Self Assessment in Physiology
Self Assessment in Physiology
Self Assessment in Physiology
HAEMATOLOGY
1. Normal pH of blood is:
September 2007
a. 7.30
b. 7.20
c. 7.70
d. 7.40
2. Monocytes remains in the circulation for: March 2005
a. 1-3 days
b. 24 hours
c. 12 hours
d. 6 hours
3. Most common Hemoglobin in normal adult is:
March 2005
a. HbA
b. HbF
c. HbS
d. HbA2
4. Carbon di oxide is transported in plasma as:
September 2005
a. Dissolved form
b. Carbamino compounds
c. Bicarbonate
d. All of the above
5. Most useful method of estimating total iron content
of blood:
March 2007
a. Ferritin
b. Transferrin
c. Erythropoietin
d. Lactoferrin
March 2009
March 2009
March 2009
September 2007
March 2008
PHYSIOLOGY
70
CIRCULATORY SYSTEM
25. CVP denotes pressure of:
a. Left ventricle
b. Left atrium
c. Right ventricle
d. Right atrium
September 2005
71
Physiology
March 2005
a. GH
b. TSH
c. FSH
d. GnRH
43. TSH is normal in:
September 2006
a. Hyperthyroid
b. Euthyroid
c. Hypothyroid
d. Graves
44. Which of the following is not related to the calcium
metabolism:
March 2007
a. Calcitonin
b. 1, 25-dihydroxycholecalciferol
c. Vitamin D
d. Thyroxine
45. At what time of the day GH levels are highest:
September 2007
a. 2 hours after sleep
b. 2 hours before sleep
c. Evening
d. Early morning
46. Fasting blood sugar in normal individuals is:
September 2007
a. 80-100 mg/100 ml
b. 100 -120 mg/100 ml
c. 120 -140 mg/100 ml
d. 140-160 mg/100 ml
47. True regarding glucose tolerance test are all except:
September 2007
a. Can be done in fasting as well as post prandial state
b. 1 gram of glucose/kg body weight is administered
c. Glucose levels are checked after 2 hours
d. Diagnosis of diabets mellitus can be established
PHYSIOLOGY
PHYSIOLOGY
72
Physiology
PHYSIOLOGY
73
PHYSIOLOGY
74
GASTROINTESTINAL TRACT
79. Faecal mass is mainly derived from:
March 2005
a. Undigested food
b. Digested food
c. Intestinal secretions
d. intestinal flora
80. Most potent stimulus for bile secretion is:
September 2005
a. Gastrin
b. Bile acid
c. Bile salt
d. Secretin
81. Rapidly absorbed in the stomach is:
September 2006
a. Protein
b. Carbohydrate
c. Fat
d. None
82. Which of the following is not produced by
hepatocytes:
September 2006
a. Gamma globulin
b. Albumin
c. Fibrinogen
d. Prothrombin
83. Urobilinogen is formed in the:
a. Liver
b. Kidney
c. Intestine
d. Spleen
September 2006
Trypsin
Pepsin
Renin
HCl
September 2007
March 2008
September 2006
75
Physiology
Fasciculus gracilis
Anterior spinothalmic tract
Dorsal spinocerebellar tract
Ventral spinocerebellar tract
September 2007
March 2007
September 2007
a.
b.
c.
d.
Dopamine
Acetylcholine
Glutamate
GABA
PHYSIOLOGY
NERVOUS SYSTEM
95. Bipolar cells is seen in:
March 2005
a. Sympathetic ganglion
b. Retina
c. Cochlear ganglion
d. Parasympathetic ganglion
96. All are carried through anterolateral system except:
March 2005
a. Proprioception
b. Temperature
c. Pain
d. Crude touch
97. All or none law is obeyed by:
March 2005
a. Post synaptic potential
b. Non propagated potential
c. Action potential
d. Spike potential
98. Sensory fiber with least conduction velocity:
September 2005
a. C- fiber
b. Alpha fiber
c. beta fiber
d. Gamma fiber
99. All are primary colours except:
September 2005
a. Green
b. Blue
c. Red
d. White
100. True about colour blindness:
September 2005
a. Autosomal dominant inheritance
b. Tritanopia is the commonest disorder
c. Trichromats are unable to appreciate blue colour
d. Defect in 1 or more prime colours
101. True about semicircular canals is:
September 2005
a. Submerged in a fluid called endolymph
b. Base of cupula is in close contact with afferent
fibres of cochlear division of the eight cranial
nerve
c. Arranged at right angles to each other
d. Associated with hearing
PHYSIOLOGY
76
77
Physiology
March 2005
a.
b.
c.
d.
September 2006
Po2 is less
Pco2 is more
In the air, percentage of oxygen is less
Decrease in number of RBCs
September 2007
a.
b.
c.
d.
R-L shunt
LV obstruction
RV obstruction
L-V shunt
September 2008
September 2009
a.
b.
c.
d.
O2
CO
CO2
Bicarbonate ions
PHYSIOLOGY
PHYSIOLOGY
78
b. LH
c. Prolactin
d. TSH
149. Milk ejection is facilitated by:
March 2007
a. Oxytocin
b. Growth hormone
c. FSH
d. LH
150. Separation of first polar body occurs at the time of:
September 2007
a. Fertilization
b. Ovulation
c. Implantation
d. Menstruation
151. All of the following are indicators of ovulation
except:
March 2008
September 2007
a. Fimbrial
b. Isthmus
c. Ampulla
d. Interstitial
153. Sperm becomes mobile in:
March 2008
a. Vas deferens
b. Prostatic urethra
c. Testis
d. Epididymis
154. Asthenospermia means:
September 2005
September 2005
Physiology
c. Chloride
d. Sodium
165. Metabolic acidosis is seen in all except:
September 2005
a. Diabetic ketaacidosis
b. Emphysema
c. Aspirin overdose
d. Uremia
166. Magnitude of action potential is mainly affected by:
September 2005
a. Calcium ion
b. Hydrogen ion
c. Sodium ion
d. Potassium ion
167. Type of exercise done to increase the muscle
strength:
September 2005
a. Aerobic isotonic
b. Isometric
c. Isotonic
d. All of the above
168. Nicotinic receptors are seen in all except:
September 2007
a. Neuromuscular junction
b. Autonomic ganglia of autonomic nervous system
c. Bronchial smooth muscle
d. Brain
169. Normal limit for postprandial (after 2 hours) blood
glucose level (in mg/dL):
March 2008
a. 80-110
b. 110-140
c. 140-170
d. 170-200
170. BMI of underweight individual:
March 2008
a. Less than 18.5
b. 18.5-24.9
c. 25-29.9
d. More than 30
171. Most abundant ion in intracellular fluid is:
September 2008
a. Protein
b. Bicarbonate
c. Potassium
d. Sodium
172. Nearly 20% of normal tensile strength of tissue at
the site of wound is gained after:
September 2008
a. 1 week of wound healing
b. 2 weeks of wound healing
c. 3 weeks of wound healing
d. 4 weeks of wound healing
PHYSIOLOGY
79
PHYSIOLOGY
80
Thiamine
Pyridoxine
Folic acid
Cyanocobalamin
March 2010
Senile
Pre senile
Post adolescent
Post senile
Glycerol
Cholesterol
Cholesterol ester
Triacyl glycerol
Normal pH is 7.35-7.45.
There are a series of buffers which help the plasma resist any change in pH. Some of them include: the hemoglobin in
the red blood cells, other plasma proteins, the bicarbonate buffer and the phosphate buffer.
Ans. D: 7.40
Ref.: Ganongs Physiology 23rd ed.,Page-4
2.
Monocytes enter the circulation from the bone marrow and remains in circulation for about 72 hours.
They then enter the tissues and become tissue macrophages. The tissue macrophages include Kupffer cells of liver,
pulmonary alveolar macrophages and microglia in the brain
Ans. A: 1-3 days
Ref.: Ganongs Physiology 23rd ed.,Page-65
3.
chain synthesis begins late in the third trimester and in adults, it has a normal range of
1.5-3.5%
Hemoglobin A1c is increased in the patients with poorly controlled diabetes mellitus
Ans. A: HbA
Ref.: Ganongs Physiology 23rd ed.,Page-523,526
4.
5.
82
If ferritin is high there is iron in excess, If ferritin is low there is a risk for lack in iron.
Serum ferritin is the most sensitive lab test for iron deficiency anemia.
Ferritin is also used as a marker for iron overload disoreders, such as hemochromatosis and porphyria in which the
ferritin level may be abnormally raised.
PHYSIOLOGY
Ans. A: Ferritin
Ref.: Guytons Physiology 11th ed.,Page-425
6.
Ans. C: VIII
Ref.: Guytons Physiology 11th ed.,Page-862
7.
Sickle haemoglobin (HbS) is a structural variant of haemoglobin in which glutamic acid, an amino acid, at position
No.6 of beta-globin chain of haemoglobin is replaced by valine.
This happens due to change of a nucleotide, adenine to thymine (GAGgGTG) of codon 6 of beta-globin gene. This
substitution of amino acid changes the net charge of haemoglobin, oxygen affinity and three-dimensional structure
thus rendering it as unstable haemoglobin.
Sickle haemoglobin gets polymerized at low oxygen tension and deforms the red blood cell from discoid shape to
sickle like (crescent) form
Ans. B: Glutamtic acid, at position No.6 of beta-globin chain of haemoglobin is replaced by valine
Ref.: Ganongs Physiology 23rd ed.,Page-527
8.
When fully saturated, each gram of normal hemoglobin contains 1.39 mL of oxygen.
But blood normally contains small amount of inactive hemoglobin derivatives, and hence the measured value
becomes 1.34 mL of oxygen.
Ans. B: 1.33 ml O2
Ref.: Ganongs Physiology 23rd ed.,Page-610
9.
Serum has essentially the same composition as that of plasma except that its fibrinogen and clotting factors II,V and
VIII has been removed and it has a higher seroton in content.
Ans. C: Factor VII
Ref.: Ganongs Physiology 23rd ed.,Page-530
10.
11.
As AB blood group doesnt have any circulating agglutinins and can receive any type of blood group without
developing a transfusion reaction due to ABO in compatibility, they are known as universal recipient.
Type O individuals are known as universal donor because they lack A and b antigens
Ans. D: AB
Ref.: Ganongs Physiology 23rd ed.,Page-528
Physiology
12.
83
Factor X can be activated by reactions in either of two systems, an intrinsic and an extrinsic system.
The extrinsic system is triggered by the release of tissue thromboplastin, a proteinphospholipid mixture that
activates factor VII. The tissue thromboplastin and factor VII activate factors IX and X. In the presence of PL, Ca 2+, and
factor V, activated factor X catalyzes the conversion of prothrombin to thrombin.
The extrinsic pathway is inhibited by a tissue factor pathway inhibitor that forms a quaternary structure with TPL,
factor VIIa, and factor Xa.
Ans. B: Thromboplastin
Ref.: Ganongs Physiology 23rd ed.,Page-533
13.
In adults, about 85% of the erythropoietin comes from the kidneys and 15% from the liver. Both these organs contain
the mRNA for erythropoietin. Erythropoietin can also be extracted from the spleen and salivary glands, but these
tissues do not contain the mRNA and consequently do not appear to manufacture the hormone.
When renal mass is reduced in adults by renal disease or nephrectomy, the liver cannot compensate and anemia
develops.
Erythropoietin is produced by interstitial cells in the peritubular capillary bed of the kidneys and by perivenous
hepatocytes in the liver. It is also produced in the brain, where it exerts a protective effect against excitotoxic damage
triggered by hypoxia; and in the uterus and oviducts, where it is induced by estrogen and appears to mediate
estrogen-dependent angiogenesis.
Ans. A: Interstitial cells of kidney
Ref: Ganongs Physiology 23rd ed.,Page-677
15.
The fluid portion of the blood, the plasma contains ions, inorganic molecules, and organic molecules.
The normal plasma volume is about 5% of body weight.
Plasma clots on standing, remaining fluid only if an anticoagulant is added. If whole blood is allowed to clot and the
clot is removed, the remaining fluid is called serum.
Serum has essentially the same composition as plasma except that its fibrinogen and clotting factors II, V, and VIII
have been removed and it has a higher serotonin content because of the breakdown of platelets during clotting.
Ans. D: 5% of Body Weight
Ref.: Ganongs Physiology 23rd ed.,Page-530
PHYSIOLOGY
84
16.
Anticlotting mechanisms:
Antithrombin III is a circulating protease inhibitor that binds to the serine proteases in the coagulation system,
blocking their activity as clotting factors. This binding is facilitated by heparin, a naturally occurring anticoagulant
that is a mixture of sulfated polysaccharides with molecular weights averaging 15,00018,000. The clotting factors that
are inhibited are the active forms of factors IX, X, XI, and XII.
The endothelium of the blood vessels also plays an active role in preventing the extension of clots into blood vessels.
All endothelial cells except those in the cerebral microcirculation produce thrombomodulin, a thrombin-binding protein.
In the circulating blood, thrombin is a procoagulant that activates factors V and VIII, but when it binds to
thrombomodulin, it becomes an anticoagulant in that the thrombomodulinthrombin complex activates protein C .
Activated protein C (APC), along with its cofactor protein S, inactivates factors V and VIII and inactivates an inhibitor
of tissue plasminogen activator, increasing the formation of plasmin
Ans. A: V
Ref.: Ganongs Physiology 23rd ed.,Page-533
17.
The capacity of tissues to regulate their own blood flow is referred to as autoregulation. Most vascular beds have an
PHYSIOLOGY
intrinsic capacity to compensate for moderate changes in perfusion pressure by changes in vascular resistance, so that
blood flow remains relatively constant. This capacity is well developed in the kidneys, but it has also been observed
in the mesentery, skeletal muscle, brain, liver, and myocardium.
i. It is probably due in part to the intrinsic contractile response of smooth muscle to stretch (myogenic theory of
autoregulation)
ii. Vasodilator substances tend to accumulate in active tissues, and these metabolites also contribute to
autoregulation (metabolic theory of autoregulation).
