscle as the structural support as you approach the terminal
bronchioles
C. No bronchioles are capable of gas exchange
D. An aspirated "beer nut" would most likely be lodged in the left primary bronchus
E. A bronchopulmonary segment is ventilated by one secondary bronchus
433. Which of the following structures is NOT found within the hilus of the lung?
A. Lymphatic vessels C. Pulmonary artery E. Autonomic nerves
B. Pulmonary vein D. Tertiary bronchus
436. The exchange of gases between the alveoli and the pulmonary capillaries is called
A. Pulmonary ventilation C. Internal respiration E. Compliance
B. External respiration D. Airway resistance
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437. Which of the following statements regarding normal, quiet breathing is FALSE?
440. Which of the following structures is a part of the conduction portion of the respiratory system?
A. Alveoli C. Alveolar ducts E. None of the above
B. Terminal bronchioles D. Respiratory bronchioles
443. Calculate the expiratory reserve volume from the following data:
Tidal volume = 525 mL
Inspiratory reserve volume = 3175 mL
Vital capacity = 4975 mL
A. 1275 mL
B. 1800 mL
C. 2650 mL
D. 3700 mL
E. This calculation CAN NOT be made from the data presented
445. Which of the following factors has the most important influence on how much O 2 combines with
hemoglobin?
A. A low, but normal hematocrit B. The thickness of the respiratory membrane
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C. Fluctuations in tidal volume-alveolar D. Partial pressure of oxygen
ventilation E. The surface area for gas exchange
446. Which of the following statements regarding the transport of O2 in blood is FALSE?
A. The higher the PO2, the more hemoglobin binds with O2
B. The majority of O2 in the blood is in the form of oxyhemoglobin
C. Oxyhemoglobin is found within plasma
D. O2 doesn't dissolve easily in H2O.
E. Only dissolved O2 in the blood can diffuse from tissue capillaries into the tissue
447. Which of the following statements regarding CO2 transport in the blood is FALSE?
A. The greatest amount of CO2 is transported in the blood plasma as HCO3-.
B. During internal respiration, Cl- diffuses into the red blood cell
C. HbCO2 dissociates into Hb and CO2 within the pulmonary capillaries
D. The least amount of CO2 is transported in the blood plasma as dissolved CO2
E. In external respiration, CO2 is converted to HCO3-.
449. A patient has an alveolar PO2 of 60 mmHg and a systemic arterial PO2 of 56 mmHg. The most likely
explanation for these values is
A. Hypoventilation
B. Diffusion limitation D. Ventilation-to-perfusion nonuniformity
C. Right-to-left shunt E. Either B, C, or D above
450. All of the following are possible causes of a higher than normal alveolar-arterial oxygen difference
EXCEPT
A. Pulmonary edema
B. Mismatching of alveolar ventilation and pulmonary perfusion
C. Chronic bronchitis
D. A cardiac septal defect that allows blood to flow from the right atrium to the left atrium
E. None of the above; that is, none are exceptions, since all could lead to a high alveolar-arterial oxygen
difference
451. Lack of oxygen equilibration due to diffusion limitation ("alveolar-capillary block") can be evaluated
by measuring the
A. Distribution of an inhaled gas mixture containing a radioactive marker
B. Diffusing capacity of CO (carbon monoxide)
C. Diffusing capacity of CO2 (carbon dioxide)
D. Diffusing capacity of N2 (nitrogen) when inhaling air
E. FEV-1/VC when inhaling pure oxygen
452. Blood gas measurements in an hypoxic patient indicates that the patient’s systemic arterial oxygen
content is normal but his systemic venous oxygen content is low. This is characteristic of
A. Diffusion limitation
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B. Right-to-left shunt
C. Pulmonary ventilation/perfusion nonuniformity
D. Anemic hypoxia (low Hb concentration)
E. Stagnant hypoxia (low cardiac output)
453. A patient has a normal oxygen partial pressure and content in pulmonary venous blood but his
systemic arterial blood shows a significantly lower than normal oxygen partial pressure and content. This
is diagnostic of
A. Diffusion limitation
B. Right-to-left shunt
C. Pulmonary ventilation/perfusion nonuniformity
D. Stagnant hypoxia (low cardiac output)
E. A, B. Or C above
454. Cyanosis (a bluish color of the skin and mucous membranes) indicates a higher than normal blood
concentration of
A. Carbon dioxide C. Hydrogen ion E. Reduced hemoglobin
B. Carbon monoxide D. Diphosphoglycerate (DPG)
455. As blood passes through systemic capillaries, what happens to the affinity of hemoglobin for oxygen
and what happens to the Hb-O2 dissociation curve?
A. Hb affinity for O2 increases and the dissociation curves shifts to the left
B. Hb affinity for O2 increases and the dissociation curves shifts to the right
C. Hb affinity for O2 decreases and the dissociation curves shifts to the left
D. Hb affinity for O2 decreases and the dissociation curves shifts to the right
E. Neither Hb affinity for O2 nor the Hb-O2 dissociation curve change
456. Suppose a person has a genetic defect causing him to continue to produce fetal hemoglobin (rather
than normal hemoglobin) throughout adult life. What would be the expected systemic arterial oxygen
partial pressure and saturation (compared to a normal person)?
A. Higher arterial PO2 and higher Hb O2 saturation
B. Higher arterial PO2 but lower Hb O2 saturation
C. Lower arterial PO2 but higher Hb O2 saturation
D. Lower arterial PO2 and lower Hb O2 saturation
E. Normal arterial PO2 but higher Hb O2 saturation
F. Normal arterial PO2 but lower Hb O2 saturation
457. Compared with systemic arterial blood, pulmonary arterial blood has a higher
A. Oxygen content C. HCO3− ion concentration E. None of the above
B. pH D. Hb concentration
458. As blood passes through systemic capillaries, the enzyme carbonic anhydrase catalyzes
A. Conversion of dissolved CO2 to carbonic acid
B. Conversion of carbonic acid to bicarbonate ion
C. Conversion of gaseous CO2 to dissolved CO2
D. Binding of carbon dioxide to hemoglobin, thus displacing oxygen
E. All of the above
459. What would be the expected systemic arterial oxygen content of a normal person inhaling pure
oxygen (100% O2) for an hour or so?
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A. 100 ml O2 / dl blood
B. 40 ml O2 / dl blood
C. 22 ml O2 / dl blood
D. 11 ml O2 / dl blood
E. None of the above, since pure oxygen is toxic and would cause death within the hour
460. An oxyhemoglobin saturation of mixed systemic venous blood of 25% for a person at rest is
A. Above normal B. Below normal C. Within the normal range
462. What would be the expected effect of pulmonary edema on the pulmonary diffusing capacity for
oxygen (DO2) and carbon dioxide (DCO2)
A. Reduce DO2 and reduce DCO2
B. Reduce DO2 but no effect on DCO2
C. Reduce DCO2 but no effect on DO2
D. No effect on either DO2 or DCO2
E. No effect on either DO2 or DCO2 unless diffusing area is reduced also
463. At which of the following sites is the partial pressure of carbon dioxide (PCO2) highest?
A. Exhaled gas D. Systemic venous blood
B. Alveolar gas E. About the same in all of the above (40 mmHg)
C. Systemic arterial blood
464. At which of the following sites is the partial pressure of oxygen (PO2) highest?
A. Exhaled gas D. Alveolar gas
B. Anatomical dead space at the end of expiration E. About the same in all of the above (100 mmHg)
C. Anatomical dead space at the end of
inspiration
465. An individual who breaths through a hose or tube while keeping his tidal volume normal would be
expected to have an increased (compared to normal) of which of the following?
A. Dead space D. All of the above
B. Wasted ventilation E. Only a and b above
C. Systemic arterial carbon dioxide content
466. At the top of a 3000 meter high mountain, which of the following alveolar partial pressures would
be expected to be lower than normal? (Remember that barometric pressure, PB, decreases as one goes
higher)
A. Alveolar PO2 C. Alveolar PH2O E. only A and B above
B. Alveolar PCO2 D. all of the above
467. Reduction of the pulmonary diffusing capacity to one-fourth of its normal value would be expected
to have what effect on systemic arterial oxygen and carbon dioxide partial pressures (compared to
normal)?
A. decrease PO2 and decrease PCO2 D. increase PO2 and increase PCO2
B. decrease PO2 and increase PCO2 E. decrease arterial PO2 but no change in arterial
C. increase PO2 and decrease PCO2 PCO2
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468. At rest, wasted ventilation as a percent of total ventilation of 30% is
A. above normal B. below normal C. within the normal range
469. When is the resistance to blood flow of the pulmonary vascular bed lowest?
A. When a person is at rest sitting up
B, When a person is at rest lying down
C. When a person is breathing air at high altitude
D. When a person is exercising maximally
E. None of the above because pulmonary vascular resistance is constant
471. In a person standing upright, which region of the lungs has the highest ventilation rate and which
region has the highest circulatory perfusion rate?
A. Highest ventilation: Apex; highest perfusion: Apex
B. Highest ventilation: Apex; highest perfusion: Base
C. Highest ventilation: Base; highest perfusion: Apex
D. Highest ventilation: Base; highest perfusion: Base
E. There is no "highest" region as the apex and base have equal ventilation and perfusion rates
472. Which one of the below is not a function of the respiratory system:
A. Allows oxygen from the air to enter the blood and carbon dioxide to leave the blood and enter the air
B. Can alter the pH by changing oxygen levels
C. Provides protection against some microorganisms by preventing their entry into the body and by
removing them from respiratory surfaces
D. Allows for speech and sound generation
475. Assume that the atmospheric pressure outside the body is 760 mm Hg. Assuming you are neither
inhaling nor exhaling, the percent of gases in your alveoli is as follows:
N2 = 74.9%
O2 = 13.6%
CO2 = 5.3%
According to Dalton's Law, the partial pressure of oxygen in your alveoli is approximately
A. 104 mm B. 136 mm C. 569 mm D. 760 mm
476. Carbon dioxide has a solubility coefficient 24 times higher than oxygen. This means that carbon
dioxide
A. Has a partial pressure that is 24 times higher than oxygen
B. Diffuses 24 times faster in air than oxygen
C. Is 24 times more soluble in water than oxygen
D. Diffuses across the respiratory membrane 24 times faster than oxygen
477. In premature infants with respiratory distress syndrome or hyaline membrane disease, surfactant is
not produced in adequate quantities and a respirator may be required. This is because surfactant
A. Decreases the compliance of the lungs
B. Decreases the surface tension of the fluid that lines the alveoli
C. Decreases the elasticity of the elastic fibers in the alveolar walls
D. Increases the ability of hemoglobin to bind to oxygen
478. At the end of a normal respiration, the pleural pressure is -4 mm Hg and the alveolar pressure is 0
mm Hg. The lungs do not pull away from the pleural wall but create a suction effect. This suction effect (-
4 mm Hg) is caused by
A. Contraction of the internal intercostals
B. Elastic recoil of the lungs and surface tension of the fluid lining the alveoli
C. Elastic recoil of the central tendon
D. Contraction of the diaphragm
479. Emphysema causes destruction of elastic lung tissue. As a result of emphysema, the elastic recoil of
the lungs would ___________ and the compliance of the lungs would _____________.
A. Decrease, decrease C. Increase, decrease
B. Decrease, increase D. Increase, increase
480. The amount of air inspired or expired in a normal inhalation or exhalation is called __________ and
has a volume of about ____________ mL.
A. Tidal volume, 4600 C. Residual volume, 1200
B. Vital capacity, 4600 D. Tidal volume, 500
481. The maximum amount of moveable air in the lungs is called ______________ and has a volume of
about _____________mL.
A. Vital capacity, 4600 C. Inspiratory reserve volume, 3000
B. Total lung capacity, 5800 D. Inspiratory capacity, 3500.
482. In a normal inspiration, the amount of air that is actually available for exchange of oxygen and
carbon dioxide is about ____________mL.
A. 150 B. 350 C. 500 D. 650
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Respiratory System Physiology
483. You went snorkeling for the first time and noticed that breathing through the tube was more
labored than breathing without the tube. This labored breathing was caused by:
A. Increase in residual volume C. Increase in expiratory reserve volume
B. Decrease in vital capacity D. Increase in dead air space
484. A resting individual has a respiratory rate of 12 breaths per minute. How much air is wasted (not
involved in gas exchange) per minute?
A. 500 mL/min C. 4200 mL/min
B. 1800 mL/min D. 6000 mL/min
485. Nitrogen is not normally exchanged in the respiratory tract, yet the partial pressure of nitrogen
varies in inhaled air, alveolar air and expired air. The differences can be explained because
A. Of random diffusing of n2 across the respiratory membranes
B. Nitrogen is the only gas not to obey Dalton's law
C. Nitrogen is added to the alveoli but removed from other areas of the respiratory tract
D. Oxygen is removed and carbon dioxide is added to the alveoli and water is added all along the
respiratory tract
487. Toxins that decrease the abundance of cilia in the respiratory tract tend to increase the
A. Partial pressures of oxygen and carbon dioxide
B. Thickness of the respiratory membrane
C. Coughing reflex
D. Surface area of the respiratory membrane
488. After vigorous exercise, you increase your rate and depth of breathing. This will cause the
A. Surface area of the respiratory membrane to increase
B. Partial pressure differences for oxygen and carbon dioxide to increase across the respiratory membrane
C. Thickness of the respiratory membrane to decrease
D. Solubility coefficients of oxygen and carbon dioxide to increase
489. Deoxygenated blood from the bronchi and bronchioles mix with oxygenated blood in the
pulmonary veins. This is called the
A. Physiologic shunt C. Pulmonary vein
B. Pulmonary artery D. Anatomical shunt
490. Blood entering the lungs has a PO2 of 40 mm Hg while blood immediately leaving the lung
capillaries has a PO2 of _______ mm Hg because it has reached equilibrium with the PO2 in the
____________.
A. 45, interstitial fluid C. 104, interstitial fluid
B. 45, alveoli D. 104, alveoli
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491. Arterial blood entering the tissues has a PO2 = 95 mm Hg and a PCO2 = 40 mm Hg. Venous blood
leaving the tissues has a PO2 = _________ mm Hg and a PCO2 = __________ mm Hg.
A. 104, 40 B. 95, 40 C. 40, 45 D. 20, 46
492. In the lungs, as a result of CO2 diffusing into the alveoli, you would expect hemoglobin's ability to
bind to oxygen to
A. Be unstable B. Stay the same C. Decrease D. Increase
493. In carbon monoxide (CO) poisoning, CO binds to the heme of hemoglobin much easier than oxygen.
What effect will this have on the ability of the tissues to get oxygen?
A. More carbonic acid will be produced, and the hemoglobin will give up more oxygen to the tissue
B. Hemoglobin will bind to less oxygen, and hemoglobin will not release as much oxygen to the tissue
C. Carbon monoxide makes hemoglobin give up oxygen more readily in the tissues
D. Carbon monoxide ties up hemoglobin's ability to bind to oxygen, but more hemoglobin will be produced
so no decline in oxygen in the tissue will be noticed
494. People living at high altitudes have increased levels of 2,3-bisphosphoglycerate (DPG) in their red
blood cells. This high level of DPG will
A. Increase the Bohr effect and make oxygen more available to the tissue
B. Bind to hemoglobin and reduce the amount of oxygen available to the tissue
C. Bind to hemoglobin and increase the amount of oxygen available to the tissue
D. Shift the oxygen-hemoglobin dissociation curve to the left and reduce the amount of oxygen available to
the tissue
495. People with anemias involving disorders of hemoglobin such as thalassemia and sickle cell anemia
are not getting enough oxygen to tissues. They have chemoreceptors in the walls of the large arteries
going to the head that monitor oxygen concentration in the blood. However, in spite of tissues getting
inadequate oxygen, the chemoreceptors do not reflexly increase heart rate and blood pressure to
provide more rapid movement of blood to the tissues. What might explain this apparent paradox;
chemoreceptors monitor oxygen in the blood but apparently they do not respond in people who have
thalassemia or sickle cell anemia to provide adequate oxygen to the tissues.
A. Chemoreceptors only monitor oxygen in arterial blood so what happens in the tissues has no effect
B. Chemoreceptors only monitor dissolved oxygen in the blood and that remains unchanged in the anemia
C. Chemoreceptors are made up of similar amino acids as hemoglobin and are also damaged in the anemia
D. Chemoreceptors actually inhibit the heart rate and blood pressure when oxygen falls below a certain
level in hemoglobin
496. Hemoglobin that has released its oxygen binds more readily to carbon dioxide than hemoglobin
that is highly saturated with oxygen. This is called
A. The Bohr effect C. Boyle's Law
B. Dalton's Law D. The Haldane effect
497. Bicarbonate ions are produced in red blood cells and then diffuse across the membrane and travel
in the blood dissolved in the plasma. Carrier molecules move bicarbonate ions across the red blood cell
membrane in exchange for ______ ions.
