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E-lfh FRCA Primary: Physiology Exam Prep Questions > RCOA Guide to the FRCA Examination The Primary (fourth edition) - Physiology > Flashcards

RCOA Guide to the FRCA Examination The Primary (fourth edition) - Physiology Flashcards

1
Q

The anterior lobe of the pituitary gland:

Synthesises vasopressin

A

False. Vasopressin, or antidiuretic hormone (ADH), is synthesised in the hypothalamus and secreted by the posterior pituitary.

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2
Q

The anterior lobe of the pituitary gland:

Has important neural connections with the pineal body

A

False.

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3
Q

The anterior lobe of the pituitary gland:

Develops separately from the posterior lobe

A

True. The anterior pituitary develops as an upgrowth from the primitive mouth (stomatodeum). The posterior pituitary is an extension of the hypothalamus.

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4
Q

The anterior lobe of the pituitary gland:

Contains chromophobe cells

A

True. These are probably degranulated secretory cells (chromophils).

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5
Q

The anterior lobe of the pituitary gland:

Has a portal blood supply independent of the posterior

A

True. The portal supply links a primary capillary plexus in the hypothalamus to a secondary plexus in the anterior pituitary (AP). Consequently, releasing and inhibitory factors secreted by the hypothalamus reach the AP in higher concentration than if they were secreted into the systemic circulation and presented to the AP via its arterial circulation.

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6
Q

The glomerular filtrate normally contains:

Inulin in a lower concentration than in plasma when given to
measure glomerular filtration rate

A

False. Inulin is freely filtered at the glomerulus and will therefore be present in the same concentration.

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7
Q

The glomerular filtrate normally contains:

Albumin at 5% of its plasma concentration

A

False. In the healthy kidney, the glomerulus is impermeable to large molecules. Albumin (MW 70 000 Da) is not filtered to any significant extent and the glomerular filtrate is essentially protein free.

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8
Q

The glomerular filtrate normally contains:

Amino acids

A

True. Amino acids are freely filtered and filtrate concentration is equal to that of plasma. They are normally completely reabsorbed in the proximal tubule.

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9
Q

The glomerular filtrate normally contains:

Glucose in a concentration equal to that in plasma

A

True. Glucose is freely filtered and completely reabsorbed in the proximal tubule unless the transport maximum is exceeded, e.g. in diabetes.

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10
Q

The glomerular filtrate normally contains:

No uric acid

A

False. Uric acid is filtered at the glomerulus. It is also reabsorbed and secreted by the proximal tubule.

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11
Q

The metabolic response to injury includes:

Catabolism

A

True. Following increased secretion of catabolic hormones.

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12
Q

The metabolic response to injury includes:

Retention of potassium in the body

A

False. Increased aldosterone secretion promotes sodium and water reabsorption from the distal tubule in exchange for potassium excretion.

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13
Q

The metabolic response to injury includes:

Hypoglycaemia

A

False. This is largely due to changes in endocrine activity outlined below.

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14
Q

The metabolic response to injury includes:

Raised plasma cortisol concentration

A

True. Secondary to increased activity of the hypothalamo-pituitary-adrenal axis.

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15
Q

The metabolic response to injury includes:

Increased production of epinephrine

A

True. Secondary to sympathetic nervous system activation.

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16
Q

Pulmonary variables that decrease during pregnancy include:

Minute ventilation

A

False. Minute ventilation increases early in pregnancy, reaching 50% above non-pregnant values at term.

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17
Q

Pulmonary variables that decrease during pregnancy include:

PaO2

A

False. This is little changed.

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18
Q

Pulmonary variables that decrease during pregnancy include:

PaCO2

A

True. As a result of increase minute ventilation.

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19
Q

Pulmonary variables that decrease during pregnancy include:

FRC

A

True. Caused largely by diaphragmatic elevation as the uterus enlarges.

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20
Q

Pulmonary variables that decrease during pregnancy include:

Total respiratory compliance

A

True. Lung compliance remains unchanged, but chest wall compliance decreases as a result of diaphragmatic elevation.

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21
Q

The cell-mediated immune response:

Provides an explanation for some auto-immune diseases

A

True. Although some auto-immune diseases are examples of hypersensitivity reactions.

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22
Q

The cell-mediated immune response:

Involves peripheral sensitisation of lymphocytes

A

True.

