Q1

Block 1
The diagram shows an action potential for a skeletal
muscle fiber recorded by an intracellular
microelectrode inserted near the motor end plate.
Which of the following is the threshold potential for
this particular myocyte?

• A. +45 mV
• B. -50 to -60 mV
• C. -60 to -70 mV
• D. -70 to -80 mV
• E. -95 mV
 1
• 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 millimolar NaCl containing
20 millimolar urea, a relatively large but
permeant molecule?
• A) Cells shrink initially, then swell over time
and lyse
• B) Cells shrink transiently and return to their
original volume over time
• C) Cells swell and lyse
• D) Cells swell transiently and return to their
original volume over time
• E) No change in cell volume will occur
• A) Cells shrink initially, then swell over time
and lyse
• B) Cells shrink transiently and return to their
original volume over time X
• C) Cells swell and lyse
• D) Cells swell transiently and return to their
original volume over time
• E) No change in cell volume will occur
The presence of 20 millimolar urea, however,
increases the solution’s osmolarity and makes it
hypertonic relative to the intracellular solution.
Water will initially move out of the cell, but
because the plasma membrane is permeable to
urea, urea will diffuse into the cell and
equilibrate across the plasma membrane. As a
result, water will re-enter the cell, and the cell
will return to its original volume.
 2
What is the calculated osmolarity of a solution
containing 12 millimolar NaCl, 4 millimolar KCl, and 2
millimolar CaCl2 (in mOsm/L)?
• A) 16
• B) 26
• C) 29
• D) 32
• E) 38
• F) 42
 2
What is the calculated osmolarity of a solution
containing 12 millimolar NaCl, 4 millimolar KCl, and 2
millimolar CaCl2 (in mOsm/L)?
• A) 16
• B) 26
• C) 29
• D) 32
• E) 38 X
• F) 42
 3
Simple diffusion and facilitated diffusion share
which of the following characteristics?
A) Can be blocked by specific inhibitors
B) Do not require adenosine triphosphate (ATP)
C) Require transport protein
D) Saturation kinetics
E) Transport solute against concentration
gradient
 3
Simple diffusion and facilitated diffusion share
which of the following characteristics? A) Can be
blocked by specific inhibitors
• B) Do not require adenosine triphosphate (ATP)
X
• C) Require transport protein
• D) Saturation kinetics
• E) Transport solute against concentration
gradient
• In contrast to primary and secondary active transport,
• neither facilitated diffusion nor simple diffusion
• requires additional energy and, therefore, can work in
• the absence of ATP. Only facilitated diffusion displays
• saturation kinetics and involves a carrier protein. By
• definition, neither simple nor facilitated diffusion can
• move molecules from low to high concentration.
 4
• 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
 4
• 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 X
• E) Na
• The resting potential of any cell is dependent on the
concentration gradients of the permeant ions and
their relative permeabilities (Goldman equation). In
the myelinated nerve fiber, as in most cells, the
resting membrane is predominantly permeable to K.
• The negative membrane potential observed in most
cells (including nerve cells) is due primarily to the
relatively high intracellular concentration and high
permeability of K.
 5
Which of the following transport mechanisms is
not rate limited by an intrinsic Vmax?
• A) Facilitated diffusion via carrier proteins
• B) Primary active transport via carrier proteins
C) Secondary co-transport
• D) Secondary counter-transport
• E) Simple diffusion through protein channels
 5
• Which of the following transport mechanisms
is not rate limited by an intrinsic Vmax?
• A) Facilitated diffusion via carrier proteins
• B) Primary active transport via carrier proteins
C) Secondary co-transport
• D) Secondary counter-transport
• E) Simple diffusion through protein channels
X
• Facilitated diffusion and both primary and
secondary active transport all involve protein
transporters or carriers that must undergo
some rate-limited conformational change. The
rate of simple diffusion is linear with solute
concentration.
 6
Assuming complete dissociation of all solutes,
which of the following solutions would be
hyperosmotic relative to 1 millimolar NaCl?
• A) 1 millimolar CaCl2
• B) 1 millimolar glucose
• C) 1 millimolar KCl
• D) 1 millimolar sucrose
• E) 1.5 millimolar glucose
 6
Assuming complete dissociation of all solutes,
which of the following solutions would be
hyperosmotic relative to 1 millimolar NaCl?
• A) 1 millimolar CaCl2 X
• B) 1 millimolar glucose
• C) 1 millimolar KCl
• D) 1 millimolar sucrose
• E) 1.5 millimolar glucose
7, 8 and 9
 7
Which of the following is primarily responsible
for the change in membrane potential between
points B and D?
• A) Inhibition of the Na, K-ATPase
• B) Movement of K into the cell
• C) Movement of K out of the cell
• D) Movement of Na into the cell
• E) Movement of Na out of the cell
 8
• Which of the following is primarily responsible
for the change in membrane potential
between points B and D?
• A) Inhibition of the Na, K-ATPase
• B) Movement of K into the cell
• C) Movement of K out of the cell
• D) Movement of Na into the cell X
• E) Movement of Na out of the cell
 9
• Which of the following is primarily responsible
for the change in membrane potential
between points D and E?
• A) Inhibition of the Na, K-ATPase
• B) Movement of K into the cell
• C) Movement of K out of the cell
• D) Movement of Na into the cell
• E) Movement of Na out of the cell
 9
• Which of the following is primarily responsible
for the change in membrane potential
between points D and E?
• A) Inhibition of the Na, K-ATPase
• B) Movement of K+ into the cell
• C) Movement of K+ out of the cell X
• D) Movement of Na into the cell
• E) Movement of Na out of the cell
10-12
 10
Trace A 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