A. Sodium B. Potassium C. Hydrogen D. Chloride
498. The dorsal and ventral respiratory groups make up the respiratory center and are located in the
A. Pons C. Mesencephalon
B. Medulla oblongata D. Hypothalamus
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Respiratory System Physiology
499. The group in the respiratory center that is most active during inspiration is the
A. Dorsal group C. Pontine respiratory group
B. Ventral group D. Pons
500. when stretch receptors are firing in the bronchi and bronchioles of the lungs, you would expect
A. Stimulation of the dorsal respiratory group
B. Inhibition of the dorsal respiratory group and stimulation of the expiratory center of the ventral
respiratory group
C. Inhibition of both the dorsal respiratory group and the entire ventral respiratory group
D. Stimulation of both the dorsal respiratory group and the entire ventral respiratory group
501. Which of the following muscles is stimulated by the dorsal respiratory group?
A. Sternocleidomastoid
B. Internal intercostals
C. Diaphragm
D. Rectus abdominus
502. A person holds his or her breath until he or she passes out. The person will resume breathing
because a(n)
A. Decrease in oxygen is detected by chemoreceptors in the carotid and aortic arteries, which inhibits the
inspiratory neurons of the respiratory center
B. Increase in pH is detected by chemoreceptors in the carotid and aortic arteries, which stimulates the
inspiratory neurons of the respiratory center
C. Increase in carbon dioxide and a decrease in pH are detected by chemoreceptors in the walls of carotid
and aortic arteries as well as chemoreceptors that detect changes in the pH of cerebrospinal fluid. These
chemoreceptors excite the inspiratory neurons of the respiratory center
D. Decrease in carbon dioxide and an increase in oxygen are detected by chemoreceptors that monitor the
blood and cerebrospinal fluid. These chemoreceptors inhibit the inspiratory neurons of the respiratory
center
504. Strong emotions can sometimes stimulate hyperventilation. The best treatment for
hyperventilation is to
A. Just let the person relax and normal breathing will resume
B. Give the person oxygen
C. Have the person increases his or her rate of breathing
D. Have the person breath into a bag
505. A drop in PO2 has little effect on the respiratory centers until the arterial PO2 drops by about 40%.
However, a 10% rise in arterial PCO2 will cause the respiratory rate to double. This can be explained
because
A. Hemoglobin carries great reserves of oxygen while PCO2 changes also cause changes in pH
B. Oxygen is not as important to the cells as is carbon dioxide
C. Chemoreceptors are not sensitive to PO2 but are sensitive to PCO2 and pH
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Respiratory System Physiology
D. Oxygen cannot diffuse from the blood into the cerebrospinal fluid while carbon dioxide can, and the
chemoreceptors in the medulla oblongata are much more important in regulating respiration
507. During an asthma attack, the patient has difficulty breathing because of constriction of the
A. Trachea C. Terminal bronchioles E. Respiratory membrane
B. Bronchi D. Alveoli
509. Contraction of the bronchiolar smooth muscle has which of these effects?
A. A smaller pressure gradient is required to get the same rate of airflow when compared to normal
bronchioles
B. Increases airflow through the bronchioles
C. Increases resistance to airflow
D. Increases alveolar ventilation
512. The rate of diffusion of a gas across the respiratory membrane increases as the
A. Respiratory membrane becomes thicker
B. Surface area of the respiratory membrane decreases
C. Partial pressure difference of the gas across the respiratory membrane increases
D. Diffusion coefficient of the gas decreases
E. All of the above
516. Which of these parts of the brainstem is correctly matched with its main function?
A. Ventral respiratory groups—stimulate the diaphragm
B. Dorsal respiratory groups—limit inflation of the lungs
C. Pontine respiratory group—switching between inspiration and expiration
D. All of the above
520. At the onset of exercise, respiration rate and depth increases primarily because of
A. Increased blood carbon dioxide levels
B. Decreased blood oxygen levels
C. Decreased blood pH
D. Input to the respiratory center from the cerebral motor cortex and proprioceptors
522. Besides lubricating the visceral and parietal pleura, pleural fluid also
A. Holds the visceral and parietal pleural membranes together
B. Prevents the lungs from overinflating
C. Helps fill the pleural cavity
D. Increases diffusion rates in the lungs
E. Prevents the lungs from leaking
525. During expiration, the volume of the thorax __________ as the diaphragm __________ .
A. Decreases, contracts C. Increases, contracts
B. Decreases, relaxes D. Increases, relaxes
526. Lung recoil occurs because of elastic fibers in the alveolar walls and
A. Barometric pressure
B. Pleural pressure
C. Surface tension of the fluid that lines the alveoli
D. Surfactant secretion in the alveoli
E. The pneumothorax principle
528. In which of these areas is the partial pressure of oxygen (PO2) normally the greatest?
A. Inspired air C. Expired air E. Tissue capillaries
B. Alveolar air D. Pulmonary capillaries
529. The partial pressure of oxygen in the air is __________ than the partial pressure of carbon dioxide;
the solubility of oxygen in water is __________ than the solubility of carbon dioxide in water.
A. Lower, lower C. Greater, lower
B. Lower, higher D. Greater, higher
530. Which of these conditions causes a decreased rate of diffusion through the respiratory membrane?
A. Increased fluid in the lungs D. Decreased partial pressure gradient
B. Decreased diffusion coefficient E. All of these
C. Decreased respiratory surface area
531. If pH decreases, PCO2 increases, or temperature increases, the amount of oxygen bound to
hemoglobin
A. Increases B. Decreases C. Remains unchanged
532. Oxygen and carbon dioxide move through the respiratory membrane and into and out of cells by
the process of
A. Active transport C. Diffusion E. Facilitated diffusion
B. Cotransport D. Exocytosis
536. What test measures the amount of gas expelled when one takes a deep breath and exhales
maximally and rapidly?
A. Forced expiratory volume test C. Forced residual capacity test
B. Forced vital capacity test D. Forced internal thoracic volume assessment
537. Stimulating the cephalic end of a cut vagus nerve would cause respiration to:
A. Cease because of the lung stretch receptor reflex
B. Increase in rate because of the increased activity of the dorsal respiratory group
C. Increase in depth because of the increased sympathetic activity
D. None of the above
538. A premature baby usually has trouble breathing. However the respiratory system is completely
developed by:
A. 17 wks B. 22 wks C. 24 wks D. 28 wks E. 20 wks
540. What happens when the V/Q of a lung unit decreases? The alveoli in that unit develop a
A. Higher PO2 D. Higher PCO2
B. Lower PO2 and a lower PCO2 E. Higher PN2 and a higher PO2
C. Higher PO2 and a lower PCO2 F. Lower PO2 and a Higher PCO2
541. Which is the letter that represents anemia in the following Hb-O2 dissociation curve?
1. A
2. B
3. C
4. D
5. E
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Respiratory System Physiology
542. Stimulation of the reticular activating system of the brainstem (RAS) plays what role in ventilation?
A. Stimulates ventilation
B. Inhibits ventilation
C. Stimulates inhalation but inhibits exhalation (apneustic breathing)
D. Stimulates exhalation but inhibits inhalation
E. Causes ventilation to cease entirely ("Ondine’s Curse")
Regarding physiologic changes during moderate isotonic exercise in a healthy young adult, which of the
following are true and which are false?
543. PO2 declines
544. PCO2 increases
545. pH of arterial blood decreases (eventually during intense exercise)
546. A-V O2 difference increases
547. SvO2 increases
548. Plasma K+ concentration increases
549. The impulse rate from carotid bodies increases
550. During maximal exercise, O2 consumption may reach up to 4 L /min, about 16 times basal oxygen
consumption
551. VO2 max (maximum oxygen consumption during intense exercise) is increased by training
552. Heart rate may remain elevated for as long as 1 hour after severe exercise
558. The exchange of gases between the blood within the capillaries and tissue fluid surrounding the
body's cells is called?
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Respiratory System Physiology
A. external respiration C. cellular respiration
B. cell metabolism D. internal respiration
559. The medulla oblongata and pons regulate and measure what?
A. The pH level of your blood C. The amount of O2 in your blood
B. Your body temperature D. The amount of air in your lungs
564. In what cellular organelle is the oxygen actually consumed and carbon dioxide produced?
A. Nucleus C. Microfilaments
B. Cytoplasm D. Mitochondria
567. When you hyperventalate you release large amounts of CO2 and drop your O2 levels. As a result you
lose the urge to breathe and may pass out. This is called what?
A. Chronic Obstructive Pulmonary Disease C. Shallow water black out
B. Asthma D. Pulmonary Fibrosis
569. When we exhale deeply some air is still left in the lungs, this air left is called?
A. Tidal Volume C. Expiratory reserve Volume
B. Vital Capacity D. Residual Volume
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1 C 21 C 41 A 61 D 81 C&E 101 D 121 D
8 B 28 B 48 D 68 E 88 A 108 E 128 A
13 B 33 B 52 C 73 C 93 D 113 C 133 B
15 C 35 D 55 C 75 A 95 A 115 D 135 E
562 A
563 B
564 D
565 C
566 C
567 C
568 D
569 D
570
571
572
573
574
575
576
577
578
579
580
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MCQs in
Cardiovascular System Physiology
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Cardiovascular System Physiology
1. The plateau of action potential recorded from ventricular muscle is caused by opening of which
voltage gated channel?
A. Na+ B. K+ C. Slow Ca++ D. Long lasting Ca++
2. The release of acetylcholine from vagal endings on the heart increases the conductance for:
A. Na+ B. K+ C. Ca++ D. Cl–
7. If preload to the heart is increased, rise in each of the following will occur EXCEPT:
A. Heart rate B. Cardiac output C. End systolic volume D. End diastolic volume
12. Tachycardia which occurs due to increase in venous return is caused by:
A. Sino aortic reflex C. Bainbridge reflex
B. Cushing reflex D. Bezold Jarisch reflex
18. Change of posture from lying down to standing shows increase in all of the following EXCEPT:
A. Blood pressure B. Heart rate C. Vagal tone D. Peripheral resistance
19. Coronary blood flow is least in which phase of the cardiac cycle?
A. Ventricular filling C. Isovolumetric relaxation
B. Isovolumetric contraction D. Ejection
20. Maximum fall in pressure occurs in which segment of the vascular system?
A. Aorta B. Arteries C. Arterioles D. Veins
26. T wave of ECG is caused by which of the following ion currents in the ventricle?
A. K+ influx B. K+ exit C. Na+ influx D. Na+ exit
27. Stimulation of vagus nerve to the heart would decrease the conduction of impulses in :
A. SA node C. Ventricular myocardium
B. Bundle of His D. AV node
28. Intravenous infusion of fluid will not improve the condition of which type of shock?
A. Hemorrhagic B. Anaphylactic C. Traumatic D. Burn
30. The portion of the heart wall that lines the heart’s chambers is the:
A. Myocardium B. Pericardium C. Endocardium D. Epicardium
31. Which heart valve controls the flow of blood between the left atrium and the left ventricle?
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Cardiovascular System Physiology
A. Pulmonary valve B. Aortic valve C. Tricuspid valve D. Mitral valve
32. What is the name of the great vessel that supplies blood to the right atrium?
A. Superior and inferior vena cavae C. Pulmonary artery
B. Aorta D. Pulmonary veins
38. The parasympathetic nervous system sends impulses to the heart via the vagus nerve, which:
A. Slows the heart rate
B. Increases the heart rate
C. Doesn’t affect the heart rate
D. Raises the blood pressure, which, in turn, slows the heart rate
39. What is the term used to describe the amount of tension, or stretch, in the ventricular muscle just
before it contacts?
A. Contractility B. Afterload C. Ascites D. Preload
40. The vessels that carry blood away from the heart are:
A. Capillaries B. Sinusoids C. Veins D. Arteries
41. The innermost layer of blood vessels is composed of what type of material?
A. Simple squamous epithelium C. Connective tissue
B. Smooth muscle D. Elastic tissue
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42. Which arteries are called elastic arteries because of their ability to expand when blood surges into
them?
A. Distributing arteries B. Conducting arteries C. Arterioles D. Metarterioles
43. Veins are called capacitance vessels because they have the:
A. Capacity to pulsate with the heart’s contractions
B. Capacity to dilate and constrict to regulate blood pressure
C. Ability to stretch, giving them a great capacity for storing blood
D. Capacity to direct blood flow to organs and tissues in need
45. What are the exchange vessels of the circulatory system, where nutrients, wastes, and hormones are
transferred between blood and tissues?
A. Arterioles B. Capillaries C. Veins D. Venules
47. What is the main reason blood flow is slowest in the capillaries?
A. Capillaries have a greater cross-sectional area
B. Capillaries have a higher osmotic pressure
C. Capillary blood has a higher viscosity than venous blood
D. Capillaries have to fight the pull of gravity
48. A 53-year-old woman is found, by arteriography, to have 50% narrowing of her left renal artery.
What is the expected change in blood flow through the stenotic artery?
A. Decrease to 1⁄2 C. Decrease to 1⁄8 E. No change
B. Decrease to 1⁄4 D. Decrease to 1⁄16
49. When a person moves from a supine position to a standing position, which of the following
compensatory changes occurs?
A. Decreased heart rate D. Decreased cardiac output
B. Increased contractility E. Increased PR intervals
C. Decreased total peripheral resistance (TPR)
51. A person’s electrocardiogram (ECG) has no P wave, but has a normal QRS complex and a normal T
wave. Therefore, his pacemaker is located in the
A. Sinoatrial (SA) node C. Bundle of his E. Ventricular muscle
B. Atrioventricular (av) node D. Purkinje system
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54. On the graph showing left ventricular volume and pressure, Isovolumetric contraction occurs from
point
A. 4 → 1 B. 1 → 2 C. 2 → 3 D. 3 → 4
57. If the heart rate is 70 beats/min, then the cardiac output of this ventricle is closest to
A. 3.45 L/min C. 5.25 L/min E. 9.85 L/min
B. 4.55 L/min D. 8.00 L/min
59. Following a sympathectomy, a 66-yearold man experiences orthostatic hypotension. The explanation
for this occurrence is
A. An exaggerated response of the renin–angiotensin–aldosterone system
B. A suppressed response of the renin–angiotensin–aldosterone system
C. An exaggerated response of the baroreceptor mechanism
D. A suppressed response of the baroreceptor mechanism
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Cardiovascular System Physiology
60. The ventricles are completely depolarized during which isoelectric portion of the electrocardiogram
(ECG)?
A. PR interval C. QT interval E. T wave
B. QRS complex D. ST segment
61. The change indicated by the dashed lines on the cardiac output/venous return curves shows
62. A 30-year-old female patient’s electrocardiogram (ECG) shows two P waves preceding each QRS
complex. The interpretation of this pattern is
A. Decreased firing rate of the pacemaker in the sinoatrial (SA) node
B. Decreased firing rate of the pacemaker in the atrioventricular (AV) node
C. Increased firing rate of the pacemaker in the sa node
D. Decreased conduction through the AV node
E. Increased conduction through the His Purkinje system
63. An acute decrease in arterial blood pressure elicits which of the following compensatory changes?
A. Decreased firing rate of the carotid sinus nerve
B. Increased parasympathetic outflow to the heart
C. Decreased heart rate
D. Decreased contractility
E. Decreased mean systemic pressure
68. An increase in arteriolar resistance, without a change in any other component of the cardiovascular
system, will produce
A. A decrease in total peripheral resistance (TPR) C. An increase in arterial pressure
B. An increase in capillary filtration D. A decrease in afterload
72. The greatest pressure decrease in the circulation occurs across the arterioles because
A. They have the greatest surface area
B. They have the greatest cross-sectional area
C. The velocity of blood flow through them is the highest
D. The velocity of blood flow through them is the lowest
E. They have the greatest resistance
74. In the sinoatrial (SA) node, phase 4 depolarization (pacemaker potential) is attributable to
A. An increase in K+ conductance D. A decrease in Ca2+ conductance
+
B. An increase in Na conductance E. Simultaneous increases in K+ and Cl− conductances
C. A decrease in Cl− conductance
76. During which phase of the cardiac cycle is aortic pressure highest?
A. Atrial systole C. Rapid ventricular ejection
B. Isovolumetric ventricular contraction D. Reduced ventricular ejection
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Cardiovascular System Physiology
E. Isovolumetric ventricular relaxation G. Reduced ventricular filling (diastasis)
F. Rapid ventricular filling
79. Carbon dioxide (CO2) regulates blood flow to which one of the following organs?
A. Heart C. Brain E. Skeletal muscle during exercise
B. Skin D. Skeletal muscle at rest
80. Cardiac output of the right side of the heart is what percentage of the cardiac output of the left side
of the heart?
A. 25% B. 50% C. 75% D. 100% E. 125%
81. The physiologic function of the relatively slow conduction through the atrioventricular (AV) node is
to allow sufficient time for
A. Runoff of blood from the aorta to the arteries D. Contraction of the ventricles
B. Venous return to the atria E. Repolarization of the ventricles
C. Filling of the ventricles
82. Blood flow to which organ is controlled primarily by the sympathetic nervous system rather than by
local metabolites?
A. Skin C. Brain
B. Heart D. Skeletal muscle during exercise
84. When propranolol is administered, blockade of which receptor is responsible for the decrease in
cardiac output that occurs?
A. α1 Receptors C. β2 Receptors E. Nicotinic receptors
B. β1 Receptors D. Muscarinic receptors
85. During which phase of the cardiac cycle is ventricular volume lowest?
A. Atrial systole E. Isovolumetric ventricular relaxation
B. Isovolumetric ventricular contraction F. Rapid ventricular filling
C. Rapid ventricular ejection G. Reduced ventricular filling (diastasis)
D. Reduced ventricular ejection
86. Which of the following changes will cause an increase in myocardial O2 consumption?
A. Decreased aortic pressure
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B. Decreased heart rate
C. Decreased contractility
D. Increased size of the heart
E. Increased influx of Na+ during the upstroke of the action potential
87. A 24-year-old woman presents to the emergency department with severe diarrhea. When she is
supine (lying down), her blood pressure is 90/60 mm Hg (decreased) and her heart rate is 100 beats/min
(increased). When she is moved to a standing position, her heart rate further increases to 120 beats/min.
Which of the following accounts for the further increase in heart rate upon standing?
A. Decreased total peripheral resistance D. Increased afterload
B. Increased venoconstriction E. Decreased venous return
C. Increased contractility
88. During which phase of the ventricular action potential is the membrane potential closest to the K+
equilibrium potential?
A. Phase 0 B. Phase 1 C. Phase 2 D. Phase 3 E. Phase 4
89. During which phase of the ventricular action potential is the conductance to Ca2+ highest?
A. Phase 0 B. Phase 1 C. Phase 2 D. Phase 3 E. Phase 4
90. Which phase of the ventricular action potential coincides with diastole?
A. Phase 0 B. Phase 1 C. Phase 2 D. Phase 3 E. Phase 4
93. Which of the following agents or changes has a negative inotropic effect on the heart?
A. Increased heart rate B. Sympathetic stimulation C. Norepinephrine
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D. Acetylcholine (ACh) E. Cardiac glycosides
94. The low-resistance pathways between myocardial cells that allow for the spread of action potentials
are the
A. Gap junctions C. Sarcoplasmic reticulum E. Mitochondria
B. T tubules D. Intercalated disks
95. Which agent is released or secreted after a hemorrhage and causes an increase in renal Na+
reabsorption?
A. Aldosterone D. Antidiuretic hormone (ADH)
B. Angiotensin I E. Atrial natriuretic peptide
C. Angiotensinogen
96. During which phase of the cardiac cycle does the mitral valve open?
A. Atrial systole
B. Isovolumetric ventricular contraction E. Isovolumetric ventricular relaxation
C. Rapid ventricular ejection F. Rapid ventricular filling
D. Reduced ventricular ejection G. Reduced ventricular filling (diastasis)
97. A hospitalized patient has an ejection fraction of 0.4, a heart rate of 95 beats/min, and a cardiac
output of 3.5 L/min. What is the patient’s end-diastolic volume?