Ans. D: All of the above
Ref.: Ganongs Physiology 23rd ed., Page-563
18.
The membrane skeleton of RBC is made up in part of spectrin and is anchored to the transmembrane protein band 3
by the protein ankyrin. Band 3 is also an important anion exchanger.
The susceptibility of red cells to hemolysis is increased by deficiency of the enzyme glucose 6-phosphate
dehydrogenase (G6PD), which catalyzes the initial step in the oxidation of glucose via the hexose monophosphate
pathway. This pathway generates NADPH, which is needed for the maintenance of normal red cell fragility
Hereditary spherocytosis is caused by abnormalities of the protein network that maintains the shape and flexibility of
the red cell membrane.
Ans. D: All of the above
Ref.: Ganongs Physiology 23rd ed.,Page-525
19.
Bleeding Time (Normal:1-6 min.) is for checking the number of platelets. It is prolonged by lack of platelets.
Clotting time (Normal:6-10 min.) varies widely depending upon the method employed, so discarded nowadays.
Instead measurements of clotting factors are being done.
aPTT/PTT is employed for assessing intrinsic system.
Physiology
85
Prothrombin time (Normal:12 sec.) gives an good indication of concentration of prothrombin in the blood. Extrinsic
pathway is assessed.
Ans. B: PT
Ref.: Guytons Physiology 11th ed.,Page-467
20.
Reticulocytes are immature RBCs, typically composing about 1% of the red cells in the human body.
Like mature red blood cells, reticulocytes do not have a cell nucleus.
They are called reticulocytes because of a reticular (mesh-like) network of ribososmal DNA
When there is an increased production of red blood cells to overcome chronic or severe loss of mature red blood cells,
such as in haemolytic anemia, there is markedly high number and percentage of reticulocytes.
Abnormally low numbers of reticulocytes can be attributed to;
i. Chemotherapy
ii. Aplastic anemia
iii. Pernicious anemia
iv. Bone marrow malignancies
21.
22.
The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT/APTT) is a performance
indicator measuring the efficacy of both the intrinsic (contact activation pathway) and the common coagulation
pathways.
Apart from detecting abnormalities in blood clotting, it is also used to monitor the treatment effects with heparin, a
major anticoagulant.
Ans. D: Henoch Schonlein purpura
Ref.: Harrisons Medicine, 17th ed.,p-718
23.
PHYSIOLOGY
86
Therefore, a temperature range of 20 C to 42 C might be considered clinically relevant. However, the effects of hypoand hyperthermia on platelets and platelet function are not well understood.
It is well recognized that the exposure of platelets to 4 C results in platelet activation. Activation of chilled platelets
(4 C) was observed as a morphological change from the resting discoid state
Ans. A: 20 degree Celsius
Ref.: Bailey & Loves Surgery, 25th ed.,p-21
24.
Transferrin/ siderophilin binds the iron in the lumen of GIT & most of the iron is transported bound to this globulin across the
mucosal brush border
PHYSIOLOGY
Transferrin
They are iron-binding blood plasma glycoproteins that control the level of free iron in biological fluids.
In humans, it is encoded by the TF gene.
Transferrin is a glycoprotein that binds iron very tightly but reversibly.
Although iron bound to transferrin is less than 0.1% (4 mg) of the total body iron, it is the most important iron pool,
with the highest rate of turnover.
Transferrin has a molecular weight of around 80 kDa and contains 2 specific high-affinity Fe (III) binding sites.
The affinity of transferrin for Fe (III) is extremely high but decreases progressively with decreasing pH below
neutrality.
When not bound to iron, it is known as "apo-transferrin"
Ferritin
It is a ubiquitous intracellular protein that stores iron and releases it in a controlled fashion.
The amount of ferritin stored reflects the amount of iron stored.
In humans, it acts as a buffer against iron deficiency and iron overload.
Ferritin is a globular protein complex consisting of 24 protein subunits and is the primary intracellular iron-storage
protein in both prokaryotes and eukaryotes, keeping iron in a soluble and non-toxic form.
Ferritin that is not combined with iron is called apoferritin.
Ans. B: Transferrin
Ref.: Bailey & Loves Surgery, 25th ed.,p-21
CIRCULATORY SYSTEM
25.
Central venous pressure denotes pressure in the great veins at their entrance into the right atrium and averages 4.6
mm Hg.
Pressure in larger veins outside thorax:5.5 mm Hg
Pressure in the venules:12-18 mm Hg
Ans. D: Right atrium
Ref.: Ganongs Physiology,23rd ed.,p-549
26.
Physiology
27.
87
28.
29.
Vitamin K is involved in the carboxylation of certain glutamate residues in proteins to form gamma-carboxyglutamate
residues (abbreviated Gla-residues). The modified residues are often (but not always) situated within specific protein
domains called Gla domains, they play key roles in the regulation of:
1. Blood coagulation: (prothrombin (factor II), factors VII, IX, X, protein C, protein S, and protein Z
Ans. C: VIII
Ref.: Guytons Physiology 11th ed.,Page-862
30.
Pulmonary arterial pressure is generated by the right ventricle ejecting blood into the pulmonary circulation,
which acts as a resistance to the output from the right ventricle. With each ejection of blood during ventricular
systole, the pulmonary artery blood volume increases, which stretches the wall of the artery. As the heart relaxes
(ventricular diastole), blood continues to flow from the pulmonary artery into the pulmonary circulation. The smaller
arteries and arterioles serve as the chief resistance vessels, and through changes in their diameter, regulate pulmonary
vascular resistance.
In hemodynamic terms, the mean pulmonary arterial pressure (PAP) can be described by
PAP = (CO PVR) + PVP
Where CO = cardiac output, PVR = pulmonary vascular resistance, and PVP = pulmonary venous pressure.
The PVP is essentially the same as left atrial pressure. Therefore, increases in CO, PVR or PVP will lead to increases in
PAP. Normally, mean pulmonary artery pressure is about 15 mmHg, and the pulmonary artery systolic and diastolic
pressures about 25 and 10 mmHg, respectively. Pulmonary venous pressure is about 8 mmHg. Therefore, the pressure
gradient driving flow through the pulmonary circulation is rather small at about 7 mmHg (mean pulmonary arterial
minus venous pressures).
Ans. B: 15 mm Hg
Ref.: Ganongs Physiology,23rd ed.,p-592(fig.35-4)
31.
The pressure in the aorta and in the brachial and other large arteries in a young adult human rises to a peak
value (systolic pressure) of about 120 mm Hg during each heart cycle and falls to a minimum value (diastolic pressure)
of about 70 mm Hg. The arterial pressure is conventionally written as systolic pressure over diastolic pressure
e.g., 120/70 mm Hg.
PHYSIOLOGY
88
The pulse pressure, the difference between the systolic and diastolic pressures, is normally about 50 mm Hg.
The mean pressure is the average pressure throughout the cardiac cycle. Because systole is shorter than diastole, the
mean pressure is slightly less than the value halfway between systolic and diastolic pressure. It can actually be
determined only by integrating the area of the pressure curve; however, as an approximation, mean pressure equals
the diastolic pressure plus one third of the pulse pressure.
Ans. A: Diastolic pressure +1/3 (Systolic pressure- diastolic pressure)
Ref.: Ganongs Physiology, 23rd ed.,p-544
32. The pressure inside the left ventricle is slightly higher than in the aorta during systole and hence blood flow in the
vessels supplying the subendocardial portion of left ventricle occurs during diastole. On the other hand, the
pressure difference between the right ventricle and aorta and the differential between the aorta and the right atria are
somewhat greater during systole than during diastole so blood flow in these parts of the heart is not appreciably
reduced during systole.
PHYSIOLOGY
Ans. B: Diastole
Ref.: Ganongs Physiology, 23rd ed.,p-578
33.
The close relationship between coronary blood flow and myocardial O 2 consumption indicates that one or more of the
products of metabolism cause coronary vasodilation. Factors suspected of playing this role include:
i. O2 lack and increased local concentrations of CO2
ii. H+,
iii. K+,
iv. Lactate,
v. Prostaglandins,
vi. Adenine nucleotides, and
vii. Adenosine.
Asphyxia, hypoxia, and intracoronary injections of cyanide all increase coronary blood flow 200300% in denervated
as well as intact hearts, and the feature common to these three stimuli is hypoxia of the myocardial fibers.
A similar increase in flow is produced in the area supplied by a coronary artery if the artery is occluded and then
released. This reactive hyperemia is similar to that seen in the skin. Evidence suggests that in the heart it is due to
release of adenosine.
Ans. A: Adenosine
Ref.: Ganongs Physiology, 23rd ed.,p-579,580
34.
Conduction rate is 4 m/s in purkinje fibers whereas it is 1 m/s in ventricular muscles, atrial pathways and Bundle of
His.
SA Node and AV Node has a conduction speed of 0.05 m/s
Ans. C: Have conduction velocity of four times than that of the heart muscle
Ref.: Ganongs Physiology, 23rd ed.,p-492
Physiology
35.
89
Ans. D: X wave
Ref.: Ganongs Physiology, 23rd ed.,p-512
36.
Hypocalcemia causes prolongation of the ST segment and consequently of the QT interval, a change that is also
produced by phenothiazines and tricyclic antidepressant drugs and by various diseases of the central nervous system.
Increases in extracellular Ca2+ concentration enhance myocardial contractility. When large amounts of Ca 2+ are infused
into experimental animals, the heart relaxes less during diastole and eventually stops in systole (calcium rigor).
However, in clinical conditions associated with hypercalcemia, the plasma calcium level is rarely if ever high enough
to affect the heart.
Ans. B: Prolongation of ST segment
Ref.: Ganongs Physiology, 23rd ed.,p-504
37.
Acute pulmonary edema is defined as the sudden increase in pulmonary capillary pressure (usually more than 20 mm Hg)
as a result of acute and fulminant left ventricular failure.
Patient appears extremely ill, poorly perfused, restless, sweaty, with an increased work of breathing and using respiratory
accessory muscles, tachypneic, tachycardic, hypoxic and coughing with frothy sputum that on occasion is blood tinged.
Patients with noncardiogenic pulmonary edema have a warm periphery, a bounding pulse, and an absence of S-3
gallop and jugular venous distention.
Differentiation is often made based on PCWP measurements from invasive hemodynamic monitoring.
PCWP is generally more than 20 mm Hg in HF and is less than 20 mm Hg in noncardiogenic pulmonary edema.
Ans. D: 20 mm Hg
Ref.: Ganongs Physiology, 23rd ed.,p-602
PHYSIOLOGY
Atrial pressure rises during atrial systole and continues to rise during isovolumetric ventricular contraction when the
AV valves bulge into the atria. When the AV valves are pulled down by the contracting ventricular muscle, pressure
falls rapidly and then rises as blood flows into the atria until the AV valves open early in diastole.
The return of the AV valves to their relaxed position also contributes to this pressure rise by reducing atrial capacity.
The atrial pressure changes are transmitted to the great veins, producing three characteristic positive waves in the
record of jugular pressure.
The a wave is due to atrial systole. As noted above, some blood regurgitates into the great veins when the atria
contract, even though the orifices of the great veins are constricted. In addition, venous inflow stops, and the resultant
rise in venous pressure contributes to the a wave.
The c wave is the transmitted manifestation of the rise in atrial pressure produced by the bulging of the tricuspid valve
into the atria during isovolumetric ventricular contraction.
The v wave mirrors the rise in atrial pressure before the tricuspid valve opens during diastole.
Venous pressure falls during inspiration as a result of the increased negative intrathoracic pressure and rises again
during expiration.
Careful bedside inspection of the pulsations of the jugular veins may give clinical information of some importance. For
example
i. in tricuspid insufficiency there is a giant c wave with each ventricular systole.
ii. In complete heart block, when the atria and ventricles are beating at different rates, the a waves that are not
synchronous with the radial pulse can be made out, and there is a giant a wave (cannon wave) whenever the
atria contract while the tricuspid valve is closed.
90
38.
When a small blood vessel is transected or damaged, the injury initiates a series of events that lead to the formation of a clot. This
seals off the damaged region & prevents further blood loss.
The initial event is constriction of the vessel
Physiological response to hemorrhage
It is a three-part process. The principal features are:
Rapidly responding neural and humoral mechanisms direct available blood flow toward vital organs.
More slowly evolving salt and water retention by the kidneys replaces the lost plasma.
Erythropoiesis gradually replaces the lost red blood cells.
Acute response to hemorrhage
The acute response includes a primary decrease in cardiac output, a secondary decrease in arterial pressure and
compensatory increases in heart rate and vascular resistance.
Autonomic involvement
Increased heart rate and peripheral vasoconstriction signal the autonomic nervous system's participation in the
acute response to hemorrhage.
Autonomic dysfunction decreases the body's tolerance to blood loss.
PHYSIOLOGY
Selective vasoconstriction
Sympathetic vasoconstriction during hemorrhage is selective.
Many organs show intense vasoconstriction, while the cerebral and coronary circulations show little response to
increased sympathetic outflow.
The benefit of selectivity is that available blood flow, as meager as it may be, is preferentially directed to the brain
and heart -- the vital organs.
Support from Renin-Angiotensin system
The renin-angiotensin system supports arterial pressure in hemorrhage by constricting nonvital organs.
This response is slower than the response of the sympathetic nervous system, but it is still an important part of the
acute circulatory response to hemorrhage.
Salt and water retention
After hemorrhage, with no intervention, salt and water retention over several days will increase blood volume to
normal or above.
Erythrocytes are replaced much more slowly
Ans. A: Vasoconstriction
Ref.: Ganongs Physiology, 23rd ed., p-531
39.
