Physiology 201-300 Flashcards
1
Q
How many oxygen molecules can 1 myoglobin molecule bind? A. 1 B. 2 C. 3 D. 4 E. 5
A
A
Myoglobin can only bind 1 molecule of oxygen, Hemoglobin can carry 4 molecules of oxygen
2
Q
An MRI of a patient who suffered from a deceleration accident revealed a lesion on the right visual cortex posterior to the lateral geniculate body, which of the following visual defects would be expected?
A. Right homonymous hemianopia
B. Left homonymous hemianopia
C. Left hemianopia with macular sparing
D. Right hemianopia with macular sparing
E. Bilateral Hemianopia
A
C
Lesions of the right visual cortex posterior to the lateral geniculate body will present with left hemianopia with macular sparing. Lesions of the optic tract will present with homonymous hemianopia.
3
Q
Which component of the complement system promotes opsonization? A. C3a B. C3b C. C4a D. C4b E. C5a
A
B
4
Q
On a NORMAL individual, What is the alveolar ventilation, given the following: Tidal Volume : 500mL, RR:22cpm? A. 7.7 L B. 8.8 L C. 9.9 L D. 10.0 L E. 11.0 L
A
A
AV= (TV-Physiologic Dead space) x RR; AV= (500-150) x 22; AV:7,700mL/ 7.7 L (a similar computation-question was asked in the boards)
5
Q
Majority of Carbon dioxide is transported in the body thru which form? A. HCO3 B. H2CO3 C. Free CO2 D. CO2 bound to albumin E. COOH
A
A
6
Q
Pulmonary Embolism shows a V/Q ratio of: A. More than 1 B. Zero C. Less than 1 D. Negative 0.8 E. Infinite
A
E
In Pulmonary embolism there is good ventilation but zero perfusion hence V/Q ratio is infinite, there is continuous ventilation with no perfusion.
7
Q
Which of the following shifts the Hemoglobin association curve to the left: A. Fever B. High pH C. Increased 2,3 BPG D. Exercise E. Increased CO2
A
B
The hemoglobin Dissociation curve shifts to the right in: Increased CO2, ACIDOSIS (low pH), Increased 2,3 -BPG, Exercise, Increased Temperature. (similar to SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, came out 3x!!!)
8
Q
Which of the following combination of hormones is synergistic with each other to promote HCl secretion? A. VIP, Ach, Histamine B. Ach, Histamine, Gastrin C. Secretin, CCK, Ach D. Motilin, Secretin, Gastrin E. Somatostatin, Gastrin, CCK
A
B
Ach, Histamine, and Gastrin are all involved in the several mechanisms of HCl secretion. Histamine is the most important of the 3.
9
Q
Basophilic Cells of the Pituitary gland secretes the following: A. FSH B. GH C. Prolactin D. A and B E. All of the above
A
A
Basophilic Cells of the Anterior Pituitary Gland secretes the ff: FSH, LH, ACTH, TSH, and MSH
10
Q
Decreased Acetylcholine levels in the brain is thought to be the reason for developing Alzheimer's Disease. Where is Acetylcholine produced in the brain? A. Locus Ceruleus of the Pons B. Ventral Tegmentum C. Basal Nucleus of Meynert D. Nucleus Accumbens E. Raphe Nucleus
A
C
Locus Ceruleus-NE, Serotonin- Raphe Nucleus, Dopamine- Ventral tegmentum of Substantia Nigra, GABANucleus Accumbens
11
Q
While walking at the mall, you incidentally saw your highschool crush, and your heart started beating fast. The heart rate is dependent on whate phase of the action potential of the SA node? A. Phase 0 B. Phase 1 C. Phase 2 D. Phase 3 E. Phase 4
A
E
The action potential of the SA node starts at Phase 4 followed by a phase 0 then a phase 3. The more steeper the phase 4 the easier it is to reach the threshold, hence a faster cardiac rate.
12
Q
Which of the following is NOT a Sympathetic response? A. Mydriasis B. Uterine contraction C. Uterine relaxation D. Piloerection E. Erection
A
E
Erection is a Parasympathetic response. Uterine contraction and relaxation are both sympathetic responses acting on alpha-1 receptor and Beta-2 receptors, respectively. Mydriasis and piloerection are both sympathetic responses
13
Q
Your lola is sufferring from cataract, bragging in front of her amigas, she asks you: "what part of the eye is the most important factor in refraction?", you will say that it is the: A. Retina B. Lens C. Uvea D. Cornea E. Pupil
A
D
The refractive power of the eye is 59 diopters and 2/3s of this is from the cornea, 1/3 is provided by the lens.
14
Q
Among which of the following hypoxemic conditions will manifest as a normal Alveolararterial Gradient? A. High altitude B. V/Q mismatch C. Diffusion Limitation D. Right to left shunt E. None of the above
A
A
15
Q
A patient presents to you in the ER with Sinus tachycardia, you immediately performed carotid massage to decrease the HR. Which of the following is responsible for the transmition of afferent signals from the carotid sinus to the medulla. A. CN V B. CN VII C. CN VIII D. CN IX E. CN X
A
D
CN IX/ Glossopharyngeal nerve is responsible for transmitting the afferent signal from the carotid sinus, its branch is specifically termed as the Herring’s Nerve.