A. 14 mL B. 37 mL C. 55 mL D. 92 mL E. 140 mL
99. During the cardiac cycle, the maximal right ventricular systolic pressure (mmHg) is:
A. 5 B. 8 C. 25 D. 80 E. 120
100. Vagal stimulation results into slowing of the heart rate. This is due to increased permeability of the
sinoatrial nodal fiber membrane to:
A. Calcium C. Potassium E. Sodium and calcium
B. Chloride D. Sodium
101. In a patient having first degree atrioventricular block, the ECG shows prolonged:
A. PR interval D. RR interval
B. QRS interval E. VAT (ventricular activation time)
C. QT interval
104. Normally about 65% of the total blood volume is present in:
A. Capillaries C. Arteriovenous anastomosis E. Veins
B. Arteries D. Arterioles
105. When arterial blood pressure falls to very low level(50 mmHg), the nervous mechanism which helps
to regulate it is mainly:
A. Baroreceptor reflex C. CNS ischemic response E. Venoconstriction
B. Chemoreceptors D. Cushing’s reflex
107. A patient having valvular heart disease shows collapsing pulse (water hammer). He is most likely to
have:
A. Aortic regurgitation C. Mitral regurgitation E. Tricuspid regurgitation
B. Aortic stenosis D. Pulmonary stenosis
108. During fetal life, the blood vessel having maximally oxygenated blood is:
A. Aorta C. Inferior vena cava E. Umbilical vein
B. Ductus arteriosus D. Pulmonary artery
109. During the exercise, skeletal muscle blood flow increases 15-25 times the resting value. This
increase is mainly due to:
A. Increased arterial blood pressure
B. Increased secretion of catecholamines
C. Local metabolic factors
D. Stimulation of sympathetic vasoconstrictor nerves
E. Stimulation of sympathetic vasodilator nerves
111. Local metabolic activity is the chief factor determining the rate of blood flow to the
A. Heart C. Skeletal muscle E. Kidney
B. Skin D. Lung
113. The second heart sound differs from the first heart sound in that it is
A. Related to turbulence set up by valve closure
B. Longer lasting than the first sound
C. Higher in frequency
D. Occasionally split
E. Heard when the ventricles are relaxing
115. Veins
A. Contain most of the blood volume
B. Have a sympathetic vasoconstrictor innervation
C. Receive nutrition from vasa vasorum arising from their lumen
D. Respond to distension by contraction of their smooth muscle
E. Undergo smooth muscle hypertrophy when exposed to high pressure through an arteriovenous fistula
117. Isometric (static) exercise differs from isotonic (dynamic) exercise in that it causes a greater
increase in
A. Venous return
B. Pressure in the veins draining the exercising muscle
C. Muscle blood flow
D. Mean arterial pressure
E. Cardiac work for the same increase in cardiac output
118. The net loss of fluid from capillaries in the legs is increased by
A. Arteriolar dilation
B. Change from the recumbent to the standing position
C. Lymphatic obstruction
D. Leg exercise
E. Plasma albumin depletion
127. When does the first heart sound occur in the ventricular pressure–volume relationship?
A. At point B
B. Between point A and point B D. Between point C and point D
C. Between point B and point C E. Between point D and point A
128. When does the fourth heart sound occur in the ventricular pressure–volume relationship?
A. At point D
B. Between point A and point B D. Between point C and point D
C. Between point B and point C E. Between point D and point A
131. A 30-year-old man has an ejection fraction of 0.25 and an end-systolic volume of 150 milliliters.
What is his end-diastolic volume?
A. 50 mL B. 100 mL C. 125 mL D. 200 mL E. 250 mL
132. In a resting adult, the typical ventricular ejection fraction has what value?
A. 20% B. 30% C. 40% D. 60% E. 80%
133. In which phase of the ventricular muscle action potential is the potassium permeability the highest?
A. 0 B. 1 C. 2 D. 3 E. 4
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134. A 60-year-old man’s ECG shows that he has an R-R interval of 1.5 seconds at rest. Which statement
best explains his condition?
A. He has fever
B. He has a normal heart rate
C. He has decreased parasympathetic stimulation of the S-A node
D. He is a trained athlete at rest
E. He has normal polarization of the S-A node
135. Which of the following is most likely to cause the heart to go into spastic contraction?
A. Increased body temperature D. Excess extracellular fluid potassium ions
B. Increased sympathetic activity E. Excess extracellular fluid calcium ions
C. Decreased extracellular fluid potassium ions
139. Which phase of the cardiac cycle follows immediately after the beginning of the QRS wave?
A. Isovolumic relaxation C. Atrial systole E. Isovolumic contraction
B. Ventricular ejection D. Diastasis
140. Which of the following structures will have the slowest rate of conduction of the cardiac action
potential?
A. Atrial muscle D. Purkinje fibers
B. Anterior internodal pathway E. Ventricular muscle
C. A-V bundle fibers
142. Which condition at the A-V node will cause a decrease in heart rate?
A. Increased sodium permeability B. Decreased acetylcholine levels
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C. Increased norepinephrine levels E. Increased calcium permeability
D. Increased potassium permeability
143. Which statement best explains how sympathetic stimulation affects the heart?
A. The permeability of the S-A node to sodium decreases
B. The permeability of the A-V node to sodium decreases
C. The permeability of the S-A node to potassium increases
D. There is an increased rate of upward drift of the resting membrane potential of the S-A node
E. The permeability of the cardiac muscle to calcium Decreases
144. What is the membrane potential (threshold level) at which the S-A node discharges?
A. −40 millivolt C. −65 millivolt E. −105 millivolt
B. −55 millivolt D. −85 millivolt
145. Which condition at the S-A node will cause heart rate to decrease?
A. Increased norepinephrine level D. Increased potassium permeability
B. Increased sodium permeability E. Decreased acetylcholine level
C. Increased calcium permeability
146. In which phase of the ventricular muscle action potential is the sodium permeability the highest?
A. 0 B. 1 C. 2 D. 3 E. 4
147. If the Purkinje fibers, situated distal to the A-V junction, become the pacemaker of the heart, what
is the expected heart rate?
A. 30/min B. 50/min C. 60/min D. 70/min E. 80/min
148. A patient had an ECG at the local emergency department. The attending physician stated that the
patient had an A-V nodal rhythm. What is the likely heart rate?
A. 30/min B. 50/min C. 65/min D. 75/min E. 85/min
149. Which condition at the A-V node will cause a decrease in heart rate?
A. Increased sodium permeability D. Increased potassium permeability
B. Decreased acetylcholine level E. Increased calcium permeability
C. Increased norepinephrine level
150. When recording lead aVL on an ECG, which is the positive electrode?
A. Left arm C. Right leg E. Right arm + left leg
B. Left leg D. Left arm + left leg
151. When recording lead II on an ECG, the right arm is the negative electrode and the positive electrode
is the
A. Left arm C. Right leg E. Right arm + left leg
B. Left leg D. Left arm + left leg
154. According to Einthoven’s law, if the QRS voltage in lead III is 0.4 millivolt, what is the QRS voltage in
lead I?
A. 0.05 millivolt C. 1.05 millivolts E. 2.05 millivolts
B. 0.50 millivolt D. 1.25 millivolts
157. When recording lead I on an ECG, the right arm is the negative electrode and the positive electrode
is the
A. Left arm C. Right leg E. Right arm + left leg
B. Left leg D. Left arm + left leg
158. A 65-year-old man had an ECG at a local emergency department after a biking accident. His weight
was 80 kilograms (176 pounds) and his aortic blood pressure was 160/90 mm Hg. The QRS voltage was
0.5 millivolt in lead I and 1.5 millivolts in lead III. What is the QRS voltage in lead II?
A. 0.5 millivolt C. 1.5 millivolts E. 2.5 millivolts
B. 1.0 millivolt D. 2.0 millivolts
159. A ventricular depolarization wave, when traveling −60 degrees in the frontal plane, will cause a
large negative deflection in which lead?
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A. aVR B. aVL C. Lead II D. Lead III E. aVF
160. What is the mean electrical axis calculated from standard leads I, II, and III shown in the woman’s
ECG?
A. −90 degrees C. −12 degrees E. +170 degrees
B. −50 degrees D. +100 degrees
161. A ventricular depolarization wave, when traveling 60 degrees in the frontal plane, will cause a large
positive deflection in which of the following leads?
A. aVR B. aVL C. Lead I D. Lead II E. aVF
162. Mr. Smith had an ECG at a local hospital, but his records were lost. The ECG technician remembered
that the QRS deflection was large and positive in lead II and 0 in aVL. What is his mean electrical axis in
the frontal plane?
A. 90 degrees C. 0 degree E. −90 degrees
B. 60 degrees D. −60 degrees
163. A 70-year-old woman came to a hospital emergency department because she was experiencing
chest pain. Based on the ECG shown above, what is the likely diagnosis?
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164. A 55-year-old man underwent an ECG at an annual physical, and his net deflection (R wave minus Q
or S wave) in standard limb lead I was −1.2 millivolts. Standard limb lead II has a net deflection of +1.2
millivolts. What is the mean electrical axis of his QRS?
A. −30 degrees C. +60 degrees E. −120 degrees
B. +30 degrees D. +120 degrees
165. A 30-year-old man had an ECG at his physician’s office, but his records were lost. The ECG technician
remembered that the QRS deflection was large and positive in lead aVF and 0 in lead I. What is the mean
electrical axis in the frontal plane?
A. 90 degrees C. 0 degree E. −90 degrees
B. 60 degrees D. −60 degrees
166. A 60-year-old woman tires easily. Her ECG shows a QRS complex that is positive in the aVF lead and
negative in standard limb lead I. What is a likely the cardiac axis of his heart?
A. Left axis deviation C. Normal cardiac axis
B. Right axis deviation stenosis
167. An 80-year-old man had an ECG taken at his local doctor’s office, and the diagnosis was atrial
fibrillation. Which condition is likely in someone with atrial fibrillation?
A. Ventricular fibrillation, which normally accompanies atrial fibrillation
B. Strong P waves on the ECG
C. An irregular and fast rate of ventricular contraction
D. A normal atrial “a” wave
E. A smaller atrial volume than normal
168. Circus movements in the ventricle can lead to ventricular fibrillation. Which condition in the
ventricular muscle will increase the tendency for circus movements?
A. Decreased refractory period
B. Low extracellular potassium concentration
C. Increased refractory period
D. Shorter conduction pathway (decreased ventricular volume)
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E. Increase in parasympathetic impulses to the heart
169. A 50-year-old man has a blood pressure of 140/85 mm Hg and weighs 90.7 kilograms (200 pounds).
He reports that he is not feeling well, his ECG has no P waves, he has a heart rate of 46 beats/min, and
the QRS complexes occur regularly. What is his likely condition?
A. First-degree heart block D. Sinoatrial heart block
B. Second-degree heart block E. Sinus bradycardia
C. Third-degree heart block
170. The following ECG tracing was obtained for a 60-year old man who weighs 99.8 kilograms (220
pounds). Standard lead II is shown below. What is his diagnosis?
172. A 65-year-old man had the below ECG tracing recorded at his annual physical examination. What is
the likely diagnosis?
176. A 60-year-old woman sees her physician for her annual physical examination. The physician ordered
an ECG, which is shown below. What is the likely diagnosis?
179. A healthy 60-year-old woman with a 10-year history of hypertension stands up from a supine
position. Which set of cardiovascular changes is most likely to occur in response to standing up from a
supine position?
Sympathetic nerve activity Parasympathetic nerve activity Heart rate
A. ↑ ↑ ↑
B. ↑ ↑ ↓
C. ↑ ↓ ↓
D. ↑ ↓ ↑
E. ↓ ↓ ↓
F. ↓ ↓ ↑
G. ↓ ↑ ↑
H. ↓ ↑ ↓
180. In an experimental study, administration of a drug decreases the diameter of arterioles in the
muscle bed of an animal subject. Which set of physiological changes would be expected to occur in
response to the decrease in diameter?
Vascular conductance Capillary filtration Blood flow
A. ↑ ↑ ↑
B. ↑ ↓ ↑
C. ↑ ↓ ↓
D. ↑ ↑ ↓
E. ↓ ↓ ↓
F. ↓ ↑ ↓
G. ↓ ↑ ↑
H. ↓ ↓ ↑
181. A 60-year-old woman has experienced dizziness for the past 6 months when getting out of bed in
the morning and when standing up. Her mean arterial pressure is 130/90 mm Hg while lying down and
95/60 while sitting. Which set of physiological changes would be expected in response to moving from a
supine to an upright position?
Parasympathetic nerve Activity Plasma Renin activity Sympathetic activity
A. ↑ ↑ ↑
B. ↑ ↓ ↑
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C. ↑ ↓ ↓
D. ↑ ↑ ↓
E. ↓ ↓ ↓
F. ↓ ↑ ↓
G. ↓ ↑ ↑
H. ↓ ↓ ↑
182. A healthy 27-year-old female medical student runs a 5K race. Which set of physiological changes is
most likely to occur in this woman’s skeletal muscles during the race?
Arteriole diameter Vascular conductance Tissue Oxygen concentration
A. ↑ ↑ ↑
B. ↑ ↑ ↓
C. ↑ ↓ ↓
D. ↑ ↓ ↑
E. ↓ ↓ ↓
F. ↓ ↓ ↑
G. ↓ ↑ ↑
H. ↓ ↑ ↓
183. Cognitive stimuli such as reading, problem solving, and talking all result in significant increases in
cerebral blood flow. Which set of changes in cerebral tissue concentrations is the most likely explanation
for the increase in cerebral blood flow?
Carbon Dioxide pH Adenosine
A. ↑ ↑ ↑
B. ↑ ↓ ↑
C. ↑ ↓ ↓
D. ↑ ↑ ↓
E. ↓ ↓ ↓
F. ↓ ↑ ↓
G. ↓ ↑ ↑
H. ↓ ↓ ↑
185. The diameter of a precapillary arteriole is increased in a muscle vascular bed. A decrease in which of
the following would be expected?
A. Capillary filtration rate C. Capillary blood flow E. Arteriolar resistance
B. Vascular conductance D. Capillary hydrostatic pressure
186. Under control conditions, flow through a blood vessel is 100 ml/min with a pressure gradient of 50
mm Hg. What would be the approximate flow through the vessel after increasing the vessel diameter by
50%, assuming that the pressure gradient is maintained at 100 mm Hg?
A. 100 ml/min B. 150 ml/min C. 300 ml/min D. 500 ml/min E. 700 ml/min
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187. A 60-year-old man visits his family practitioner for an annual examination. He has a mean blood
pressure of 130 mm Hg and a heart rate of 78 beats/min. His plasma cholesterol level is in the upper 25th
percentile, and he is diagnosed as having atherosclerosis. Which set of changes would be expected in this
patient?
Pulse pressure Arterial compliance Systolic pressure
A. ↑ ↑ ↑
B. ↑ ↓ ↑
C. ↑ ↓ ↓
D. ↑ ↑ ↓
E. ↓ ↓ ↓
F. ↓ ↑ ↓
G. ↓ ↑ ↑
H. ↓ ↓ ↑
188. In control conditions, flow through a blood vessel is 100 ml/min under a pressure gradient of 50
mm Hg. What would be the approximate flow through the vessel after increasing the vessel diameter to
four times normal, assuming that the pressure gradient was maintained at 50 mm Hg?
A. 300 ml/min B. 1600 ml/min C. 1000 ml/min D. 16,000 ml/min E. 25,600 ml/min
189. An increase in which of the following would be expected to decrease blood flow in a vessel?
A. Pressure gradient across the vessel D. Viscosity of the blood
B. Radius of the vessel E. Plasma sodium concentration
C. Plasma colloid osmotic pressure
190. Assuming that vessels A to D are the same length, which one has the greatest flow?
Pressure gradient Radius Viscosity
A. 100 1 10
B. 50 2 5
C. 25 4 2
D. 10 6 1
191. A 22-year-old man enters the hospital emergency department after severing a major artery in a
motorcycle accident. It is estimated that he has lost approximately 700 milliliters of blood. His blood
pressure is 90/55 mm Hg. Which set of changes would be expected in response to hemorrhage in this
man?
Heart rate Sympathetic nerve activity Total peripheral resistance
A. ↑ ↑ ↑
B. ↑ ↓ ↑
C. ↑ ↓ ↓
D. ↑ ↑ ↓
E. ↓ ↓ ↓
F. ↓ ↑ ↓
G. ↓ ↑ ↑
H. ↓ ↓ ↑
192. A healthy 28-year-old woman stands up from a supine position. Moving from a supine to a standing
position results in a transient decrease in arterial pressure that is detected by arterial baroreceptors
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located in the aortic arch and carotid sinuses. Which set of cardiovascular changes is most likely to occur
in response to activation of the baroreceptors?
Mean circulatory filling pressure Strength of cardiac contraction Sympathetic nerve activity
A. ↑ ↑ ↑
B. ↑ ↓ ↑
C. ↑ ↓ ↓
D. ↑ ↑ ↓
E. ↓ ↓ ↓
F. ↓ ↑ ↓
G. ↓ ↑ ↑
H. ↓ ↓ ↑
193. An ACE inhibitor is administered to a 65-year-old man with a 20-year history of hypertension. The
drug lowered his arterial pressure and increased his plasma levels of renin and bradykinin. Which
mechanism would best explain the decrease in arterial pressure?
A. Inhibition of angiotensin I
B. Decreased conversion of angiotensinogen to angiotensin I
C. Increased plasma levels of bradykinin
D. Increased plasma levels of renin
E. Decreased formation of angiotensin II
194. A 25-year-old man enters the hospital emergency department after severing a major artery during a
farm accident. It is estimated that the patient has lost approximately 800 milliliters of blood. His mean
blood pressure is 65 mm Hg, and his heart rate is elevated as a result of activation of the chemoreceptor
reflex. Which set of changes in plasma concentration would be expected to cause the greatest activation
of the chemoreceptor reflex?
Oxygen Carbon Dioxide Hydrogen
A. ↑ ↑ ↑
B. ↑ ↓ ↑
C. ↑ ↓ ↓
D. ↑ ↑ ↓
E. ↓ ↓ ↓
F. ↓ ↑ ↓
G. ↓ ↑ ↑
H. ↓ ↓ ↑
195. Under normal physiological conditions, blood flow to the skeletal muscles is determined mainly by
which of the following?
A. Sympathetic nerves D. Metabolic needs
B. Angiotensin II E. Capillary osmotic pressure
C. Vasopressin
196. A healthy 22-year-old female medical student has an exercise stress test at a local health club. An
increase in which of the following is most likely to occur in this woman’s skeletal muscles during
exercise?
A. Vascular conductance C. Carbon dioxide concentration E. All the above
B. Blood flow D. Arteriolar diameter
197. Which of the following segments of the circulatory system has the highest velocity of blood flow?
A. Aorta B. Arteries C. Capillaries D. Venules E. Veins
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199. A balloon catheter is advanced from the superior vena cava into the heart and inflated to increase
atrial pressure by 5 mm Hg. An increase in which of the following would be expected to occur in response
to the elevated atrial pressure?
A. Atrial natriuretic peptide C. Aldosterone
B. Angiotensin II D. Renal sympathetic nerve activity
200. Which of the following vessels has the greatest total cross-sectional area in the circulatory system?
A. Aorta B. Small arteries C. Capillaries D. Venules E. Vena cava
202. Autoregulation of tissue blood flow in response to an increase in arterial pressure occurs as a result
of which of the following?
A. Decrease in vascular resistance
B. Initial decrease in vascular wall tension
C. Excess delivery of nutrients such as oxygen to the tissues
D. Decrease in tissue metabolism
203. Which component of the circulatory system contains the largest percentage of the total blood
volume?
A. Arteries C. Veins E. Heart
B. Capillaries D. Pulmonary circulation
204. An increase in which of the following would be expected to occur in a person 2 weeks after an
increase in sodium intake?
A. Angiotensin II C. Potassium excretion
B. Aldosterone D. Atrial natriuretic peptide
205. A decrease in the production of which of the following would most likely result in chronic
hypertension?
A. Aldosterone B. Thromboxane C. Angiotensin II D. Nitric oxide
206. Which of the following would be expected to occur during a Cushing reaction caused by brain
ischemia?
A. Increase in parasympathetic activity C. Decrease in heart rate
B. Decrease in arterial pressure D. Increase in sympathetic activity
209. Which set of physiological changes would be expected to occur in a person who stands up from a
supine position?
Venous hydrostatic pressure in legs Heart rate Renal blood flow
A. ↑ ↑ ↑
B. ↑ ↑ ↓
C. ↑ ↓ ↓
D. ↓ ↓ ↓
E. ↓ ↓ ↑
F. ↓ ↑ ↑
210. An increase in which of the following tends to increase capillary filtration rate?
A. Capillary wall hydraulic conductivity D. Interstitial hydrostatic pressure
B. Arteriolar resistance E. Plasma sodium concentration
C. Plasma colloid osmotic pressure
215. A 50-year-old woman received an overdose of furosemide, and her arterial pressure decreased to
70/40. Her heart rate is 120, and her respiratory rate is 30/min. What therapy would you recommend?