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23
Q

The cell-mediated immune response:

Causes proliferation of plasma cells

A

False. Plasma cells are B cells which have been exposed to antigen and secrete large quantities of antibody. Antibody production is a humoral response.

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24
Q

The cell-mediated immune response:

Involves increased IgM synthesis

A

False. Antibody production is a humoral response.

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25
Q

The cell-mediated immune response:

Causes massive release of histamine

A

False. This is a feature of a type I hypersensitivity reaction.

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26
Q

Ptosis results from damage to the:

Oculomotor nerve

A

True. The third cranial nerve supplies the levator palpebrae superioris muscle.

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27
Q

Ptosis results from damage to the:

Parasympathetic supply of the eye

A

False. Interruption of the parasympathetic supply to the eye causes mydriasis, or dilatation of the pupil.

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28
Q

Ptosis results from damage to the:

Cervical sympathetic chain

A

True. As a result of loss of sympathetic innervation to the superior tarsal muscle. One of the features of Horner’s syndrome.

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29
Q

Ptosis results from damage to the:

Trigeminal nerve

A

False. The fifth cranial nerve supplies the muscles of mastication and provides the sensory supply to the face.

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30
Q

Ptosis results from damage to the:

Supra-orbital nerve

A

False. The supra-orbital nerve, a branch of the frontal nerve, is purely sensory in function.

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31
Q

In the cerebrospinal fluid of a normal individual:

The reduced buffering capacity is mainly due to a lower
bicarbonate concentration

A

False. This is due to a relative lack of protein in CSF.

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32
Q

In the cerebrospinal fluid of a normal individual:

pH is the same as that of arterial blood

A

False. Hydrogen ion concentration is slightly higher in CSF than in arterial blood.

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33
Q

In the cerebrospinal fluid of a normal individual:

Protein concentration is less than in plasma

A

True. CSF protein concentration is only about 0.5% that of plasma.

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34
Q

In the cerebrospinal fluid of a normal individual:

Chloride concentration is higher than in venous blood

A

True. In order to maintain electrical neutrality. Anionic protein concentration is less than that of blood.

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35
Q

In the cerebrospinal fluid of a normal individual:

Glucose concentration is higher than in arterial blood

A

False. Glucose concentration is lower in CSF.

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36
Q

In the liver:

Hepatic arterial blood flow exceeds portal blood flow

A

False. Portal blood flow exceeds hepatic arterial blood flow by a
2:1 ratio.

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37
Q

In the liver:

The bile canaliculus is at the centre of the lobule

A

False. It is at the periphery and forms a triad along with hepatic arterial and portal venous branches.

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38
Q

In the liver:

The portal vein contributes approximately one third of the total hepatic blood flow

A

False. Portal blood flow exceeds hepatic arterial blood flow by a
2:1 ratio.

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39
Q

In the liver:

Venous pressure normal exceeds 20 mmHg

A

False. Venous pressures as high as this are pathological (portal hypertension). Normal is below 10mmHg.

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40
Q

In the liver:

The oxygen tension is at the lowest at the centre of the lobule

A

True. At the periphery of the lobule, portal venous and hepatic arterial blood mix to flow along sinusoids towards the centre of the lobule. The centre is most vulnerable in low perfusion states or hypoxia (centrilobular necrosis).

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41
Q

Consequences of 24 hours starvation include:

Increased brain uptake of glucose

A

False. This is unchanged.

42
Q

Consequences of 24 hours starvation include:

Reduction of the respiratory quotient

A

True. The respiratory quotient, RQ, is the ratio of the volume of carbon dioxide produced to oxygen consumed. When only glucose is metabolised, C6H12O6 + 6O2 → 6CO2 + 6H2O, the RQ is one. RQ decreases during starvation as alternative, more reduced, oxygen inefficient, energy sources are used. Eg fat.

43
Q

Consequences of 24 hours starvation include:

Elevated blood glucagon concentration

A

True. In order to promote gluconeogenesis.

44
Q

Consequences of 24 hours starvation include:

Increased urinary nitrogen output

A

True. Glucose production switches from glycogenolysis to gluconeogenesis from non-carbohydrate sources. Amino acids are mobilised from muscle and are deaminated during gluconeogenesis.

45
Q

Consequences of 24 hours starvation include:

Development of metabolic alkalosis

A

False. Free fatty acids are an important energy source and in addition, production of ketone bodies such as acetoacetic acid and B-hydroxybutyric acid increases, leading to acidosis.