16
Q
This phase of the cell cycle is where the 2nd heart sound is heard, the ventricular pressure decreases but the ventricular volume remains the same A. Atrial Contraction B. Isovolumic Contraction C. Rapid Ventricular Ejection D. Reduced Ventricular Ejection E. Isovolumic Relaxation
A
E
In Isovolumic relaxation the the aortic pressure is greater than the ventricular pressure hence the semilunar valve closes and the second heart sound is heard.
17
Q
A nurse accidentally infused a large amount of Calcium gluconate into your patient, what will be the expected cardiac effect? A. Increased Heart rate B. Arrhythmia C. Increased Cardiac output D. Decreased Heart rate E. None of the above
A
B
18
Q
Osmotic Diuretics act on all parts of the Nephron EXCEPT: A. Proximal Convoluted Tubule B. Loop of Henle C. Distal Convoluted Tubules D. Collecting Ducts E. No exception
A
C
19
Q
Glucose Transporters (GLUT) are of what type of Transport Mechanism? A. Simple Diffusion B. Facilitated Diffusion C. Primary Active Transport D. Cotransport E. Counter transport
A
B
GLUTs are passive transport mechanisms, has a downhill approach and is carrier mediated, which does not use metabolic energy, they are also independent of Na gradient.
20
Q
On what phase of the female menstrual cycle is a patient in, given the following lab results: Estrogen, FSH and LH: INCREASED; Progesterone: DECREASED? A. Menstruation B. Follicular Phase C. Ovulation D. Luteal Phase E. Proliferative Phase
A
C
21
Q
Which myofibril band does not shorten during contraction? A. H band B. A band C. I band D. All of the above
A
B
*Generally a recall type of exam. Hband (heller) is the zone of the thick filaments that is not superimposed by the thin filaments; whereas A-band (anisotropic) contains the entire length of a single thick filament; and finally, Iband (isotropic) is the zone of thin filaments that is not superimposed by thick filaments. During contraction, the A-band does not change its length, whereas the I-band and the H-band shorten. This also causes the Z lines to come closer together.
22
Q
Which of the following ECG findings will best suggest an old inferior wall myocardial infarction?
A. Q wave in the beginning of QRS complex in lead I
B. Q wave in leads II, III, avF
C. J point elevation in leads II, III, avF
D. All of the above
A
B
The appearance of Q waves (i.e. significant Q - wider and deeper waves) indicates that irreversible myocardial cell death has occurred. Its presence is diagnostic of MI. Leads II, III, avF assess the posterior wall territory. J point is the place where ST segment takes off from the QRS complex and said to have ho pathologic implications whatsoever.
23
Q
Osmotic pressure is defined as the amount of pressure required to stop movement of water through a semipermeable membrane. Which of the following is not true about osmotic pressure?
A. It is determined by the number of particles per unit volume of fluid.
B. It is determined by the mass of particles per unit volume of fluid.
C. The molar concentration of the solution dictates the osmotic pressure.
D. None of the above
A
B
24
Q
How much body water is lost in the feces during prolonged heavy exercise? A. 50 ml/day B. 100 ml/day C. 250 ml/day D. 400 ml/day
A
B
Must memorize several values; they are asked. Water loss from the skin and feces remain constant even during prolonged heavy exercise, set at 350 and 100 ml/day, respectively. On the other hand, loss from respiration increases from 350 to 650 ml/day; sweat - from 100 to 5000 ml/day. Urine finally decreases from 1400 to as little as 500 ml/day.
25
Which of the following will decrease the glomerular filtration rate?
A. An increase in the hydraulic conductivity of the glomerulus
B. An increase in the glomerular capillary osmotic pressure
C. A decrease in the sympathetic activity to the afferent renal vasculature
D. A moderate increase in angiotensin II acting on efferent arterioles
B
Hydraulic conductivity influences the filtration coefficient and hence the GFR. It refers to the ease with which substances can pass through the glomerular capillary membrane. Increasing the conductivity, therefore will not decrease the GFR. Decreasing the sympathetic effect on afferent arteriole would mean dilatation and an increase in glomerular hydrostatic pressure and hence increased GFR. Moderate increase in angiotensin II will cause efferent arteriole constriction and will contribute to increased ccapillary hydrostatic pressure. It should be noted however that in excessive stimulation by angiotensin II, the severe constriction will eventually increase the glomerular capillary oncotic pressure (trapped protein and ions) and therefore will diminish GFR.
26
```
What is the last nucleated stage found in erythropoiesis?
A. Basophilic erythroblast
B. Polychromatophilic erythroblast
C. Orthochromatic erythroblast
D. Reticulocyte
```
C
| Reticulocyte, on the other hand, is the earliest RBC stage found in peripheral blood. It is already anucleated.
27
```
What is the endothelial cell molecule responsible for the adhesion, arrest and transmigration of all leukocytes?
A. P-selectin
B. VCAM
C. ICAM
D. Integrins
```
C
Please refer to Acute and Chronic Inflammation Chapter of Robbins (Unit 1, Chapter 2, Table 2-1, p. 54, 7th ed). It was very helpful! =)
28
Which of the following platelet/coagulation studies results are most consistent with von Willebrand's disease?