A. Whole blood infusion D. Infusion of a sympathomimetic drug
B. Plasma infusion E. Administration of a glucocorticoid
C. Infusion of a balanced electrolyte solution
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216. A 30-year-old woman comes to a local emergency department with severe vomiting. She has pale
skin, tachycardia, an arterial pressure of 70/45, and trouble walking. What therapy do you recommend to
prevent shock?
A. Infusion of packed red blood cells D. Infusion of a sympathomimetic drug
B. Administration of an antihistamine E. Administration of a glucocorticoid
C. Infusion of a balanced electrolyte solution
217. A 30-year-old man is resting, and his sympathetic output increases to maximal values. Which set of
changes would be expected in response to this increased sympathetic output?
Resistance to venous return Mean systemic filling pressure Venous return
A. ↑ ↑ ↑
B. ↑ ↓ ↑
C. ↑ ↓ ↓
D. ↑ ↑ ↓
E. ↓ ↓ ↓
F. ↓ ↑ ↓
G. ↓ ↑ ↑
H. ↓ ↓ ↑
219. Which condition would be expected to decrease mean systemic filling pressure?
A. Norepinephrine administration D. Increased venous compliance
B. Increased blood volume E. Skeletal muscle contraction
C. Increased sympathetic stimulation
221. In which condition would you expect a decreased resistance to venous return?
A. Anemia D. Increased sympathetic output
B. Increased venous resistance E. Obstruction of veins
C. Increased arteriolar resistance
223. In which condition would you normally expect to find a decreased cardiac output?
A. Hyperthyroidism D. Anemia
B. Beriberi E. Acute myocardial infarction
C. A-V fistula
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225. If a person has been exercising for 1 hour, which organ will have the smallest decrease in blood
flow?
A. Brain C. Kidneys E. Pancreas
B. Intestines D. Non-exercising skeletal muscle
227. Which vasoactive agent is usually the most important controller of coronary blood flow?
A. Adenosine B. Bradykinin C. Prostaglandins D. Carbon dioxide E. Potassium ions
230. At the onset of exercise, the mass sympathetic nervous system strongly discharges. What would
you expect to occur?
A. Increased sympathetic impulses to the heart D. Reverse stress relaxation
B. Decreased coronary blood flow E. Venous dilation
C. Decreased cerebral blood flow
231. Which of the following blood vessels is responsible for transporting the majority of venous blood
flow that leaves the ventricular heart muscle?
A. Anterior cardiac veins C. Bronchial veins E. Thebesian veins
B. Coronary sinus D. Azygos vein
232. A 70-year-old man with a weight of 100 kilograms (220 Pounds) and a blood pressure of 160/90 has
been told by his doctor that he has angina caused by myocardial ischemia. Which treatment would be
beneficial to this man?
A. Increased dietary calcium C. A beta-1 receptor stimulator E. Nitroglycerin
B. Isometric exercise D. Angiotensin II infusion
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233. Which event normally occurs during exercise?
A. Arteriolar dilation in non-exercising muscle D. Decreased release of epinephrine by the adrenals
B. Decreased sympathetic output E. Decreased release of norepinephrine by the
C. Venoconstriction adrenals
234. What is the most frequent cause of decreased coronary blood flow in patients with ischemic heart
disease?
A. Increased adenosine release
B. Atherosclerosis
C. Coronary artery spasm
D. Increased sympathetic tone of the coronary arteries
E. Occlusion of the coronary sinus
235. What is one of the major causes of death after myocardial infarction?
A. Increased cardiac output C. Fibrillation of the heart
B. A decrease in pulmonary interstitial volume D. Increased cardiac contractility
236. A 60-year-old man had a heart attack 2 days ago, and his blood pressure has continued to decrease.
He is now in cardiogenic shock. Which therapy would be most beneficial?
A. Placing tourniquets on all four limbs D. Administering a blood volume expander
B. Administering a sympathetic inhibitor E. Increasing dietary sodium intake
C. Administering furosemide
237. Which intervention would be appropriate therapy for a patient in cardiogenic shock?
A. Placing tourniquets on the four limbs
B. Withdrawing a moderate amount of blood from the patient
C. Administering furosemide
D. Infusing a vasoconstrictor drug
239. Which of the following is associated with the first heart sound?
A. Inrushing of blood into the ventricles as a result of atrial contraction
B. Closing of the A-V valves
C. Closing of the pulmonary valve
D. Opening of the A-V valves
E. Inrushing of blood into the ventricles in the early to middle part of diastole
240. Which condition often occurs in a person with progressive hemorrhagic shock?
A. Increased capillary permeability D. Increased urine output
B. Stress relaxation of veins E. Increased mean systemic filling pressure
C. Tissue alkalosis
241. In which condition will administration of a sympathomimetic drug be the therapy of choice to
prevent shock?
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Cardiovascular System Physiology
A. Spinal cord injury C. Hemorrhagic shock
B. Shock due to excessive vomiting D. Shock caused by excess diuretics
242. Which condition often occurs in compensated hemorrhagic shock? Assume systolic pressure is 48
mm Hg.
A. Decreased heart rate
B. Stress relaxation of veins
C. Decreased ADH release
D. Decreased absorption of interstitial fluid through the capillaries
E. Central nervous system (CNS) ischemic response
243. If a patient undergoing spinal anesthesia experiences a large decrease in arterial pressure and goes
into shock, what would be the therapy of choice?
A. Plasma infusion
B. Blood infusion
C. Saline solution infusion
D. Glucocorticoid infusion
E. Infusion of a sympathomimetic drug
244. A 25-year-old man who has been in a motorcycle wreck enters the emergency department. His
clothes are very bloody, and his arterial pressure is decreased to 70/40. His heart rate is 120, and his
respiratory rate is 30/min. Which therapy would the physician recommend?
A. Infusion of blood D. Infusion of a sympathomimetic drug
B. Infusion of plasma E. Administration of a glucocorticoid
C. Infusion of a balanced electrolyte solution
246. A 20-year-old man who has been hemorrhaging as a result of a gunshot wound enters a local
emergency department. He has pale skin, tachycardia, an arterial pressure of 60/40, and trouble walking.
Unfortunately, the blood bank is out of whole blood. Which therapy would the physician recommend to
prevent shock?
A. Administration of a glucocorticoid D. Infusion of a sympathomimetic drug
B. Administration of an antihistamine E. Infusion of plasma
C. Infusion of a balanced electrolyte solution
247. A 10-year-old girl in the hospital had an intestinal obstruction, and her arterial pressure decreased
to 70/40. Her heart rate is 120, and her respiratory rate is 30/min. Which therapy would the physician
recommend?
A. Infusion of blood D. Infusion of a sympathomimetic drug
B. Infusion of plasma E. Administration of a glucocorticoid
C. Infusion of a balanced electrolyte solution
250. The heart continues to beat even after all nerves to it are sectioned. This property is called:
A. excitability B. conductivity C. automaticity D. contractility
252. What is the effect of vagal stimulation on the membrane potential of the SA node?
A. It increases inward calcium current C. It activates hyperpolarizing potassium current
B. It increases the slope of the prepotential D. It increases intracellular cAMP
256. The cardiac output of a 50 year old man at rest is 6 L / min; mean HR is 75 BPM. Left ventricular
end-diastolic volume (LVEDV) is 120 ml. What is the mean ejection fraction?
A. 50 % B. 66 % C. 75 % D. 35 %
258. Across which site in the circulation is the pressure drop maximum?
A. Arterioles B. Venules C. Capillaries D. Aortic valve
261. What fraction of total blood volume is present in the capillaries at any given time?
A. 5% B. 20% C. 15% D. 1%
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Cardiovascular System Physiology
263. Turbulence is almost always present when Reynolds number is more than:
A. 2000 B. 2500 C. 3000
264. Thin walled capillaries do not burst when intracapillary pressure is increased because:
A. they lack smooth muscle cells
B. the blood flow rate is less
C. they have a small radius
D. capillary hematocrit is less than whole-body hematocrit
265. That capillaries can withstand high internal pressures without bursting is explained using:
A. Bernoulli’s principle C. Poiseuille Hagen law
B. Laplace’s law D. Fahraeus-Lindquist effect
267. Quantitatively, the most important means of increasing flow to an actively metabolizing tissue is:
A. increasing cardiac output C. increasing blood pressure
B. increasing peripheral resistance D. decreasing local vascular resistance
270. Which one of the following does not have vasodilator actions?
A. NO B. CO C. Potassium D. Angiotensin III
271. Blood flow to exercising skeletal muscle is increased by all of the following EXCEPT:
A. K+ B. norepinephrine C. ↑ in PCO2 in muscle D. adenosine
E. products of muscle metabolism
F. activation of beta-adrenergic receptors in skeletal muscle
G. activation of sympathetic cholinergic vasodilator system
H. nitric oxide
274. Which of the following maneuvers evokes an increase in vagal discharge to the heart?
A. IV infusion of phenylephrine C. Pressure on the eyeball
B. Carotid massage D. Irrigation of the ear canals
278. During severe exercise, a well-trained athlete may be able to achieve a cardiac output of:
A. 15 liters B. 25 liters C. 35 liters D. 45 liters
279. Vasomotor ischemia triggers an increase in sympathetic outflow increasing BP and thereby
facilitating restoration of cerebral blood flow. This is called:
A. Bainbridge reflex C. Head’s paradoxical reflex
B. The CNS ischemic pressor response D. Marey’s reflex
282. During the strain phase of the Valsalva maneuver (forced expiration with the glottis open and
maintaining an expiratory pressure of 40 mm Hg for 15 seconds):
A. venous return decreases D. heart rate increases
B. cardiac output decreases E. sympathetic outflow to blood vessels ↑
C. blood pressure decreases F. TPR gradually increases
283. The mechanism that regulates cerebral blood flow during cerebral compression is the:
A. CNS ischemic response C. Bezold-Jarisch reflex
B. Cushing’s reflex D. Bainbridge reflex
285. If the noradrenergic nerves to the heart are stimulated after giving a β-blocker, then what would be
the effect on coronary blood flow?
A. Coronary vasodilation C. No change
B. Coronary vasoconstriction D. Unpredictable
286. Of the following vascular beds, autoregulation of tissue blood flow is least prominent in the:
A. skin B. heart C. brain D. kidneys
287. When determining BP with a sphygmomanometer, a spuriously high value (of either SBP or DBP)
may be recorded when:
A. there is an auscultatory gap C. the person is obese
B. the cuff is smaller than preferable D. the arm is not placed at the level of the heart
289. In the fetal circulation before birth, all the following are true EXCEPT:
A. The PO2 is higher in the ductus venosus than in the ductus arteriosus
B. Blood can go from the right atrium to the aorta without passing through the left atrium and ventricle
C. The PO2 in the aortic arch is higher than in the descending aorta
D. Blood flowing through the foramen ovale comes principally from the superior vena cava
E. Blood passes through the ductus arteriosus because of the high pulmonary vascular resistance
303. In a healthy adult human heart the, all the following are true EXCEPT:
A. Left ventricular end-systolic volume is approximately 30 ml
B. First heart sound coincides with the onset of ventricular systole
C. Stroke volume is approximately 70 ml
D. Left ventricular end-diastolic pressure is about 50 mmhg
E. Second heart sound is caused by closure of the aortic and pulmonary valves
306. In the healthy heart, an increase in stroke volume is seen with an increase in:
A. Left ventricular end-diastolic volume C. Heart rate
B. Aortic systolic pressure D. Left ventricular end-systolic pressure
312. What is the primary ionic basis of the prepotential in the SA node?
A. Ca influx through transient T Ca channels
B. Inwardly directed long-lasting Ca current
C. Outward Na current
D. Potassium efflux through leak channels
313. Normally, the impulse that excites the left ventricular myocardium originates in the:
A. SA node B. Purkinje system C. left bundle branch D. ventricle
315. Activation of beta-adrenergic receptors in the heart is normally associated with which of the
following?
A. Decrease in the slope of phase 4 depolarization in SA nodal cells
B. Decrease in conduction speed through AV node
C. Inhibition of Ca induced Ca release following depolarization in ventricular myocytes
D. Accelerated sequestration of Ca in the sarcoplasmic reticulum by the Ca-ATPase
E. Reduction in the rate of rise in ventricular pressure during isovolumic contraction
317. The propagation of repolarization from the ventricular epicardium to endocardium is represented
by the
A. QRS complex B. QT interval C. T wave D. TP period
320. Electrical activity in which region of the heart does not result in deflections on the surface
electrocardiogram?
A. Atria D. Free wall of the right ventricle
B. Bundle of His E. Muscular portion of the ventricular septum
C. Free wall of the left ventricle
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Cardiovascular System Physiology
321. In sinus rhythm, the last portion of the ventricle to depolarize is:
A. Interventricular septum from left to right
B. Anteroseptal region of the myocardium
C. Most of the myocardium from endocardium to epicardium
D. Posterobasal portion of left ventricle and the pulmonary conus
323. In which of the following leads are you most likely to observe ST segment elevation when there is
an acute and extensive infarction of the anterior and lateral wall of the heart?
A. Leads I, II and III C. Leads I, aVL, and V1-V6
B. Leads aVR, aVL and aVF D. Leads II, III and aVF
324. Clinical examination of a 45 year old man reveals splitting of the second heart sound as A2 followed
by P2 during deep inspiration, and the split was not apparent during expiration. S1 is normal in intensity,
and there is no cardiac murmur. BP is 130/80 mm Hg and pulse is 80 bpm and regular. Which of the
following is the most likely cause of this pattern of splitting of the second heart sound?
A. Aortic regurgitation C. Physiologic splitting of S2
B. Left bundle branch block D. Pulmonic stenosis
325. Normally, which of the following events in the cardiac cycle occurs at some point between S1 and
the following S2?
A. Onset of ventricular diastole D. The ‘a’ wave of the JVP
B. Atrial systole E. The ‘y’ descent in the JVP
C. Rapid ventricular filling
326. In postnatal life, steady state outputs of the right and left ventricle are matched in vivo by:
A. The Frank-Starling mechanism
B. Sympathetic influences on the SA node
C. Vagal influences on the SA node
D. Varying the afterload for each ventricle
E. Matching the tension generated by each ventricle
327. The mean systemic arterial pressure and the mean pulmonary artery pressure are respectively 90
and 15 mm Hg. What is the ratio of systemic and pulmonary vascular resistances?
A. Data inadequate B. 1 C. 6 D. 10
328. Which of the following is usually associated with turbulence in blood flow?
A. Reynolds number less than 2000 C. Decrease in density of blood
B. Decrease in blood flow velocity D. Increase in diameter of blood vessel
329. Select all correct answers. Which of the following statements is/are correct?
A. Pulse pressure is directly proportional to stroke volume
B. Pulse pressure is inversely proportional to compliance of large arteries
C. Reflected arterial pulse waves normally serve to increase coronary perfusion during diastole
332. Which of the following has a direct vasodilator effect on smooth muscle in arterioles in the
presence of endothelial dysfunction?
A. Acetylcholine C. Nitric oxide E. Thromboxane A2
B. Angiotensin II D. Norepinephrine
334. Intravenous injection of norepinephrine to a normotensive healthy adult human leads to:
A. An increase in BP & HR C. An increase in HR & decrease in BP
B. A decrease in BP & HR D. An increase in BP & decrease in HR
336. The ‘last ditch stand’ in defense of a falling blood pressure is the:
A. Arterial baroreflex mechanism C. CNS ischemic pressor response
B. Arterial chemoreflex mechanism D. Bainbridge reflex
337. In a healthy normotensive individual at rest, heart rate is typically increased by:
A. Deep expiration C. Anger
B. Fear D. IV infusion of phenylephrine
338. The acute effect of bilateral clamping of the carotid arteries proximal to the carotid sinuses is a/an:
A. Increase in heart rate and mean arterial pressure
B. Decrease in heart rate and mean arterial pressure
C. Decrease in heart rate and an increase in mean arterial pressure
D. Increase in heart rate and a decrease in mean arterial pressure
339. The acute effect of clamping internal carotid arteries proximal to the carotid sinuses in a dog is
most likely:
A. An increase in discharge rate in afferent fibers from the carotid sinus
B. A decrease in discharge rate of neurons in the rostral ventrolateral medulla
C. An increase in sympathetic outflow to the heart and resistance vessels
D. An increase in cardiac vagal outflow
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Cardiovascular System Physiology
340. In hemorrhaged dogs with marked hypotension (mean arterial pressure < 50 mm Hg), denervation
of arterial chemoreceptors would:
A. Increase BP since chemoreceptors reduce sympathetic outflow
B. Produce no change in BP since chemoreceptors do not influence sympathetic outflow
C. Result in a further fall in BP since the arterial chemoreflex is sympathoexcitatory
D. Depend on whether arterial baroreceptors are reset or not
341. Normally, in an adult at rest, total blood flow to the brain is about:
A. 250 ml/min B. 500 ml/min C. 750 ml/min D. 1200 ml/min
342. Normally, the brain is perfused with what fraction of resting cardiac output?
A. 5% B. 10% C. 15% D. 20%
343. Which of the following is least likely to aggravate insult in an injured brain?
A. Hypercapnia B. Hypoxia C. Hypotension D. Hypothermia
344. Stimulation of sympathetic nerves to which of the following tissues invariably reduces blood flow to
that vascular bed?
A. Skin B. Heart C. Brain
346. Normally, in postnatal life, the left ventricle is more vulnerable to ischemia and infarction
compared to the right ventricle because:
A. diastolic pressure is comparable in both ventricles
B. Pulmonary vascular resistance is greater than systemic vascular resistance
C. The left ventricle pumps much more blood than the right ventricle
D. Left ventricular subendocardial perfusion is limited to ventricular diastole
E. Flow through the right ventricle is largely passive
347. The most frequent cause of diminished coronary blood flow is:
A. Mitral stenosis C. Atherosclerosis E. Increased venous return
B. Exercise D. Mass sympathetic discharge
351. During the cardiac cycle, the maximal right ventricular systolic pressure (mmHg) is:
A. 5 B. 8 C. 25 D. 80 E. 120
354. Which of the following is consistent with the ECG tracing shown below?
355. The mean electrical axis during the ventricular depolarization recorded in the three leads shown
below would be closest to
358. Propagation of the action potential through the heart is fastest in the
A. SA node C. Av node E. Ventricular muscle
B. Atrial muscle D. Purkinje fibers
359. Closure of the aortic valve occurs at the onset of which phase of the cardiac cycle?
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Cardiovascular System Physiology
A. Isovolumetric contraction C. Protodiastole E. Rapid filling
B. Rapid ejection D. Isovolumetric relaxation
360. If the QRS complex is positive in leads II and aVF and negative in lead III, the mean electrical axis
(MEA) is between
A. −30° and 0° C. +30° and +60° E. +90° and +120°
B. 0° and +30° D. +60° and +90°
361. Normal splitting of the second heart sound (S2) into two components is increased during inspiration
because
A. The closing of the aortic valve is delayed
B. The opening of the mitral valve is delayed
C. The closing of the pulmonic valve is delayed
D. The stroke volume of the left ventricle is increased
E. The heart rate is decreased
371. Which one of the following correctly describes an event that normally occurs during the PR
interval?
