Physiology Flashcards
42 y/o woman complains of burning pain in upper middle region of her abdomen. Pain usually occurs about 2 hours after a meal and frequently awakens her at night. Antacids can usually relieve the pain within a few minutes. Xray reveals a typical duodenal ulcer identified as a discrete crater in the proximal portion of the duodenal bulb. Because the woman does not have a history of chronic use of aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs), the bacterium Helicobacter pylori is assumed to be the ajor factor in the etiology of the ulcer. Which of the following is likely to be normal in this woman?
Fasting serum gastrin
The fasting serum gastrin is normal in patients with duodenal ulcer (DU), however, the gastrin response to a meal is increased. The increase in serum gastrin following a meal occurs, in part because acid suppresses gastrin release less effectively in DU patients compared with controls. DU patients have an increase in parietal cell mass which may be caused by the trophic growth promoting effects of gastrin. Patients with DU have increased basal acid output that totally disappears following eradication of H pylori infection.
However, the increase in maximal acid output which occurs in response to IV gastrin, can remain follwoing eradication of H pylori infection and is likely to result form the increased parietal cell mass. The secretion of pepsin is usually doubled in DU patients.

Photographs taken of middle aged man over a period of 2 decades demonstrates gradual coarsening of facial features and progressive protrusion of the brows. Patient reports wear larger shoes that he did as a young man. which of the following pair of hormones normally regulates the hormone responsible for these changes?
Somatostatin and GHRH
The disease is acromegaly, which is typically produced by a growth hormone secreting pituitary adenoma. Growth hormone synthesis is predominately regulated by hypothalamic GHRH (growth hormone releasing hormone), and its pulsatile secretion is predominately regulated by hypothalamic somatostatin.
Acromegaly is a disorder that results from excess growth hormone (GH) after the growth plates have closed.[3] The initial symptom is typically enlargement of the hands and feet.[3] There may also be an enlargement of the forehead, jaw, and nose.[3] Other symptoms may include joint pain, thicker skin, deepening of the voice, headaches, and problems with vision.[3] Complications of the disease may include type 2 diabetes, sleep apnea, and high blood pressure.[3]
Acromegaly is usually caused by the pituitary gland producing excess growth hormone.[3] In more than 95% of cases the excess production is due to a benign tumor, known as a pituitary adenoma.[3] The condition is not inherited from a person’s parents.[3] Acromegaly is rarely due to a tumor in another part of the body.[3] Diagnosis is by measuring growth hormone after a person has drunk a glucose solution, or by measuring insulin-like growth factor I in the blood.[3] After diagnosis, medical imaging of the pituitary is carried out to determine if an adenoma is present.[3] If excess growth hormone is produced during childhood, the result is the condition gigantism rather than acromegaly.[3]
Given these data below what is the net filtration pressure at the glomerulus?
Glomerular hydrostatic pressure = 44 mm / Hg
Bowmans capsule hydrostatic pressure = 9 mm / Hg
Osmotic presure of plasma = 28 mm / Hg
Osmotic pressure of tubular fluid = 0
7 mm / Hg
there is more than one way to tihink about this quesiton. one way is to determine which of each of the descriptions corresponds to Pc, Pp, (pi)c, (Pi)i and then to use the starling equation for net filtration pressure: (Pc - Pi) - (Pic - Pii). Perhaps faster and more intuitive is to just envision that the filtration pressure will be the difference betwen the forces pushing fluid out and the forces pulling fluid back into the glomerulus. The Pushing forces are the hydrostatic pressure of the glomerulus (44 mm / Hg) and the osmotic pressure of the tubular fluid 0. So the total pressure forcing fluid from the glomerulus into the tubular fluid is 44 mm / Hg. The forces pulling the fluid back are the hydrostatic pressure of the bowmans capsule 9 mm / Hg and the osmotic pressure of the plasma 28 mm / Hg. The total pressure pushing the fluid back into the glomerulus is 9 + 28 = 37 mm / Hg. The difference between the forces favoring filtration and those opposing it is therefore 44 - 37 = 7 mm Hg.
50 y/o woman undergoes surgery to remove a large abdominal tumor. Histologic findings show that the mass contains a large number of blood vessels. Several metastases were found 2 months after surgery. A decrease in which of the following is the most likely cause for the development of metastases after the removal of th large tumor?