Physiology
91
Where LVEDP = Left ventricular end diastolic pressure, LVEDR = Left ventricular end diastolic radius (at the
ventricle's midpoint), and h = thickness of the ventricle.
This calculation is based on the Law of Laplace.
Preload is affected by venous blood pressure and the rate of venous return.
These are affected by venous tone and volume of circulating blood.
Preload is related to the ventricular end-diastolic volume; a higher end-diastolic volume implies a higher preload.
Preload increases with exercise (slightly), increasing blood volume (over transfusion, polycythemia) and
neuroendocrine excitement (sympathetic tone).
An arteriovenous fistula can increase preload
Preload best describes the maximum viscous blood volume of end diastole while afterload better describes the
maximum tension of the myocardial muscle mass in end systole.
Ans. B: Rest
Ref.: AK Jains Physiology/I, 4th ed., p-180; Ganongs Physiology, 23rd ed., p-515
40.
Maximum coronary blood flow occurs during the phase of isovolumetric ventricular relaxation phase
Isovolumetric/ isometric relaxation time/ IVRT
An interval in the cardiac cycle, from the aortic component of the second heart sound, that is, closure of the aortic
valve, to onset of filling by opening of the mitral valve.
Ventricular pressure decreases to zero rapidly while aortic pressure decreases only to 80 mm Hg i.e. it remains
fairly high.
Therefore, intra myocardial compression of blood vessels is minimal & perfusion pressure is maintained fairly high.
So coronary blood flow rises sharply
Maximum coronary blood flow occurs during this phase
It can be used as an indicator of diastolic dysfunction.
Prolonged IVRT indicates poor myocardial relaxation.
A normal IVRT is about 70 12 ms, and approximately 10ms longer in people over forty years.
In abnormal relaxation, IVRT is usually in excess of 110ms.
With restrictive ventricular filling, it is usually under 60 ms
Ans. A: Isovolumic relaxation phase
Ref.: Guytons Physiology, 12th ed., p-106, 246; AK Jains Physiology/I, 4 th ed., p-371t
PHYSIOLOGY
Afterload
It is the tension or stress developed in the wall of the left ventricle during ejection.
Following Laplace's law, the tension upon the muscle fibers in the heart wall is the product of the pressure within
the ventricle, multiplied by the volume within the ventricle, divided by the wall thickness.
Therefore, a dilated left ventricle has a higher afterload.
Conversely, a hypertrophied left ventricle has a lower afterload.
When contractility becomes impaired and the ventricle dilates, the afterload rises and limits output.
This may start a vicious circle, in which cardiac output is reduced as oxygen requirements are increased.
Afterload can also be described as the pressure that the chambers of the heart must generate in order to eject blood
out of the heart and thus is a consequence of the aortic pressure (for the left ventricle) and pulmonic pressure or
pulmonary artery pressure (for the right ventricle).
The pressure in the ventricles must be greater than the systemic and pulmonary pressure to open the aortic and
pulmonic valves, respectively.
As afterload increases, cardiac output decreases.
92
41.
Isovolumetric ventricular relaxation phase begins after the closure of semilunar valves (aortic & pulmonary valves)
Cardiac Diastole
It is the period of time when the heart relaxes after contraction in preparation for refilling with circulating blood.
During ventricular diastole, the pressure in the (left and right) ventricles drops from the peak that it reaches in
systole.
When the pressure in the left ventricle drops to below the pressure in the left atrium, the mitral valve opens, and
the left ventricle fills with blood that was accumulating in the left atrium.
The isovolumic relaxation time (IVRT) is the interval from the aortic component of the second heart sound, that
is, closure of the aortic valve, to onset of filling by opening of the mitral valve.
Likewise, when the pressure in the right ventricle drops below that in the right atrium, the tricuspid valve opens,
and the right ventricle fills with blood that was accumulating in the right atrium.
During diastole the pressure within the right ventricle is lower than that in aorta, allowing blood to circulate in the
heart itself via the coronary arteries.
PHYSIOLOGY
43.
In hyperthyroidism:
i. Total plasma T3, T4, RT3 is high
ii. Free plasma T3, T4, RT3 is high
iii. Plasma TSH is low
In hypothyroidism:
i. Total plasma T3, T4, RT3 is low
ii. Free plasma T3, T4, RT3 is low
iii. Plasma TSH is high
Graves disease is most common cause of hyperthyroidism.
Ans. B: Euthyroid
Ref.: Ganongs Physiology,23rd ed.,p-306
44.
Two hormones serve as primary regulators of the calcium in blood: parathyroid hormone and calcitonin.
Parathyroid hormone stimulates bones to release calcium into blood, digestive tract to absorb more calcium and
kidneys to excrete less calcium and activate more vitamin D.
Calcitonin slows the release of calcium from bones (inhibits resorption)
Physiology
93
FBS in early morning is normally 80-90 mg/100 ml and 110 mg/100ml is considered to be the upper limit of normal.
Ans. A: 80-100 mg/100 ml
Ref.: Guytons Physiology, 11th ed.,p-975
47.
48.
In oral glucose tolerance test, time taken for blood glucose level to fall back to control value is more important.
Blood glucose values return back to below normal in non diabetics in about 2 hours whereas blood glucose in diabetics
fall back to control only after 4-6 hours and it fails to fall below the control level.
Control level is the value before the test was undertaken
Ans. B: Fasting blood sugar value more than 200 mg/100ml
Ref.: Guytons Physiology, 11th ed.,p-975
PHYSIOLOGY
45.
94
49.
Ans. C: Calcitonin
Ref.: Ganongs Physiology, 23rd ed.,p-370
50.
Prolactin causes milk secretion from the breast after estrogen and progesterone priming. Its effect on the breast
involves increased action of mRNA and increased production of casein and lactalbumin.
Prolactin also inhibits the effects of gonadotropins, possibly by an action at the level of the ovary.
The function of prolactin in normal males is unsettled, but excess prolactin secreted by tumors causes impotence.
Remember oxytocin causes Ejection of milk.
Ans. D: Prolactin
Ref.: Ganongs Physiology, 23rd ed.,p-401
PHYSIOLOGY
51.
Trace elements are defined as elements found in tissues in minute amounts. These are believed to be essential for life.
In humans:
i. Iron deficiency causes anemia
ii. Cobalt is part of the vitamin B12 molecule, and vitamin B12 deficiency leads to megaloblastic anemia
iii. Iodine deficiency causes thyroid disorders
iv. Zinc deficiency causes skin ulcers, depressed immune responses, and hypogonadal dwarfism.
v. Copper deficiency causes anemia and changes in ossification.
vi. Chromium deficiency causes insulin resistance.
vii. Fluorine deficiency increases the incidence of dental caries.
Ans. B: Zinc
Ref.: Ganongs Physiology, 23rd ed.,p-464
52.
When plasma glucose is episodically elevated over time, small amounts of hemoglobin A are nonenzymatically
glycated to form HbAIc
Careful control of the diabetes with insulin reduces the amount formed and consequently HbA Ic concentration is
measured clinically as an integrated index of diabetic control for the 4- to 6-week period before the measurement.
Ans. D: HbA1c
Ref.: Ganongs Physiology,23rd ed.,p-323
53.
54.
Primary adrenal insufficiency due to disease processes that destroy the adrenal cortex is called Addisons disease.
The condition used to be a relatively common complication of tuberculosis, and now it is usually due to autoimmune
inflammation of the adrenal.
Patients lose weight, are tired, and become chronically hypotensive. They have small hearts, probably because the
hypotension decreases the work of the heart. Eventually they develop severe hypotension and shock (addisonian crisis).
Physiology
95
This is due not only to mineralocorticoid deficiency but to glucocorticoid deficiency as well. Fasting causes fatal
hypoglycemia, and any stress causes collapse. Water is retained, and there is always the danger of water intoxication.
Circulating ACTH levels are elevated. The diffuse tanning of the skin and the spotty pigmentation characteristic of
chronic glucocorticoid deficiency are due, at least in part, to the MSH activity of the ACTH in the blood. Minor
menstrual abnormalities occur in women, but the deficiency of adrenal sex hormones usually has little effect in the
presence of normal testes or ovaries.
Secondary adrenal insufficiency is caused by pituitary diseases that decrease ACTH secretion, and tertiary adrenal
insufficiency is caused by hypothalamic disorders disrupting CRH secretion. Both are usually milder than primary
adrenal insufficiency because electrolyte metabolism is affected to a lesser degree. In addition, there is no
pigmentation because in both of these conditions, plasma ACTH is low, not high.
Ans. C: Cortisol
Ref.: Ganongs Physiology,23rd ed.,p-360
55.
Ans. B: Glucose load in fasting state, measurement of blood glucose after 2 hours
Ref.: Guytons Physiology,11th ed.,p-975
56.
Free glucocorticoids inhibit ACTH secretion, and the degree of pituitary inhibition is proportionate to the circulating
glucocorticoid level. The inhibitory effect is exerted at both the pituitary and the hypothalamic levels. The inhibition is
due primarily to an action on DNA, and maximal inhibition takes several hours to develop, although more rapid fast
feedback also occurs. The ACTH-inhibiting activity of the various steroids parallels their glucocorticoid potency.
A drop in resting corticoid levels stimulates ACTH secretion, and in chronic adrenal insufficiency the rate of ACTH
synthesis and secretion is markedly increased.
Thus, the rate of ACTH secretion is determined by two opposing forces: the sum of the neural and possibly other
stimuli converging through the hypothalamus to increase ACTH secretion, and the magnitude of the braking action of
glucocorticoids on ACTH secretion, which is proportionate to their level in the circulating blood
Ans. B: ACTH
Ref.: Ganongs Physiology,23rd ed.,p-354
57.
Hyperthyroidism is characterized by nervousness; weight loss; hyperphagia; heat intolerance; increased pulse
pressure; a fine tremor of the outstretched fingers; a warm, soft skin; sweating; and a BMR from +10 to as high as +100.
It has various causes. However, the most common cause is Graves disease (Graves hyperthyroidism), which
accounts for 6080% of the cases. The condition, which for unknown reasons is much more common in women, is an
autoimmune disease in which antibodies to the TSH receptor stimulate the receptor. This produces marked T4 and T3
secretion and enlargement of the thyroid gland (goiter). However, due to the feedback effects of T 4 and T3, plasma
TSH is low, not high.
PHYSIOLOGY
In diabetes, glucose piles up in the bloodstream, especially after meals. If a glucose load is given to a diabetic, the
plasma glucose rises higher and returns to the baseline more slowly than it does in normal individuals. The response
to a standard oral test dose of glucose, the oral glucose tolerance test, is used in the clinical diagnosis of diabetes
Impaired glucose tolerance in diabetes is due in part to reduced entry of glucose into cells (decreased peripheral
utilization). In the absence of insulin, the entry of glucose into skeletal, cardiac, and smooth muscle and other tissues
is decreased.
Glucose uptake by the liver is also reduced, but the effect is indirect.
Intestinal absorption of glucose is unaffected, as is its reabsorption from the urine by the cells of the proximal tubules
of the kidneys. Glucose uptake by most of the brain and the red blood cells is also normal.
96
Another hallmark of Graves disease is the occurrence of swelling of tissues in the orbits, producing protrusion of the
eyeballs (exophthalmos). This occurs in 50% of patients and often precedes the development of obvious
hyperthyroidism.
Ans. D: Graves disease
Ref.: Guytons Physiology,11th ed.,p-941
58.
PTH is essential for life. After parathyroidectomy, there is a steady decline in the plasma Ca 2+ level. Signs of
neuromuscular hyperexcitability appear, followed by full-blown hypocalcemic tetany.
In humans, tetany is most often due to inadvertent parathyroidectomy during thyroid surgery. Symptoms usually
develop 23 days postoperatively but may not appear for several weeks or more. Injections of PTH correct the
chemical abnormalities, and the symptoms disappear. Injections of Ca2+ salts give temporary relief.
The signs of tetany in humans include Chvosteks sign, a quick contraction of the ipsilateral facial muscles elicited
by tapping over the facial nerve at the angle of the jaw; and Trousseaus sign, a spasm of the muscles of the upper
extremity that causes flexion of the wrist and thumb with extension of the fingers
PHYSIOLOGY
Features of hypocalcemia:
i. Petechia which appear as one-off spots, then later become rashes.
ii. Perioral tingling and paraesthesia, 'pins and needles' sensation over the extremities of hands and feet. This is the
earliest symptom of hypocalcaemia.
iii. Tetany, carpopedal spasm are seen.
iv. Trousseau sign of latent tetany (eliciting carpal spasm by inflating the blood pressure cuff and maintaining the cuff
pressure above systolic)
v. Chvosteks sign (tapping of the inferior portion of the zygoma will produce facial spasms)
vi. Tendon reflexes are hyperactive
vii. Life threatening complications
a. Laryngospasm
b. Cardiac arrythmias
viii. ECG changes include:
a. Prolonged QT interval
b. Prolonged ST interval
Ans. D: Tetany
Ref.: Ganongs Physiology, 22nd ed.,p-382
60.
Endocrine mechanisms which causes heat production (thermogenesis) are epinephrine, norepinephrine & thyroxine
Thermoregulatory response activated by exposure to cold (via posterior hypothalamus)
Increased heat production
o Shivering
o Hunger
o Increased voluntary activity
o Increased TSH secretion
o Increased catecholamines
Physiology
97
Most of the stressful stimuli that increase ACTH secretion also activate the sympathetic nervous system
Alpha adrenergic stimulators (epinephrine & norepinephrine) inhibits insulin secretion
The condition in which sympathetic nervous system, including the sympatho-adrenal medullary system is activated are: fear,
trauma, haemorhhage, fluid loss etc.