 10
Trace A 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 X
 11
• 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
• 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
 11
• 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 X
• 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
 12
• A 37-year-old woman presents with severe migraine
headaches that are accompanied by hemiparalysis. Genetic
analysis confirms the suspicion of an inherited
channelopathy. The membrane potential will depolarize by
the greatest amount if the membrane permeability increases
for which of the following ions?
• a. Chloride
• b. Potassium
• c. Sodium
• d. Chloride and potassium
• e. Sodium and potassium
 12
• A 37-year-old woman presents with severe migraine
headaches that are accompanied by hemiparalysis. Genetic
analysis confirms the suspicion of an inherited
channelopathy. The membrane potential will depolarize by
the greatest amount if the membrane permeability increases
for which of the following ions?
• a. Chloride
• b. Potassium
• c. Sodium x
• d. Chloride and potassium
• e. Sodium and potassium
 13
• A 52-year-old man presents at the oral surgeon’s office with
an abscessed tooth. Prior to surgery to extract the tooth,
the patient is given a shot of procaine.
• Preventing the inactivation of sodium channels by local
anesthetics will decrease which of the following?
• a. Downstroke velocity of nerve cell action potentials
• b. Duration of nerve cell action potentials
• c. Magnitude of the overshoot in nerve cell action potentials
• d. Relative refractory period of nerve cells
• e. Upstroke velocity of nerve cell action potentials
 13
• A 52-year-old man presents at the oral surgeon’s office
with an abscessed tooth. Prior to surgery to extract the
tooth, the patient is given a shot of procaine.
• Preventing the inactivation of sodium channels by local
anesthetics will decrease which of the following?
• a. Downstroke velocity of nerve cell action potentials x
• b. Duration of nerve cell action potentials
• c. Magnitude of the overshoot in nerve cell action
potentials
• d. Relative refractory period of nerve cells
• e. Upstroke velocity of nerve cell action potentials
The repolarization phase of the action potential is produced by a
decrease in Na+ conductance caused by the inactivation of Na+
channels, and the increase in K+ conductance due to the
activation of K+ channels. Preventing the inactivation of Na+
channels will decrease the downstroke velocity of the action
potential. This will slow down the normal repolarization phase of
the action potential and thereby prolong the duration of the
action potential. The relative refractory period is prolonged
because of the prolonged duration of the action potential. The
upstroke velocity and the magnitude depend on how rapidly and
how long the sodium channels are opened. By preventing
inactivation of the Na+ channel, the rate of the upstroke and the
magnitude of the overshoot may be increased.
 14
A 58-year-old man with a history of hypertension and renal disease
presents at his physician’s office with a complaint of headaches. His
blood pressure is 190/115 mm Hg and laboratory results show an
elevated plasma renin activity with hypernatremia. Which of the
following best describes the sodium gradient across the nerve cell
membrane?
• a. It is a result of the Donnan equilibrium
• b. It is maintained by a Na+/Ca2+ exchanger
• c. It is significantly changed during an action potential
• d. It is the primary determinant of the resting membrane potential
• e. It is used as a source of energy for the transport of other ions
 14
A 58-year-old man with a history of hypertension and renal disease
presents at his physician’s office with a complaint of headaches. His
blood pressure is 190/115 mm Hg and laboratory results show an
elevated plasma renin activity with hypernatremia. Which of the
following best describes the sodium gradient across the nerve cell
membrane?
• a. It is a result of the Donnan equilibrium
• b. It is maintained by a Na+/Ca2+ exchanger
• c. It is significantly changed during an action potential
• d. It is the primary determinant of the resting membrane potential
• e. It is used as a source of energy for the transport of other ions
XXX
 15
A 16-year-old, highly allergic girl who is stung by a bee
gives herself a shot of epinephrine prescribed by her
physician. Because epinephrine activates β-adrenergic
receptors, it will relieve the effects of the bee sting by
decreasing which of the following?
• a. Contraction of airway smooth muscle
• b. Rate of depolarization in the SA node
• c. Rate of glycogenolysis in the liver
• d. Strength of ventricular muscle contraction
• e. Transport of calcium into skeletal muscle fibers
 15
A 16-year-old, highly allergic girl who is stung by a bee
gives herself a shot of epinephrine prescribed by her
physician. Because epinephrine activates β-adrenergic
receptors, it will relieve the effects of the bee sting by
decreasing which of the following?
• a. Contraction of airway smooth muscle x
• b. Rate of depolarization in the SA node
• c. Rate of glycogenolysis in the liver
• d. Strength of ventricular muscle contraction
• e. Transport of calcium into skeletal muscle fibers
 16
A 2-day-old infant starts having brief tonic–clonic seizures throughout the day.
His neurological function in between seizures is normal, and he has no other
medical or neurological problems. The history reveals no readily apparent causes
for the seizures, though the mother recalled that her first baby also developed
seizures shortly after birth that only lasted for 2 weeks, with no subsequent
episodes or developmental problems. Genetic analysis revealed a mutation of
voltage-gated K+ channels consistent with a diagnosis of benign familial neonatal
seizures. Which of the following would cause an immediate reduction in the
amount of potassium leaking out of a cell?