A. NORMAL bleeding time, platelet count, PT and PTT
B. NORMAL bleeding time, platelet count, PT; PROLONGED PTT
C. PROLONGED bleeding time; NORMAL platelet count and PT; PROLONGED PTT
D. PROLONGED bleeding time; LOW platelet count; PROLONGED PT and PTT
C
Appreciate the purpose of the different lab tests including: BLEEDING TIME - a qualitative test for platelet function (we mean, does it adhere, aggregate well?), while PLATELET COUNT - obviously, a quantitative test. PT is a coagulation test that assesses both the extrinsic (factors VII, III/tissue factor) and the common (factors V, X, II, I, XIII) pathways - mnemonic: PeT. While PTT assesses both the intrinsic (HMWK, factors XII, XI, VIII, IX) and the common pathways - mnemonic: PiTT. In von Willebrand disease, there is problem with vWf which is important both in platelet adhesion and in intrinsic pathway stabilizer/vehicle/cofactor of factor VIII) hence prolonged BT and PTT.
29
```
Speech is a complex mechanism that makes use of the respiratory system, cerebral cortex, and the articulation and phonation structures of the mouth and nasal cavities. Its mechanical function phonation is particularly achieved through the:
A. Tongue
B. Larynx
C. Lips
D. Epiglotti
```
B
30
Zone 2, the predominant pulmonary blood flow type in the lung apices, is characterized by:
A. Alveolar air pressure that is greater than arterial pressure during the entire cardiac cycle
B. Alveolar air pressure that is lesser than arterial pressure during systole but greater only during diastole
C. Arterial pressure and pulmonary capillary pressure remaining greater than alveolar air pressure at all times
D. None of the above
B
Option A refers to Zone 1, while option C refers to Zone 3. Normally, the lungs have only zones 2 and 3 blood flow - zone 2 (intermittent blood flow) in the apices, and zone 3 (continuous flow) in all lower areas
31
Vasopressin secretion is triggered by:
A. LOW blood volume; LOW blood pressure; HIGH urine osmolality
B. HIGH blood volume; HIGH blood alcohol; LOW plasma osmolality
C. HIGH blood pressure; HIGH body alcohol; HIGH urine osmolality
D. LOW blood volume; LOW blood pressure; HIGH plasma osmolality
D
Vasopressin or ADH is waterregulating hormone (waterconserving). It responds to low blood/plasma volume, low BP, and high plasma osmolality --- all suggesting water depletion.
32
```
Which of the following will cause increased K secretion?
A. Hyperaldosteronism
B. Alkalosis
C. Luminal anions
D. All of the above
E. None of the above
```
D
33
```
All of the following will shift the oxygen dissociation curve to the right except:
A. Increased 2,3- bisphosphoglycerate
B. Hypercarbia C. Fever
D. Alkalosis
E. None of the above
```
D
*Should you fail to master this topic, you may not take the physio exam =). The O2 dissociation curve (which is, by the way, sigmoidal in shape) shifts to the right (meaning hemoglobin has lower affinity to O2 and releases more O2 to tissues) happens during C-A-B-ET: high Carbon dioxide; Acidosis or low pH or high H ions; increased 2,3- Bisphosphoglycerate; Exercise; and high Temperature or fever
34
Pathogenesis of Alzheimer's disease is believed to involve the destruction of:
A. Dopamine-secreting cell bodies in the substantia nigra pars compacta
B. Acetylcholineproducing neurons in many parts of the brain
C. GABA-producing neurons in caudate nucleus
D. Norepinephrinesecreting neurons in locus cereleus
B
| Option A is Parkinson's; option C is Huntington's. At least know their basic pathophysio, useful also
35
What is the importance of secondary peristaltic waves in GI functions?
A. It mediates what is known as the gastrocolic reflex.
B. It delays gastric emptying time promoting mixing of foods until they form chyme.
C. It is responsible for the mass movements of the colon.
D. It mediates esophageal contraction until all retained foods are emptied into the stomach.
D
Primary and secondary peristalsis are exhibited by the esophagus. Primary peristalsis is the wave that begins in the pharynx and spreads into the esophagus during the pharyngeal stage of swallowing. If it fails to move into the stomach all the food that have gone to the esophagus, secondary peristalsis results from distention of the esophagus itself by the retained food and continue until all of them reach the stomach.
36
```
Pancreatic secretion is stimulated by:
A. Cholecystokinin
B. Secretin
C. Acetylcholine
D. All of these
```
D
37
This serves as the feeding center of the brain, destruction of which results in progressive inanition - marked weight loss, muscle weakness and decreased metabolism:
A. Ventromedial nuclei of hypothalamus
B. Lateral nuclei of hypothalamus
C. Anteroventral walls of the 3rd ventricle
D. Posteromedial walls of the 3rd ventricle
B
Option A is the satiety center; stimulation of which results in aphagia (refuses to eat), and conversely, its destruction leads to voracious eating.
38
Which of the following is effected by somatotropin?