Stressful stimuli stimulates secretion of growth hormone in humans
Stress hormones
Stress hormones rise in the body during any neuroendocrine reaction such as surgery and they remain high as
long as 72 hours, after which all these hormones return to their normal level, the last being cortisol.
Stress hormones act by mobilizing energy from storage to muscles, increasing heart rate, blood pressure and
breathing rate and shutting down metabolic processes such as digestion, reproduction, growth and immunity.
PHYSIOLOGY
61.
98
EXCRETORY SYSTEM
62.
63.
The descending part of the thin segment of the loop of Henle is highly permeable to water and moderately permeable
to most solutes and little or no active reabsorption.
The thick ascending limb of the loop of Henle reabsorbs about 25% of the filtered loads of sodium, chloride and
potassium as well as large amount of calcium, bicarbonate and magnesium. It also secretes hydrogen ions into the
tubular lumen
PHYSIOLOGY
Ans. B: Urea
Ref.: Guytons Physiology, 11th ed.,p-334
64.
Normally about 65% of the filtered load of sodium and water, essentially all the filtered glucose and amino acids and
a slightly lower percentage of filtered chloride are reabsorbed by the proximal tubule.
The proximal tubules also secrete organic acids, bases and hydrogen ions into the tubular lumen.
Ans. A: PCT
Ref.: Guytons Physiology,11th ed.,p-333
65.
Physiology
66.
99
67.
Water reabsorption keeps pace with the sodium reabsorption in the proximal tubules and hence the concentration
of sodium and total osmolarity remains the same.
Ans. B: Bulk of water reabsorption occurs secondary to sodium absorption
Ref.: Guytons Physiology, 11th ed.,p-334
68.
Because one of its principal physiologic effects is the retention of water by the kidney, vasopressin is often called the
antidiuretic hormone (ADH).
It increases the permeability of the collecting ducts of the kidney, so that water enters the hypertonic interstitium of
The urine becomes concentrated, and its volume decreases. The overall effect is therefore retention of water in excess
of solute; consequently, the effective osmotic pressure of the body fluids is decreased. In the absence of vasopressin,
the urine is hypotonic to plasma, urine volume is increased, and there is a net water loss. Consequently, the osmolality
of the body fluid rises.
Ans. D: Collecting ducts
Ref.: Guytons Physiology,11th ed.,p-350
69.
70.
71.
Normally about 65% of the filtered load of sodium and water, essentially all the filtered glucose and amino acids
and a slightly lower percentage of filtered chloride are reabsorbed by the proximal tubule.
PHYSIOLOGY
100
The proximal tubules also secretes organic acids, bases and hydrogen ions into the tubular lumen.
Ans. D: Hydrogen ions
Ref.: Guytons Physiology,11th ed.,p-333
72.
Glucose, amino acids, and bicarbonate are reabsorbed along with Na + in the early portion of the proximal tubule.
Farther along the tubule, Na+ is reabsorbed with Cl. Glucose is typical of substances removed from the urine by
secondary active transport. It is filtered at a rate of approximately 100 mg/min (80 mg/dL of plasma x 125 mL/min).
Essentially all of the glucose is reabsorbed, and no more than a few milligrams appear in the urine per 24 hours.
Ans. A: PCT
Ref.: Guytons Physiology,11th ed.,p-333
PHYSIOLOGY
73.
Angiotensin II acts at the PCT,Thick ascending loop of Henle/distal tubule, collecting tubule and leads to
increased absorption of NaCl and water and increased H+ secretion.
ADH, Aldosterone and ANP acts at the collecting tubule and duct
Ans. D: Angiotensin II
Ref.: Guytons Physiology,11th ed.,p-342
74.
ANP act on the collecting tubule and duct to increase Na+ excretion.
It produce this effect by dilating afferent arterioles and relaxing mesangial cells. Both of these actions increase
glomerular filtration. In addition, it act on the renal tubules to inhibit Na + reabsorption. Other actions include an
increase in capillary permeability, leading to extravasation of fluid and a decline in blood pressure. In addition, it relax
vascular smooth muscle in arterioles and venules. These peptides also inhibit renin secretion and counteract the
pressor effects of catecholamines and angiotensin II.
In the brain, ANP is present in neurons, and an ANP-containing neural pathway projects from the anteromedial part
of the hypothalamus to the areas in the lower brainstem that are concerned with neural regulation of the
cardiovascular system. In general, the effects of ANP in the brain are opposite to those of angiotensin II, and ANPcontaining neural circuits appear to be involved in lowering blood pressure and promoting natriuresis.
Ans. C: Collecting tubule
Ref.: Guytons Physiology,11th ed.,p-342
75.
Ans. B: Hypotension
Ref.: Guytons Physiology,11th ed.,p-318
76.
i. The descending limb of the loop of Henle is permeable to H2O, so H2O diffuses out into the surrounding fluids.
Because the loop is impermeable to Na+ and Cl and because these ions are not pumped out by active transport,
Na+ and Cl remain inside the loop.
ii. As the fluid continues to travel down the descending limb of the loop, it becomes more and more concentrated, as
water continues to diffuse out. Maximum concentration occurs at the bottom of the loop.
iii. The ascending limb of the loop of Henle is impermeable to water, but Na + and Cl are pumped out into the
surrounding fluids by active transport.
iv. As fluid travels up the ascending limb, it becomes less and less concentrated because Na + and Cl are pumped
out. At the top of the ascending limb, the fluid is only slightly less concentrated than at the top of the descending
Physiology
101
limb. In other words, there is little change in the concentration of the fluid in the tubule as a result of traversing
the loop of Henle.
v. In the fluid surrounding the loop of Henle, however, a gradient of salt (Na +, Cl) is established, increasing in
concentration from the top to the bottom of the loop.
vi. Fluid at the top of the collecting duct has a concentration of salts about equal to that at the beginning of the loop
of Henle (some water is reabsorbed in the DCT).
vi. As the fluid descends the collecting duct, the fluid is exposed to the surrounding salt gradient established by the
loop of Henle.
Two outcomes are possible:
a. If water conservation is necessary, as in contraction of the extra cellular fluid volume, ADH stimulates the
opening of water channels in the collecting duct, allowing H 2O to diffuse out of the duct and into the surrounding
fluids. The result is concentrated urine.
b. If water conservation is not necessary, ADH is not secreted and the duct remains impermeable to H 2O. The result
is dilute urine.
Ans. D: Contraction in extracellular fluid volume
Ref.: Guytons Physiology,10th ed.,p-315
The JGA is composed of JG cells, macula densa cells & mesangial/ Lacis cells
Juxtaglomerular apparatus
There are 3 different types of cells in the Juxtaglomerular Apparatus: Granular Cells/ juxtaglomerular cells,
Macula Densa Cells and Mesangial Cells.
Granular Cells/ juxtaglomerular cells
Granular cells are modified pericytes of glomerular arterioles.
They are also known as Juxtaglomerular cells.
The Juxtaglomerular cells secrete renin in response to:
o Beta1 adrenergic stimulation
o Decrease in renal perfusion pressure (detected directly by the granular cells)
o Decrease in NaCl absorption in the Macula Densa (often due to a decrease in glomerular filtration rate, causing
slower filtrate movement through the proximal tubule and thus more time for reabsorption. This results in a lower
NaCl concentration by the time the filtrate reaches the Macula Densa).
Macula Densa Cells
Macula densa cells are columnar epithelium thickening of the distal tubule.
The macula densa senses sodium chloride concentration in the distal tubule of the kidney and secretes a locally
active (paracrine) vasopressor which acts on the adjacent afferent arteriole to decrease glomerular filtration rate
(GFR), as part of the tubuloglomerular feedback loop.
Specifically, excessive filtration at the glomerulus or inadequate sodium uptake in the proximal tubule / thick
ascending loop of Henle brings fluid to the distal convoluted tubule that has an abnormally high concentration of
sodium.
Na/Cl cotransporters move sodium into the cells of the macula densa.
The macula densa cells do not have enough basolateral Na/K ATPases to excrete this added sodium, so the cell's
osmolarity increases.
Water flows into the cell to bring the osmolarity back down, causing the cell to swell.
When the cell swells, a stretch-activated non-selective anion channel is opened on the basolateral surface.
ATP escapes through this channel and is subsequently converted to adenosine.
Adenosine vasoconstricts the afferent arteriole via A1 receptors and vasodilates (to a lesser degree) efferent
arterioles via A2 receptors which decreases GFR.
PHYSIOLOGY
77.
102
Also, adenosine inhibits renin release in JG cells via A2 receptors on JG cells using Gi pathway.
Also, when macula densa cells detect higher concentrations of Na and Cl they inhibit Nitric Oxide Synthetase
(decreasing renin release).
Mesangial cells/ Lacis cells
Mesangial cells are structural cells in the glomerulus that under normal conditions serve as anchors for the
glomerular capillaries.
The mesangial cells within the glomerulus communicate with mesangial cells outside the glomerulus
(extraglomerular mesangial cells), and it is the latter cells that form part of the juxtaglomerular apparatus.
These cells form a syncytium and are connected with glomerular mesangial cells via gap junctions.
They contain actin and myosin, allowing them to contract when stimulated by renal sympathetic nerves, which
may provide a way for the sympathetic nervous system to modulate the actions of the juxtaglomerular apparatus.
Ans. B: Glomerulus
Ref.: Guytons Physiology,12th ed.,p-320; AK Jains Physiology, 4th ed., p-519, 521
PHYSIOLOGY
REPRODUCTIVE SYSTEM
78.
Aldosterone acts on the principal (P) cells of DCT and collecting tubules
Aldosterone
It increases the reabsorption of sodium ions and water and the secretion of potassium ions in the collecting ducts
and distal convoluted tubule of the kidneys' functional unit, the nephron.
This increases blood volume and, therefore, increases blood pressure.
Drugs that interfere with the secretion or action of aldosterone are in use as antihypertensives.
One example is spironolactone, which lowers blood pressure by blocking the aldosterone receptor.
Aldosterone is part of the renin-angiotensin system.
Aldosterone is a yellow steroid hormone (mineralocorticoid family) produced by the outer-section (zona
glomerulosa) of the adrenal cortex.
The overall effect of aldosterone is to increase reabsorption of ions and water in the kidney.
Its activity is reduced in Addison's disease and increased in Conn's syndrome.
Ans. A: DCT
Ref.: AK Jains Physiology, 4th ed., p-745
GASTROINTESTINAL TRACT
79.
Faeces normally are about 3/4th water and 1/4th solid waste.
Solid water is composed of:
i. About 30% dead bacteria
ii. 30% undigested roughage from the food and dried constituents of digestive juices.
iii. 10-20% fat
iv. 10-20% inorganic matter
v. 2-3% protein
Ans. A: Undigested food
Ref.: Guytons Physiology,11th ed.,p-817
Physiology
80.
103
81.
82.
Urobilinogen is a colourless product of bilirubin reduction. It is formed in the intestines by bacterial action. Some
urobilinogen is reabsorbed, taken up into the circulation and excreted by the kidney. This constitutes the normal
enterohepatic urobilinogen cycle.
Urobilinogen content is determined by a reaction with Ehrlichs reagent, which contains para-Dimethyl amino
benzaldehyde and may be measured in Ehrlich units
Ans. C: Intestine
Ref.: Ganongs Physiology,23rd ed.,p-483
84.
Trypsin is secreted into the duodenum, where it hydrolyses peptides into its smaller building blocks, namely amino
acids.
Trypsin catalyses the hydrolysis of peptide bonds.
Trypsins have an optimal operating pH of about 8.
Trypsins are considered endopeptidases, i.e., the cleavage occurs within the polypeptide chain rather than at the
terminal amino acids located at the ends of polypeptides.
Trypsin is produced in the pancreas in the form of inactive trypsinogen.
It is then secreted into the small intestine, where the enzyme enteropeptidase activates it into trypsin by proteolytic
cleavage. The resulting trypsins themselves activate more trypsinogens (autocatalysis), chymotrypsinogen,
Elastase/proelastase, Carboxypeptidase A and B, Colipase and Phospholipase A2.
Ans. A: Trypsin
Ref.: Ganongs Physiology, 23rd ed., p-437 (table-26-2)
PHYSIOLOGY
The hepatocyte manufactures serum albumin, fibrinogen, and the prothrombin group of clotting factors (except for
Factor 3,4)
It is the main site for the synthesis of lipoproteins, ceruloplasmin, transferrin, complement, and glycoproteins
The liver forms fatty acids from carbohydrates and synthesizes triglycerides from fatty acids and glycerol.
Hepatocytes also synthesize apoproteins
It also synthesizes cholesterol from acetate and further synthesizes bile salts. The liver is the sole site of bile salts formation
Remember the only major class of plasma proteins not synthesized by the liver are the immunoglobulins.
104
85.
Glucose enters cells by facilitated diffusion or, in the intestine and kidneys, by secondary active transport with Na+.
In muscle, fat, and some other tissues, insulin facilitates glucose entry into cells by increasing the number of glucose
transporters in the cell membranes.
The glucose transporters that are responsible for facilitated diffusion of glucose across cell membranes are a family of
closely related proteins that cross the cell membrane 12 times and have their amino and carboxyl terminals inside the
cell. They differ from and have no homology with the sodium-dependent glucose transporters, SGLT 1 and SGLT 2,
responsible for the secondary active transport of glucose out of the intestine, although the SGLTs also have 12
transmembrane domains. Particularly in transmembrane helical segments 3, 5, 7, and 11, the amino acids of the
facilitative transporters appear to surround channels that glucose can enter. Presumably, conformation then changes
and glucose is released inside the cell.
Ans. C: Na+
Ref.: Ganongs Physiology, 23rd ed.,p-453
86.
Fat soluble vitamins (A,D,E,K) are poorly absorbed in the absence of bile/pancreatic lipase.
