1. Which of the following is NOT true about body fluids?

1) The total body fluid per unit body weight is more in

infants as compared to adults

2) ECF volume of 70 kg adult man would be

approximately 14 L

3) Intracellular fluid is 66% of total bodyweight

4) Synovial fluid is transcellular fluid

Answer:
● 3

Solution:
Total Body Fluid Depends on age, 60% of the body
gender and % of body fat weight in man
50% of the body
weight in woman
70-75% of the body
weight in infants
● Due to relatively greater amount of adipose tissue in the
females, the total body water is ~10% less in a normal
young adult female than that in an average adult male.
 ● In both sexes the value decreases with age due to
increasing % of body fat. Brain (contains 74% - 80% of
water) forms a large fraction and bones (contains 20%
water) form a small fraction of body weight in infant as
compared to adult. Because of this infant contains
proportionately more body fluid than adult.
● Total body water is 60% of body weight . Therefore, 42
L in 70 kg man
● Intracellular fluid(ICF) is 2/3rd or 66.7% of total body
water(TBW) i.e 28L whereas 40% of body weight . But
option 3 says ICF is 66% of total body weight. So option
3 is not true.
● Extracellular fluid(ECF) is 1/3rd or 33.3% of total body
water(TBW) i.e 14L whereas 20% of body weight

Reference:
Guyton and Hall Textbook of Medical Physiology 13th
Edition, Page No. 306
 2. In the lecture on cellular fluids, you were taught that
there is no direct method or indicators to measure
interstitial fluids. Which substances are best suited to
measure interstitial fluid volume?

● Inulin and heavy water

● Inulin and 22Na
● Heavy water and 125I-albumin
● Inulin and 125I-albumin
Answer Type:
Single Correct
Answer:
● 4

Solution:
● Interstitial fluid volume= ECF volume – Plasma volume
● Inulin is the best indicator of ECF volume and 125I-
albumin is most commonly used for plasma volume
estimation
Reference:
Guyton and Hall Textbook of Medical Physiology 13th
Edition, Page No. 309

3. A monovalent anion has the following

concentrations in body fluids ~ ICF = 10
mEq/L, ECF = 100 mEq/L. Its equilibrium
potential would be:
1) – 10 mV
2) + 10 mV
3) – 61 mV
4) + 61 mV

4. Acetylcholine is the chief neurotransmitter of the

parasympathetic nervous system and has both
 excitatory and inhibitory effects. Acetylcholine release
can be increased from the presynaptic membrane by?
1) Blocking voltage gated Na+ channels on
presynaptic membrane
2) Blocking voltage gated Ca+ channels on
presynaptic membrane
3) Blocking voltage gated K+ channels on presynaptic
membrane
4) Blocking voltage gated CI- channels on presynaptic
membrane
Answer:
● 3

Solution:
●
 Blocking
v
ltage gated K

hannels on presynaptic membrane↓K+

e
it stops↓Membrane d
● When an AP depolarizes the presynaptic
membrane⇒Ca++ channel open⇒allow release of
neurotransmitter⇒from terminal⇒into synaptic
cleft⇒forming bridge for the vesicles and release sites of
a depolarized membrane.
● Blocking voltage gated Na++ channels will block the AP
propagation
● Chloride channels are present⇒on the post synaptic
membrane.
Reference:
Guyton and Hall Textbook of Medical Physiology 13th
Edition, Page No. 582
 5. A primary active transport occurs in the absence of or
against the existing electrochemical gradient and is
powered by metabolic energy, such as that originated
by the exergonic hydrolysis of ATP. All of the following
are examples of primary active transport, except?
1) The Na+/K+ ATPase in the red cell membrane
2) The H+/K+ ATPase in the parietal cell of stomach
3) NCX in the myocardial cell
4) SERCA in the skeletal muscle
Answer:
● 3

Solution:
● NCX is an example of secondary active transport.
● Cotransport is driven by active sodium extrusion by the
basolateral sodium/potassium-ATPase, thus facilitating
glucose uptake against an intracellular uphill gradient,
so-called secondary active transport.
● They belong to SLC family 5 (Solute Carrier Family)
● Rest 3 are examples of primary active transport.

SERCA:
● Sarco Endoplasmic Reticulum Ca++ ATPase
(110kDa transport membrane protein).
● It transports two molecules of Ca++ for each
 molecule of ATP hydrolysed.
● Ca++ pumped out of the sarcoplasm, into the
longitudinal tubules, to decrease the sarcoplasmic
[Ca++] and thus causes muscle relaxation.