Endostatin
Tumors produce both angiogenic and anti-angiogenic factors (also called antiostatic factors). Angiogenic factors stimulate the growth of blood vessels (angiogenesis), whereas angiostatic factors inhibit blood vessel growth (anti-angiogenesis). Angiogenic factors such as VEGF and bFGF have relatively long half-lives in the blood compared with angiostatic factors such as endostatin or angiostatin. Large tumors often produce sufficient amounts of angiostatic factors to suppress the growth of blood vessels in small, undetectable tumors present elsewhere in the body. This suppression of angiogenesis in the smaller tumors also suppresses the overall growth of the tumors, because the small tumors cannot grow without an adequate blood supply, ie.e. tumor growth is angiogenesis-dependent.
When the large tumor is removed, the blood levels of angiostatic factor (endostatin) decrease, allowing angiogenesis to occur in the smaller tumors. The smaller tumors grow rapidly as a consequence of this angiogenesis and can be detected within a few weeks. Endostatin is a fragment of collagen XVIII, which inhibits angiogenesis an shrinks tumors. It shows promising behavior as an anticancer agent in early, preclinical trials.
The astute student may wonder how angiogenesis can occur in large tumors in the presence of angiostatic factors. The answer is that angiogenesis occurs when the levels (or activities) of angiogenic factors become greater compared with the levels of angiostatic factors, i.e. both angiogenic and angiostatic factors may be present in a tumor, but angiogenesis occurs when the influence of angiogenic factors predominates. The student may also ask how a large tumor can suppress angiogenesis in small tumors when both angiostatic and angiogenic factors are released from the large tumor. The answer is that angiostatic factors have long half-lives in the blood compared with that of angiogenic factors, as discussed above. Thus, the smaller tumors see higher levels of angiostaic factors compared with angiogenic factors.
Endostatin
Endostatin is a naturally occurring, 20-kDa C-terminal fragment derived from type XVIII collagen. It is reported to serve as an anti-angiogenic agent, similar to angiostatin and thrombospondin.
48 y/o presents to emerg with chest pain that radiates to his jaw and left shoulder. Angina pectoris is suspected, and he is sent for an angiogram. Test reveals atherosclerotic coronary artery that is 50% occluded. The maximal blood flow through this artery is reduced by?
1/16
According to the equation
R = 8nl/(pi)r^4
where R is resistance, n is viscosity of blood, l is the length of the blood vessel and r^4 is the radius of the blood vessel wall to the fourth power, the resistance is inversely proportional to the fourth power of the radius. In other words, if the radius is reduced by one half the resistance is multiplied by 16. In addition, blood flow can be expressed as the following:
Q = DeltaP/R
where Q is blood flow, Delta p is the pressure gradient at both ends of the vessel, and R is the resistance. Blood flow is inversely proportional to resistance. So when the resistance is increassed by 16 fold, blood flow must decrease by 16 fold.
24 y/o paraplegic after he severs his spinal cor at T1. Chronic constipation is a problem, but he wants to be independent. Physician advises him to distend the rectum digitally on a regular schedule to initiate the defecation reflex. Rectal distention causes which of the folloiwng in this patient?
Increased peristaltic waves
Defecation is initiated by defecation reflexes. An intrinsic reflex mediated entirely by the local enteric nervous system is stimulated when feces enters the rectum. Distention of the rectum initiates afferent signals that spread through the myenteric plexus to initiate peristaltic contractions in the descending colon, sigmoid, and rectum and force the feces toward the anus.
14 y/o boy has a craniotomy performed under general endotracheal anestheia for removal of a craniopharyngioma. The anesthetic agent used is halothane, and when he awake he is extubated and sent to the floor. Five percent dextrose in one-third normal saline was dripping in his intravenous line at a rate of 125 ml/h. Four hours later, the nurses report that he cannot be roused from a deep sleep. point out his urinary output in 4 hours was 1050, 1100, 980, and 1250ml, respectively. Laboratory findsings show:
Sodium 156 mEq/L
Osmolarity 312 mOsm/L
pH 7.55
pCO2 28 mm Hg
Bicarbonate 24 mEq/L
what explains these findings?
surgical trauma to the posterior pituitary
The clinical and laboratory picture is that of diabetes insipidus. His surgical procedure took place in the vicinity of the pituitary gland (where craniopharyngiomas are typically located), thus, the most likely scenario is that of inadvertent damage to the posterior pituitary or the stalk.

26 y/o woman stranded no food. what substances can be converted to glucose to supply the needs of the brain during this period. Starvation
Amino acids.
during starvation the diet is inadequate to provide sufficient glucose to maintain the brain, yet the brain requires glucose as energy source. Glucose used in the brain during starvation is synthesized rom amino acids, primarily derived from muscle protein. This use of amino acids in starvation leads to profound muscle wasting.