A. The ventricle is contracting
B. The cardiac action potential passes through the AV node
C. There is no change in the voltage tracing on the ECG
D. The mitral and aortic valves are both closed
E. The second heart sound is heard
The phases of the ventricular muscle action potential are represented by the lettered points on the
diagram
372. At which point on the above ventricular action potential is membrane potential most dependent on
calcium permeability?
A. Point A B. Point B C. Point C D. Point D E. Point E
373. During which interval on the above ECG does the aortic valve close?
A. A B. B C. C D. D E. E
374. During which interval on the ECG does the bundle of His depolarize?
A. A B. B C. C D. D E. E
381. A mild hemorrhage will cause stroke volume to shift from point X to point
A. A B. B C. C D. D E. E
382. An increase in afterload and venous compliance can cause stroke volume to change from the point
marked X to point
A. A B. B C. C D. D E. E
383. The upstroke of the SA nodal action potential is produced by opening a channel that is
A. Primarily permeable to Na+ D. Primarily permeable to Cl−
2+
B. Primarily permeable to Ca E. Equally permeable to Na+ and K+
+
C. Primarily permeable to K
384. The channel responsible for the initiation of phase-4 depolarization in SA nodal cells
A. Is primarily permeable to Na+ D. Is primarily permeable to K+
B. Is opened by membrane depolarization E. Is closed by norepinephrine
C. Is opened by vagal nerve stimulation
386. An exercise stress test to rule out ischemic heart disease is positive if
A. The systolic blood pressure rises D. A diastolic murmur is heard
B. The ST segment of the ECG is depressed E. The diastolic blood pressure decreases
C. The heart rate fails to increase
387. After a mild hemorrhage, compensatory responses initiated by the baroreceptor reflex keeps blood
pressure at or close to its normal value. Which one of the following values is less after compensation for
the hemorrhage than it was before the hemorrhage?
A. Venous compliance C. Ventricular contractility E. Coronary blood flow
B. Heart rate D. Total peripheral resistance
388. The constriction of a blood vessel to one-half of its resting diameter would increase its resistance to
blood flow by a factor of
A. 2 B. 4 C. 8 D. 12 E. 16
389. During aerobic exercise, blood flow remains relatively constant within
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Cardiovascular System Physiology
A. The skin C. The brain E. The kidneys
B. The heart D. The skeletal muscles
391. Sudden standing evokes the baroreceptor reflex. Which one of the following will be greater after a
person suddenly stands up than it was before the person stood?
A. The end-diastolic volume C. The venous return E. The ejection fraction
B. The renal blood flow D. The pulse pressure
396. Which one of the following organs has the highest arteriovenous O2 difference under normal resting
conditions?
A. Brain C. Skeletal muscle E. Stomach
B. Heart D. Kidney
397. The percentage of the total cardiac output distributed to any single organ is most dependent on
A. The contractile state of the heart
B. The magnitude of mean blood pressure
C. The magnitude of diastolic pressure
D. The ratio of an organ’s vascular resistance to total peripheral resistance (TPR)
E. The magnitude of cardiac output
398. At which of the following sites does the blood flow lose the greatest amount of energy?
A. Mitral valve B. Large arteries C. Arterioles D. Capillaries E. Venules
400. Which one of the following characteristics is most similar in the systemic and pulmonary
circulations?
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Cardiovascular System Physiology
A. Stroke work C. Afterload E. Blood volume
B. Preload D. Peak systolic pressure
401. Which one of the following statements correctly describes the ductus arteriosus?
A. It prevents the flow of blood into the lungs of the fetus
B. It delivers oxygenated blood from the placenta to the left ventricle
C. It allows blood to flow from the aorta to the pulmonary artery in the fetus
D. Its resistance to blood flow decreases soon after birth
E. It is located in the septum between the left and right atrium
403. Correct statements about the increase in pulmonary blood flow during vigorous exercise include
which of the following?
A. The percentage of increase in flow is greater in the bases of the lungs than in the apices
B. The increase in flow is caused by a greater-than-fivefold increase in pulmonary arterial pressure
C. The increase in pulmonary blood flow is less than the increase in systemic blood flow
D. The increase in pulmonary blood flow is accommodated by dilation of pulmonary arterioles and
capillaries
E. The increase in pulmonary blood flow is caused by sympathetic nerve stimulation of the pulmonary
vasculature
405. Which of the following will be lower than normal in a patient with an abnormally high intracranial
pressure?
A. Ventricular contractility C. Mean blood pressure E. Total peripheral resistance
B. Heart rate D. Stroke volume
406. After an episode of exercise training, the trained individual will have a
A. Decreased density of mitochondria in the trained muscles
B. Increased resting heart rate
C. Decreased maximum oxygen consumption
D. Increased stroke volume
E. Decreased extraction of oxygen by exercising muscles
409. The distribution of blood among the various organs of the body is regulated by regulating the
resistance of the
A. Arteries C. Precapillary sphincters E. Veins
B. Arterioles D. Postcapillary venules
410. Which one of the following signs is observed in a patient who has lost a significant amount of
blood?
A. Respiratory acidosis C. Polyuria E. Low hematocrit
B. Dry skin D. Bradycardia
411. A patient is diagnosed with anaphylactic shock rather than hypovolumic shock because
A. Cardiac output is higher than normal
B. Ventricular contractility is greater than normal
C. Total peripheral resistance is greater than normal
D. Serum creatinine is elevated
E. Heart rate is greater than normal
412. Which one of the following will increase if massaging the neck stretches the carotid sinus
baroreceptor?
A. Total peripheral resistance D. Ventricular contractility
B. Right atrial pressure E. Vagal nerve activity
C. Venous tone
413. An increase in total peripheral resistance and contractility is represented by a shift from the resting
state to point
A. A B. B C. C D. D E. E
414. Which one of the following would be consistent with a shift from the resting state (control) to point
B?
A. The person stood up suddenly D. The person’s afterload was increased
B. The person began exercising E. The person was given a positive inotropic drug
C. The person was given a transfusion
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Cardiovascular System Physiology
415. Which one of the following would be consistent with a shift from the resting state (control) to point
E?
A. The person stood up suddenly D. The person’s afterload was increased
B. The person began exercising E. The person was given a positive inotropic drug
C. The person was given a transfusion
421. Which of the following conducting systems has the slowest conducting velocity
A. SAN B. Atrial muscle C. Purkinje fibers D. AVN
422. In heart, within physiological limits the force of contraction is directly proportional to the
A. Pacemaker activity C. Initial length of the cardiac muscle
B. A-V nodal delay D. Respiratory rate
427. When a pheochromocytoma suddenly discharges a large amount of epinephrine into the circulation
the patients heart rate would be expected to
A. Increase because epinephrine has a direct chronotropic effect on the heart
B. Increase because of increased parasympathetic discharge to the heart
C. Decrease because the increase in blood pressure stimulates the carotid and aortic baroreceptors
D. Decrease because of increased tonic parasympathetic discharge to heart
429. The 'T' wave in ECG is above the isoelectric line because of
A. Depolarization of ventricles
B. Depolarization of bundle of his
C. Change in the direction of repolarization from the wave of depolarization of the ventricles
D. Repolarization of Purkinje fibers
438. The sinoatrial node is the pacemaker for the heart because the SA node
A. Is the most richly enervated structure in the heart
B. Is the only structure in the heart capable of generating action potentials
C. Has the highest rate of automatic discharge
D. Has the most stable transmembrane potential
E. Is the cardiac cell least sensitive to catecholamines
439. An independence of the P waves and the QRS complexes of the ECG indicates
A. An early repolarization of ventricular fibers
B. A failure of the AV node to conduct
C. A depression of the sinoatrial node
D. Slowing of conduction at the atrioventricular node
E. A conduction block in the left bundle branch
440. If the end-diastolic ventricular volumes are increased (within physiologic limits)
A. The stroke volume would be increased
B. Cardiac output would be decreased
C. Venous pressure would be decreased
D. The force of cardiac contraction would be decreased
E. The output of the left ventricle would exceed the output of the left ventricle
441. One of the major factors that controls the force of heart contraction is the
A. Initial length (preload) of cardiac muscle fibers
B. Number of intercalated disks in the cardiac muscle fibers
C. Number of gap junctions between cardiac muscle fibers
D. Degree of depolarization in the SA node
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Cardiovascular System Physiology
E. Length of the His bundle
443. Increased pressure within the carotid sinus causes all of the following EXCEPT
A. A decrease in sympathetic tone to arterioles D. Vasodilatation of arterioles
B. A decrease in aortic pressure E. Atrial tachycardia
C. Reflex bradycardia
446. Which of the following mechanisms is most important for maintaining an increased blood flow to
skeletal muscle during exercise?
A. An increase in aortic pressure
B. An increase in a-mediated adrenergic impulses
C. An increase in b-mediated adrenergic impulses
D. A vasoconstriction in the splanchnic and renal areas
E. A local vasodilatation secondary to the effect of local metabolites
447. Which of the following is most important to blood flow regulation at the local level?
A. Vessel-tissue transmural pressure difference D. Circulating neurotransmitters
B. Metabolic activity of the organ or tissue E. Cardiac output
C. Local neurotransmitters
449. A decrease in heart rate, with stroke volume and peripheral resistance held constant, will cause a
decrease in all of the following, EXCEPT
A. Arterial diastolic pressure C. Cardiac output E. Mean arterial pressure
B. Arterial systolic pressure D. Arterial pulse pressure
450. An EKG is recorded with displays no P waves, but a normal appearing QRS and T wave. The
pacemaker most likely is located in the
A. SA node C. His bundle E. ventricular muscle
B. AV node D. Purkinje system
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Cardiovascular System Physiology
451. Which of the following best describes conditions consistent with increased contractility?
A. Increased cardiac output for a given end-systolic volume
B. Increased cardiac output for a given end-diastolic volume
C. Decreased cardiac output for a given end-systolic volume
D. Decreased cardiac output for a given end-diastolic volume
E. The ventricles are unexcitable for most of the contraction period
452. The ventricles are depolarized or depolarizing during all of the following EKG waves EXCEPT
A. QRS complex B. QT interval C. ST segment D. PR interval
455. Cardiac output of the right heart is what percentage of the left heart?
A. 25% B. 50% C. 75% D. 100% E. 125%
456. The greatest pressure drop in the circulation occurs across the arterioles because
A. They have the greatest surface area
B. They have the greatest cross-sectional area
C. The velocity of blood flow through them is highest
D. The velocity of blood flow through them is lowest
E. They have the greatest resistance
458. During rapid acceleration, as a fighter pilot might experience, the pooling of blood in the
extremities will
A. Increase cardiac output C. Decrease arterial blood pressure
B. Increase venous return D. Decrease venous blood volume
459. The physiological function of the relatively slow conduction through the AV node is to allow
sufficient time for
A. Run-off of blood from the aorta to the arterioles
B. Venous return to the atria
C. Filing of the ventricles
D. Contraction of the ventricles
E. Repolarization of the ventricles
464. The increase in arterial pulse pressure usually observed in an elderly person with high blood
pressure (hypertension) is produced mainly by
A. An increased stroke volume D. An increased vagal activity
B. An increased heart rate E. A decreased arterial elasticity
C. Decreased cardiac output
465. The circulatory variable that is maintained relatively constant by the baroreceptor reflex is
A. Heart rate C. Peripheral resistance E. Mean arterial pressure
B. Stroke volume D. Velocity of blood flow
466. Cardiac output (in liters per minute) divided by the heart rate (in beats per minute) equals
A. Cardiac index C. Mean arterial pressure E. Blood velocity
B. Cardiac efficiency D. Stroke volume
467. The segment of the vascular bed responsible for local regulation of blood flow in most tissues is the
A. Distributing arteries C. Capillaries E. Arterioles
B. Large veins D. Venules
468. The most important function of the Starling mechanism in the heart is
A. To decrease fluid loss from the cardiac capillaries
B. To ensure that the ventricles operate at an optimum length
C. To couple the efficiency of muscle contraction to the heart rate
D. To match the output of one ventricle to that of the other
E. To ensure that right and left atrial pressures are equal
469. The initial depolarization phase of an action potential in cardiac ventricular muscle is caused by?
A. Increased Na+ permeability C. Decreased Ca++ permeability
+
B. Increased K permeability D. Inhibition of the Na+/K+ pump
470. The plateau phase of the action potential of cardiac ventricular muscle is maintained by a:
A. Balance between the rates of K+ efflux and Na+ influx across the cell membrane
B. Balance between the rates of K+ efflux and Ca++ influx across the cell membrane
C. Voltage dependent increase in K+ permeability
D. Voltage dependent increase in Na+ permeability
471. Which of the following changes in the ionic permeabilities of the membrane is associated with the
repolarization phase of the action potential of ventricular muscle?
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Cardiovascular System Physiology
A. Increased Na+ permeability
B. Increased Ca++ permeability
C. Increased K+ permeability and decreased Ca++ permeability
D. Increased Na+ permeability and increased Ca++ permeability
472. Repolarization of the ventricular muscle cell at the end of an action potential occurs when the cell
membrane becomes:
A. More permeable to Na+ and more permeable to Ca++
B. Less permeable to Ca++ and more permeable to K+
C. More permeable to Ca++ and less permeable to K+
D. More permeable to Na+ and less permeable to K+
473. On a normal electrocardiograph a wave for repolarization of the atria is not seen. This is because:
A. The leads are not placed in a position where they can pick up atrial repolarization
B. Normally the atria do not repolarize to any significant extent
C. The wave for atrial repolarization is masked by the wave for ventricular depolarization
D. The wave is too small to be detected by external recording electrodes
474. The wave of depolarization is passing through the atrioventricular node at which phase of the
electrocardiogram?
A. During the P wave C. Between the QRS complex and the T wave
B. Between the P wave and the QRS complex D. Between the T wave and the succeeding P wave
475. Depolarization of the sinoatrial node of the heart occurs at which phase of the electrocardiogram?
A. During the P wave C. Between the QRS complex and the T wave
B. Between the P wave and the QRS complex D. Between the T wave and the succeeding P wave
476. At which phase of the electrocardiogram are the ventricular muscle cells in the plateau phase of
their action potentials?
A. During the P wave C. Between the QRS complex and the T wave
B. Between the P wave and the QRS complex D. Between the T wave and the succeeding P wave
479. If cardiac output remains constant, an increase in total peripheral resistance will have which of the
effects?
A. Increase mean arterial blood pressure C. Decrease end systolic blood volume
B. Decrease mean arterial blood pressure D. Decrease end diastolic blood volume
480. The cardiovascular center in the medulla of the brain stem is involved in the regulation of systemic
blood pressure by performing which of the following functions?
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Cardiovascular System Physiology
A. Receiving afferent impulses from the carotid sinus
B. Sending impulses via sympathetic nerves to the heart
C. Sending impulses via parasympathetic nerves to the heart
D. The cardiovascular center performs all of the above functions
484. Given that a person has a blood pressure of 126/78 mm Hg, that person’s mean arterial pressure is:
A. 48 mm Hg C. 102 mm Hg
B. 94 mm Hg D. 120 mm Hg
485. When measuring a person’s blood pressure no sound is heard when the pressure in the cuff is
greater than systolic blood pressure. This is because:
A. The air pressure within the cuff muffles the sound
B. No blood is flowing through the artery
C. Blood flow in the artery is laminar (none turbulent)
D. Arterial blood flow only occurs during diastole
486. The cause of the increase in systolic pressure with age is:
A. An increase in the force of contraction of the aging heart
B. Decreased compliance of systemic arteries
C. Weakening of the aortic valve
D. Decreased muscle mass which increases peripheral resistance
487. The large systemic arteries have which of the following functions?
A. Acting as a volume reservoir for blood
B. Acting as a pressure reservoir for blood
C. Regulating the volume of blood flowing to tissues
D. Exchanging nutrients and wastes with tissues
489. Which of the following events will relax the smooth muscle of systemic arterioles?
A. Increased blood PCO2 C. Increased pH of blood (reduced acidity)
B. Increased blood PO2 D. Increased blood pressure within the arteriole
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490. Peripheral resistance is determined primarily by:
A. Stroke volume C. Capillary diameter
B. Venous capacity D. Arteriolar tone
491. The greatest pressure drop in the circulation occurs as blood passes through which of the following
vessels?
A. Arteries C. Capillaries
B. Arterioles D. Veins
492. In which of these blood vessels is the velocity of blood flow the lowest? (In this case blood flow
means how far a red blood cell will travel along the vessel in one second).
A. Arteries C. Capillaries
B. Arterioles D. Veins
493. Under normal resting conditions over 60% of the blood is found within the:
A. Systemic capillaries C. Chambers of the heart
B. Systemic veins D. Pulmonary circulation
495. The volume of blood within the veins is primarily regulated by:
A. Activity of the sympathetic nervous system
B. Activity of the parasympathetic nervous system
C. Metabolic products which accumulate in blood
D. None of the above; their volume does not vary significantly
496. During which phase of the cardiac cycle are the atrioventricular, aortic semilunar and pulmonary
semilunar valves all open?
A. Ventricular filling phase C. Ventricular ejection phase
B. Isovolumetric ventricular relaxation phase D. These valves are never all open at the same time
498. Closing of the atrioventricular valves during the cardiac cycle is caused by:
A. Contraction of the papillary muscles
B. Activity of the parasympathetic nervous system
C. The blood pressure in the ventricle falling below the blood pressure in the aorta
D. The blood pressure in the ventricles becoming greater than the blood pressure in the atria
501. The first heart sound is caused by which of the following events?
A. Closing of the atrioventricular valves
B. Opening of the aortic and pulmonary valves
C. Closing of the aortic and pulmonary valves
D. A shock wave passing through blood in the aorta and pulmonary artery
503. Ejection of blood into the aorta will only occur under which of the following circumstances?
A. When ventricular pressure exceeds the aortic pressure
B. When ventricular pressure is increasing most rapidly
C. While the atrioventricular valve is open
D. Throughout all of ventricular systole
504. In which phase of the cardiac cycle is the blood pressure of the atrium greater than the blood
pressure of its corresponding ventricle?
A. Ventricular filling phase
B. Ventricular ejection phase
C. Isovolumetric ventricular relaxation phase
D. Ventricular pressures are always greater than atrial pressures
505. During the ventricular filling phase of the cardiac cycle, which of these statements correctly
describes the pressures in the various compartments?
A. Aortic > ventricular > atrial C. Aortic > atrial > ventricular
B. Atrial > ventricular > aortic D. Atrial > aortic > ventricular
506. The blood pressure in the aorta is greater than that in the pulmonary artery because the:
A. Blood flow through the systemic circulation is greater than the pulmonary circulation
B. Resistance of the systemic circulation is greater than the pulmonary circulation
C. Volume of blood within the systemic circulation is greater than the pulmonary circulation
D. Blood entering the systemic circulation is oxygenated
509. In which of the following phases of the cardiac cycle does the ventricular pressure rise most
rapidly?