Reference:
Guyton and Hall Textbook of Medical Physiology 13th
Edition, Page No. 55

6. Reperfusion injury is caused due to:

1) Increased ECF Ca++
2) Decreased ECF Ca++
3) Increased ICF Ca++
4) Decreased ICF Ca++

Answer: 3
 7. Cell membrane of a cell is freely permeable to three ions
X, Y and Z. At resting membrane potential, the
respective equilibrium potentials of X and Y are – 30m
V and – 40 mV. Equilibrium potential for Z = - 50 mV.
What will happen to the membrane potential if a drug is
infused which can block the permeability of Z?
1) Depolarization
2) Hyperpolarization
3) No change
4) Hyperpolarization following repolarization

Answer:
● 1

Solution:
● Assuming both the ions X & Y have equal permeability,
the resting membrane potential of cell moves from – 70
mv to equilibrium potential between – 30 mv & -40 mv
at equilibrium.
● It means that the potential becomes more positive,
indicating depolarization.
Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No:65, 66.

8. While walking, you accidentally step on a sharp nail.

Sharp pain is transmitted by which type of fibers?

1) Aα

2) Aβ
3) Aδ
4) C

Answer:
● 3
Solution:
Sharp somatic pain (fast pain) is carried by Aδ fibers. Pain
is carried by two types of fibers:
1. Aδ → These are relatively fast. Therefore the pain
carries by these is fast pain (epicritic pain or first pain).
2. C → These are slow, therefore the pain carries by these
is slow pain (protopathic pain or second pain).
Reference:
Ganong review of medical physiology 25th Ed Pg 167

9. During a skeletal muscle contraction, which of the

following decreases in length?
1) A band of the sarcomere
2) I band of the sarcomere
3) Thick filaments
4) Thin filaments
Answer:
● 2

Solution:
● The physical lengths of the actin and myosin filaments
do not change during contraction.
● Therefore, the A band, which is composed of myosin
filaments, does not change either.
● The Z disks do not change but the distance between the
Z disks decreases.
● As the muscle contracts, only the I band decreases in
length.
Reference:
Guyton and Hall Textbook of Medical Physiology 13th
Edition, Page No: 78
 10. A 6-year-old, boy was scheduled for strabismus
surgery in both eyes. He had not previously received
general anesthesia. Anesthesia was induced with
sevoflurane 2.5 vol% by mask ventilation in a mixture
of nitrous oxide and oxygen (FiO2 0.5). 1 min after
intubation, the heart rate of the patient was increased
from 160 to 195 beats/min. The oral temperature was
increased to 38.9º C within 5 min after induction.
Which of the following is the possible basis for this
occurrence?
1) Increased Ca++ transport via T-type calcium
channels in T-tubules
2) Increased Ca++ transport via T-type calcium
channels in L-tubules
3) Increased Ca++ transport via L-type calcium
channels in T-tubules
4) Increased Ca++ transport via L-type calcium
channels in L-tubules
Answer:
 ● 4
Solution:
● Malignant hyperthermia is a genetic disorder; there is a
defect in the gene that codes for the protein ryanodine
receptor (RyR) in skeletal muscle.
● Ryanodine receptor is a Ca2+-release channel present
in the membrane of L-tubule of skeletal muscle. When it
couples with dihydropyridine receptor (DHPR)from T
Tubules , there is release of Ca2+ into the sarcoplasm,
initiating muscle contraction.So Increased Ca++
transport via L-type calcium channels in L-tubules
leads to malignant hyperthermia
● DHPR is an L-type voltage-sensitive Ca2+ channel.
● Rarely inhalational anaesthetics can cause malignant
hyperthermia manifesting as muscle rigidity, sweating
and masseteric spasm
Reference:
Ganong’s Review of Medical Physiology. 26th edi, pg no -
106,313
 11. To regulate gastric emptying, the antrum, pylorus,
and upper duodenum apparently function as a unit.
Among the following, one does not help in decreasing
gastric emptying, identify?