54 y/o man complains of palpitations and light-headedness. Exam ramarkable for a heart rate of greater than 200 min and a blood pressure of 75/40 mm Hg. Which of the following adjustments have probably occurred in the cardiac cycle.?
Systolic time has decreased but diastolic time has decreased more.
Under normal conditions, one third of the cardiac cycle is spent in the systole and two thirds spent in diastole. As heart rate increases dramatically, the time spent in diastole falls precipitously but the time spent in systole falls to a lesser extent. A large increase in heart rate must produce a decrease in both diastole and systole. The major change with increased heart rate is in diastole not systole. Heart rate cannot increase if diastolic time increases. An increase in heart rate must be accompanied by a decrease in diastolic time.
25 y/o visits friend living in mountain at 5000 meters. 5 days he increase ventilation rate and a decrease in arterial PCO2 what physiologic changes is also expected?
Increased renal excretion of HCO3-
Compensation for high altitude includes an increase in the renal excretion of bicarbonate. The diminished barometric pressure found at high altitude causes arterial hypoxia. which is sensed by peripheral chemoreceptors. The ventilation rate increases, thereby causing a respiratory alkalosis. The kidney then compensates by increasing the excretion of HCO3-.
High altitude leads to respiratory alkalosis. Renal compensation is a metabolic acidosis characterized by decreased H+ excretion and increased HCO3- excretion. Respiratory acidosis is reanally compensated with a metabolic alkalosis that would incrude increases in H+ excretion.
As part of an experimental study a volunteer agrees to have 10g mannitol injected intravenously. After sufficient time for equilibration, blood is drawn, and the concentration of mannitol in the plasma is found to be 65mg/100ml. Urinalysis reveals that 10% of the mannitol had been excreted into the urine during this time period. What is the approximate extracellular fluid volume of this volunteer.
14L
Volume = amount/concentration
The amount of mannitol in the volunteer is equal to the amount injected minus the amount excreted:
10g - 1g = 9g = 9000mg. Therefore.
Volume = 9000/65mg/100ml = 13.8L
A neuro physiologist is studying the functional properties of various receptor subtypes, using whole-cell voltage clamp recordings made from coronal brain slices. At a holding potential of -70mV, bath application of receptor agonists for four different receptor types consistently elicited either excitatory postsynaptic currents or inhibitory postsynaptic currents. During the study of one receptor, however, agonist application failed to elicit a postsynaptic response at -70mV but did elicit a reliable response at a holding potential of 0mV. This receptor is most likely which of the following?
N-Methyl-D-aspartate (NMDA)
The NMDA receptor, a type of glutamate receptor is unique in that it is both voltage and ligand-gated. In other words, it requires both an agonist and neuronal depolarization to be activated. The NMDA receptor is an ion channel that allows the passage of Na+ and Ca2+ when open. At resting membrane potential, the channel is plugged by a Mg2+ ion. Depolarization (and agonist activation) causes the Mg2+ ion to dislodge, allowing the receptor to be functional.
GABA receptor is a ligand-gated chloride channel.
Kainate receptor a type of glutamate receptor the nicotinic acetylcholine receptor and the 5-HT3 receptor are ligand-gated Na+ channels.

Researcher experiment on anesthetized animal to study cardiovascular and neural responses to stimuli. measures blood pressure and monitor the electrocardiogram. Isolates the afferent nerves from carotid sinus and aortic arch and implants microelectrodes to record nerve activity. Take baseline measurements, massages teh right carotid artery for 60 seconds. Which of the following data sets coresponds best to his experimental findings during the carotid massage?

This is actually a straightforward question. The fastest way to approach it is to predict the physiologic responses that would occur as a result of a carotid massage and identify the appropriate graph, rather than spending the time to read all of the graphs.
During a carotid massage, the carotid sinus baroreceptors sense the distortion of the vessel wall. This leads to an increase in afferent traffic (firing rate) in the glossopharyngeal nerve. A signal indicating high blood pressure travels to the nucleus of the solitary tract (NTS) in the medulla, and the baroreceptor reflex occurs. The animal is tricked into thinking it has high blood pressure, so it decreases sympathetic outlfow and increases parasympathetic outflow, leading to decreases in blood pressure and heart rate. Meanwhile, the aortic arch baroreceptors, which are innervated by the vagus nerve, correctly sense that the blood pressure has decreased. This decreases afferent traffic along the vagus nerve to the brainstem.