A. Ventricular filling phase C. Ventricular ejection phase
B. Isovolumetric ventricular contraction phase D. Isovolumetric ventricular relaxation phase
512. Which of the following manipulations would increase the stroke volume of the heart?
A. Increased arterial blood pressure
B. Increased end diastolic volume
C. Hemorrhage of 500 ml of blood
D. The Valsalva maneuver (increasing pressure in the lungs while preventing expiration)
513. An increase in plasma epinephrine concentration increases the heart rate. This response is the
result of the action of epinephrine on which of the following cells?
A. Sinoatrial node cells C. Atrial muscle cells
B. Atrioventricular cells D. Ventricular muscle cells
514. Increased activity of the sympathetic nervous system increases the stroke volume of the heart. This
response is the result of the action of the sympathetic nervous system on which of the following cells?
A. Sinoatrial node cells C. Atrial muscle cells
B. Atrioventricular cells D. Ventricular muscle cells
515. The decrease in heart rate which occurs in response to parasympathetic nervous stimulation of the
heart is related to:
A. Reduced cytosolic Ca++ concentration
B. Increased cytosolic cyclic AMP concentration
C. Reduced rate of spontaneous depolarization of the sinoatrial node
D. Increased phosphorylation of myosin
519. Which of the following is the correct sequence of blood flow in the cardiovascular system?
A. Pulmonary artery, right atrium, left ventricle, aorta
B. Systemic vein, right atrium, right ventricle, pulmonary artery
C. Systemic vein, left atrium, left ventricle, pulmonary artery
D. Pulmonary vein, pulmonary artery, right atrium, right ventricle
520. Which of the following is the correct sequence of blood flow through the cardiovascular system?
A. Pulmonary vein, left atrium, left ventricle, aorta
B. Systemic vein, right ventricle, right atrium, pulmonary artery
C. Systemic vein, left atrium, left ventricle, pulmonary artery
D. Pulmonary vein, left ventricle, left atrium, aorta
521. The valve between the left atrium and the left ventricle is called the:
A. Semilunar valve C. Mitral valve
B. Sinoatrial valve D. Tricuspid valve
522. The wall of the left ventricle is thicker than the wall of the right ventricle because the left ventricle:
A. Pumps a greater volume of blood per minute
B. Pumps blood against a higher resistance
C. Pumps oxygenated blood
D. Has a higher density of Purkinje fibers
525. The function of the aortic valve is to prevent backflow of blood into the:
A. Right atrium during ventricular diastole C. Right ventricle during ventricular systole
B. Left ventricle during ventricular diastole D. Left atrium during ventricular systole
526. Which of the following features is characteristic of cardiac muscle but not of skeletal muscle?
A. Its force of contraction is under the influence of the sympathetic nervous system
B. Contraction is triggered by an action potential passing across the cell surface
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Cardiovascular System Physiology
C. Ca++ binds to troponin during the excitation contraction sequence
D. It appears striated under the electron microscope
528. Which of the following properties is characteristic of heart muscle but not of smooth muscle?
A. Innervated by the somatic nervous system
B. Consists of multinucleate cells
C. Has a striated appearance under the microscope
D. Ca++ binds to calmodulin during muscle contraction
529. Summation of contractions can occur in skeletal muscle but not with heart muscle because:
A. Heart muscle cells are connected by gap junctions
B. Heart muscle contraction time lasts longer than a skeletal muscle twitch
C. The refractory period of heart muscle is almost as long as its contraction time
D. Heart muscle sarcoplasmic reticulum has a more active Ca++ pump
531. The part of the heart with the fastest rate of spontaneous rhythmicity is:
A. Atrial muscle C. Atrioventricular node
B. Purkinje fibers D. Sinoatrial node
532. The conduction of the wave of depolarization through the heart could proceed by which of the
following routes?
A. Atrioventricular node, sinoatrial node, bundle of His, Purkinje fibers
B. Sinoatrial node, atrial muscle fibers, atrioventricular node, bundle of His
C. Sinoatrial node, right or left bundle branches, bundle of His, atrioventricular node
D. Sinoatrial node, Purkinje fibers, atrioventricular node, bundle of His
533. The sinoatrial node is the pacemaker for the heart because it:
A. Is located close to where the blood enters the heart
B. Has the fastest rate of spontaneous depolarization of any heart tissue
C. Is innervated by sympathetic nerves
D. Is the only nervous tissue in the heart
534. Which part of the conducting system of the heart has the slowest conduction rate?
A. Sinoatrial node C. Right and left bundle branches
B. Purkinje fibers D. Atrioventricular node
535. The right and left bundle branches of the interventricular septum consist of:
A. Sympathetic nervous tissue C. Somatic nervous tissue
B. Parasympathetic nervous tissue D. Modified cardiac muscle cells
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Cardiovascular System Physiology
536. The conduction delay caused by the atrioventricular node:
A. Ensures that the atria contract prior to ventricular systole
B. Ensures that the ventricles contract prior to atrial systole
C. Ensures that tetanic contraction of cardiac muscle is impossible
D. Is shortened by parasympathetic stimulation
537. Which of these heart conditions would be the most likely to result in rapid death of your patient?
A. Ectopic foci of contraction C. Atrial fibrillation
B. Ventricular fibrillation D. All would result in rapid death
543. Which of the following conducting systems has the slowest conducting velocity
A. SAN C. Purkinje fibers
B. Atrial muscle D. AVN
544. In heart, within physiological limits the force of contraction is directly proportional to the
A. Pacemaker activity C. Initial length of the cardiac muscle
B. A-V nodal delay D. Respiratory rate
549. When a pheochromocytoma suddenly discharges a large amount of epinephrine into the circulation
the patients heart rate would be expected to
A. Increase because epinephrine has a direct chronotropic effect on the heart
B. Increase because of increased parasympathetic discharge to the heart
C. Decrease because the increase in blood pressure stimulates the carotid and aortic baroreceptors
D. Decrease because of increased tonic parasympathetic discharge to heart
551. The 'T' wave in ECG is above the isoelectric line because of
A. Depolarization of ventricles
B. Depolarization of bundle of His
C. Change in the direction of repolarization from the wave of depolarization of the ventricles
D. Repolarization of Purkinje fibers
552. The blood vessels most responsible for regulation of blood pressure are:
A. Veins C. Venules E. Capillaries
B. Arterioles D. Arteries
554. Within normal limits, an increase in the end-diastolic volume of the right ventricle will cause:
A. An increase in the stroke volume of the right ventricle
B. An increase the stroke work of the ventricle
C. An increase in the mean ejection pressure of the ventricle
D. All of the above
555. Which of the following cardiac tissues has the most rapid conduction velocity?
A. The SA node D. Purkinje fibers
B. Atrial muscle E. Ventricular muscle fibers
C. The AV node
557. A 55-year old patient of yours wishes to begin a vigorous exercise program. As a precaution, you
assess his family history and, noting that he is at high risk for cardiac disease, perform a routine ECG. You
note in his ECG that not every P-wave is followed by a QRS and that the PR interval lengthens with each
successive beat until there is a dropped beat. The arrhythmia exhibited by this patient is:
A. First degree block C. Third degree block
B. Second degree block D. Mobitz II block
558. Ejection fraction is defined as __________. In a normal individual, the ejection fraction is typically
__________.
A. ESV / EDV; 60% C. ESV / EDV; 30%
B. SV / EDV; 30% D. SV / EDV; 60%
559. The first heart sound occurs when the __________ and __________ valves __________.
A. Mitral; Tricuspid; Close C. Mitral; Tricuspid; Open
B. Aortic; Pulmonic; Close D. Aortic; Pulmonic; Open
561. During the isovolumetric contraction phase of the cardiac cycle, the A-V valves are __________ (C,
closed; O, open) and the aortic and pulmonic valves are __________ (C, closed; O, open).
A. O, open; O, open C. C, close; O, open
B. O, open; C, close D. C, close; C, close
564. What type of blood vessel has the lowest mean blood velocity?
A. Arteries D. Venules
B. Arterioles E. Veins
C. Capillaries
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Cardiovascular System Physiology
565. Most of the total blood volume in the body is contained in:
A. Systemic arteries C. Capillaries
B. Systemic veins D. Pulmonary circulation
567. The location of the secondary pacemaker in the human heart is in the:
A. Atrioventricular node C. Left ventricle
B. Purkinje fibres D. Sinoatrial node
568. When the blood reaches the _____, this is where exchange of gases and nutrients takes place
A. Arteries C. Arterioles
B. Venules D. Capillaries
570. In the normal heart The majority of blood enters the left ventricle:
A. During early diastole C. After the aortic valve opens
B. During isovolumic relaxation D. As a result of atrial contraction
572. Which of the following factors is most important for cardiac output control?
A. Metabolic needs of the tissues D. Venous resistance
B. Right atrial pressure E. Sympathetic nervous system
C. Mean systemic pressure
573. An increase in sympathetic stimulation of the peripheral vasculature will most likely:
A. Decrease venous resistance C. Decrease arterial blood low
B. Increase venous compliance D. Decrease arterial resistance
577. The natural rate of rhythmic discharge is greatest in which part of the heart?
A. Ventricular myocardium D. Purkinje fibers
B. Atria E. A-V node
C. Sinoatrial node
578. A decrease in the velocity of impulse conduction through the A-V node will usually cause:
A. The PR interval to increase D. Increased heart rate
B. The PR interval to decrease E. Atrial fibrillation
C. Disappearance of the T wave
581. Blood flow through the coronary arteries is markedly attenuated during:
A. Systole C. Exercise
B. Diastole D. Isovolumic relaxation
582. Sympathetic simulation of which vessels causes the greatest increase in total peripheral resistance?
A. Veins D. Arterioles
B. Venules E. Arteries
C. Capillaries
583. Which of the following types of shock is often associated with an elevated cardiac output?
A. Septic shock D. Hemorrhagic shock
B. Neurogenic shock E. Anaphylactic shock
C. Traumatic shock
585. When measuring blood pressure by auscultatory method the following are true EXCEPT:
A. The cuff pressure at which the first sound are heard indicates systolic pressure
B. Systolic pressure estimated tends to be higher than those made by the palpatory method
C. Wider cuffs are required for larger arm
D. The sound that are heard are generated in the heart
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Cardiovascular System Physiology
586. Sympathetic drive to the heart increases in the following conditions EXCEPT:
A. Exercise C. Sleep
B. Hypotension D. Hemorrhage
587. The strength of contraction of left ventricular muscle increases in the following EXCEPT:
A. End diastolic ventricular filling pressure rise C. Blood calcium level rise
B. Serum potassium level rise D. Strenuous exercise is under taken
589. Wide QRS complex in EGG recording could be seen in any of the following EXCEPT:
A. Bundle branch block C. Ventricular ectopic
B. Sinus bradycardia D. Paroxysmal ventricular tachycardia
591. In normal EGG recording, the following are correctly paired EXCEPT:
A. P wave : atrial depolarization C. QRS complex : ventricular depolarization
B. PR segment : atrial repolarization D. T wave : ventricular repolarization
593. The phase of the fast-response action potential that is associated with the voltage-gated calcium
current is:
A. Phase 0. C. Phase 2.
B. Phase 1. D. Phase 3 and 4.
595. During moderate exercise, all of the following will increase EXCEPT:
A. Heart rate and strock volume C. Mean arterial blood pressure
B. Arteriovenous oxygen difference D. Systemic vascular resistance
596. Regarding the rate of blood flow, which of the following statement is false:
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Cardiovascular System Physiology
A. It is inversely proportional to vessel length C. It is inversely proportional to blood viscosity
B. It increases with increased pressure difference D. It is inversely proportional to vessel radius
597. Regarding the rate of blood flow, which of the following statement is false:
A. It is inversely proportional to vessel length C. It is inversely proportional to blood viscosity
B. It increases with increased pressure difference D. It is inversely proportional to vessel radius
599. During moderate exercise, all of the following will increase EXCEPT:
A. Heart rate and mean arterial blood pressure C. Arteriovenous oxygen difference
B. Stroke volume D. Systemic vascular resistance
601. In the normal heart The majority of blood enters the left ventricle:
A. During early diastole C. After the aortic valve opens
B. During isovolumic relaxation D. As a result of atrial contraction
610. The stroke volume of the heart is the volume of blood that:
A. Enters each ventricle per beat C. Leaves each ventricle per beat
B. Enters both ventricles per beat D. None of above
613. When the baroreceptor activity is increased the heart rate is:
A. Increased C. Remains normal
B. Decreased D. None of above
626. The cardiovascular segment containing the highest percentage of circulating blood volume is the:
A. Capillaries C. Arterioles
B. Heart and arteries D. Venous system
627. Compared with other segments of systemic circulation, arterioles have the greatest:
A. Pulse pressure C. Resistance component
B. Mean pressure D. Distensibility
629. An irregular, rapid rate with normal QRS complex and no P waves suggests:
A. Sinus arrhythmia
B. Second – degree heart block
C. Paroxysmal tachycardia with a ventricular pacemaker
D. Atrial fibrillation
630. The delay between the P wave and Q wave in the normal electrocardiogram is primarily caused by:
A. A slow transmission through the AV node and junctional fibers
B. Delay at the intermodal pathways
C. Circus movement
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Cardiovascular System Physiology
D. The slow rate of conduction in atrial heart muscle
634. The peripheral vasculature under the least control of the sympathetic nervous system are the:
A. Arteries C. Capillaries E. Veins
B. Arterioles D. Venules
636. When a person moves form a supine position to a standing position, which of the following
compensatory changes occurs?
A. Decreased heart rate D. Decreased cardiac output
B. Increased contractility E. Increased PR intervals
C. Decreased total peripheral
638. A person`s electrocardiogram (ECG) has no P wave, but has a normal QRS complex and a normal T
wave. Therefore, his pacemaker is located in the:
A. Sinoatrial (SA) node D. Purkinje system
B. Atrioventricular (AV) node E. Ventricular muscle
C. Bundle of His
643. The ventricles are completely depolarized during which isoelectric portion of the electrocardiogram
(ECG)?
A. PR interval C. QT interval E. T wave
B. QRS complex D. ST segment
644. An acute decrease in arterial blood pressure elicits which of the following compensatory changes?
A. Decreased firing rate of the carotid sinus nerve D. Decreased contractility
B. Increased parasympathetic outflow to the heart E. Decreased mean systemic pressure
C. Decreased heart rate
645. " Splitting " of the second heart sound occurs because:
A. The aortic valve closes before the pulmonic valve
B. The pulmonic valve closes before the aortic valve
C. The mitral valve closes before the tricuspid valve
D. The tricuspid valve closes before the mitral valve
E. Filling of the ventricles has fast and slow components
646. During exercise, total peripheral resistance (TPR) decreases because of the effect of
A. The sympathetic nervous system on splanchnic arterioles
B. The parasympathetic nervous system on skeletal muscle arterioles
C. Local metabolites on skeletal muscle arterioles
D. Local metabolites on cerebral arterioles
E. Histamine on skeletal muscle arterioles
647. An increase in arteriolar resistance, without a change in any other component of the cardiovascular
system, will produce:
A. A decrease in total peripheral resistance (TPR) C. An increase in arterial pressure
B. An increase in capillary filtration D. A decrease in afterload
648. The greatest pressure decrease in the circulation across the arterioles because:
A. They have the greatest surface area
B. They have the greatest cross-sectional area
C. The velocity of blood flow through them is the highest
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Cardiovascular System Physiology
D. The velocity of blood flow through them is the lowest
E. They have the greatest resistance
650. In the sinoatrial (SA) node, phase 4 depolarization (pacemaker potential) is attributable to:
A. An increase in K+ conductance
B. An increase in Na+ conductance
C. A decrease in Cl- conductance
D. A decrease in Ca 2+ conductance
E. Simultaneous increases in K + and Cl -conductances
651. The low-resistance pathways between myocardial cells that allow for the spread of action
potentials are the:
A. Gap junctions D. Intercalated disks
B. T tubules E. Mitochondria
C. Sarcoplasmic reticulum (SR)
652. Myocardial contractility is best correlated with the intracellular concentration of:
A. Na+. C. Ca+2. E. Mg2+.
B. K+. D. Cl-.
654. Carbon dioxide (CO2) regulates blood flow to which one of the following organs?
A. Heart D. Skeletal muscle at rest
B. Skin E. Skeletal muscle during exercise
C. Brain
655. Cardiac output of the right side of the heart is what percentage of the cardiac output of the left side
the heart?
A. 25%. C. 75%. E. 125%.
B. 50%. D. 100%.
656. The physiologic function of the relatively slow conduction through the atrioventricular (AV)
node is to allow sufficient time for:
A. Runoff of blood from the aorta to the C. Filling of the ventricles
arteries D. Contraction of the ventricles
B. Venous return to the atria E. Repolarization of the ventricles
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Cardiovascular System Physiology
657. Blood flow to which organ is controlled primarily by the sympathetic nervous system rather
than by local metabolites?
A. Skin C. Brain
B. Heart D. Skeletal muscle during exercise
659. Which of the following agents or changes has a negative inotropic effect on the heart?
A. Increased heart rate C. Norepinephrine E. Cardiac glycosides
B. Sympathetic stimulation D. Acetylcholine (Ach)
660. Which agent is released or secreted after a hemorrhage and causes an increasing renal Na+
reabsorption?
A. Aldosterone D. Antidiuretic hormone (ADH)
B. Angiotensin I. E. Atrial natriuretic peptide
C. Angiotensin II.
661. Which of the following changes will cause an increase in myocardial O2 consumption?
A. Decreased aortic pressure
B. Decreased heart rate
C. Decreased contractility
D. Increased size of the heart
E. Increased influx of Na+ during the upstroke of the action potential
664. An increase in systemic blood pressure leads to which one of the following effects?
A. An increase in the velocity at which blood is ejected from the left ventricle
B. An increase in cardiac output
C. An increase in the residual volume of blood in the ventricle
D. A decrease in the time it takes for the left ventricular wall to develop peak tension
E. A decrease in the maximal wall tension developed in the left ventricular muscle
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Cardiovascular System Physiology
665. The time from the upstroke of the carotid artery pulse to the incisura (dicrotic notch) is a measure
of the period of:
A. Atrial diastole D. Rapid ventricular filling
B. Ventricular ejection E. Ventricular isovolumic relaxation
C. Rapid ventricular filling
666. An electrocardiogram (ECG) reveals no P waves in any lead This would indicate that impulses from
which one of the following structures are being blocked?
A. Sinoatrial (SA) node D. Left bundle branch
B. Bundle of His E. Ventricular muscle
C. Purkinje fibers
667. The pulmonic valve normally closes after the aortic valve because the:
A. Diameter of the pulmonary artery is less than that of the aorta
B. Right ventricular contraction begins after left ventricular contraction
C. Velocity of ejection in the right ventricle is less than that in the left ventricle
D. Diastolic pressure in the pulmonary artery is less than in the aorta
e) Leaflets of the pulmonic valve are stiffer
E. Leaflets of pulmonic valve are stiffer and harder to close, compared with those of the aortic valve
668. Which one of the following mechanisms is most important for maintaining an increased blood flow
to skeletal muscle during exercise?