A. Enhances amino acid reuptake and protein synthesis by cells
B. Stimulates the transcription of DNA to RNA for translation
C. May cause excessive mobilization of fat from the adipose tissue
D. All of the above
D
Somatotropin is GH. Its tissue effector are the insulin-like growth factors (IGFs) or somatomedins, particularly IGF 1 or somatomedin C. They are synthesized from the liver
39
```
This refers to the extra osmotic pressure caused by cations, primarily Na and K, held in the plasma by the proteins -- contributing to the total plasma colloid osmotic pressure:
A. Bohr effect
B. Scavenger system principle
C. Bainbridge
D. Donnan effect
```
D
40
```
The specific ability to pump iodide actively to the interior of the thyroid cell from its basal membrane is known as:
A. Organification
B. Iodide trapping
C. Oxidation of iodide ion
D. Deiodination
```
B
Oxidation of iodide ion is considered as the first essential step in thyroid hormone synthesis because it requires that iodide be converted to the oxidized ions before combining directly with amino acid tyrosine. In contrast, organification refers to the binding of iodine with the thyroglobulin molecule.
41
```
Among the following cellular organelles, this organelle has the greatest potential for selfreplication
A. Lysosome
B. Golgi complex
C. Mitochondria
D. Cell membrane E. Ribosome
```
C
Mitochondria are self-replicative, which means that one mitochondrion can form a second one, a third one, and so on, whenever there is a need in the cell for increased amounts of ATP
42
A 24 year-old woman was diagnosed with myasthenia gravis. She was prescribed with Pyridostigmine and she noted increased muscle strength when she took the prescribed medicine. The basis for this improvement is increased in the:
A. Amount of acetylcholine destroyed in the motor end plates
B. Levels of acetylcholine at the motor end plates
C. Number of acetylcholine receptors in the motor end plate
D. Amount of norepinehrine released from the motor nerves
E. Amount of norepinephrine receptors in the motor end plates
B
Pyridostigmine is an indirect-acting cholinomimetic. It inhibits acetylcholinesterase which increases levels of acetylcholine at the motor end plates resulting to increased muscle strength.
43
The resting membrane potential is determined largely by:
A. Sodium influx through the voltage-gated channels
B. Sodium influx through the Na-K leak channels
C. Potassium efflux throught the voltagegated channels
D. Potassium efflux through the Na-K leak channels
E. Sodium and potassium exchange by ATPase
D
The resting membrane potential is about -90 millivolts which is determined largely by potassium efflux through the Na-K leak channels. The channels are more permeable to potassium than to sodium, normally about 100 times as permeable. This differential in permeability is exceedingly important in determining the level of the normal RMP.
44
Which of the following forces causes osmosis of fluid outwards through the capillary membrane?
A. Interstitial colloid osmotic pressure
B. Positive interstitial fluid pressure
C. Plasma colloid osmotic pressure
D. Plasma oncotic pressure
E. All of the above
A
Osmosis is the spontaneous net movement of solvent through a selectively permeable membrane such as a cell membrane, into a region of higher solute concentration. Interstitial colloid osmotic pressure is an osmotic pressure exerted by proteins which tends to pull water into interstitial space. It opposes the plasma colloid osmotic pressure.
45
```
Tetrodotoxin block or inhibit:
A. Sodium channel
B. Potassium channel
C. Sodium-potassium pump
D. Na-K leak channel
E. Calcium channel
```
A
Tetrodotoxin is a potent neurotoxin from a pufferfish which inhibits the firing of action potentials in nerves by binding to the voltage-gated sodium channels in nerve cell membranes and blocking the passage of sodium ions.
46
Thromboembolic conditions in humans is mainly caused by:
A. Presence of thrombomodulin in the vascular system
B. Roughened endothelial surface of vessels
C. Presence of glycocalyx on the inner surface of endothelium
D. Increased blood flow throught the vessels
E. All of the above
B
Thromboembolic conditions is mainly caused by roughened endothelial surface of vessels. Endothelial dysfunction as an altered phenotype impairs vasoreactivity or induces a surface that is thrombogenic or abnormally adhesive to inflammatory cells. Thrombomodulin is a glycoprotein present in plasma membrane of endothelial cells that binds thrombin, an additional regulatory mechanism in coagulation.
47
Sinoatrial Node is the pacemaker of a normal heart because:
A. It has the fastest velocity of impulse conduction
B. It has both sympathetic and parasympathetic innervations
C. It has the highest frequency of impulse generation
D. It has the capability of spontaneous diastolic depolarization
E. It has the strongest capacity to stimulate the myocardium
C
Sinoatrial Node is virtually the pacemaker of a normal heart because it has the highest frequency of impulse generation. The sinus node controls the beat of the heart because its rate of rhythmical discharge is faster than that of any other part of the heart
48
```
Pulmonary circulation has a lower pressure due to
A. Lesser vessel diameter
B. Less viscous blood
C. High resistance vessels
D. Dilatable vessels
E. High blood velocity
```
D
Pulmonary ciculation has a lower pressure due to dilatable vessels resulting to low resistance based on Poiseuille's equation. Recruitment or opening of previously closed blood vessels also contribute to low pressure. With low BP, some small blood vessels at the top of the lung may be closed, but these vessels will open when the BP increases
49
Blood Pressure measurement is one of the vital signs monitored in patients primarily with cardiovascular and renal conditions. Korotkoff sounds are used to identify the systolic and diastolic measurements. Auscultatory gap is best described as disappearance of Korotkoff sounds:
A. at the level of the diastolic pressure
B. below the level of the diastolic pressure
C. at the level above the diastolic pressure
D. at the level above the systolic pressure
E. at the level of the systolic pressure
C
Blood Pressure measurement is one of the vital signs monitored in patients primarily with cardiovascular and renal conditions. Korotkoff sounds are used to identify the systolic and diastolic measurements. Auscultatory gap is best described as disappearance of Korotkoff sounds at the level above the diastolic pressure.