1) Protein breakdown products

2) CCK
3) Enterogastric reflexes
4) Gastrin
Answer:
● 4

Solution:
● Acidity of the chyme, hyper- or hypo-osmolarity of the
duodenal contents, irritation of the duodenal mucosa,
protein or fat breakdown products in duodenum are the
factors sensed by the duodenal receptors.
● Gastric emptying will then be decreased, by a
combination of neural and hormonal signals.
 ● Neural signals would be enterogastric reflexes in the
ENS; they are triggered by the acidic chyme in the
duodenum.
● Hormonal signals would be in the form of CCK,
Secretin, G.I.P. released from duodenal mucosa.
● Fat in the duodenum is very potent inhibitor of gastric
emptying; it causes CCK release.
● Hormonal factors decrease the gastric motility and
cause constriction of pyloric sphincter. Other effects
include: fundic relaxation, inhibition of antral motor
activity.

● Gastrin, in physiological amounts, is known to

increase gastric motility.

Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No. 489

12. Which of the following motor events is integrated

entirely within the Enteric Nervous System?

1) Intesto-intestinal reflex
2) Recto-sphincteric reflex
3) Gastro-ileal reflex
 4) Peristaltic reflex
Answer:
● 4

Solution:
When the gut wall is stretched by the contents of the lumen,
initiates a reflex response known as Peristalsis, which occurs
in all parts of the gastrointestinal tract starting from the
esophagus to the rectum. A very good example is the
integrated activity of the enteric nervous system.
Intesto-intestinal reflex: Contractile activity in the rest of the
bowel is inhibited, if an area of the bowel is grossly
distended. It depends on the extrinsic neural connections
with the Enteric Nervous System; sectioning of the extrinsic
nerve will abolish this reflex.
Recto-sphincteric reflex: When the rectum is distended by
fecal material, the internal anal sphincter relaxes. This reflex
will also signal the urge for defecation. (When the rectum is
filled to about 25% of its capacity, there is an urge for
defecation). If the environmental conditions are not suitable
for defecation, then there will be voluntary contraction of
the external anal sphincter to overcome the urge for
defecation. When it is convenient to defecate, there is
voluntary relaxation of the external anal sphincter and
evacuation of faeces occurs. First urge to defecate occurs at a
rectal pressure of 18 mm Hg.
Gastro-ileal reflex: Shortly after eating food , there is
relaxation of the ileo-cecal sphincter and increase in the
contractile activity of the ileum. It promotes passage of small
intestinal contents into the colon. Extrinsic autonomic nerves
mediates this reflex to the intestine.
Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No. 485

13. Short-chain fatty acids (SCFAs) are the main

metabolites formed in the colon with the help of
bacterial fermentation of dietary fibers, plays a key role
in neuro-immunoendocrine regulation. The SCFAs
produced by bacteria are maximally absorbed in?
1) Duodenum
2) jejunum
3) ileum
4) Colon
Answer:
● 4
Solution:
● Short-chain fatty acids [SCFA]are produced in the
colon by the action of colonic bacteria on complex
carbohydrates, and other dietary components that
could not be digested in the small intestine (like dietary
fibres-60% of the total is acetate, 25% propionate, 15%
butyrate)
● These short-chain fatty acids are absorbed from the
colon.
● SCFAs have trophic effect on colonic epithelial cells,
they also combat inflammation and maintain acid-base
equilibrium.
Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No. 476

14. Which of the following statements is true about

protein digestion?
 1) Protein digestion starts with the salivary action
2) Trypsinogen is converted to trypsin by the action of
bicarbonate in duodenum
3) Trypsin and chymotrypsin are exopeptidases
4) 10%-20% protein digestion occurs by pepsin
action in stomach.
Answer:
● 4

Solution:
- Saliva does not contain proteolytic enzyme; protein
digestion begins in the stomach by the action of pepsin.
- Trypsinogen is converted to trypsin by the action of
enterokinase in duodenum.
- Trypsin and chymotrypsin are endopeptidases;
carboxypeptidase and aminopeptidase are exopeptidases.
- Of the total protein digestion, 10%-20% occurs by the
action of pepsin.
Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No. 471
 15. Bile serves as a critical excretory fluid through
which the body excretes lipid-soluble end products of
metabolism as well as lipid-soluble xenobiotics. Which
of the following statements about bile secretion is NOT
true?