Malabsorption syndrome includes deficient absorption of amino acids, with marked body wasting and, eventually,
PHYSIOLOGY
hypoproteinemia and edema. Carbohydrate and fat absorption are also depressed. Because of the defective fat
absorption, the fat-soluble vitamins (vitamins A, D, E, and K) are not absorbed in adequate amounts. The amount of
fat and protein in the stools is increased, and the stools become bulky, pale, foul-smelling, and greasy (steatorrhea).
Ans. D: All of the above
Ref.: Ganongs Physiology,23rd ed.,p-458
87.
In each hepatic lobule, the plates of hepatic cells are usually only one cell thick. Large gaps occur between
the endothelial cells, and plasma is in intimate contact with the cells. Hepatic artery blood also enters the sinusoids.
The central veins coalesce to form the hepatic veins, which drain into the inferior vena cava
Numerous macrophages (Kupffer cells) are anchored to the endothelium of the sinusoids and project into the lumen.
Ans. C: Phagocytic cells
Ref.: Ganongs Physiology, 23rd ed.,p-480
88.
In adults, the amount of iron lost from the body is relatively small. The losses are generally unregulated, and total
body stores of iron are regulated by changes in the rate at which it is absorbed from the intestine.
Various dietary factors affect the availability of iron for absorption; for example, the phytic acid found in cereals reacts
with iron to form insoluble compounds in the intestine. So do phosphates and oxalates.
Most of the iron in the diet is in the ferric (Fe3+) form, whereas it is the ferrous (Fe2+) form that is absorbed. Fe3+
reductase activity is associated with the iron transporter in the brush borders of the enterocytes
No more than a trace of iron is absorbed in the stomach, but the gastric secretions dissolve the iron and permit it to
form soluble complexes with ascorbic acid and other substances that aid its reduction to the Fe 2+ form. The importance
of this function in humans is indicated by the fact that iron deficiency anemia is a troublesome and relatively
frequent complication of partial gastrectomy.
Almost all iron absorption occurs in the duodenum. Some is stored in ferritin, and the remainder is transported out
of the enterocytes by a basolateral transporter named ferroportin 1. A protein called hephaestin (Hp) is associated
with ferroportin 1. It is not a transporter itself, but it facilitates basolateral transport.
Physiology
105
In the plasma, Fe2+ is converted to Fe3+and bound to the iron transport protein transferrin. This protein has two ironbinding sites. Normally, transferrin is about 35% saturated with iron.
Intestinal absorption of iron is regulated by three factors: recent dietary intake of iron, the state of the iron stores in the
body, and the state of erythropoiesis in the bone marrow.
Ans. D: Decreases following gastrectomy
Ref.: Ganongs Physiology,23rd ed.,p-459
Ans. A: Active co-transport with sodium
Ref.: Ganongs Physiology,23rd ed.,p-453
90.
91.
Salivary Amylase break large, insoluble starch molecules into soluble starches (amythrodextrin, achrodestrin and
ultimately maltose.
Ptyalin acts on linear alpha (1,4) glycosidic linkages.
Optimum conditions for ptyalin
i.
Optimum pH 5.6 -6.9
ii.
Human body temperature-37 degrees Celsius
iii. Presence of certain anions and activators:
a.
Chlorine and bromine most effective
b.
Iodine less effective
c.
Sulfate and phosphate least effective
Ans. B: Chlorine Ion
Ref: Ganongs Physiology, 23th ed., p-437 (Table 26.2)
92.
Iron-binding proteins are carrier proteins and metalloproteins which play many important roles in metabolism.
They bind Iron and can therefore inhibit microbial growth.
Two iron-binding proteins are lactoferrin and transferrin.
PHYSIOLOGY
89.
106
Some of the iron after absorption is stored in ferritin, and the remainder is transported out of the enterocytes by a
transporter named ferroportin 1. Hephaestin is associated with ferroportin 1.
Ans. C: Transferrin
Ref: Ganongs Physiology, 23th ed., p-459
93.
The strength of the contractions of small intestine is proportional to the frequency of the spike generated by the slow waves
Slow wave amplitude is increased by GIT hormones released during digestion e.g. gastrin, CCK-PZ & motilin; whereas secretin
and glucagons decrease the slow wave amplitude
Intestinal motility
Digestive hormones, cholecystokinin (CCK), gastrin and motilin increase intestinal motility
Secretin decreases the activity.
Serotonin and insulin can increase motility
Glucagon can decrease motility.
PHYSIOLOGY
Secretin
Secretin is synthesized in cytoplasmic secretory granules of S-cells which are found mainly in mucosa of
duodenum and smaller numbers in jejunum of small intestine
Secretin is released into circulation and/or intestinal lumen in response to low duodenal pH.
Also the secretion of secretin is increased by the products of protein digestion bathing the mucosa of the upper
small intestine.
It is the active form of prosecretin.
This acidity is due to hydrochloric acid in the chyme that enters the duodenum from the stomach via the pyloric
sphincter.
Secretin targets the pancreas, which causes the organ to secrete a bicarbonate-rich fluid that flows into the intestine.
Bicarbonate ion is a base that neutralizes the acid, thus establishing a pH favorable to the action of other digestive
enzymes in the small intestine and preventing acid burns.
Other factors are also involved in the release of secretin such as bile salts and fatty acids, which result in additional
bicarbonates being added to the small intestine.
Secretin release is inhibited by H2 receptor antagonists, which reduce gastric acid secretion.
As a result, if the pH in the duodenum increases above 4.5, secretin cannot be released
Secretin increases water and bicarbonate secretion from duodenal Brunner's glands in order to buffer the incoming
protons of the acidic chyme.
It also enhances the effects of cholecystokinin to induce the secretion of digestive enzymes and bile from pancreas
and gallbladder, respectively.
It counteracts blood glucose concentration spikes by triggering increased insulin release from pancreas, following
oral glucose intake.
Although secretin releases gastrin from gastrinomas, it inhibits gastrin release from the normal stomach.
It reduces acid secretion from the stomach by inhibiting gastrin release from G cells.
In addition, secretin stimulates pepsin secretion from chief cells
Ans. D: Secretin
Ref: Ganongs Physiology, 22nd ed., p-480-491; AK Jains Physiology, 4th ed., p-252
94.
Food in the stomach increase gastric acid secretion by stretching the receptors in the wall of the stomach (mechanical stimulus)
The fibers from the receptor enter Meissners plexus (site of ganglion cells of vagus nerve)
Physiology
107
Products of digestion (specially amino acids) in the stomach also stimulates gastric mucosa (chemical stimulus)
Gastric secretion
Gastric acid is produced by parietal cells (also called oxyntic cells) in the stomach. There are three phases in the
secretion of gastric acid:
The cephalic phase: Thirty percent of the total gastric acid secretions to be produced is stimulated by anticipation of
eating and the smell or taste of food
The gastric phase: Sixty percent of the acid secreted is stimulated by the distention of the stomach with food. Plus,
digestion produces proteins, which causes even more gastrin production
The intestinal phase: The remaining 10% of acid is secreted when chyme enters the small intestine, and is
stimulated by small intestine distention.
Retina is organized in 10 layers and contains rods and cones, which are the visual receptors, plus four types of neurons:
i. Bipolar cells
ii. Ganglion cells
iii. Horizontal cells
iv. Amacrine cells
Ans. B: Retina
Ref.: Ganongs Physiology,23rd ed.,p-182
96.
PHYSIOLOGY
Regulation of secretion
Gastric acid production is regulated by both the autonomic nervous system and several hormones.
The parasympathetic nervous system, via the vagus nerve, and the hormone gastrin stimulate the parietal cell to
produce gastric acid, both directly acting on parietal cells and indirectly, through the stimulation of the secretion of
the hormone histamine from enterochromaffine-like cells (ECL).
Vasoactive intestinal peptide, cholecystokinin, and secretin all inhibit production.
The production of gastric acid in the stomach is tightly regulated by positive regulators and negative feedback
mechanisms.
Four types of cells are involved in this process: parietal cells, G cells, D cells and enterochromaffine-like cells.
Besides this, the endings of the vagus nerve (CN X) and the intramural nervous plexus in the digestive tract
influence the secretion significantly.
Nerve endings in the stomach secrete two stimulatory neurotransmitters: acetylcholine and gastrin-releasing
peptide. Their action is both direct on parietal cells and mediated through the secretion of gastrin from G cells and
histamine from enterochromaffine-like cells.
Gastrin acts on parietal cells directly and indirectly too, by stimulating the release of histamine.
The release of histamine is the most important positive regulation mechanism of the secretion of gastric acid in the
stomach.
Its release is stimulated by gastrin and acetylcholine and inhibited by somatostatin.
108
iii. Crude touch and pressure sensations capable only of crude ability on the surface of the body
iv. Tickle and itch sensations
v. Sexual sensations
Proprioception is carried in dorsal column-medial lemniscal system
Ans. A: Proprioception
Ref.: Guytons Physiology, 11th ed.,p-588
97.
98.
Alpha fibers are the thickest (fiber diameter of 12-20 micrometer) and fastest conduction velocity (of 70-120 m/.s)
PHYSIOLOGY
whereas C-fibers are the thinnest (fiber diameter of 0.3-1.2 micrometer) and slowest conduction velocity (of 0.5-2 m/s)
Ans. A: C- fiber
Ref.: Ganongs Physiology,23rd ed.,p-89
99.
Physiology
109
102. Blind spot/physiological blind spot,/punctum caecum is the place in the visual field that corresponds to the lack of
light-detecting photoreceptor cells on the optic disc of the retina where the optic nerve passes through it.
The ora serrata is the serrated junction between the retina and the ciliary body. This junction marks the transition from
the simple non-photosensitive area of the retina to the complex, multi-layered photosensitive region.
Ans. B: Optic disc
Ref.: Ganongs Physiology,23rd ed.,p-182
PHYSIOLOGY
103. The smooth muscle of the bladder (detrusor) is innervated by sympathetic nervous system fibers (from the lumbar
spinal cord) and parasympathetic fibers (from the sacral spinal cord).
Fibers in the pelvic nerves are the afferent limb of the voiding reflex, and the parasympathetic fibers to the bladder
that constitutes the efferent limb also travel in these nerves.
The reflex is integrated in the sacral portion of the spinal cord.
Muscle bundles pass on either side of the urethra called the internal urethral sphincter.
Farther along the urethra is a sphincter of skeletal muscle called external urethral sphincter.
When the individual is ready to urinate, he or she consciously initiates voiding, causing the bladder to contract and the
outlet to relax.
During the storage phase the internal urethral sphincter remains tense and the detrusor muscle relaxed by sympathetic
stimulation.
During micturition, parasympathetic stimulation causes the detrusor muscle to contract and the internal urethral
sphincter to relax. The external urethral sphincter (sphincter urethrae) is under somatic control and is consciously
relaxed during micturition.
Once the voluntary signal to begin voiding has been issued, neurons in pontine micturition center fire maximally,
causing excitation of sacral preganglionic neurons. The firing of these neurons causes the wall of the bladder to
contract; as a result, a sudden, sharp rise in pressure in intravesical pressure occurs.
When the external urinary sphincter is relaxed urine flows from the urinary bladder when the pressure there is great
enough to force urine to flow through the urethra.
When the sacral dorsal roots are interrupted by diseases of the dorsal roots such as tabes dorsalis in humans, all reflex
contractions of the bladder are abolished. The bladder becomes distended, thin-walled, and hypotonic.
When the afferent and efferent nerves are both destroyed, as they may be by tumors of the cauda equina or filum
terminale, the bladder is flaccid and distended for a while. Gradually, however, the muscle of the decentralized
bladder becomes active. The bladder becomes shrunken and the bladder wall hypertrophied.
During spinal shock, the bladder is flaccid and unresponsive. It becomes overfilled, and urine dribbles through the
sphincters (overflow incontinence).
After spinal shock has passed, the voiding reflex returns, although there is, of course, no voluntary control and no
inhibition or facilitation from higher centers when the spinal cord is transected. Bladder capacity is reduced, and the
wall becomes hypertrophied. This type of bladder is sometimes called the spastic neurogenic bladder.
110
106. The Pyramidal Tract/ corticspinal tract is group of fibers carries messages for voluntary motor movement to the lower
motor neurons in the brain stem and spinal cord.
Approximately 80% of the cell bodies of the pyramidal tract are located on the precentral gyrus of the frontal lobe (the
motor strip). Approximately 20% of the pyramidal tract fibers also originate in the postcentral gyrus of the parietal
lobe, in Brodmanns areas 1, 2, and 3. Regardless of the location of their cell bodies, pyramidal tract fibers begin their
descent from the cortex as a corona radiata (radiating crown) before forming the internal capsule.
This tract is direct and monosynaptic which allows messages to be transmitted very rapidly from the central nervous
system to the periphery.
PHYSIOLOGY
The fibers of the pyramidal tract that synapse with spinal nerves sending information about voluntary movement to
the skeletal muscles form the cortico-spinal tract. As they descend through the brain, they form part of the posterior
limb of the internal capsule.
At the pyramids in the inferior part of the medulla, eighty-five to ninety percent of cortico-spinal fibers decussate, or
cross to the other side of the brain. The remaining ten to fifteen percent continue to descend ipsilaterally. The fibers
that decussate are called the lateral cortico-spinal tract or the lateral pyramidal tract. Because they descend along the
sides of the spinal cord, the uncrossed or direct fibers that synapse with spinal nerves on the ipsilateral side of the
body are called the direct pyramidal tract. They may also be referred to as the ventral pyramidal tract or the anterior
cortico-spinal tract since they travel down the ventral aspect of the spinal cord.
The spinal nerves receive only contralateral innervation from the cortico-spinal tract. This means that unilateral
pyramidal tract lesions above the point of decussation in the pyramids will cause paralysis of the muscles served
by the spinal nerves on the opposite side of the body. For example, a lesion on the left pyramidal tract above the
point of decussation could cause paralysis on the right side of the body.