If you simply knew that a crotid massage leads to a decrease in blood pressure and heart rate, you could immediately narrow choices. Knowledge of baroreceptor physiology allows you to distinguish between A and B.

In clinical trials, an experimental drug is found to cause impotence in a large percentage of male patients. Inhibition of which of the following could be responsible for this side effect?
Nitric oxide synthase (NOS)
Penile erection is mediated by the parasympathetic nervous system. The neurons involved are termed nonadrenergic, noncholinergic (NANC) autonomic neurons, and they may release nitric oxide (NO). NO binds to the iron in the heme molecule of guanylate cyclase, activating it to form cGMP. This results in a decrease in intracellular calcium and subsequent smooth muscle relaxation and vasodilation in the corpus cavernosa, producing erection. Nitric oxide synthase (NOS) is the enzyme required for the formation of NO from circulating arginine, and androgens are necessary to maintain normal amounts of this enzyme. Inhibition of this enzyme could result in impotence (although most currently used drugs that have impotence as a side effect do not affect NOS).
Healthy 22 y/o female medical student has an exercise stress test at local health club. Which of the following is most likely to decrease in her skeletal muscles during exercise?
Arteriolar resistance
The increase in muscle blood flow that occurs during exercise is caused by dilation of the arterioles (i.e. decreased arteriolar resistance). In normal skeletal muscles, the blood flow can increase as much as 20 fold during strenuous exercise. Most of this increase in blood flow can be attributed to the dilatory actions of metabolic factors (e.g. adenosine, alctic acid, carbon dioxide) produced by exercising muscles.
A decrease in vascular conductance occurs when the vasculatur is constricted. Resistance and conductance are inversely related, so that a decrease in arteriolar resistance is associated with an increase in arteriolar conductance.
Young man go to gym ln way home. Runs on treadill for 30min, lifts weights for 20min, and does pushups and situps for 10min. Which of the following is quantitatively the most important method for transporting the CO2 in the blood that is produced by his muscles?
As bicarbonate in serum
Red blood cells (and many other blood cells) contain the enzyme carbonic anhydrase, which catalyzes the intracellular conversion of CO2 to bicarbonate and H+ ion. Most of the bicarbonate in the red cell is exchanged across the plasmalemma for chloride ion. This means that although the bulk of the production of bicarbonate occurs in the red cell, the bulk of the actual transport occurs in serum. Carbonic anhydrase is not present in serum. Bicarbonate can also be produced in serum by nonenzymatic means, but the process is slow.

17 answer is C.
The various points on the volume-pressure diagram correspond to specific events of the cardiac cycle as follows. A the mitral valve opens and the period of filling begins.
B this is the period of filling
C this marks the beginning of ventricular systole. The mitral valve closes, and S1 can be heard. The end-diastolic pressure (5mm Hg) and end-diastolic volume (125ml) can be determined on the Y-axis and x-axis from this point.
D This is the period of isovolumetric contraction. Left ventricular pressure increases rapidly, but left ventricular volume remains constant. All heart valves are closed.
E the aortic valve opens, which marks the beginning of the period of ejection. The pressure at this point is equal to the aortic diastolic blood pressure, which is about 80mm Hg on the diagram.
F This is the period of ejection. The pressure at the apex of the curve is the peak systolic pressure of the left ventricle.
G This marks the beginning of diastole. The aortic valve closes, and S2 can be heard. The end-systolic volume (50ml) can be read from x-axis at this point.
H This is the period of isovolumetric relaxation. Left ventricular pressure is falling rapidly, but left ventricular volume remains constant. All heart valves are closed.
43 y/o history of ulcer disease associated with diarrhea and strong family history of duodenal ulcer disease suspected of having Zollinger-Ellison syndrom (gastrinoma). Secretin (1 U/kg) is given as a rapid intravenous injection to test for gastrinoma. Which results would support the existence of gastrinoma following secretin administration?
Increased serum gastrin
Gastrinomas are gastrin-secreting tumors usually present in the pancrease. Patients with gastrinoma have high serum gastrin levels, which lead to hypersecretion of gastric acid and consequent duodenal and jejunal ulcers. Injection of secretin is the most specific and easiest test for gastrinoma.
Secretin inhibits antral release of gastrin, but it stimulates release of gastrin from gastrin tumors (gastrinoma) in almost all patients. A doubling of serum gastrin 5 to 10 minutes after admin of secreting (1U/kg), coupled with acid hypersecretion and increased basal serum gastrin, strongly indicates the presence of gastrinoma. Secretin can inhibit gastric emptying, inhibit gastric secretion and stimulate pancreatic HCO3- secretion, but these effects are not diagnostic for gastrinoma.