1) Cholecystokinin is most potent choleretic

2) Secretion of bile into bile canaliculus is an active
process
3) Hepatic bile is more alkaline than gall bladder bile
4) Bilirubin is a constituent of bile
Answer:
● 1

Solution:
● Substances that increase the secretion of bile are known
as choleretics.
 ● Bile acids themselves are among the most important
physiologic choleretics.
● Choleretics - Secretin, glucagon, VIP, and gastrin-
releasing peptide (GRP).
● By far the most potent stimulus for causing the
gallbladder contractions (cholagogue) is the hormone
CCK.
● The gallbladder is also stimulated less strongly by
acetylcholine-secreting nerve fibers from both the vagi
and the intestinal enteric nervous system.
● Hepatocytes need active, energy-dependent secretion of
inorganic and organic solutes into the canalicular
lumen, followed by the passive movement of water for
the formation of bile.
● This movement of water through the tight junctions
between hepatocytes carries with it other solutes by
solvent drag.

Hepatic Gallbladde
duct bile r bile
Percentage of 2-4 10-12
solids
Bile acids 10-20 50-200
(mmol/L)
PH 7.8-8.6 7.0-7.4
Billirubin 0.04g/dl 0.3g/dl

Reference:
Guyton and Hall Textbook of Medical Physiology 13th
Edition, Page No. 829
 16. A 50-year-old woman with celiac disease visited the
physician because of difficulty seeing at night. She
complained about frequent, foul-smelling stools on
further investigation. Stool analysis revealed a high
content of partially digested fat. Deficiency of which of
the following causes her condition?
1) Amino acids
2) Glucose
3) Vitamin A
4) Vitamin B12
Answer:
● 3

Solution:
● The Woman presents with malabsorption syndrome
and undigested fat in the stool so deficiency of fat-
soluble vitamin is suspected.
● Vitamin A is a fat-soluble vitamin that can be excreted
in the faeces along with fat in persons with celiac disease
and other diseases that cause malabsorption of
intestinal contents.
● Retinal , which is necessary for the synthesis of
rhodopsin in the rods of the retina, can be deficient,
when there is a lack of Vitamin A.
 ● Decreased levels of rhodopsin in the rods can lower the
sensitivity of the retina to light, thus causing night
blindness.
Reference:
Guyton and Hall Textbook of Medical Physiology 13th
Edition

17. A patient suspected to be in

congestive heart failure is being given
digitalis. Which of the following will be a
clear cut indicator that digitalis is
working?
A. Increased end-systolic volume (ESV)
B. Decreased end-diastolic volume (EDV)
C. Increased ESV and decreased EDV
D. Decreased ESV; normal EDV

18. A 25-year old athlete has an ejection

fraction of 0.50 and an end-systolic
 volume of 50 mL. What is his end-
diastolic volume?
A. 75 mL
B. 100 mL
C. 125 mL
D. 150 mL

19. Before isovolumetric contraction phase of cardiac

cycle, which one of the following is CORRECT?

1) LV excitation starts before that of RV

2) RV excitation starts before that of LV
3) Excitation begins simultaneously in both ventricles
4) Beginning of RV or LV excitation depends on
ventricular size
Answer:
● 1

Solution:
● AV node is continuous with the bundle of His, which
gives off a left bundle branch (divides into an anterior
fascicle and a posterior fascicle) at the top of the
interventricular septum and then continues as the right
bundle branch.
 ● From the bundle of His, impulse enters the left branch
first (The septum depolarizes from left to right)
● Then, to the right branch (via interventricular septum),
and it continues further down the left branch.
● Then, having entered the right branch, it travels down
the right ventricle.
● Depolarization of the ventricular muscle starts at the left
side of the interventricular septum and moves first to the
right across the mid-portion of the septum.
● Thus, LV excitation begins just ahead of the RV
excitation (option-1).
● Practically, however, both ventricles begin to contract
simultaneously.
The sequence of depolarization in cardiac tissue.
Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No. 509

20. Among the following, the last part of the ventricle

to be depolarized is?

1) Epicardium of the base of LV

2) Endocardium of the base of LV
3) Apical epicardium
4) Apical endocardium
Answer:
 ● 1
Solution:
● The endocardial surfaces of both ventricles are
activated rapidly, depolarization spreads from apex to
base and from endocardium to epicardium at a slower
velocity ( ≈ 0.3 to 0.4 m/sec).
● Thus, the last part of the heart to be depolarized is the
epicardium of the base of the LV.
● In addition, the apical and central epicardial regions of
both ventricles are activated somewhat earlier than
their respective basal regions.
● The last portions of the ventricles to be excited are the
pulmonary CONUS, posterior basal epicardial regions,
and a small zone in the basal portion of the
interventricular septum.
Reference:
● Ganong’s Review of Medical Physiology 26th Edition,
Page No. 512

21. Which among the following ions is responsible for

the Major currents of depolarization in Purkinje fibers
of Heart?