A. An increase in aortic pressure
B. An increase in α - adrenergic impulses
C. An increase in β- adrenergic impulses
D. Vasoconstriction in the splanchnic and renal areas
E. Vasodilation secondary to the effect of local metabolites
670. Venous return is enhanced during exercise by all of the following factors EXCEPT:
A. Increased depth of respiration C. Reduced arteriolar resistance
B. Pumping action of skeletal muscles E. An erect position
678. The following are true about resistance to blood flow in the vessel EXCEPT:
A. It is dependent on the hematocrit
B. It depends on the thickness of the vessel wall
C. It is directly proportional to the length of the vessel
D. It is directly proportional to the pressure drop along the vessel
E. It is inversely proportional to the fourth power of the radius of the vessel
680. True statements about ECG include all the following EXCEPT:
A. The P-R interval corresponds to the duration of atrial systole
B. The T-wave ends at the time of aortic valve closure
C. The ST segment represents repolarization of the ventricles
D. The QRS complex represents atrial repolarization
E. P-wave represents depolarization of the atrium
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Cardiovascular System Physiology
684. In the fetal circulation before birth, all are true EXCEPT
A. The PO2 is higher in the ductus venous than in the ductus arteriosus
B. Blood can go from the right atrium to the aorta without passing through the left atrium and ventricle
C. The PO2 in the aortic arch is higher than the descending aorta
D. Blood flowing through the foramen ovale comes principally from the superior vena cava
E. Blood passes through the ductus arteriosus because of the high pulmonary vascular resistance
689. Dilatation of the peripheral arterial blood vessels can be caused by:
A. Thromboxane A2 B. Adenosine diphosphate
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Cardiovascular System Physiology
C. Endothelin E. Nitric oxide
D. Prostaglandins
For each event, select the mechanism that is associated with it:
A. Increase in contractility.
B. Increase in fiber length.
C. Both.
D. Neither.
690. An increase in the maximal velocity of shortening (Vmax)
691. A shift to a new frank-starling curve
692. An increase in intracellular Ca2+.
Match the cardiac event with the interval of the cardiac cycle in which it occurs:
A. Atrial contraction.
B. Isovolumic contraction.
C. Rapid ventricular ejection.
D. Reduced ventricular ejection.
E. Isovolumic relaxation.
698. Second heart sound (S2)
699. Achievement of maximal ventricular volume
700. Closure of the atrioventricular (AV) valves
701. Opening of the aortic valve
Match each cardiovascular adjustment with the factor that is responsible for it:
A. Functional hyperemia.
B. Histamine.
C. Hypertension.
D. CO2 tension (PCO2).
E. Capillary pressure.
702. Regulation of capillary filtration rate
703. Elevation of arterial diastolic pressure
704. Metabolic regulation of blood flow
705. Regulation of cerebral blood flow
706. Increase in microvascular permeability
Match each numbered phenomenon with the appropriate phase of the ventricular action potential
shown in the figure 1.
(A) Phase 0.
(B) Phase 1.
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Cardiovascular System Physiology
(C) Phase 2.
(D) Phase 3.
(E) Phase 4.
707. Phase of the ventricular action potential in which the membrane potential is close to the K+
equilibrium potential
708. Phase of the ventricular action potential that has the highest conductance to Ca++.
709. Phase of the ventricular action potential that coincides with diastole
Match each occurrence with the appropriate phase of the cardiac cycle:
(A) Atrial systole.
(B) Isovolumetric ventricular contraction.
(C) Rapid ventricular ejection.
(D) Reduced ventricular ejection.
(E) Isovolumetric ventricular relaxation.
(F) Rapid ventricular filling.
(g) Reduced ventricular filling (diastasis).
712. Aortic pressure is highest
713. Ventricular volume is lowest
714. The mitral valve opens
715. A 50-year-old woman had an echocardiogram. The results indicated a thickened right ventricle.
Other data indicated that the patient had severely decreased arterial oxygen content and equal systolic
pressures in both cardiac ventricles. What condition is present?
A. Interventricular septal defect D. Pulmonary valve regurgitation
B. Tetralogy of Fallot E. Patent ductus arteriosus
C. Pulmonary valve stenosis
716. Dilatation of the peripheral arterial blood vessels can be caused by:
A. Thromboxane A2 C. Endothelin
B. Adenosine diphosphate D. Prostaglandins
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Cardiovascular System Physiology
E. Nitric oxide
721. Of the following, which is the most significant factor affecting peripheral resistance?
A. Blood viscosity C. Blood vessel radius
B. Blood vessel length D. Blood pH
724. Consider the following events and then put them in correct chronological order.
1. Sustained blood pressure depression
2. Release of aldosterone
3. Conversion of angiotensin I to angiotensin II
4. Release of renin
5. Cleavage of angiotensinogen
A. 1,2,3,4,5 B. 1,4,2,5,3 C. 1,4,5,3,2 D. 1,2,5,3,4
725. If MAP becomes >160mmHg, then which of the following may occur?
A. Cerebral edema C. Renal atelectasis
B. Cerebral polythemia D. Renal perfusion
729. A person with primary hypertension would be expected to have a plasma aldosterone level that is:
A. Greater than normal B. Less than normal C. Normal
731. An increase in tissue lactic acid will cause the arterioles feeding that tissue to:
A. Constrict D. Increase their resistance
B. Dilate E. 2 of the above
C. Contract their vascular smooth muscle
732. Epinephrine causes the blood vessels serving skeletal musculature to:
A. Constrict
B. Dilate
C. Epinephrine has NO EFFECT on these blood vessels
736. If a segment of pulmonary tissue has a low O2 concentration, then the arterioles serving that
segment will:
A. Dilate C. Release nitroprusside
B. Constrict D. Release ACE
740. The blood vessels that play the most important role in the regulation of blood flow to a tissue and
blood pressure are the:
A. Arterioles C. Capillaries E. Arteries
B. Veins D. Venules
742. A patient with a hypothalamic tumor has hypersecretion of ADH. Which of the following BP
readings would be most likely for this patient?
A. 95/65 B. 115/80 C. 120/60 D. 165/100
743. The difference between the systolic and the diastolic pressures is known as the:
A. Blood Pressure C. Mean Arterial Pressure
B. Pulse Pressure D. End-ventricular Pressure
747. As blood flows from the aorta to the capillaries of the gastrocnemius, its velocity of flow will:
A. Increase B. Decrease C. Stay the same
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Cardiovascular System Physiology
748. Which of the following is true?
A. Arteries typically have thinner walls than veins
B. Veins typically have a much wider tunica media than arteries
C. Veins typically have much more elastin than conducting arteries
D. You typically would find fewer valves in arteries than in veins
749. Increasing blood vessel length will cause peripheral resistance to:
A. Increase B. Decrease C. Stay the same
750. As you go from arteries to capillaries, the fluid pressure exerted by blood on the vessel walls:
A. Increases B. Decreases C. Stays the same
751. If MAP increased by 10 mmHg, how much must the diastolic pressure have changed?
A. -10mmHg
B. +10mmHg
C. 0 mmHg
D. Cannot be determined from the information given
753. The volume of blood moving through a given area in a given time is the:
A. Blood velocity C. Blood pressure
B. Blood flow D. Blood resistance
1 C 21 C 41 A 61 C 81 C 101 A 121
A, B,
2 B 22 C 42 B 62 D 82 A 102 C 122
C
A, B,
3 D 23 D 43 C 63 A 83 E 103 A 123
D, E
4 A 24 A 44 B 64 A 84 B 104 E 124 D, E
5 B 25 B 45 B 65 C 85 E 105 C 125 B, E
6 A 26 B 46 C 66 A 86 D 106 E 126 E
7 C 27 D 47 A 67 D 87 E 107 A 127 A
8 D 28 B 48 D 68 C 88 E 108 E 128 B
9 A 29 C 48 B 69 B 89 C 109 C 129 D
B, D,
10 B 30 C 50 E 70 C 90 E 110 130 B
E
11 B 31 D 51 B 71 B 91 A 111 A, C 131 D
A, C,
12 C 32 A 52 C 72 E 92 D 112 132 D
E
13 C 33 D 52 A 73 D 93 D 113 C, E 133 D
14 D 34 D 54 B 74 B 94 A 114 C, E 134 D
A, B,
15 B 35 B 55 C 75 A 95 A 115 135 E
D, E
16 D 36 D 56 A 76 D 96 E 116 E 136 D
B, D,
17 B 37 A 57 C 77 C 97 D 117 137 E
E
A, B,
18 C 38 A 58 C 78 B 98 D 118 138 B
D, E
19 B 39 D 59 D 79 C 99 C 119 B, E 139 E
A, B,
20 C 40 D 60 D 80 D 100 C 120 140 C
C, E
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Cardiovascular System Physiology
141 D 161 D 181 G 201 D 221 A 241 A 261 A
MCQs in
Autonomic Nervous System Physiology
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Autonomic Nervous System Physiology
1. Which of the following is one of the actions of the parasympathetic division of the autonomic nervous
system?
A. Increases heart rate C. Stimulates sweat glands
B. Constricts bronchial tubes D. Inhibits intestinal motility
3. Which autonomic receptor is blocked by hexamethonium at the ganglia, but not at the neuromuscular
junction? Hexamethonium is a nicotinic blocker, acts only at ganglionic (not neuromuscular junction)
nicotinic receptors
A. Adrenergic α receptors D. Cholinergic muscarinic receptors
B. Adrenergic β1 receptors E. Cholinergic nicotinic receptors
C. Adrenergic β2 receptors
4. A 66-year-old man with chronic hypertension is treated with prazosin by his physician. The treatment
successfully decreases his blood pressure to within the normal range. What is the mechanism of the
drug’s action? Prazosin is a specific antagonist of α1 receptors, which are present in vascular smooth
muscle, but not in the heart.
A. Inhibition of β1 receptors in the SA node I. Inhibition of α1 receptors in the SA node
B. Inhibition of β2 receptors in the SA node J. Inhibition of α1 receptors on vascular smooth
C. Stimulation of muscarinic receptors in the SA node muscle
D. Stimulation of nicotinic receptors in the SA node K. Stimulation of α1 receptors on vascular smooth
E. Inhibition of β1 receptors in ventricular muscle muscle
F. Stimulation of β1 receptors in ventricular muscle L. Stimulation of α2 receptors on vascular smooth
G. Inhibition of α1 receptors in ventricular muscle muscle
H. Stimulation of α1 receptors in the SA node
6. Which of the following is a feature of the sympathetic, but not the parasympathetic, nervous system?
A. Ganglia located in the effector organs
B. Long preganglionic neurons
C. Preganglionic neurons release norepinephrine
D. Preganglionic neurons release acetylcholine (ACh)
E. Preganglionic neurons originate in the thoracolumbar spinal cord
F. Postganglionic neurons synapse on effector organs
G. Postganglionic neurons release epinephrine
H. Postganglionic neurons release Ach
8. Administration of which of the following drugs is contraindicated in a 10-year-old child with a history
of asthma?
A. Albuterol (β2 Agonists) D. Norepinephrine (β2 Agonists)
B. Epinephrine (β2 Agonists) E. Propranolol (2 Antagonists)
C. Isoproterenol (β2 Agonists)
10. Sympathetic
A. Ganglionic transmission is mediated by acetylcholine
B. Neuromuscular transmission at the heart is mediated by adrenaline
C. Neuromuscular transmission in hand skin arterioles is mediated by acetylcholine
D. Neuroglandular transmission at sweat glands is mediated by noradrenaline
E. Neuromuscular transmission at the iris is mediated by noradrenaline
15. Acetylcholine
A. Acts on the same type of receptor on postganglionic in sympathetic and parasympathetic ganglia
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Autonomic Nervous System Physiology
B. Acts on the same type of receptor on target organs at cholinergic sympathetic and parasympathetic
nerve terminals
C. Acts on the same type of receptor at autonomic ganglia and at somatic neuromuscular junctions
D. Acts as an excitatory transmitter in the basal ganglia
E. In blood is hydrolyzed by the same cholinesterase as is found at neuromuscular junctions
20. Which of the following is not found in appreciable quantities in postganglionic sympathetic neurons?
A. L-Dopa C. Norepinephrine E. Acetylcholine
B. Dopamine D. Histamine
21. Targets of the autonomic nervous system include all of the following EXCEPT
A. Cardiac muscle C. Skeletal muscle
B. Exocrine glands D. Endocrine glands
22. Somatic motor neurons have cell bodies located ____ the CNS that project axons only to ____; and
are usually under ____ control.
A. Outside; skeletal muscle; involuntary C. Inside; the viscera; involuntary
B. Inside; the viscera; voluntary D. Inside; skeletal muscle; voluntary
23. Which of the following statements does not describe denervation hypersensitivity?
A. Autonomic target tissues become more sensitive than normal to stimulating agents
B. Skeletal muscle effectors enter a state of flaccid paralysis and undergo atrophy
C. Severing (cutting) autonomic motor neurons may stimulate denervation hypersensitivity
D. One example is restoring the secretion of acid from the stomach following vagotomy (severing the vagus
nerve)
26. Which of the following is innervated by postganglionic fibers arising from the cervical ganglia?
A. The eyes C. The urinary system
B. The digestive system D. The reproductive system
28. Which of the following cranial nerves does not contain preganglionic parasympathetic fibers?
A. Oculomotor (III) C. Optic (II)
B. Facial (VII) D. Glossopharyngeal (IX)
29. The very long cranial nerve that originates from nuclei in the medulla oblongata and projects
preganglionic fibers through the neck to the thoracic and abdominal cavities is the _____ nerve.
A. Optic (II) C. Facial (VII)
B. Oculomotor (III) D. Vagus (X)
33. The drug muscarine, derived from some poisonous mushrooms stimulates all of the following
cholinergic receptors, EXCEPT those receptors in the
A. Heart
B. Neuromuscular junction of skeletal muscle fibers
C. Digestive system
D. Most target organs of postganglionic parasympathetic nerve fibers
34. The drug that should aid the suffering of asthmatics by serving as a selective β2 agonist, resulting in
dilation of the airways in the lung, is
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Autonomic Nervous System Physiology
A. Terbutaline B. Atenolol C. Phenylephrine D. Clonidine
36. All of the following molecules are considered "nonadrenergic noncholinergic" neurotransmitters
produced by postganglionic autonomic axons, EXCEPT
A. Adenosine triphosphate C. Vasoactive intestinal peptide
B. Acetylcholine D. Nitric oxide
37. The separate effects of sympathetic and parasympathetic innervation of the pacemaker region of the
heart can best be described as
A. Antagonistic B. Complementary C. Cooperative
38. The effects of sympathetic and parasympathetic innervation on the urinary and reproductive
systems, causing the male erection and ejaculation for example, are called
A. Antagonistic B. Complementary C. Cooperative
39. The effects of sympathetic and parasympathetic stimulation of the salivary glands, producing a
thicker, more viscous saliva, are called
A. Antagonistic B. Complementary C. Cooperative
40. Which of the following target tissues is innervated by only neurons from the sympathetic nervous
system?
A. Adrenal medulla B. Lacrimal glands C. Bronchioles D. Pupil of the eye
41. The brain area that most directly controls the activity of the autonomic nervous system, is the
A. Medulla oblongata B. Pituitary gland C. Cerebellum D. Hypothalamus
43. The hypothalamus does not contain a control center for the homeostatic regulation of
A. Body temperature C. Urinary bladder reflexes
B. Various emotional states D. Eating
48. The vagus nerve regulates major elements of which part of the nervous system?
A. Parasympathetic nervous system C. Sympathetic nervous system
B. Enteric nervous system D. Central nervous system
49. Which of these is not a feature of postganglionic neurons in the sympathetic nervous system?
A. Originating distal to the effector organ C. Short
B. Unmyelinated D. Noradrenergic
50. Acetylcholine is synthesized and packaged in the presynaptic terminal before being released to act
on the postsynaptic receptors. Which of these statements about that process in parasympathetic
postganglionic neurons is not true?
A. Acetylcholine is synthesized by the action of choline-o-acetyltransferase on choline and acetyl coenzyme
A.
B. Release of neurotransmitter is triggered when voltage sensitive calcium channels open to allow the influx
of calcium
C. The released acetylcholine acts on postsynaptic nicotinic receptors
D. Choline is recycled by being taken back up into the presynaptic terminal
52. Activation of the sympathetic nervous system leads to the 'fight and flight' response. Which of these
is not part of that process?
A. Vasodilatation in skeletal muscle C. Bladder relaxation
B. Sweating D. Increased gut motility
53. Which of the following is not caused by the activation of the sympathetic nervous system?
A. An increase Ca2+ release in cardiomyocytes C. An increase in blood pressure
B. An increase in cardiac output D. A decrease in heart rate
57. Which of the below answers is NOT correct concerning a preganglionic neuron
A. Form the first part of an autonomic motor pathway
B. Form a gap junction with the postganglionic neuron
C. Have its cell body in the brain or spinal cord
D. Have its axon exiting the CNS with a cranial or spinal nerve
E. Have myelinated axons
60. These are structures containing sympathetic preganglionic axons that connect the anterior ramus of
the spinal nerve with the ganglia of the sympathetic trunk.
A. Greater splanchnic nerve D. Gray rami communicantes
B. Inferior cervical ganglion E. Lumbar splanchnic nerve
C. White rami communicantes
63. Which of these physiological changes would not be considered part of the sympathetic fight-or-flight
response?
A. Increased heart rate C. Dilated pupils
B. Increased sweating D. Increased stomach motility
65. Which signaling molecule is most likely responsible for an increase in digestive activity?
A. Epinephrine B. Norepinephrine C. Acetylcholine D. Adrenaline
68. What gland produces a secretion that causes fight-or-flight responses in effectors?
A. Adrenal medulla B. Salivary gland C. Reproductive gland D. Thymus
70. Which of these locations in the forebrain is the master control center for homeostasis through the
autonomic and endocrine systems?
A. Hypothalamus C. Amygdala
B. Thalamus D. Cerebral cortex
71. Which nerve projects to the hypothalamus to indicate the level of light stimuli in the retina?
A. Glossopharyngeal B. Oculomotor C. Optic D. Vagus
72. What region of the limbic lobe is responsible for generating stress responses via the hypothalamus?
A. Hippocampus B. Amygdala C. Mammillary bodies D. Prefrontal cortex
73. What is another name for the preganglionic sympathetic fibers that project to the heart?
A. Solitary tract C. Vagus nerve
B. Vasomotor nerve D. Cardiac accelerator nerve
74. What central fiber tract connects forebrain and brain stem structures with the hypothalamus?
A. Cardiac accelerator nerve C. Dorsal longitudinal fasciculus
B. Medial forebrain bundle D. Corticospinal tract
75. A drug that affects both divisions of the autonomic system is going to bind to, or block, which type of
neurotransmitter receptor?
A. Nicotinic B. Muscarinic C. A-adrenergic D. ß-adrenergic
78. Which type of drug could be used to treat asthma by opening airways wider?
A. Sympatholytic drug C. Anticholinergic drug
B. Sympathomimetic drug D. Parasympathomimetic drug
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Autonomic Nervous System Physiology
82. The two major divisions of the autonomic system are the sympathetic and parasympathetic. Where
do parasympathetic originate?