Students studying clearance of inulin by the kidneys on a computer simulated patient. Professor programs the computer so patients ratio of urinary concentration to plasma concentration of inulin (U/P) inulin) decreases. Which of the following is true if the glomerular filtration rate remains constant?
Urine flow rate has increased.
Inulin is freely filtered, but is neither reabsorbed nor secreted. Since all inulin filtered in the glomerulus will appear in the urine, the amount of water in the urine will determine the concentration of the inulin. Therefore, (U/P) inulin will decrease if the urine flow rate increases.
Blood is drawn from a 14 y/o boy with a bacterial meningitis for a complete blood count. The leukocyte count is elevated. Which of the following is released by the predominant type of white blood cell present?
Lysozyme
This question requires you to know that bacterial infections are associated with an elevated enutrophil count. These leukocytes have 3 to 5 nuclear lobes and are filled with granules that contain bactericidal products, including lysozyme. Note that neutrophils normally constitute 54 to 62% of leukocytes, so if you were unsure of the percentages occuring in response to bacterial infections, C still would have been a good guess. Had the infection been viral there would have been an increase in lymphocytes instead.
21 y/o man competing in weight lifting competition. Lifts weight ove rhead, arms give way and he drops weight. Which of the following receptors is responsible for this sudden muscle relaxation.
Golgi tendon organ
Normally, stretching of muscle results in a reflex contraction: the harder the stretch, the stronger the contraction. At a certain point, when the tension becomes too great, the contracting muscle suddenly relaxes. the reflex that underlies this sudden muscle relaxation is called the golgi tendon organ (GTO) reflex, also known as the inverse stretch reflex or autogenic inhibition. The GTO is an extensive arborization of nerve endings (encapsulated by a connective tissue sheath and located near the muscle attachment). That is connected in series with the extrafusal skeletal muscle fibers. As a result, GTO’s respond to muscle tension rather than muscle length. Increased tension leads to stimulation of Ib afferents, which inhibit the homonymous muscle via spinal interneurons.
The Golgi tendon reflex[1] (also called inverse stretch reflex, autogenic inhibition,[2] tendon reflex[3]) is an inhibitory effect on the muscle resulting from the muscle tension stimulating Golgi tendon organs (GTO) of the muscle, and hence it is self-induced. The reflex arc is a negative feedback mechanism preventing too much tension on the muscle and tendon. When the tension is extreme, the inhibition can be so great it overcomes the excitatory effects on the muscle’s alpha motoneurons causing the muscle to suddenly relax.[1] This reflex is also called the inverse myotatic reflex,[4] because it is the inverse of the stretch reflex.

16 y/o type 1 diabetic is noncompliant with insulin therapy and develops hyperglycemia after eating candy. Release of which intestinal hormones would most likely be stimulated?
GASRTRIC INHIBITORY PEPTIDE (GIP)
Gastric inhibitoriy peptide (GIP) is produced in the duodenal and jejunal mucosa by K cells. and is released in reponse to intraluminal glucose and fatty acids. GIP is sometimes called (glucose-dependent insulinotropic) peptide because it stimulates pancreatic insulin secretion in the presence of hyperglycemia. Note that although GIP release would be stimulated, the hormone would not have a pronounced effect in this type 1 diabetic, whose pancreatic islet cells do not produce adequate amounts of insulin.

69 y/o alcoholic has had severe progressively increasing epigastric pain for the past 24 hours. He has been nauseous, and he vomited three times. Laboratory studies show hypocalcemia and metabolic hypochloremic alkalosis. The primary metabolic effect of the principal hormone secreted by the alpha cells of his organ is?
Stimulation of glycogenolysis
Glucagon is released from the alpha cells of the pancrease in response to hypglycemia and sitmulates glycogenolysis to increase serum glucose.
Researcher studying the substance para-aminohippuric acid (PAH) and its interaction with the kidneys. She injects a volunteer with the substance. She finds that which of the following can be determined by calculating the clearance of PAH
Effective renal plasma flow (ERPF)
At less than saturating concentrations, PAH is completely secreted into the proximal tubule and excreted into the urine. Therefore, the volume of plasma cleared of PAH is approximately equal to the volume of plasma flowing through the peritubular capillaries, also called the effective renal plasma flow, or ERPF.
ERPF = Upah x V / Ppah
At very high concentrations, the clearance of PAH would be less than ERPF and approaches GFR.






