50
True of the Rh hemolytic disease of the newborn:
A. First pregnancy is the most severely affected
B. Mother is Rh positive, while fetus is Rh negative
C. After an erythroblastic child is born, future children are certainly with disease
D. Preformed maternal antibodies cross the placenta to react with fetal Rh+ cells
E. Subsequent pregnancies are protected from maternal antibodies
D
Rh hemolytic disease of the newborn occurs when preformed maternal antibodies cross the placenta to react with fetal Rh+ cells. Subsequent pregnancies are severely affected compared to first child. The mother is Rh negative while the fetus is Rh positive. After an erythroblastic child is born, future children may be protected from the disease by administration of Rhogam.
51
One of the following is not a physiologic effect of testosterone:
A. Increased RBC production
B. Skeletal and muscle growth
C. Maturation of internal and external genitalia
D. Decreased calcium deposition in the bones
E. None of the above
D
Physiologic effects of testosterone are: growth and differentiation of internal and external genitalia, increased bone and muscle mass, calcium deposition, epiphyseal closure, RBC production, increased BMR and pubertal growth spurt
52
```
Adrenergic receptors in smooth muscle and glands are:
A. Alpha 1 and beta 1
B. Alpha 1 and beta 2
C. Alpha 2 and beta 1
D. Alpha 2 and beta 2
E. All of the above
```
B
| Adrenergic receptors in smooth muscle and glands are Alpha 1 and Beta 2.
53
```
Three basic renal processes except:
A. Glomerular filtration
B. Tubular reabsorption
C. Tubular secretion
D. Glomerular excretion
E. All of the above
```
D
| The three basic renal processes are glomerular filtration, tubular reabsorption and tubular secretion.
54
```
A neurotransmitter that is synthesized from tryptophan, converted to melatonin and is involved in mood and sleep is found in great amounts in:
A. Locus ceruleus of pons
B. Substancia nigra
C. Median raphe of brainstem
D. Postganglionic neurons
E. Nucleus basalis of Meynert
```
C
Serotonin is a monoamine neurotransmitter that is biochemically derived from tryptophan. It is found in great amounts in median raphe of brainstem which is involved in regulation of mood, appetite and sleep.
55
The association area/s of the central cortex that provide/s a high level of interpretive meaning from the surrounding sensory areas is/are the:
A. Corpus callosum
B. Prefrontal association area
C. Parietooccipitotemporal association area
D. Secondary somatic sensory area
E. All of the above
C
The association area of the central cortex that provides a high level of interpretive meaning from the surrounding sensory areas is the parieto-occipitotemporal association area.
56
Parathyroid hormone maintains normal ionized serum calcium concentration by the action on the bone:
A. Inhibits bone mineralization
B. Increases formation of new osteoclasts
C. Increases osteoblastinitiated recruitment of osteocytes
D. A to C
E. B and C
E
Parathyroid hormone maintains normal ionized serum calcium concentration by the action on the bone which increases formation of new osteoclasts and increases osteoblastinitiated recruitment of osteocytes.
57
The auditory function of the middle ear ossicles is to:
A. Convert mechanical energy to sound to electrochemical energy
B. Detect the direction and intensity of sound
C. Filter high frequency sound
D. Amplify the sound
E. All of the above
D
| The auditory function of the middle ear ossicles is to amplify the sound.