• a. Decreasing the extracellular potassium concentration

• b. Decreasing the extracellular sodium concentration
• c. Hyperpolarizing the membrane potential
• d. Increasing the permeability of the membrane to potassium
• e. Reducing the activity of the sodium–potassium pump
 16
A 2-day-old infant starts having brief tonic–clonic seizures throughout the
day. His neurological function in between seizures is normal, and he has no
other medical or neurological problems. The history reveals no readily
apparent causes for the seizures, though the mother recalled that her first
baby also developed seizures shortly after birth that only lasted for 2 weeks,
with no subsequent episodes or developmental problems. Genetic analysis
revealed a mutation of voltage-gated K+ channels consistent with a diagnosis
of benign familial neonatal seizures. Which of the following would cause an
immediate reduction in the amount of potassium leaking out of a cell?
• a. Decreasing the extracellular potassium concentration
• b. Decreasing the extracellular sodium concentration
• c. Hyperpolarizing the membrane potential xxx
• d. Increasing the permeability of the membrane to potassium
• e. Reducing the activity of the sodium–potassium pump
 17
A 23-year-old man is brought to the emergency department after
collapsing during basketball practice. On admission, he is
lethargic and appears confused. His coach reports that it was hot
in the gym and he was drinking a lot of water during practice. An
increase in which of the following is the most likely cause of his
symptoms?