1) Na+
 2) Ca++
3) K+
4) Cl-
Answer:
● 1

Solution:
● Purkinje fiber is a fast-response type or rapidly
depolarizing fiber.
● The rapid depolarization is due a rapid influx of Na+
through the fast Na+ channels.
● Major current for depolarization in pacemaker cells is
due to Ca++
NOTE: The action potential of the Purkinje fibers depends
on four-time and voltage-dependent membrane currents:
INa (not present in the SA and AV nodal cells), ICa, IK, and
If. The maximum diastolic potential is −80 mV. From that
negative Vm, these cells produce a very slow pacemaker
depolarization (phase 4) that depends on If.
Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No. 510
 22. A 50-year old female, with H/O HT, approched
cardiologist with complaints of dizzness, breathlessness,
and fainting attacks. Her ECG record is shown below.
What could be the probable diagnosis?

1) Wolff-Parkinson-White syndrome
2) Mitral stenosis
3) Hypokalemia
4) Congestive heart failure
Answer:
● 2

- P mitrale: Seen in mitral stenosis

23. A 32 yr old male patient came in with history of

trauma. On examination, BP = 80/60 mmhg ; distant
 heart sounds and bulging neck veins, Raised JVP.
Patient was planned for Pericardiocentesis. Normally
'Y' descent in the JVP is due to?

1) Atrial diastole
2) Closure of the tricuspid valve
3) Opening of the tricuspid valve
4) Isovolumetric relaxation of right ventricle
Answer:
● 3

Solution:
● “y” wave indicates fall of right atrial pressure due to
opening of tricuspid valve leading to the ventricular
filling.
Reference:
 ● Guyton and Hall Textbook of Medical Physiology 13th
Edition
24. Immediately after the beginning of the QRS wave,
which phase of the cardiac cycle is seen ?

1) Isovolumic relaxation
2) Atrial systole
3) Diastasis
4) Isovolumic contraction
Answer:
● 4

Solution:
● Isovolumic contraction occurs immediately after the
QRS wave.
● Before the ejection phase, the isovolumic contraction
occurs which increases the ventricular pressure enough
to mechanically open the aortic and pulmonary valves
Reference:
Guyton and Hall Textbook of Medical Physiology 13th
Edition, Page No. 118

25. The PR interval is the time from the onset of the P

wave to the start of the QRS complex. It reflects
conduction through the AV node. PR interval is
constant in?

1) Mobitz type I block

2) Mobitz type II block
3) All types of second degree blocks
4) None of the varieties of heart block.
Answer:
● 2

Solution:
- Mobitz type II of the second-degree block has a constant
PR interval (option-2), with every ‘nth' beat is dropped; that
is, inconsistently one impulse from atria does not reach
ventricles.
- Mobitz type I of the second-degree block shows lengthening
PR interval in successive beats, with finally in one beat P
wave is not followed by QRS complex.
- In the third variety of thesecond-degree block, atria-to-
ventricle excitation is a fixed small number ratio (e.g., 3:2).
For instance, every third impulse from the SA node will fail
to reach the ventricles.

Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No. 518.

26. Electrical conversion (an electrical shock) given

during the vulnerable period in itself initiates
ventricular fibrillation. Refractory areas of cardiac
muscle are spread among non-refractory areas.
Vulnerable period' during the cardiac excitation
coincides with?

1) PR interval
2) J-point
3) Peak of T wave
4) U wave
Answer:
 ● 3
Solution:
● Peak or midportion of T wave (option-3) is the
‘vulnerable period’ in the heart.
● T-wave represents ventricular repolarization.
● The mid-portion of the T wave indicates that the
ventricular repolarisation is partly complete.
● Each cell will have different status of excitability, at this
point of time.
● If a premature impulse arrives in the ventricles at this
time, it may result in ventricular fibrillation.
● During this time, the excitability of the ventricular
fibers varies spatially.
● Some fibers are completely repolarized (and hence have
recovered their excitability, and are ready to conduct
another impulse), whereas others are partially
recovered, and still others are in their refractory
periods.

● J-point or reference point. The end of S-wave (of

QRS) is sometimes called the reference point or J-
point. It is an isoelectric point. It indicates the
completion of ventricular depolarization. It means,
all the ventricular cells are in an equipotential
(depolarized).
● U wave represents the repolarization of the papillary
 muscle.

Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No. 530.