58
```
The decrease in oxygen affinity of hemoglobin with high concentration of carbon dioxide is called:
A. Chloride shift
B. Haldane effect
C. Bohr effect
D. Physiologic shunting
E. Fick's Law
```
C
The decrease in oxygen affinity of hemoglobin with high concentration of carbon dioxide is called Bohr effect. Haldane effect is the decrease in the amount of carbaminohemoglobin due to increased oxygenation. Chloride shift is the exchange of chloride and bicarbonate in the RBC
59
```
In sudden ascent of scuba divers to the surface from deeper ocean bodies, this is the main cause of the symptoms:
A. Oxygen toxicity
B. Carbon dioxide excess
C. Increased nitrogen bubbles
D. Metabolic alkalosis
E. Severe respiratory acidosis
```
C
If a diver has been beneath the sea long enough that large amounts of nitrogen have dissolved in his body and the diver then suddenly comes back to the surface of the sea, significant quantities of nitrogen bubbles can develop in the body fluids and can cause minor or serious damage in almost any area of the body, depending on the number and sizes of bubbles formed
60
```
The role of hydrochloric acid in gastric juice is to:
A. Activate pepsinogen to pepsin
B. Protect the gastric mucosa
C. Open pyloric sphincter
D. Prevent esophageal reflux
E. All of the above
```
A
When stimulated, the parietal cells secrete an acid solution that has a pH of 0.8 demonstrating an extreme acidity. When pepsinogen is first secreted, it has no digestive activity. As soon as it comes in contact with hydrochloric acid, it is activated to form pepsin because it only functions as a proteolytic enzyme in a highly acidic medium
61
In Cushing syndrome, dorsocervical fat pad is due to:
A. Increase gluconeogenesis
B. Increase lipolysis
C. Increase protein catabolism in muscles
D. Fat generation is faster than metabolism
E. Increase sodium retention
D
dorsocervical fat pad is due to faster fat generation than its metabolism in some tissues. Other choices are just effect of cortisol but will not specifically cause dorsocervical fat pad
62
```
Hormones and neurotransmitters are synthesized by:
A. Ribosomes of the RER
B. Smooth endoplasmic reticulum
C. Free floating ribosomes
D. Golgi apparatus
E. Lysosomes
```
A
Proteins bound for the cell membrane, lysosomes, and outside of the cell such as hormones and neurotransmitters are synthesized by the ribosomes of the RER. Free floating ribosomes synthesized proteins bound for the cytoplasm and mitochondria. SER synthesized lipids. Golgi apparatus is for tagging and packaging. Lysosomes for autolysis.
63
```
Osmolarity is defined as:
A. Osmoles/L of water
B. Osmoles/kg of water
C. Osmoles/pound of water
D. Osmoles/gallon of water
E. None of the choices
```
A
| Osmolarity is defined as osmoles/liter of water. Osmolality is defined as osmoles/kilogram of water.
64
```
A 40 year old man was brought in to the emergency department with trismus, rigidity and photophobia. What is the axonal transport utilized by the organism causing the disease?
A. Anterograde transport
B. Orthograde transport
C. retrograde transport
D. primary transport
E. none of the choices
```
C
| tetanus and botulism utilized the retrograde axonal transport that is from the axon terminal to the cell body.
65
The "happy hormone" involved in mood and sleep is mainly produced by:
A. Pineal gland
B. Median raphe of the brainstem
C. Tuberomammillary nucleus of the hypothalamus
D. Nucleus basalis of Meynert E. Substantia nigra
B
serotonin is the happy hormone involved in mood and sleep which is mainly secreted by the median raphe of the brainstem. Pineal gland produce melatonin; tuberomammillary nucleus of the hypothalamus secretes mainly histamine; nucleus basalis of Meynert secretes mainly acetylcholine; substantia nigra secretes dopamine
66
```
When you walk straight and change direction suddenly without falling into the ground, maintaining balance, what nerve fiber type is used?
A. A
B. B
C. C
D. D
E. E
```
A
In general, there are 3 fiber types - A, B, C. Type A is the fastest which is further subdivided into 4. Proprioception, and motor use the type A alpha fiber. Type B fiber is used by all preganglionic autonomic sytem. Type C is for slow pain, temperature, and postganglionic sympathetic
67
A 50 year old male American travels to the Philippines to visit his girlfiend. When he arrived, he had a jet lag. What is the treatment?
A. Place him in a dark room for at least 24 hrs
B. anxiolytic drugs
C. melatonin and/or sunlight exposure
D. tell him to go back to his place of origin
E. just observe
C
jet lag is due to alteration of circadian rhythm when one travels across time zones. It is treated with melatonin and sunlight exposure
68
```
During your duty in Baguio, you noted the temperature at 12 deg. C. What thermal receptor is mainly activated at this temperature?
A. Pain receptor
B. Warmth receptor
C. Cold receptor
D. freezing receptor
E. Cold and freezing receptors
```
A
there are 3 thermal receptors: warmth, cold, and pain receptors. Pain receptor is activated at temperature below 15deg. C and above 43 deg. C.
69
```
The brain is a relatively small organ but is highly metabolic. How many percent of blood flows to the brain?
A. 25%
B. 20%
C. 5%
D. 15%
E. 10%
```
D
| 15% to the brain; 5% to the heart; 5% to the skin; 25% each to the kidney, GIT, and skeletal muscle.
70
```
Patient complained of dyspnea and peripheral edema. You suspect for a possible cardiac problem. You request for 2D echo. What parameter is considered as the marker for cardiac function or contractility?
A. Cardiac output
B. Ejection fraction
C. stroke volume
D. End diastolic volume
E. heart rate
```
B
71
```
A 24 year old male came in for an annual PE. You perform auscultation of the heart, and you heard the first heart sound which is heard in what phase of the cardiac cycle?
A. Isovolumic contraction
B. Isovolumic relaxation
C. rapid inflow
D. Ejection
E. Atrial systole
```
A
1st heart sound is heard during isovolumic contraction. 2nd heart sound is heard during isovolumic relaxation. 3rd heart sound is heard during rapid inflow. 4th heart soound maybe heard during atrial systole
72
```
A 19 year old male lacerated his wrist cutting a major blood vessel was bleeding profusely. Heart rate was 120bpm and BP was 80/60mmHg. The decreased BP is detected by macula densa which is found in:
A. Proximal tubule
B. Collecting ducts
C. distal tubule
D. loop of henle
E. vasa recta
```
C
| macula densa is part of the JG apparatus. It is found in the distal tubule of the kidney.