Ans. A: Paralysis of the opposite half of the body
Ref.: Ganongs Physiology,23rd ed.,p-244
107. Fasciculus gracilis and fasciculus cuneatus lies in the dorsal column.
It is part of an ascending pathway that is important for well-localized fine touch and conscious proprioception called
the posterior column-medial lemniscus pathway.
Joint capsules, tactile and pressure receptors send a signal through the dorsal root ganglia up through the fasciculus
gracilis for lower body sensory impulses and the fasciculus cuneatus for upper body impulses. Once the fasciculus
gracilis reaches the nucleus gracilis and the fasciculus cuneatus reaches the nucleus cuneatus in the lower medulla,
they begin to cross over the medulla as the internal arcuate fibers. When they reach the contralateral side, they become
the medial lemniscus, which is the second part of the posterior column-medial lemniscus pathway.
Lesions in this pathway can diminish or completely abolish tactile sensations and movement or position sense below
the lesion
Ans. A: Fasciculus gracilis
Ref.: Ganongs Physiology,23rd ed.,p-174
108. No matter where a particular sensory pathway is stimulated along its course to the cortex, the conscious sensation
produced is referred to the location of the receptor. This principle is called the law of projection.
i. Cortical stimulation experiments during neurosurgical procedures on conscious patients illustrate this
phenomenon. For example, when the cortical receiving area for impulses from the left hand is stimulated, the
patient reports sensation in the left hand, not in the head.
Physiology
111
ii. Another example is seen in amputees. Some of these patients may complain, often bitterly, of pain and
proprioceptive sensations in the absent limb (phantom limb). The ends of the nerves cut at the time of
amputation often form nerve tangles called neuromas. These may discharge spontaneously or when pressure is
put on them. The impulses generated in them are in nerve fibers that previously came from sense organs in the
amputated limb, and the sensations evoked are projected to where the receptors used to be.
Ans. B: Law of projection
Ref.: Ganongs Physiology,23rd ed.,p-155,176
109. When the muscles are hypertonic, the sequence of moderate stretch muscle contraction, strong stretch muscle
relaxation is clearly seen. Passive flexion of the elbow, for example, meets immediate resistance as a result of the
stretch reflex in the triceps muscle. Further stretch activates the inverse stretch reflex. The resistance to flexion
suddenly collapses, and the arm flexes. Continued passive flexion stretches the muscle again, and the sequence may
be repeated. This sequence of resistance followed by give when a limb is moved passively is known as the clasp-knife
effect because of its resemblance to the closing of a pocket knife. It is also known as the lengthening reaction because
it is the response of a spastic muscle to lengthening.
110. Parkinsons disease has both hypokinetic and hyperkinetic features. In this condition, which was originally described
by James Parkinson and is named for him, the nigrostriatal dopaminergic neurons degenerate. The fibers to the
putamen are most severely affected.
Dopaminergic neurons and dopamine receptors are steadily lost with age in the basal ganglia in normal
individuals, and an acceleration of these losses apparently precipitates parkinsonism. Symptoms appear when 60
80% of the nigrostriatal dopaminergic neurons are lost. Parkinsonism is also seen as a complication of treatment with
the phenothiazine group of tranquilizer drugs and other drugs that block D 2 dopamine receptors.
Ans. A: Dopamine
Ref.: Ganongs Physiology,23rd ed.,p-253
111. From a functional point of view, the cerebellum is divided into three parts:
i. The nodulus in the vermis and the flanking flocculus in the hemisphere on each side form the flocculonodular
lobe, or vestibulocerebellum. This lobe, which is phylogenetically the oldest part of the cerebellum, has
vestibular connections and is concerned with equilibrium.
ii. The rest of the vermis and the adjacent medial portions of the hemispheres form the spinocerebellum, the region
that receives proprioceptive input from the body as well as a copy of the motor plan from the motor cortex. By
comparing plan with performance, it smoothes and coordinates movements that are ongoing. The vermis projects
to the brainstem area concerned with control of axial and proximal limb muscles, whereas the hemispheres project
the brainstem areas concerned with control of distal limb muscles.
iii. The lateral portions of the cerebellar hemispheres are called the cerebrocerebellum, or neocerebellum. They are
the newest from a phylogenetic point of view, reaching their greatest development in humans. They interact with
the motor cortex in planning and programming movements.
Ans. B: Equilibrium
Ref.: Ganongs Physiology,23rd ed.,p-257
PHYSIOLOGY
112
112. The term limbic lobe, or limbic system, is applied to the part of the brain that consists of a rim of cortical tissue around
the hilum of the cerebral hemisphere and a group of associated deep structuresthe amygdala, the hippocampus, and
the septal nuclei. The region was formerly called the rhinencephalon because of its relation to olfaction, but only a
small part of it is actually concerned with smell
Ans. D: Planned motor activity
Ref.: Guytons Physiology,11th ed.,p-732,736
113.
114. The axons of the ganglion cells pass caudally in the optic nerve and optic tract to end in the lateral geniculate body, a
part of the thalamus. The fibers from each nasal hemiretina decussate in the optic chiasm. In the geniculate body, the
fibers from the nasal half of one retina and the temporal half of the other synapse on the cells whose axons form the
geniculocalcarine tract. This tract passes to the occipital lobe of the cerebral cortex.
The primary visual receiving area (primary visual cortex, Brodmanns area 17; also known as V1), is located
PHYSIOLOGY
Physiology
113
tight junctions that form the bloodbrain barrier. They also send processes that envelop synapses and the surface
of nerve cells. They have a membrane potential that varies with the external K + concentration but do not generate
propagated potentials. They produce substances that are tropic to neurons, and they help maintain the
appropriate concentration of ions and neurotransmitters by taking up K+ and the neurotransmitters glutamate
and -aminobutyrate.
Ans. D: Kupffer cells
Ref.: Ganongs Physiology, 23rd ed.,p-80
118. Into the cupula are projected hundreds of cilia from hair cells located on the ampullary crest.
When the head suddenly begins to rotate in any direction (angular acceleration); the endolymph in the semicircular
canals, because of its inertia, tend to remain stationary while the semicircular canals turn. This cause relative fluid flow
in the ducts in the direction opposite to the head rotation.
Similarly When the rotation stops suddenly: the endolymph continues to rotate. And this time cupula bends in
opposite direction, causing hair cells to stop discharging entirely.
119. The eye is unique in that the receptor potential of the photoreceptors and the electrical responses of most of the other
neural elements in the retina are local, graded potentials and it is only in ganglion cells that all or none action
potentials are generated.
The response of rods, cones and horizontal cells are hyperpolarizing.
Response of bipolar cells are either hyperpolarizing/depolarizing
Amacrine cells produces depolarizing potentials and spikes.
Ans. A: Hyperpolarisation occurs
Ref.: Ganongs Physiology, 23rd ed.,p-190
120. In a myelinated neuron, number of sodium channels per square micrometer is:
i. Cell body-50-75
ii. Axon terminal-20-75
iii. Surface of myelin-Less than 25
iv. Nodes of Ranvier-2000-12,000
v. In the initial segment:350-500
In unmyelinated neurons, number is about 110
Ans. D: Nodes of Ranvier
Ref.: Ganongs Physiology,23rd ed.,p-85
121. The neurons that are cholinergic:
i. All preganglionic neurons
ii. All parasympathetic postganglionic neurons
iii. Sympathetic postganglionic neurons innervating sweat glands.
PHYSIOLOGY
114
iv. Sympathetic postganglionic neurons innervating blood vessels in some skeletal muscles and produces
vasodilation when stimulated
Ans. A: Cholinergic mediated sympathetic activity
Ref.: Ganongs Physiology, 23rd ed.,p-266
122. When the muscle spindle is stretched, its sensory endings are distorted and receptor potentials are generated. These in
turn set up action potentials in the sensory fibers at a frequency proportionate to the degree of stretching. The spindle
is in parallel with the extrafusal fibers, and when the muscle is passively stretched, the spindles are also stretched. This
initiates reflex contraction of the extrafusal fibers in the muscle. On the other hand, the spindle afferents
characteristically stop firing when the muscle is made to contract by electrical stimulation of the nerve fibers to the
extrafusal fibers because the muscle shortens while the spindle does not.
Muscle spindle and its reflex connections operates to maintain muscle length
PHYSIOLOGY
Physiology
115
b. Relaxation:
i. Sphincters of stomach, intestines and bladder
c. Decreases:
i. Heart rate, Contractility and conduction velocity
d. Increases:
i. Motility of stomach and intestines
ii. Secretion of exocrine pancreas, salivary glands and lacrimal gland
Ans. A: Tachycardia
Ref.: Ganongs Physiology, 23rd ed.,p-267 (Table 17-1)
126. Ans. D: Seen in REM sleep
Ref.: Ganongs Physiology, 23rd ed.,p-233
127. Melatonin and the enzymes responsible for its synthesis from serotonin by N-acetylation and O-methylation are
present in pineal parenchymal cells, and the hormone is secreted by them into the blood and the cerebrospinal fluid.
Melatonin synthesis and secretion are increased during the dark period of the day and maintained at a low level
by the postganglionic sympathetic nerves (nervi conarii) that innervate the pineal. The norepinephrine acts via adrenergic receptors in the pineal to increase intracellular cAMP, and the cAMP in turn produces a marked increase in
N-acetyltransferase activity. This results in increased melatonin synthesis and secretion.
Effects of Melatonin:
i. It plays a role in sleep mechanism
ii. It is supposed to decrease gonadotropic hormone secretion by anterior pituitary
Vomiting centre is located in the brain stem. From here, motor impulses that cause the actual vomiting are
transmitted from the vomiting center by the way of the 5 th,7th,9th,10th and 12th cranial nerves to the upper GIT, through
vagal and sympathetic nerves to the lower tract and through spinal nerves to the diaphragm and abdominal vessels.
Ans. A: Vomiting
Ref.: Ganongs Physiology,23rd ed.,p-238,Guytons Physiology,11th ed.,p-1010,823
128. Ans. D: Bronchial musculature relaxation
Ref.: Ganongs Physiology,23rd ed.,p-267, 268
129. Despite their name, some neurotransmitters inhibit the transmission of nerve impulses. They do this by opening
i. Chloride channels and/or
ii. Potassium channels in the plasma membrane.
In each case, opening of the channels increases the membrane potential by
i. Letting negatively-charged chloride ions (Cl) in and
ii. Positively-charged potassium ions (K+) out
This hyperpolarization is called an inhibitory postsynaptic potential (IPSP).
Although the threshold voltage of the cell is unchanged, it now requires a stronger excitatory stimulus to reach
threshold.
PHYSIOLOGY
during the daylight hours. This remarkable diurnal variation in secretion is brought about by norepinephrine secreted
116
Example: Gamma amino butyric acid (GABA). This neurotransmitter is found in the brain and inhibits nerve
transmission by both mechanisms:
i. Binding to GABAA receptors opens chloride channels in the neuron.
ii. Binding to GABAB receptors opens potassium channels.
Ans. B: Chloride ion
Ref.: Ganongs Physiology,23rd ed.,p-120
130.
i. Alpha waves generally are seen in all age groups but are most common in adults.
They occur rhythmically on both sides of the head but are often slightly higher in amplitude on the nondominant
side, especially in right-handed individuals.
A normal alpha variant is noted when a harmonic of alpha frequency occurs in the posterior head regions.
They tend to be present posteriorly more than anteriorly and are especially prominent with closed eyes and with
relaxation.
Alpha activity disappears normally with attention (e.g., mental arithmetic, stress, opening eyes).
PHYSIOLOGY
Physiology
117
132. Vomiting is believed to be controlled by two distinct brain centresthe vomiting centre and the chemoreceptor
trigger zoneboth located in the medulla oblongata.
The vomiting centre initiates and controls the act of emesis, which involves a series of contractions of the smooth
muscles lining the digestive tract
Ans. D: Medulla
Ref.: Ganongs Physiology,23rd ed.,p-474
133. In the case of the optic nerve and tracts there are three separate neurons linked together, extending from the retina to
PHYSIOLOGY
118
135.
Inferior parietal lobule (parietal lobe) helps in spatial recognition (tactile localization, tactile discrimination etc.)
PHYSIOLOGY
Spatial relationship
Recognition of spatial relationship is a function of angular gyrus (inferior parietal lobule)
Temporal lobe
It is located beneath the Sylvian fissure on both cerebral hemispheres.
The temporal lobe is involved in auditory perception and is home to the primary auditory cortex.
It is also important for the processing of semantics in both speech and vision.
The temporal lobe contains the hippocampus and plays a key role in the formation of long-term memory.
The superior temporal gyrus includes an area (within the Sylvian fissure) where auditory signals from the cochlea
(relayed via several subcortical nuclei) first reach the cerebral cortex.
This part of the cortex (primary auditory cortex) is involved in hearing.
Adjacent areas in the superior, posterior and lateral parts of the temporal lobes are involved in high-level auditory
processing.
This includes speech, for which the left temporal lobe in particular seems to be specialized.
Wernicke's area, which spans the region between temporal and parietal lobes, plays a key role (in tandem with
Broca's area, which is in the frontal lobe).
The functions of the left temporal lobe are not limited to low-level perception but extend to comprehension,
naming, verbal memory and other language functions.
The underside (ventral) part of the temporal cortices appear to be involved in high-level visual processing of
complex stimuli such as faces (fusiform gyrus) and scenes (parahippocampal gyrus).
Anterior parts of this ventral stream for visual processing are involved in object perception and recognition.
The medial temporal lobes are involved in episodic/declarative memory.
Deep inside the medial temporal lobes lie the hippocampi, which are essential for memory function - particularly
the transference from short to long term memory and control of spatial memory and behavior.
Damage to this area typically results in anterograde amnesia.