27. All of the following occur when the blood flows

through the capillaries except?

1) Increase in haemotocrit
2) Hb curve shift to the left
3) Decreased protein content
4) Decrease in pH
Answer:
● 2

Solution:
● Capillaries in tissue have CO2 diffused from cells; it
would displace O2 from Hb (Bohr Effect).
The curve shifts to the right, not to left (option-2)
 ● Fluid leaks out of the capillaries. Hence, hematocrit (the
ratio of cells to plasma) would increase.
● However, this is a generalized statement.
● In some capillary beds (e.g. muscle), hematocrit may
become as low as 20%.
● Reason: red cells at the center have faster velocities.
The cell-free portion near the vessel wall is much
slower. The mean transit time of the plasma, which
moves more uniformly across the wall, is slower.
● There is some leakage of proteins across the capillary
wall. Hence, protein content would be decreased.
● Acidic metabolites released by the cells would decrease
the pH of capillary blood. Note that: When this blood
goes to the venous side, chloride shift into the RBCs
have caused bicarbonate to enter plasma, from RBCs.
Blood pH will now increase.
Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No. 631.

28. A metarteriole is a short microvessel in the

microcirculation that links arterioles and capillaries. A
capillary that connects metarteriole directly with a
venule is called as?

1) Windkessel vessel
 2) Resistance vessel
3) Exchange vessel
4) Thoroughfare vessel
Answer:
● 4

Solution:
‘Thoroughfare’ means a channel or a road that connects two
major roads.

A.V. anastomosis is called a thoroughfare (option-4) vessel.

Windkessel vessels --> aorta and large arteries
Resistance vessels --> arterioles
Exchange vessels --> capillaries
Reference:
Guyton and Hall Textbook of Medical Physiology 13th
Edition, Page No. 179.
 29. Following are the changes that occurs in Lung
functioning that decreases with the age, EXCEPT?

● Total lung capacity

● Pa02
● FRC
● FEV1
Answer Type:
Single Correct
Answer:
● 3

Solution:
● With the aging process, there is a progressive loss of
alveolar elastic recoil, costal cartilage calcification,
decreased intervertebral space, and greater spinal
curvature. These changes result in a decline in lung
function
 ● The decline in lung function with aging is indicated by a
decrease in FEV1. This decrease is due to the dynamic
compression of airways.
● FRC increases with age. This is due to decreased elastic
recoil and greater dynamic compression of airways.
More amount of air is trapped in the lungs at the end of
expiration. Hence, option C is the answer.
● PO2 decreases with age. Decreased elastic recoil
combined with dynamic compression results in early
airway closure, mainly in the dependent airways.
● Hence, ventilation would be greater at the apex, the
region which is normally less ventilated. It results in a
VA/Q inequality, causing decreased PO2.
● Loss of alveolar surface area and reduced pulmonary
blood flow would also lead to a decreased PO2. Reduced
expansibility of lungs and weakened respiratory
muscles would cause a decrease in TLC.
Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No:617

30. 35 yr old male, a known case of Interstitial lung

disease. All of the following pulmonary function
abnormalities are seen in this patient, except?
 1) Reduced vital capacity
2) Reduced FEV1/FVC ratio
3) Reduced diffusion capacity
4) Reduced total lung capacity
Answer:
● 2

Solution:
● Interstitial lung disease is a restrictive lung disease.
● In restrictive lung disease, lung compliance or
expansibility is decreased. Hence, vital capacity is
reduced.
● Total lung capacity will also decrease. The diffusion
capacity of the respiratory membrane is reduced as the
diffusion distance is increased in interstitial lung
disease.
● Since VC is reduced, FEV1/FVC ratio is increased.

Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No. 618

31. PFT performed on a patient showed

the following results (depicted in the
graphs).
 How much is the ‘specific’ compliance in
this patient?
A. 0.1 mL/cm H2O/mL
B. 1 mL/cm H2O/mL
C. 20 mL/cm H2O/mL
D. 200 mL/cm H2O/mL

32. A patient of CO-poisoning was

brought to the hospital. He was
 immediately started with 100% O2 at 6
atm. His Hb is 12 gm%. How much will be
the total O2 content of his arterial blood
after about 30 minutes?
A. 4 mL/100 mL
B. 8 mL/100 mL
C. 12 mL/100 mL
D. 16 mL/100 mL

33. Sigmoid shape in O2-Hb dissociation curve is seen

characteristically due to the T–R inter-conversion. In
which of the following does the o2 dissociation curve
does not shift to left?