73
Which statement is true during skeletal muscle contraction?
A. There is shortening of the sarcomere, actin and myosin
B. There is shortening of sarcomere, but not of actin and myosin
C. There is shortening of actin and myosin but not of sarcomere
D. There is shortening of actin and myosin, and lengthening of sarcomere
E. There is shortening of sarcomere, and lengthening of actin and myosin
B
During skeletal muscle contraction, there is no shortening of actin and myosin, what happens is just sliding of actin and myosin, what actually shortens is the sarcomere.
74
```
What energy system is used when you play badminton?
A. Phosphagen energy system
B. Glycogen-lactic acid system
C. Aerobic system
D. All of the above
E. A and C
```
B
physical activities which last for 10 sec. use phosphagen energy. Those activities lasting for 1.6min like badminton use glycogen-lactic acid. Those lasting for more than 2 min or more use aerobic system.
75
```
In a patient with hypovolemic shock, what part of the kidney is the most susceptible to hypoxia?
A. Collecting duct
B. Loop of henle, descending limb
C. Distal convoluted tubule
D. Proximal convoluted tubule
E. Loop of henle, ascending limb
```
D
| PCT is the workhorse of the nephron which is higly metabolic, thus considered to be the most susceptible to hypoxia.
76
```
A 52 year old male patient came in due to dyspnea. ABG result showed: pH of 7.2, pCO2 of 50mmHg, H+ of 45meq/L, and HCO3 of 30meq/L. What is the acid - base abnormality?
A. Respiratory acidosis
B. Metabolic acidpsis
C. Respiratory alkalosis
D. metabolic alkalosis
E. normal result, no abnormality
```
A
normal ABG result: pH=7.35-7.45; H+ =40meq/L; pCO2=40mmHg; HCO3=24meq/L. In acidosis, pH is below normal, and H+ is above normal; the cause is respiratory if pCO2 is above normal, and as renal compensation, HCO3 is also above normal; it is metabolic in nature if HCO3 is below normal, and as pulmonary compensation pCO2 is also below normal. When the pH is above normal, it is alkalosis.
77
```
Bone marrow starts to form blood cells at what age?
A. 3rd week of fetal development
B. 4th week of fetal development
C. 3rd month of fetal development
D. 4th month of fetal development
E. At birth
```
D
bone marrow starts to form blood cells at 4th month of fetal development and become the major hematopoeitic organ postnatally
78
```
What is the life span of platelet?
A. 7-9 days
B. 11-12 days
C. 13-14 days
D. 3-5 days
E. 21 days
```
A
| The average life span of platelet is 7- 10days
79
```
What is the clotting factor IV?
A. Labile factor
B. Conversion factor
C. Calcium
D. Hageman factor
E. Magnesium
```
C
| clotting factor IV is calcium
80
```
What happens if after puberty, the male is castrated?
A. Increase in body hair
B. Increased libido
C. Can not erect
D. Can not ejaculate
E. All choices are correct
```
D
If male is castrated after puberty, there is loss of body hair, musculature, thick bones, and decreased libido. Erection still happens but without ejaculation.
81
A 40-year-old male was stabbed by an assailant. He was found to have continuous bleeding. At the ER, his bp was found to be 80/60 mmHg. Which of the following is expected in this patient?
A. Decrease in renin activity
B. Increase in urine osmolality
C. Increased conversion of angiotensin II to angiotensin I
D. None of the above
B
Hypovolemic shock, like in massive hemorrhage, will increase renin activity and increase conversion of angiotensin I to angiotensin II. Urine osmolality will increase because the body's tendency is to conserve water (due to increased aldosterone).
82
```
A previously normal newborn in a community hospital is noted at 14 hours of life to be cyanotic. She is placed on facemask but she remains cyanotic and her pulse oximetry reading does not change. There are clear bilateral breath sounds and she has no murmur. You are concerned about a congenital heart disease. You should initiate which of the following?
A. Indomethacin infusion
B. Saline infusion
C. Prostaglandin E1 infusion
D. Adenosine infusion
```
C
This case describes an infant with a ductal-dependent cyanotic congenital heart lesion. The ductus arteriosus typically closes in the first few hours causing the cyanosis of this neonate. Prostaglandin will help keep the ductus patent until a definitive procedure can be performed.
83
```
Which among the anterior pituitary hormone is under tonic inhibitory control?
A. FSH
B. LH
C. PRL
D. GH
```
C
| Among the pituitary hormones only prolactin is under tonic inhibition.
84
A 67-year-old patient presents with fever and respiratory distress. She was noted to have multiple infiltrates on chest radiograph. ABG on room air shows pH of 7.1, PO2 35 mmHg, and PaCO2 28 mmHg. These values indicate?
A. metabolic acidosis, respiratory alkalosis and hypoxia
B. respiratory acidosis, metabolic alkalosis and hypoxia
C. primary respiratory alkalosis
D. acidosis with compensatory hypoventilation
A
Inadequate oxygenation caused by the low PO2 results to increased lactic acid causing metabolic acidosis. The low PCO2 reflects hyperventilation, secondary to the respiratory difficulty, and is a respiratory compensation for metabolic acidosis
85
```
A 20-year-old athlete is accidentally hit in the abdomen by a baseball bat. Over the 24 hours, he develops fever, abdominal pain radiating to the back and persistent vomiting. The abdomen is tender with decreased bowel sounds. Which of the following tests is most likely to confirm the diagnosis?