Ans. C: Spatial relationship
Ref.: Guytons Physiology, 12th ed., p-699t; AK Jains Physiology, 4th ed., p-1037, 1043
RESPIRATORY SYSTEM
136. The immediate effect of decreased pressure causes decreased partial pressure of oxygen. Resulting hypoxemia,
sensed by the carotid bodies, causes hyperventilation. However, hyperventilation also causes the adverse effect of
respiratory alkalosis, inhibiting the respiratory center from enhancing the respiratory rate as a result of fall in Pco2.
In the short term, the human body undergoes hyperventilation, fluid loss (due to a decreased thirst drive and decrease
in ADH), an increase in heart rate, and slightly lowered stroke volume. In the longer term, the body has lower lactate
production (because reduced glucose breakdown decreases the amount of lactate formed), compensatory alkali loss in
urine, decreased plasma volume, increased Hematocrit (polycythemia), increased RBC mass, a higher concentration
of capillaries in skeletal muscle tissue, increased myoglobin, increased mitochondria, increased aerobic enzyme
concentration, increase in 2, 3-BPG, hypoxic pulmonary vasoconstriction, and right ventricular hypertrophy.
Ans. A: Po2 is less
Ref.: Ganongs Physiology,23rd ed.,p-618
Physiology
119
137. Shunting of blood from the right side to the left side of the circulation (right-to-left shunt) is a powerful cause of
hypoxemia. The shunt may be intracardiac or may be intrapulmonary. It has been traditionally thought that this cause
could be readily distinguished from the others as the only cause that cannot be corrected by the administration of
100% oxygen.
Ans. A: R-L shunt
Ref.: Ganongs Physiology,23rd ed.,p-620
138. Haemoglobin is the primary vehicle for transporting oxygen in the blood.
The oxygen carrying capacity is determined by the amount of haemoglobin present in the blood. Oxygen is also
carried dissolved in the bloods plasma, but to a much lesser degree.
A hemoglobin molecule can bind up to four oxygen molecules in a reversible way.
The oxygen-hemoglobin dissociation curve has a sigmoidal or S-shape.
The partial pressure of oxygen in the blood at which the hemoglobin is 50% saturated, is known as the P50. The P50 is
a conventional measure of hemoglobin affinity for oxygen. An increased P50 indicates a rightward shift and a
decreased affinity of the standard curve, which means that a larger partial pressure is necessary to maintain a 50%
oxygen saturation. Conversely, a lower P50 indicates a leftward shift and a higher affinity.
With fetal hemoglobin, the shift facilitates diffusion of oxygen across the placenta. The oxygen dissociation curve for
myoglobin exists even further to the left.
Ans. B: Decreased PaCO2
Ref.: Ganongs Physiology,23rd ed.,p-611
139. Although the body requires oxygen for metabolism, low oxygen levels do not stimulate breathing. Rather, respiratory
centre is directly stimulated by higher carbon dioxide levels or excess hydrogen ions in the blood. As a result,
breathing low-pressure air or a gas mixture with no oxygen at all (such as pure nitrogen) can lead to loss of
consciousness without ever experiencing air hunger.
The respiratory centers try to maintain an arterial CO2 pressure of 40 mm Hg. With intentional hyperventilation, the
CO2 content of arterial blood may be lowered to 10-20 mm Hg (the oxygen content of the blood is little affected), and
the respiratory drive is diminished.
Ans. C: CO2
Ref.: Guytons Physiology,11th ed.,p-516
140. The amount of air that moves into the lungs with each inspiration (or the amount that moves out with each expiration)
is called the tidal volume (500 ml)
The air inspired with a maximal inspiratory effort in excess of the tidal volume is the inspiratory reserve volume. (3000 ml)
The volume expelled by an active expiratory effort after passive expiration is the expiratory reserve volume (1200 ml),
and the air left in the lungs after a maximal expiratory effort is the residual volume (1200 ml).
PHYSIOLOGY
Left shift of the curve is a sign of hemoglobins increased affinity for oxygen (e.g. at the lungs). Similarly, right shift
shows decreased affinity, as seen in:
i. An increase in body temperature,
ii. An increase in hydrogen ion,
iii. An increase in 2,3-bisphosphoglycerate
iv. An increase in carbon dioxide concentration (the Bohr effect)
120
The space in the conducting zone of the airways occupied by gas that does not exchange with blood in the pulmonary
vessels is the respiratory dead space.
The vital capacity (4700 ml), the largest amount of air that can be expired after a maximal inspiratory effort, is
frequently measured clinically as an index of pulmonary function. It gives useful information about the strength of the
respiratory muscles and other aspects of pulmonary function (ERV+TV+IRV)
The fraction of the vital capacity expired during the first second of a forced expiration (FEV 1, timed vital capacity)
gives additional information; the vital capacity may be normal but the FEV1 reduced in diseases such as asthma, in
which airway resistance is increased because of bronchial constriction.
The amount of air inspired per minute (pulmonary ventilation, respiratory minute volume) is normally about 6 L
(500 mL/ breath x 12 breaths/min).
The maximal voluntary ventilation (MVV), or, as it was formerly called, the maximal breathing capacity, is the largest
volume of gas that can be moved into and out of the lungs in 1 minute by voluntary effort. The normal MVV is 125
170 L/min.
Inspiratory Capacity (TV+IRV)=3500 ml
Functional Residual Capacity (RV+ERV)=2400 ml
PHYSIOLOGY
141. The decrease in O2 affinity of hemoglobin when the pH of blood falls is called the Bohr effect and is closely related
to the fact that deoxygenated hemoglobin (deoxyhemoglobin) binds H+ more actively than does oxyhemoglobin.
The pH of blood falls as its CO2 content increases, so that when the PCO2 rises, the curve shifts to the right and the
P50 rises.
Ans. D: Decrease in O2 affinity of hemoglobin when the pH of blood falls
Ref.: Ganongs Physiology,23rd ed.,p-611
142. Although the rhythmic discharge of medullary neurons concerned with respiration is spontaneous, it is modified by
neurons in the pons and afferents in the vagus from receptors in the airways and lungs. An area known as the
pneumotaxic center in the medial parabrachial and KllikerFuse nuclei of the dorsolateral pons contains neurons
active during inspiration and neurons active during expiration.
Stretching of the lungs during inspiration initiates impulses in afferent pulmonary vagal fibers. These impulses
inhibit inspiratory discharge.
Ans. D: Decreased depth of respiration
Ref.: Ganongs Physiology,23rd ed.,p-627
143. The low surface tension when the alveoli are small is due to the presence in the fluid lining the alveoli of surfactant, a
lipid surface-tension-lowering agent.
Surfactant is a mixture of dipalmitoylphosphatidylcholine (DPPC), other lipids, and proteins. If the surface tension is
not kept low when the alveoli become smaller during expiration, they collapse in accordance with the law of Laplace.
Physiology
121
Surfactant is produced by type II alveolar epithelial cells. Typical lamellar bodies, membrane-bound organelles
containing whorls of phospholipid, are formed in these cells and secreted into the alveolar lumen by exocytosis.
Tubes of lipid called tubular myelin form from the extruded bodies, and the tubular myelin in turn forms the
phospholipid film. Some of the proteinlipid complexes in surfactant are taken up by endocytosis in type II alveolar
cells and recycled.
Surfactant is important at birth. The fetus makes respiratory movements in utero, but the lungs remain collapsed until
birth. After birth, the infant makes several strong inspiratory movements and the lungs expand. Surfactant keeps them
from collapsing again. Surfactant deficiency is an important cause of infant respiratory distress syndrome (IRDS, also
known as hyaline membrane disease), the serious pulmonary disease that develops in infants born before their
surfactant system is functional.
Maturation of surfactant in the lungs is accelerated by glucocorticoid hormones. Fetal and maternal cortisol increase
near term, and the lungs are rich in glucocorticoid receptors.
Patchy atelectasis is also associated with surfactant deficiency in patients who have undergone cardiac surgery
involving use of a pump oxygenator and interruption of the pulmonary circulation. In addition, surfactant deficiency
may play a role in some of the abnormalities that develop following occlusion of a main bronchus, occlusion of one
The Haldane effect is a property of hemoglobin first described by the Scottish physician John Scott Haldane.
Deoxygenation of the blood increases its ability to carry carbon dioxide; this property is the Haldane effect.
Conversely, oxygenated blood has a reduced capacity for carbon dioxide.
Ans. C: Deoxygenation of blood increases capacity for carbon dioxide
Ref.: Ganongs Physiology, 22nd ed.,p-669
145. An area in lower pons is referred to as apneustic centre & the activity of the neurons of this area is inhibited by afferents in the
vagus nerve from the airway & lungs
If vagi are cut, arrest of respiration occurs in inspiration, called apneusis
Apneustic center
It promotes inspiration by stimulation of the I-neurons in the medulla oblongata providing a constant stimulus.
The apneustic center of pons sends signals to the dorsal respiratory center in the medulla to delay the 'switch off'
signal of the inspiratory ramp provided by the pneumotaxic center of pons.
It is an abnormal pattern of breathing characterized by deep, gasping inspiration with a pause at full inspiration
followed by a brief, insufficient release.
PHYSIOLOGY
pulmonary artery, or long-term inhalation of 100% O2. Cigarette smoking also decreases lung surfactant.
122
Accompanying signs and symptoms may include decerebrate posturing; fixed, dilated pupils; coma or profound
stupor; quadriparesis; absent corneal reflex; absent doll's eye sign; negative oculocephalic reflex; and obliteration of
the gag reflex
Specifically, concurrent removal of input from the vagus nerve and the pneumotaxic center causes this pattern of
breathing.
PHYSIOLOGY
REPRODUCTIVE SYSTEM
147. In Vitro fertilization is a technique employed in cases of infertility. Steps include removing mature ova, fertilizing it
with sperm and implanting one or more of them back in uterus at the four cell stage.
It has a 5-10% chance of producing a live birth
Ans. C: Removing mature ova, fertilizing it with sperm and implanting back in uterus
Ref.: Ganongs Physiology,23rd ed.,p-424
148. Ans. B: LH
Ref.: Ganongs Physiology,23rd ed.,p-414
Physiology
123
149. Hormonal control of Breast development and secretion and ejection of milk
i. Progesterone influences the growth in size of alveoli and lobes.
ii. Oestrogen stimulates the milk duct system to grow and become specific.
iii. Follicle stimulating hormone
iv. Luteinizing hormone
v. Prolactin contributes to the increased growth of the alveoli during pregnancy and formation of milk
vi. Oxytocin oxytocin contracts the smooth muscle layer of band-like cells surrounding the alveoli to squeeze the
newly-produced milk into the duct system. Oxytocin is necessary for the milk ejection reflex, or let-down to
occur.
vii. Human placental lactogen (HPL) This hormone appears to be associated with breast, nipple, and areola growth
before birth.
Colostrum contains higher amounts of white blood cells and antibodies than mature milk, and is especially high in
immunoglobulin A (IgA), which coats the lining of the babys immature intestines, and helps to prevent germs from
invading the babys system.
150. Asymmetrical cell division (cytokinesis) leads to the production of polar bodies during oogenesis. To conserve
nutrients, the majority of cytoplasm is segregated into either the secondary oocyte and, or ovum, during meiosis I or
meiosis II, respectively.
The remaining daughter cells generated from the meiotic events contain relatively little cytoplasm and are referred to
as polar bodies. Eventually, the polar bodies degenerate.
There may be one or two polar bodies in the ovum. The first polar body is one of the two products in the first stage
of meiosis, just before ovulation and is considered diploid, with 23 duplicated chromosomes. The second polar body
is haploid, with 23 unduplicated chromosomes and is produced only when a sperm penetrates the oocyte.
Ans. B: Ovulation
Ref.: Ganongs Physiology,23rd ed.,p-412
151. Frequent physical signs indicating ovulation are:
i. Increased body temperature
ii. LH surge
iii. Increased cervical mucus -cervical mucus is most abundant and becomes clear and slippery and stretches like egg
white
iv. Change of position and firmness of cervix
v. Abdominal cramps (Mittelschmerz)
vi. Increased libido
vii. Tender breasts
Ans. D: Fall in body temperature
Ref.: Ganongs Physiology,23rd ed.,p-414
PHYSIOLOGY
Ans. A: Oxytocin
Ref.: Ganongs Physiology,23rd ed.,p-426
124
152. On maturity of the ovum, the follicle and the ovarys wall rupture, allowing the ovum to escape.
The egg is caught by the fimbriated end and travels to the ampulla where fertilization occurs; the fertilized ovum,
now a zygote, travels towards the uterus aided by activity of tubal cilia and activity of the tubal muscle.
Ans. C: Ampulla
Ref.: Ganongs Physiology,23rd ed.,p-423
153. Spermatozoa leaving the testes are not fully mobile. They continue their maturation and acquire motility during their
passage through the epididymis.
Motility is obviously important in vivo, but fertilization occurs in vitro if an immotile spermatozoon from the head of
the epididymis is microinjected directly into an ovum.
The ability to move forward (progressive motility), which is acquired in the epididymis, involves activation of a
unique protein called CatSper, which is localized to the principal piece of the sperm tail.
PHYSIOLOGY
Ans. D: Epididymis
Ref.: Ganongs Physiology,23rd ed.,p-404
154. Asthenozoospermia/asthenospermia is the term for reduced sperm motility.
It decreases the sperm quality and is therefore one of the major causes of infertility or reduced fertility in men
Ans. B: Reduction in motility of sperms
Ref.: Shaws Gynecology,13th ed.,p-202
155. The process of ovulation is controlled by the hypothalamus of the brain and through the release of hormones secreted
in the anterior lobe of the pituitary gland, LH and FSH.
In the follicular (pre-ovulatory) phase of the menstrual cycle, the ovarian follicle will undergo a series of
transformations called cumulus expansion, this is stimulated by the secretion of FSH. After this is done, a hole called
the stigma will form in the follicle, and the ovum will leave the follicle through this hole.