1) Alkalosis
2) Hypercapnia
 3) Fetal Hb
4) CO poisoning
Answer:
● 2

Solution:
When the O2 affinity for Hb is increased, the dissociation
curve shifts to the left.
O2 has less affinity for Hb which is in “T-state”. When Hb is
snapped into “R-state”, O2 affinity for it increases.

Increased affinity of O2 for

Hb/shift to the left

Decreased H+/alkalosis
Decreased PCO2
Decreased temperature
Decreased 2,3-DPG
HbF
CO poisoning
Stored blood (2,3-DPG
decreases)
NO & H2S (bind to Hb; snap it
into “R-state”)

Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No. 631

34. Which of the following will decrease the

physiologic dead space?

1) Emphysema
2) Neck flexion
3) Increase in tidal volume
4) IPPV
Answer:
● 2

Solution:
● Neck flexion decreases the volume of anatomic dead
space and thus the total or physiologic dead (which
includes anatomic dead space) will decrease.
● Physiologic dead space includes those alveoli which do
not receive perfusion, making it a wasted ventilation in
those alveoli.
 ● Physiologic dead space increases in emphysema.
● Increase in tidal volume increases anatomic dead space
& thus physiologic dead space
● In IPPV, the positive pressure ventilation increases
alveolar pressure, which in turn compresses vessels.
This will decrease the blood flow to some regions of the
lung.
Reference:
Textbook of Medical Physiology. Guyton & Hall. 2nd South
Asia edition

35. A 25-year-old patient admitted to the emergency

room developed a pneumothorax after a chest wall
 injury. Which of the following statements best describes
the changes in lung and thoracic volume in this patient
compared to normal?

1) Lung Thoracic
Volume Volume

Increased
Decreased

2) Lung Thoracic
Volume Volume

Decreased
Decreased

3) Lung Thoracic
Volume Volume

Decreased
Increased

4) Lung Thoracic
Volume Volume
 No change
Decreased

Answer:
● 1

Solution:
● The elastic tendency of the lungs to collapse is exactly
equal to the elastic tendency of the thoracic cage to
expand under normal conditions.
● But when air enters pleural space, the pleural pressure
becomes equal to atmospheric pressure.
● So, the chest wall will expand i.e. thoracic volume
increases, and lungs will collapse i.e. lung volume
decreases in pneumothorax.
Reference:
Ref: Guyton 13th pg. 563
 36. Hypoxic exposure is a potent activator of ANS.
Hypoxia induces tachycardia when oxygen
concentration is lower than 17%. Tachycardia caused
by hypoxia is due to?

1) Diffuse Vasoconstriction
2) Diffuse vasodilatation
3) central chemoreceptor stimulation
4) Secondary reflex after hyperventilation
Answer:
● 4

Solution:
● The primary reflex evoked by hypoxic stimulation of
carotid chemoreceptor leads to excitation of the
medullary vagal center. This will decrease the heart
rate
● There is also a secondary reflex. Hyperventilation
caused by hypoxic stimulation of chemoreceptor
initiates pulmonary inflation reflex.
 ● Stretch receptors in the thorax stimulated by
hyperventilation initiate this reflex which will inhibit
the medullary vagal center. This will result in
tachycardia. There is also the effect of hypocapnia
produced by hyperventilation; it will also add to the
secondary reflex-induced tachycardia.
Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No. 580

37. Damage to lower pons, leaving upper pons intact,

will result in?

1) Apneusis
2) Rapid, shallow breathing
3) Irregular gasping type of breathing
4) No change in pattern of breathing
Answer:
● 2

Solution:
● Damage to lower pons will damage the apneustic center.
This center was causing the breathing to be slow and
deep.
 ● Upper pons has pneumotaxic center. It causes the
breathing to be rapid and shallow. Since this center is
intact (and apneustic is damaged), breathing will
become shallow and rapid.
Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No:647

38. Which of the following Breathing patterns have

prolonged inspiratory spasms that resemble breath
holding?