A. serum lipase
B. serum amylase
C. serum bilirubin
D. electrolyte panel
```
A
Trauma can cause pancreatitis. No diagnostic test is completely accurate but serum lipase is more specific for pancreatitis compared to serum amylase.
86
```
There is increased steroid production in the following organ/s:
A. adrenals
B. testes
C. ovary
D. all of the above
```
D
| All these organs are steroid-producing. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
87
A patient in a coma with severe brain injury has developed very dilute urine with an output of 100ml/h. This condition can be managed by which of the following?
A. Fluid restriction
B. Giving insulin
C. Giving synthetic vasopression intranasally
D. Replacement with D5water and normal saline
C
This patient likely has developed diabetes insipidus, a common complication of severe head trauma, due to a deficiency in secretion of antidiuretic hormone.
88
```
A 4-year-old child came into your clinic with blue sclerae and a history of multiple fractures with minimal trauma. The expected serum concentration of calcium and phosphate is:
A. Low phosphate, normal calcium
B. Normal phosphate, normal calcium
C. Normal phosphate, low calcium
D. High phosphate, low calcium
```
B
The basic defect of osteogenesis imperfecta is an abnormality in the production and composition of the matrix of the bone. Both calcium and phosphate concentrations remain normal. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE.
89
This type of RTA is due to a defect in proximal tubule bicarbonate reabsorption. Untreated patients have a urine pH of
B
Type 1 is known as distal RTA which is due to a defect in the collecting tubule's ability to excrete hydrogen ions. Type 4 is due to hypoaldosteronism or the lack of collecting tubule response to aldosterone. There is no Type 3 RTA.
90
```
The hormone which is responsible for a positive pregnancy test is secreted by:
A. the syncytiotrophoblast
B. the cytotrophoblast
C. the yolk sac
D. the blastula
```
A
| HCG is produced by the syncytiotrophoblast.
91
```
A castrated male is expected to:
A. Have no erection
B. Have complete loss of libido
C. Still have an orgasm
D. Have reversal of secondary sexual characteristics
```
C
Castration, the removal of testicles where testosterone is produced, in an adult male results in partial loss of his sex drive or libido (but not complete). However, he can still have sex, erection and orgasm. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
92
```
During exercise, all are expected, EXCEPT:
A. Increase in respiratory rate
B. V/Q ratio approaches zero
C. Increase in CO2 production
D. Blood pH decreases
```
B
| With exercise, there is vasodilation of apical capillaries, resulting in a V/Q ratio that approaches 1.
93
```
In the lungs, oxygenation of hemoglobin promotes dissociation of H+ from hemoglobin. This shifts equilibrium toward CO2 formation, therefore CO2 is released from RBC. This is known as the:
A. Haldane effect
B. Gibbs Donnan effect
C. Bohr effect
D. Boyle effect
```
A
Contrast this to Bohr effect which happens in the peripheral tissues. There is unloading of O2 due to increased hydrogen from tissue metabolism. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE
94
```
The c wave in jugular venous pulse is secondary to:
A. Atrial contraction
B. Atrial relaxation
C. RV contraction
D. Blood flow from RA to RV
```
C
| The c wave reflects RV contraction (closed tricuspid valve bulging into atrium).
95
```
The T wave in the electrocardiogram represents:
A. Ventricular repolarization
B. Atrial repolarization
C. Ventricular depolarization
D. Atrial depolarization
```
A
The QRS complex represents: ventricular depolarization; P wave: atrial depolarization; atrial repolarization is buried under the QRS complex. This is a must-know concept.
96
```
The following are absorbed in the ileum, EXCEPT:
A. Bile salts
B. Vitamin B12
C. Vitamin K
D. Iron
```
D
| Iron is absorbed mainly in the duodenum and upper jejunum.
97
```
This hormone increases pancreatic bicarbonate and bile secretion:
A. Gastrin
B. Secretin
C. Cholecystokinin
D. VIP
```
B
| Secretin increases pancreatic bicarbonate and bile secretion, while it decreases gastric acid secretion.
98
```
A decrease in ESR is expected in:
A. SLE
B. URTI
C. Sickle cell anemia
D. Pregnancy
```
C
| A decrease in ESR is expected in polycythemia, sickle cell anemia, congestive heart failure and hypofibrinogenemia.
99
```
Vitamin K deficiency results in a decrease in the following, EXCEPT:
A. Factor II
B. Protein C
C. Factor I
D. Factor X
```
C
| Vitamin-K dependent factors are: factors X, IX, VII, II, (10972) protein C and S.
100
Which is TRUE regarding Type 1 muscle fibers?
A. They are fast twitch fibers.
B. They have increased mitochondrial concentration.
C. They have decreased myoglobin concentration.
D. They are known as white fibers.
B
| Type 1 muscle fibers are slow twitch red fibers resulting from increased mitochondria and myoglobin concentration.