• a. Intracellular tonicity
• b. Extracellular tonicity
• c. Intracellular volume
• d. Extracellular volume
• e. Plasma volume
 17
A 23-year-old man is brought to the emergency department
after collapsing during basketball practice. On admission, he is
lethargic and appears confused. His coach reports that it was
hot in the gym and he was drinking a lot of water during
practice. An increase in which of the following is the most likely
cause of his symptoms?
• a. Intracellular tonicity
• b. Extracellular tonicity
• c. Intracellular volume x
• d. Extracellular volume
• e. Plasma volume
 18
A 49-year-old man in end-stage renal failure is able to
perform peritoneal dialysis at home. The osmolality of the
solution chosen for peritoneal dialysis will determine the
rate of ultrafiltration. 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.
 18
• A 49-year-old man in end-stage renal failure is able to perform
peritoneal dialysis at home. The osmolality of the solution
chosen for peritoneal dialysis will determine the rate of
ultrafiltration. 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 xxx
• e. It is transported across the membrane by a carrier.
19. 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
B. isotonic mannitol
C. hypertonic mannitol
D. hypotonic urea
E. hypertonic urea
The answer is D.
Lysis of the patient's red blood cells (RBCs) was caused by entry of
water and swelling of the cells to the point of rupture. Water
would flow into the RBCs if the extracellular fluid became
hypotonic (had a lower osmotic pressure) relative to the
intracellular fluid. By definition, isotonic solutions do not cause
water to flow into or out of cells because the osmotic pressure is
the same on both sides of the cell membrane.
Hypertonic solutions would cause shrinkage of the RBCs. 150 mM
NaCl and 300 mM mannitol are isotonic. 350 mM mannitol and
150 mM CaCl3 are hypertonic. Because the reflection coefficient
of urea is <1.0, 300 mM urea is hypotonic.
20. During a nerve action potential, a stimulus is delivered
as indicated by the arrow shown in the following figure.
In response to the stimulus, a second action potential

A. of smaller magnitude will occur

B. of normal magnitude will occur
C. of normal magnitude will occur, but will be delayed
D. will occur, but will not have an overshoot stimulus

E. will not occur

20. During a nerve action potential, a stimulus is delivered
as indicated by the arrow shown in the following figure.
In response to the stimulus, a second action potential

A. of smaller magnitude will occur

B. of normal magnitude will occur
C. of normal magnitude will occur, but will be delayed
D. will occur, but will not have an overshoot stimulus

E. will not occur

21. 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
B. Triple
C. Be unchanged
D. Decrease to one-half
E. Decrease to one-third
The answer is B.

Flux is proportional to the concentration difference across the

membrane, J = -PA (CA - CB). Originally, CA - CB = 10 mM - 5 mM
= 5 mM. When the urea concentration was doubled in solution
A, the concentration difference became 20 mM - 5 mM = 15 mM,
or three times the original difference. Therefore, the flux would
also triple. Note that the negative sign preceding the equation is
ignored if the lower concentration is subtracted from the higher
concentration.
A 53-year-old man comes to the physician because of worsening
morning headaches. An MRI of the brain shows an invasive glioma
at the base of the brain. He undergoes surgical resection of the
tumor. However, cranial nerves IX and X are accidentally severed
bilaterally during the procedure. The immediate consequences will
most likely be which of the following findings?

A. Bradycardia with hypertension

B. Bradycardia with hypotension
C. Sinus arrhythmia with hypotension
D. Tachycardia with hypertension
E. Tachycardia with hypotension
During an investigational study, a researcher prepares
anesthetized experimental animals for blood pressure and
electrocardiogram monitoring. The glossopharyngeal
afferent fibers that supply the carotid sinus are isolated
and severed. Which of the following changes are most
likely to be seen in these experimental animals?

A. Hypertension with bradycardia

B. Hypertension with tachycardia
C. Hypotension with bradycardia
D. Hypotension with tachycardia
E. No changes in blood pressure or heart rate
An investigator characterizes a newly synthesized drug.
Previous studies of this drug have shown that it acts by
increasing the activity of postganglionic sympathetic
cholinergic neurons. Which of the following responses
is most likely to be expected upon administration of
this drug to a healthy volunteer?

A. Bradycardia
B. Bronchoconstriction
C. Diaphoresis
D. Increased gastrointestinal motility
E. Increased systemic vascular resistance
During an investigational study, changes in heart rate and blood
pressure with nerve stimulation are studied in experimental
animals. The afferent portions of the glossopharyngeal and vagus
nerves are selectively stimulated. Which of the following
outcomes is most likely to occur during the period of
stimulation?

A. Bradycardia with hypertension

B. Bradycardia with hypotension
C. Hypertension, no change in heart rate
D. Tachycardia with hypertension
E. Tachycardia with hypotension
A 42-year-old female complains of double vision while reading in
the evening. She first noticed the double vision several months
ago, but her symptoms have been getting worse recently. She has
also developed difficulty chewing and therefore avoids eating
tough foods like steak. She does not have any extremity weakness
or sensory complaints.
 Which of the following post-synaptic changes most likely explains
her symptoms?

A. Reduced end-plate potential

B. Reduced action potential amplitude
C. Reduced action potential propagation velocity
D. Prolonged absolute refractory period
E. Impaired excitation-contraction coupling
The correct answer is A. Reduced end-plate potential.