1) Biot breathing
2) Apneustic breathing
3) Cheyne stokes breathing
4) Kussmaul breathing
Answer:
● 2

Solution:
APNEUSTIC BREATHING → long inspiratory spasms
(resembles breath holding)
CHEYNE-STROKE BREATHING → apnea followed by
hyperapnea
KUSSMAUL RESPIRATION → increased depth and
prolonged inspiration
REGULARLY IRREGULAR → seen in meningitis
See the attached treasure for further details.
Reference:
Ganong’s Review of Medical Physiology 26th Edition, Page
No:647
39. A patient’s urine is collected for 2 hours, and
the total volume is 600 milliliters during this time.
Her urine osmolarity is 150 mOsm/L, and her
plasma osmolarity is 300 mOsm/L. What is her
“free water clearance”?
A. +5.0 ml/min
B. +2.5 ml/min
C. 0.0 ml/min
D. −2.5 ml/min
 40. Plasma concentration of substance “x” is 10
mg%. After getting freely filtered at glomerulus,
this substance is neither reabsorbed nor secreted
into tubules. If the GFR in a given individual is 100
mL/min, what will be the urinary excretion rate of
this substance?
A. 1 mg/min
B. 10 mg/min
C. 100 mg/min
D. 1000 mg/min

41. When the drug is not actively secreted and

the reabsorption is negligible, the renal CL of a
drug is often related to the renal glomerular
filtration rate. Drugs are usually filtered through
the glomerulus in a nonselective process if they
are in a free, nonprotein-bound form. If a
substance “X” has more renal clearance than the
GFR, it means?
A. “X” is only being reabsorbed by the
tubules
B. “X” is being secreted by the tubules
C. “X” is being secreted as well as
reabsorbed by the tubules
D. “X” is neither secreted nor reabsorbed
42. If a patient has a creatinine clearance of 90
ml/min, a urine flow rate of 1 ml/min, a plasma K+
concentration of 4 mEq/L, and a urine K+
concentration of 60 mEq/L, what is the
approximate rate of K+ excretion?
A. 0.06 mEq/min
B. 0.30 mEq/min
C. 0.36 mEq/min
D. 3.6 mEq/min

43. The GFR of a 26-year-old man with

glomerulonephritis decreases by 50% and
remains at that level. For which substance would
you expect to find the greatest increase in plasma
concentration?
A. Creatinine
B. K+
C. Glucose
 D. Na+

44. A 60-year-old man, weighing 60 Kgs, has a

plasma creatinine value of 3 mg/dL. How much is
his creatinine clearance?
A. 22 mL/min
B. 44 mL/min
C. 66 mL/min
D. 88 mL/min
 45. A 30-year old male came to the hospital with
the following complaints ~ blurred vision and
diplopia, tingling and numbness in the limbs
which became worse during the recent episode of
fever, lack of co-ordination and unsteady gait.
Which of the following is the most likely molecular
mechanism responsible for this condition?
A. Antibodies against Schwann cell
B. Antibodies against parietal cell
C. Antibodies against aquaporin 4 (AQP 4)
D. Antibodies against oligodendrocyte

46. Laron syndrome (LS)is

anautosomalrecessive disorder. Affected
individuals classically present withshort
staturebetween -4 to -10 standard deviations
below median height, obesity,craniofacial
abnormalities,micropenis,low blood sugar,
and low serum IGF-1 despite elevated basal
serum GH. True about Laron dwarfism is?
A. Growth hormone deficiency
B. Growth hormone insensitivity
C. Plasma IGF-1 is markedly increased
D. Plasma IGF-BP3 at normal levels
47. It is a distinct nucleus of the midbrain, lying
immediately dorsal to the oculomotor
complex. It is located just slightly ventral and
lateral to the cerebral aqueduct at the level of
the superior colliculus. It is also involved in
both light reflex and accommodation reflex.
Which one of the following is described
here?
A. Pretectal nucleus
B. Edinger – Westphal nucleus
C. Suprachiasmatic nucleus
D. Supraoptic nucleus

48. Incorrectly matched among the following is:

A. Post ganglionic sympathetic fibres - release
norepinephrine
B. Sweat glands – innervated by sympathetic
adrenergic fibres
C. Postganglionic parasympathetic fibres - release
acetylcholine
D. Preganglionic sympathetic fibres – release
acetylcholine

49. Anandamide is a ligand involved in analgesia.

Which of the following is true about anadamide?
A.It is an endocannabinoid
 B.It is synthesized from POMC
C.It blocks the action of substance P
D.It is a glutamate agonist

50. Which of the following is NOT an effect related to

ATP-sensitive K+ channel?
A.Hypoxic Vasoconstriction in pulmonary circulation
B.Action of insulin secretagogues
C.Hypoxic vasodilation in systemic circulation
D.Ischemic preconditioning in the cardiac myocytes.