Ovulation is triggered by a spike in the amount of FSH and LH released from the pituitary gland. During the luteal
(post-ovulatory) phase, the ovum will travel through the fallopian tube toward the uterus.
If fertilized by a sperm, it may perform implantation there 612 days later.
In humans, the few days near ovulation constitute the fertile phase.
The average time of ovulation is the fourteenth day of an average length (twenty-eight day) menstrual cycle.
It is normal for the day of ovulation to vary from the average, with ovulation anywhere between the tenth and
nineteenth day being common, but commonly occurs 14 days before the next cycle.
Cycle length alone is not a reliable indicator of the day of ovulation.
Ans. B: 14 days prior to next menstruation
Ref.: Ganongs Physiology,23rd ed.,p-412
156. The embryonic period in humans begins at fertilization (12-24hrs after ovulation, generally between the 2nd and 3rd
week of gestational age) and continues until the end of the 9th week of gestation (8th week by embryonic age).
Ans. B: 14 days to 9 weeks of gestation
Ref.: OP Ghais Pediatrics,7th ed.,p-3 (Table 1.1)
Physiology
125
Leydig/ Interstitial cells secrete androgenic hormone testosterone at the time of puberty
Primary cell types of testes
(A). Within the seminiferous tubules
Here, germ cells develop into spermatogonia, spermatocytes, spermatids and spermatozoon through the process of
spermatogenesis. The gametes contain DNA for fertilization of an ovum
Sertoli cells - the true epithelium of the seminiferous epithelium, critical for the support of germ cell development
into spermatozoa. Sertoli cells secrete inhibin.
PHYSIOLOGY
126
The stages of the menopause transition have been classified according to a womans reported bleeding pattern,
supported by changes in the pituitary follicle stimulating hormone/ FSH levels.
PHYSIOLOGY
In younger women, during a normal menstrual cycle the ovaries produce estradiol, testosterone and progesterone
in a cyclical pattern under the control of FSH and luteinising hormone (LH) which are both produced by the
pituitary gland.
Blood estradiol levels remain relatively unchanged, or may increase approaching the menopause, but are usually
well preserved until the late perimenopause.
Menopause is based on the natural or surgical cessation of estradiol and progesterone production by the
ovaries, which are a part of the body's endocrine system of hormone production, in this case the hormones which
make reproduction possible and influence sexual behavior.
After menopause, estrogen continues to be produced in other tissues, notably the ovaries, but also in bone, blood
vessels and even in the brain.
However the dramatic fall in circulating estradiol levels at menopause impacts many tissues, from brain to skin.
In contrast to the sudden fall in estradiol during menopause, the levels of total and free testosterone, as well as
dehydroepiandrosterone sulfate (DHEAS) and androstenedione decline more or less steadily with age.
Ans. B: FSH
Ref.: Ganongs Physiology, 23rd ed., p-402; AK Jains Physiology, 4th ed., p-827
MISCELLANEOUS
161. Unitary smooth muscle (as present in a walls of a hollow viscus) is characterized by the instability of its membrane
potential and by the fact that it shows continuous, irregular contractions that are independent of its nerve supply.
This maintained state of contraction is called tonus/tone
It does have actin and myosin-II but they are not arranged in regular arrays to give striations as in skeletal and
cardiac muscle.
They require calcium for initiation of contraction like skeletal and cardiac muscle.
Ans. C: It contracts when stretched in the absence of any extrinsic innervation
Ref.: Ganongs Physiology,23rd ed.,p-109,110
Physiology
127
162. Plasma osmolality is a measure of the concentration of substances such as sodium, chloride, potassium, urea, glucose,
and other ions in blood
Osmolal concencentration of plasma is 290 mOsm/L
Osmolality of blood increases with dehydration and decreases with overhydration.
In normal people, increased osmolality in the blood will stimulate secretion of antidiuretic hormone (ADH). This will
result in increased water reabsorption, more concentrated urine, and less concentrated blood plasma.
A low serum osmolality will suppress the release of ADH, resulting in decreased water reabsorption and more
concentrated plasma.
Ans. C: 280-290 mOsm/L
Ref.: Ganongs Physiology,23rd ed.,p-6
163. Cells of proximal and distal tubules secrete hydrogen ions which comes from carbonic acid
For each hydrogen ion secreted, one sodium ion and one bicarbonate ion enters the interstitial fluid.
Ans. A: Kidney
Ref.: Ganongs Physiology,23rd ed.,p-679
Ans. A: Potassium
Ref.: Ganongs Physiology,23rd ed.,p-84
165. Metabolic acidosis occurs when the body produces too much acid, or when the kidneys are not removing enough acid
from the body
1. Diabetic acidosis
2. Hyperchloremic acidosis results from excessive loss of sodium bicarbonate from the body,
3. Lactic acidosis is a buildup of lactic acid-alcohol, cancer, liver failure, low blood sugar
Common mnemonic is mudpile
M - Methanol
U - Uremia
D - Diabetic Ketoacidosis (also alcohol ketosis, starvation ketosis)
P - Para-aldehyde
I - Isoniazid, Iron, Inborn Errors of Metabolism
L - Lactic Acid
E - Ethylene Glycol
S Salicylates
Ans. B: Emphysema
Ref.: Ganongs Physiology,23rd ed.,p-615
PHYSIOLOGY
164. In neurons resting membrane potential is about -70 mV, which is close to the equilibrium potential of potassium
ions
128
167. While isometric training increases strength at the specific joint angles of the exercises performed and additional joint
angles to a lesser extent, dynamic exercises increase strength throughout the full range of motion.
Generally speaking however, people who train isometrically dont train through a full range of motion as the strength
gained at the training joint angle is where they require it. While dynamic exercises are slightly better than isometric
exercises at enhancing the twitch force of a muscle, isometrics are significantly better than dynamic exercises at
increasing maximal strength at the joint angle.
Flexibility may be increased when isometrics are performed at joint range of motion extremes.
Ans. C: Isotonic
Ref.: Ganongs Physiology, 23rd ed.,p-101
168. The nicotinic cholinergic receptors are found in the neuromuscular junctions of somatic muscles; stimulation of
these receptors causes muscular contraction. They are also found in the autonomic ganglia of autonomic nervous
system and central nervous system
Muscarinic receptors are found in:
PHYSIOLOGY
M 1-brain
M 2-heart
M 3-smooth muscle
M 4-smooth muscle, pancreatic acinar and islet tissue
Ans. C: Bronchial Smooth Muscle
Ref.: Ganongs Physiology,23rd ed.,p-135
169. Ans. A: 80-110
Ref.: Harrisons Medicine,17th ed.,p-A-5
170. BMI=Weight/Height
i. Less than 18.5- underweight
ii. 18.5-24.9- Normal
iii. 25-29.9- Overweight
iv. More than 30- Obese
Ans. A: Less than 18.5
Ref.: Harrisons Medicine, 17th ed.,p-A-452
171. Intracellular component of the body water accounts for about 40% of body weight and extracellular component for
about 20%.
Concentration of potassium in cytosol is 139 millimeter and of Amino acids (in proteins) is 138 millimeter,
Ans. C: Potassium
Ref.: Ganongs Physiology,23rd ed.,p-3(Fig.-1.1-B)
172. When tissue is damaged, platelets adhere to exposed matrix via integrins that bind to collagen and laminin.
Blood coagulation produces thrombin, which promotes platelet aggregation and granule release. The platelet granules
generate an inflammatory response.
Physiology
129
White blood cells are attracted by selections and bind to integrins on endothelial cells, leading to their extravasation
through the blood vessel walls. Cytokines released by the white blood cells and platelets up-regulate integrins on
macrophages, which migrate to the area of injury, and on fibroblasts and epithelial cells, which mediate wound
healing and scar formation.
Plasmin aids healing by removing excess fibrin. This aids the migration of keratinocytes into the wound to restore the
epithelium under the scab. Collagen proliferates, producing the scar.
Wounds gain 20% of their ultimate strength in 3 weeks and later gain more strength, but they never reach more than
about 70% of the strength of normal skin.
Ans. C: 3 weeks of wound healing
Ref.: Ganongs Physiology,23rd ed.,p-3 (Fig.-1.1-B)
Ans. A: Sodium
Ref.: Ganongs Physiology, 23rd ed.,p-6
174. During prolonged starvation, keto acids derived from fats are used by the brain and other tissues.
Most of the protein burned during total starvation comes from the liver, spleen, and muscles and relatively little from
the heart and brain. The blood glucose falls somewhat after liver glycogen is depleted, but is maintained above levels
that produce hypoglycemic symptoms by gluconeogenesis.
Ketosis is present, and neutral fat is rapidly catabolized. When fat stores are used up, protein catabolism increases
even further, and death soon follows.
Serum albumin level is reduced but it stays above 2.8 g/dL
Ans. D: Level of serum proteins less than 2.8 g/dL
Ref.: Harrisons Medicine, 17th ed.,p-450
175. The Na+ channels rapidly enter the inactivated state and remain in this state for a few milliseconds before returning to
the resting state. In addition, the direction of the electrical gradient for Na + is reversed during the overshoot because
the membrane potential is reversed, and this limits Na+ influx.
A third factor producing repolarization is the opening of voltage-gated K+ channels.
The net movement of positive charge out of the cell due to K + efflux at this time helps complete the process of
repolarization.
The slow return of the K+ channels to the closed state also explains the after-hyperpolarization.
Ans. B: Potassium ions
Ref.: Ganongs Physiology,23rd ed.,p-85
PHYSIOLOGY
173. All but about 20 of the 290 mosm in each liter of normal plasma are contributed by Na+ and its accompanying
anions, principally Cl and HCO3. Other cations and anions make a relatively small contribution.
Although the concentration of the plasma proteins is large when expressed in grams per liter, they normally contribute
less than 2 mosm/L because of their very high molecular weights.
The major nonelectrolytes of plasma are glucose and urea, which in the steady state are in equilibrium with cells.
Their contributions to osmolality are normally about 5 mosm/L each but can become quite large in hyperglycemia
or uremia.
The total plasma osmolality is important in assessing dehydration, overhydration, and other fluid and electrolyte
abnormalities. Hyperosmolality can cause coma (hyperosmolar coma).
130
PHYSIOLOGY
Physiology
131
184. The meibomian glands (or tarsal glands) are a special kind of sebaceous glands at the rim of the eyelids inside the
tarsal plate, responsible for the supply of meibum, an oily substance that prevents evaporation of the eyes tear film,
prevents tear spillage onto the cheek, makes the closed lids airtight and acts as a blockade for tear fluid, trapping tears
between the oiled edge and eyeball
Ans. B: Meibomian gland
Ref.: Internet resources
185. Remember:
i.
ICF is more abundant than ECF
ii.
ECF contains large amounts of sodium and chloride ions
iii.
ICF contains large amount of potassium ions and phosphate ions
Ans. C: High sodium to potassium ratio is seen in ECF
Ref.: Guytons Physiology, 11th ed.,p-293-296
186. Red reaction or red line in triple reaction is due to dilatation of precapillary sphincters
It is a cutaneous response that occurs from firm stroking of the skin, which produces an initial red line, followed by
a flare around that line, and then finally a wheal.
The triple response of Lewis is due to the release of histamine.
Histamine, or 2-(imidazol-4-yl) ethanamine, is a dibasic vasoactive amine that is located in most body tissues but is
highly concentrated in the lungs, skin, and gastrointestinal tract.
Histamine is derived from the decarboxylation of the aminoacid histidine, a reaction catalyzed by the enzyme Lhistidine decarboxylase.
Histamine is a small molecule, stored as granules in mast cells and basophils.
Mast cells and basophils are the effector cells involved in the immediate hypersensitivity response.
Explanation :Injected intradermally histamine elicits the triple response consisting of:
o
Flare: redness in the surrounding area due to arteriolar dilatation mediated by axon reflex.
PHYSIOLOGY
132
The blood would have a weight five times its normal value.
This would make it difficult for the Heart to pump an adequate amount of blood to the brain.
Blood would, therefore, tend to drain out of, the upper part of the body and become pooled in the abdomen and
the legs, and the aviator would suffer from cerebral ischemia.
The first effect of this ischemia would be a blurring and graying of the vision as though a semi-transparent curtain
were lowered before the eyes.
This would be accompanied by a narrowing of the visual field.
If the centrifugal force on the body is continued or increased, the aviator will "black out," that is, he will suffer a
complete loss of vision and finally will lose consciousness.
The extent of the physiological changes produced depends upon both the magnitude and duration of the
centrifugal force applied to the body.
Ans. D: Pooling of blood in lower body
Ref.: Guytons Physiology, 12th ed., p- 531; AK Jains Physiology, 4th ed., p-396
PHYSIOLOGY
188. When the motor nerve to a skeletal muscle is cut, it causes disuse atrophy of the muscle, complete paralysis of the muscle,
fibrillations, abnormal excitability of the muscle & increased sensitivity to circulating acetylcholine (denervation hypersensitivity)
Fibrillation
It happens when muscle bers lose contact with their innervating axon producing a spontaneous action potential,
"fibrillation potential" that results in the muscle fiber's contraction.
These contractions are not visible under the skin and are detectable through needle electromyography (EMG) and
ultrasound.
Fibrillations do not occur in healthy individuals.
They are a major symptom in acute and severe peripheral nerve disorders, in myopathies in which muscle bers
are split or inammed, and lower motor neuron lesions.
Fasciculations
They are visible spontaneous contractions involving small groups of muscle fibers.
Fasciculation does not necessarily denote pathology, as does fibrillation, although it can be seen in lower motor
neuron lesions as well.
Ans. D: Strong stimulus
Ref.: Ganongs Physiology, 23rd ed., p-104; AK Jains Physiology, 4th ed., p-170