A. The thoraco-lumbar spinal region B. The cranial and sacral regions
83. Adult spinal cord often terminates inferiorly at the vertebral level of:
A. T 12. B. L 1-2. C. L 2-3. D. L3-4. E. S1-S2
84. Effector organs of the ANS include all of the following EXCEPT:
A. Medulla oblongata C. Heart E. Glands
B. Arteriolar smooth muscle D. Visceral smooth muscles
85. The system that controls smooth muscle, cardiac muscle, and gland activity is the:
A. Somatic nervous system C. Skeletal division
B. Autonomic nervous system D. Sensory nervous system
90. A modular body which contains large numbers of neuronal cell bodies and is located within the
peripheral neurons system is called a:
A. Ganglion B. Nerve C. Nucleus D. Tract E. Plexus
91. The affecter pathway of the ANS generally contains _____ Neuron(s).
A. 1 B. 2 C. 3 D. 4
92. Concerning the autonomic ganglia, all the following is true EXCEPT:
A. They act as distributing centers
B. They are 3 types
C. Their chemical transmitter is acetylcholine
D. Their receptors are specifically blocked by atropine
101. The sympathetic nervous system has all of the following characters EXCEPT:
A. It is mostly noradrenergic
B. It is involved more frequently in generalized actions
C. It is of little importance in visual accommodation
D. It antagonizes mostly parasympathetic functions
E. It is anabolic
107. The parasympathetic nervous system affects all of these organs EXCEPT:
A. Heart C. Salivary glands
B. Pupillary smooth muscles D. Adrenal glands
108. Which of the following structures is an example where double innervation does not apply?
A. The heart C. The stomach E. Splenic capsule
B. The bladder D. The intestines
114. An injury to the first 4 sacral segments of the spinal cord produces:
A. Hyperglycemia
B. Vasodilatation in the cutaneous blood vessels
C. Disturbance of sweat secretion
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Autonomic Nervous System Physiology
D. Lack of erection of the penis in males & clitoris in females
E. Relaxation of the internal anal & urethral sphincters
115. About the vagus nerve, all the following is true EXCEPT:
A. It originates mainly from medulla oblongata
B. It contains parasympathetic preganglionic fibers
C. It has no direct effect on ventricular contraction
D. It causes increased peristaltic movements of the intestinal wall
E. It produces micturition
116. Concerning the adrenal medulla, all the following is true EXCEPT:
A. Its secretion is increased in emergency conditions
B. It secrets epinephrine 80% & norepinephrine 20%.
C. It augments and prolongs the effects of sympathetic stimulation
D. It is a modified sympathetic ganglion
E. It receives preganglionic nerve supply from the anterior horn cells of the lower 6 thoracic segments of
spinal cord
118. It is true to say that nicotine in small dose has an excitatory influence on the:
A. Receptors located in the neurons present in the sympathetic ganglia
B. Beta adrenergic receptors
C. Alpha adrenergic receptors
D. Receptors those are normally responsive to postganglionic parasympathetic fibers
131. Integration of the autonomic functions involves the following higher centers EXCEPT :
A. Cerebral cortex B. Cerebellum C. Hypothalamus D. Limbic system E. Brain stem
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Autonomic Nervous System Physiology
135. Which of the following drugs would not increase sympathetic activity?
A. Norepinephrine C. Amphetamine E. Epinephrine
B. Phenylephrine D. Pilocarpine
136. About the drugs that affect the autonomic N.S., all following is true EXCEPT:
A. Acetylcholine injection causes catecholamine secretion from the adrenal medulla
B. Atropine injection causes relaxation of the skeletal muscles
C. Epinephrine injection helps in the treatment of bronchial asthma
D. Acetylcholine injection stimulates the autonomic ganglia
E. In the body, epinephrine is formed only in the adrenal medulla & C.N.S.
137. A drug that blocks the alpha adrenergic receptors is likely to cause:
A. A reduction in sweat production
B. A fall in the arterial B.P. due to slowing of the heart
C. Failure of mydriasis in emotions
D. Constriction of the bronchi
E. Absence of secretion of the penis
141. A drug that blocks the beta adrenergic receptors in likely to cause:
A. Relaxation of the sphincters of the GIT.
B. An increase in the cardiac properties
C. Increased glycogenolysis & lipolysis in response to epinephrine
D. Bronchoconstriction
E. Excessive vasodilatation in skeletal muscles in response to epinephrine
146. The alpha adrenergic receptors mediate all the following effects EXCEPT:
A. Vasoconstriction D. Relaxation of the intestinal wall
B. Pupil dilatation E. Increased cardiac activity
C. Spleen contraction
149. A physiological action of epinephrine produced by contact with the beta adrenergic receptors is;
A. Vasoconstriction in skeletal muscles
B. Dilatation of the pupil
C. Intestinal contraction
D. Contraction of the erector pilli muscles
E. Increased strength of myocardial contraction
152. The autonomic nervous system is involved in the following functions Except:
A. Initiation of smooth muscle contraction C. Initiation of heart beats
B. Initiation of sweat secretion D. Inhibition of gastrointestinal motility
164. Acetylcholine:
A. Is released by all the autonomic nerve fibers
B. Is blocked by alpha blockers
C. Is blocked by ganglion blocker
D. Is taken back by presynaptic nerve terminals after dissociating from postsynaptic receptors
165. Acetylcholine:
A. Binds with nicotinic receptors in cells of autonomic effector tissues
B. Stimulates nicotinic receptors, but inhibits muscarinic receptors
C. Synthesis is catalyzed by choline esterase enzyme
D. Is released in response to Ca++ influx into synaptic knobs
169. Increased release of epinephrine from adrenal medulla during muscular exercise:
A. Stimulates glycogenolysis in the liver
B. Stimulates glycogenesis in the liver
C. Causes vasoconstriction of arterioles all over the body
D. Constricts the ciliary muscle in the eye
175. An abnormally high level of acetylcholine in tissues all over the body is due to:
A. Exposure to stress
B. Widespread physiological activation of the parasympathetic nervous system
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Autonomic Nervous System Physiology
C. Increased activity of muscarinic receptors
D. Decreased activity of cholinesterase enzyme
177. Which of the following visceral tissues receives sympathetic postganglionic neurons only?
A. Adrenal medulla C. Anal sphincters
B. Sweat glands D. The iris
178. Neurotransmitters released by the parasympathetic preganglionic and postganglionic nerve are:
A. Acetylcholine and norepinephrine C. Norepinephrine and acetylcholine
B. Acetylcholine and epinephrine D. Acetylcholine and acetylcholine
185. The sympathetic preganglionic neurons release….. At their terminals and the effect is always ……..:
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Autonomic Nervous System Physiology
A. Norepinephrine; inhibitory C. Acetylcholine; excitatory
B. Norepinephrine; excitatory D. Acetylcholine; inhibitory
188. Increased release of norepinephrine from the sympathetic nerves in the heart would:
A. Increase heart rate C. Directly dilate coronary vessels
B. Decrease heart rate D. Decrease the force of cardiac contraction
196. The following processes are brought about by activation of the parasympathetic nerve fibers:
A. Defecation C. Sweating E. Dilation of the pupil
B. Micturition D. Ejaculation of semen
198. A drug which augment parasympathetic activity can be any of the following EXCEPT:
A. Diisopropylfluorophosphate C. Pilocarpine E. Muscarine
B. Isoproterenol D. Prostigmine
204. Sympathetic:
A. Ganglia have acetylcholine as a transmitter substance
B. Nerve terminals supplying the heart transmit via adrenaline
C. Nerves supplying skin arterioles transmit via acetylcholine
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Autonomic Nervous System Physiology
D. Nerves supplying sweat glands transmit via noradrenaline
E. Ganglia are closer to the end organ than parasympathetic ganglia
205. Among the clinical uses of atropine are the following EXCEPT:
A. Induction of anesthesia in surgical operations
B. Examination of the fundus of the eye due to its mydriatic effect
C. Treatment of constipation
D. Treatment of intestinal & renal colic
225. Compared to the somatic nervous system, the autonomic nervous system secretes
A. Acetylcholine only C. Acetylcholine or norepinephrine
B. Norepinephrine only D. Acetylcholine or dopamine
226. Compared to the autonomic nervous system, receptors of the somatic nervous system include
A. Nicotinic cholinergic receptors only C. Nicotinic and muscarinic cholinergic receptors
B. Muscarinic cholinergic receptors only D. Cholinergic and nicotinic receptors
227. Compared to the somatic nervous system, which of the following describes the neuron
arrangement from the central nervous system (CNS) to the effector in the autonomic nervous system?
A. One motor neuron extending from the CNS to C. Three motor neurons in series
the effector D. Four motor neurons in series
B. Two motor neurons in series
228. Which of the following receptors occur in the membranes of target cells of sympathetic
postganglionic neurons?
A. Alpha and beta adrenergic C. Nicotinic cholinergic
B. Muscarinic cholinergic D. α or β adrenergic or muscarinic cholinergic
229. Which of the following receptors occur in the membranes of target cells of parasympathetic
postganglionic neurons?
A. Alpha and beta adrenergic C. Nicotinic cholinergic
B. Muscarinic cholinergic D. α or β adrenergic or muscarinic cholinergic
230. Which of these receptors occur in the membranes of sympathetic postganglionic neurons?
A. Alpha and beta adrenergic C. Nicotinic cholinergic
B. Muscarinic cholinergic D. α or β adrenergic or muscarinic cholinergic
231. Acetylcholine is always the neurotransmitter employed by each of the following EXCEPT
A. Parasympathetic preganglionic neurons C. Sympathetic preganglionic neurons
B. Parasympathetic postganglionic neurons D. Sympathetic postganglionic neurons
233. What type of receptors occurs in the membranes of the adrenal medulla cells that respond to
sympathetic stimulation by secreting the hormones epinephrine and norepinephrine?
A. Alpha adrenergic C. Muscarinic cholinergic
B. Beta adrenergic D. Nicotinic cholinergic
234. Nicotinic acetylcholine receptors occur in each of the following locations EXCEPT the membranes of
A. Parasympathetic effector cells B. Postganglionic parasympathetic neurons
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Autonomic Nervous System Physiology
C. Postganglionic sympathetic neurons D. Skeletal muscle fibers
237. Because it selectively activates beta receptors, which of the following drugs is used to dilate
bronchioles in respiratory disorders such as asthma?
A. Albuterol B. Atropine C. Phenylephrine D. Propranolol
238. Which of the following is a parasympathetic blocking agent used to dilate the pupils during an eye
examination?
A. Albuterol B. Atropine C. Phenylephrine D. Propranolol
241. The two divisions of the autonomic nervous system have antagonistic effects on each of the
following EXCEPT
A. Contraction of the urinary bladder C. The diameter of blood vessels in skeletal muscles
B. Heart rate D. The diameter of bronchioles in the lungs
242. The two divisions of the autonomic nervous system have antagonistic effects on which of the
following?
A. Contraction of the urinary bladder C. Sweating
B. Gastrointestinal motility D. The diameter of blood vessels in skeletal muscles
243. _______________ stimulation leads to dilation of the pupils of the eyes and _______________
stimulation leads to constriction of the pupils.
A. Increased parasympathetic; decreased parasympathetic
B. Increased sympathetic; decreased sympathetic
C. Parasympathetic; sympathetic
D. Sympathetic; parasympathetic
244. The two divisions of the autonomic nervous system have antagonistic effects on each of the
following EXCEPT
A. The diameter of blood vessels in skeletal muscles C. Gastrointestinal peristalsis
B. The diameter of bronchioles in the lungs D. Heart rate
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Autonomic Nervous System Physiology
245. During stress the sympathetic division of the ANS would cause each of the following EXCEPT
A. Bronchodilation C. Contraction of the urinary bladder
B. Constriction of arteries to the gastrointestinal D. Dilation of arteries in skeletal muscles and the
tract heart
248. The parasympathetic fibers that control the muscles involved in constriction of the pupils in
response to a bright light shined in eyes are conveyed in the
A. Facial nerves C. Oculomotor nerves
B. Glossopharyngeal nerves D. Vagus nerves
249. The sympathetic division of the autonomic nervous system normally controls target cells with ____
receptors.
A. Nicotinic and muscarinic C. Alpha 1 and beta 1
B. All alpha and beta D. Alpha 2 and beta 2
250. Which of the following brain areas is the most important integrating center for autonomic nervous
system functions?
A. Hypothalamus B. Midbrain C. Pons D. Thalamus
251. Each of the following areas of the central nervous system serves as an integrating center for
autonomic nervous system functions EXCEPT the
A. Hypothalamus C. Spinal cord
B. Reticular formation in the brainstem D. Thalamus
252. All of the following are true about the parasympathetic division of the autonomic nervous system
EXCEPT which one?
A. Preganglionic fibers are relatively long
B. Preganglionic and postganglionic neurons synapse in terminal ganglia
C. Nerve fibers arise from the brainstem or sacral region of the spinal cord
D. Each preganglionic neuron synapses with as many as 17 postganglionic neurons
253. Which of the following is NOT true about the sympathetic division of the autonomic nervous
system?
A. Fibers arise from spinal nerves in the thoracic and lumbar regions
B. Preganglionic fibers are short
C. Preganglionic and postganglionic neurons synapse in paravertebral or prevertebral ganglia
D. Effects on target organs are specific and local
254. Which of the following is NOT true about the parasympathetic division of the autonomic nervous
system?
A. Postganglionic fibers are unmyelinated
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Autonomic Nervous System Physiology
B. Stimulation affects several organs at the same time resulting in generalized effects
C. Preganglionic fibers are relatively long
D. Preganglionic and postganglionic neurons synapse in terminal ganglia
255. A decrease in blood pressure is detected by _______________ in the common carotid arteries and
leads to a _______________ reflex that stimulates an increase in the heart rate and force of contraction.
A. Baroreceptors; parasympathetic C. Nociceptors; parasympathetic
B. Baroreceptors; sympathetic D. Nociceptors; sympathetic
256. The effector organs for the somatic motor nervous system are
A. Cardiac muscle C. Glands E. All of these
B. Smooth muscle D. Skeletal muscle
257. Which of these characteristics describe the somatic motor nervous system?
A. One neuron between CNS and skeletal muscle
B. Effect can be excitatory or inhibitory
C. Cell bodies in lateral part of the spinal cord
D. Receptor molecules can be nicotinic or muscarinic
E. All of these
259. Cell bodies of the sympathetic preganglionic neurons are located in the
A. Dorsal horn of the spinal cord gray matter D. Sympathetic chain ganglia
B. Ventral horn of the spinal cord gray matter E. Collateral ganglia
C. Lateral horn of the spinal cord gray matter
261. Sympathetic preganglionic axons enter the chain ganglia through the
A. Gray ramus communicans C. Afferent neurons E. White ramus communicans
B. Splanchnic nerve D. Postganglionic neuron
263. All preganglionic neurons of the sympathetic and parasympathetic divisions are
A. Adrenergic B. Cholinergic C. Myelinated D. Unmyelinated E. Both B and C
264. Postganglionic neurons of the sympathetic division that innervate thermoregulatory sweat glands
are
A. Adrenergic B. Cholinergic
272. The effect of sympathetic stimulation on the urinary bladder is to __________ the wall and
__________ the sphincter.
A. Contract, contract C. Relax, contract
B. Contract, relax D. Relax, relax
273. The effect of parasympathetic stimulation on the eye is to __________ the ciliary muscle and to
__________ the pupil.
A. Contract, constrict C. Relax, constrict
B. Contract, dilate D. Relax, dilate
275. In the autonomic reflex that regulates blood pressure, the type of sensory receptors involved are
A. Baroreceptors B. Chemoreceptors
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Autonomic Nervous System Physiology
C. Nociceptors D. Thermoreceptors
276. Which of these structures is innervated almost entirely by the sympathetic division?
A. Heart C. Urinary bladder E. reproductive organs
B. Gastrointestinal tract D. Blood vessels
277. A patient suffering a myocardial infarction (heart attack) has cold, clammy skin because of strong
stimulation of the
A. Parasympathetic division B. Sympathetic division
278. Which of the following statements regarding the adrenal gland is true?
A. The parasympathetic division stimulates the adrenal gland to release acetylcholine
B. The parasympathetic division stimulates the adrenal gland to release epinephrine
C. The sympathetic division stimulates the adrenal gland to release acetylcholine
D. The sympathetic division stimulates the adrenal gland to release epinephrine
283. The following are true about the muscarinic receptors EXCEPT:
A. They are found at the postganglionic parasympathetic synapses
B. They can be selectively blocked by atropine
C. M1 muscarinic receptors are found in the brain
D. M4 muscarinic receptors are found in the pancreas
E. M2 muscarinic receptors mediate a positive chronotropic effect
284. The following are true about the autonomic nervous system EXCEPT:
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Autonomic Nervous System Physiology
A. The preganglionic fibers are mainly myelinated, slow conducting B fibers
B. The postganglionic fibers are mainly unmyelinated C fibers
C. All preganglionic neurons are cholinergic neurons
D. All sympathetic postganglionic neurons are adrenergic neurons
E. The postganglionic neurons of the sympathetic pathway is longer than that of the parasympathetic
pathway
285. True statements about the following neurotransmitters include all the following EXCEPT:
A. Dopamine is formed from tyrosine
B. In the synapse, noradrenaline is inactivated by active reuptake into the presynaptic terminals
C. Noradrenaline is formed by hydroxylation of dopamine
D. Noradrenaline is oxidized by monoamine oxidase found in the presynaptic space
E. Serotonin is formed from the amino acid tryptophan
287. Spasm of digital vessels in the hands in response to cold (Raynaud’s phenomenon) may be relieved
by
A. Cutting sympathetic nerves to the hand
B. Stimulating parasympathetic nerves to the hand
C. Alpha (α) adrenoceptor blockade
D. Beta (β) adrenoceptor agonists
E. Wearing gloves
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Autonomic Nervous System Physiology
1 B 21 C 41 A 61 B 81 B 101 E 121 E
2 C 22 D 42 C 62 A 82 B 102 E 122 D
3 E 23 B 43 C 63 D 83 B 103 C 123 D
4 J 24 B 44 A 64 A 84 A 104 B 124 B
5 B 25 D 45 D 65 C 85 B 105 B 125 E
6 E 26 A 46 A, C 66 B 86 A 106 B 126 D
7 B 27 B 47 D 67 B 87 D 107 D 127 D
8 E 28 C 48 A 68 A 88 C 108 E 128 D
9 E 29 D 48 C 69 C 89 D 109 C 129 B
10 A, E 30 B 50 C 70 A 90 A 110 A 130 E
11 A 31 B 51 A 71 C 91 B 111 D 131 B
12 C, D 32 D 52 D 72 B 92 D 112 D 132 C
A, B,
13 33 B 52 D 73 D 93 C 113 D 133 E
C
14 C, E 34 A 54 C 74 B 94 B 114 D 134 E
A, B,
15 35 A 55 A 75 A 95 A 115 E 135 D
D
16 D 36 B 56 D 76 C 96 C 116 E 136 B
17 A, E 37 A 57 B 77 D 97 B 117 D 137 C
18 D, E 38 C 58 B 78 B 98 D 118 A 138 C
B, C,
19 39 B 59 D 79 A 99 C 119 C 139 B
D
20 E 40 A 60 C 80 C 100 C 120 C 140 A
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Autonomic Nervous System Physiology
141 D 161 C 181 D 201 C 221 D 241 C 261 E