46
Q

The following are examples of active transport of substances across membranes:

Movement of sodium out of a nerve

A

True. Intracellular sodium concentration (15 mmol.L-1 ) is much less than extracellular (140 mmol.L-1).

47
Q

The following are examples of active transport of substances across membranes:

Reabsorption of water in the proximal renal tubule

A

False. Active reabsorption of sodium and other solutes decreases the osmotic pressure of tubular fluid and passive water reabsorption occurs down the osmotic gradient.

48
Q

The following are examples of active transport of substances across membranes:

Movement of water across the collecting duct

A

False. In the presence of ADH, the wall of the collecting duct (CD) becomes permeable to water, allowing water to passively follow the osmotic gradient between CD and medullary interstitium, which has very high osmolarity.

49
Q

The following are examples of active transport of substances across membranes:

Iodide uptake by the thyroid gland

A

True. The process known as iodide trapping.

50
Q

The following are examples of active transport of substances across membranes:

Hydrogen ion secretion by the gastric parietal cells

A

True. Via a H+/K+ ATPase (proton pump). There is a 105-106-fold hydrogen ion concentration gradient between parietal cells (pH 7.3
or so), and the gastric lumen (pH 1-2). (pH = -log10[H+]).

51
Q

Albumin:

Is absorbed from the large bowel

A

False. Dietary protein is broken down into amino acids for absorption in the small intestine.

52
Q

Albumin:

Is filtered at the glomeruli in significant quantities

A

False. In health, protein is not filtered at the glomerulus in significant quantities.

53
Q

Albumin:

Is a specific carrier protein

A

False. Albumin is a non-specific carrier for a variety of substances such as bilirubin, fatty acids, thyroid hormone, calcium and drugs.

54
Q

Albumin:

Has antibody properties

A

False. Immunoglobulins are the proteins with antibody properties.

55
Q

Albumin:

Has a molecular weight of approximately 70,000 daltons

A

True.

56
Q

Closing volume:

Is greater than closing capacity

A

False. Closing capacity (CC) equals residual volume plus closing
volume.

57
Q

Closing volume:

Is attributed to collapse of segmental bronchi in dependent parts of the lung

A

False. It is attributable to collapse of smaller airways.

58
Q

Closing volume:

Tends to increase with age

A

True.

59
Q

Closing volume:

Is measured by the helium dilution technique

A

False. It is measured by measuring nitrogen concentration in expired gas following a vital capacity breath of 100% oxygen. An abrupt increase in nitrogen concentration at the onset of phase 4 occurs as a result of preferential emptying of apical units and represents the volume of the lung at which dependent airways begin to close.

60
Q

Closing volume:

Is reduced by moving from the supine to the upright position

A

False. However, FRC increases on moving from supine to standing and CC is then less liable to encroach on FRC.

61
Q

The oxyhemoglobin dissociation curve:

May be used to calculate the P50

A

True. The partial pressure of oxygen at which haemoglobin is 50% saturated is a measure of the affinity of haemoglobin for oxygen and can be readily plotted on the curve.

62
Q

The oxyhemoglobin dissociation curve:

Indicates the oxygen carrying capacity of the blood

A

False. Oxygen carrying capacity is determined primarily by haemoglobin concentration.

63
Q

The oxyhemoglobin dissociation curve:

Is displaced to the left in anaemia

A

False. Red cell 2,3-DPG is increased in anaemia, shifting the curve to the right, facilitating the offloading of oxygen at cellular level.

64
Q

The oxyhemoglobin dissociation curve:

Has the same shape as the carboxyhaemoglobin dissociation curve

A

False. The carboxyhaemoglobin (COHb) curve is hyperbolic rather than sigmoid shaped. In the presence of COHb, the dissociation curve of the remaining HbO, shifts to the left. In addition, haemoglobin has an affinity for CO 200 times that of O2 and COHb releases CO very slowly.

65
Q

The oxyhemoglobin dissociation curve:

Is displaced to the left by passive hyperventilation

A

True. Hyperventilation causes respiratory alkalosis and shifts the curve to the right.

66
Q

Airway resistance:

Can be measured using a body plethysmograph

A

True.

67
Q

Airway resistance:

Is expressed as litres/kPa

A

False. Resistance = Pressure difference between alveoli and
mouth per unit of airflow (compare electrical resistance: R =V/I), so the units are kPa.s.L-1

68
Q

Airway resistance:

Is independent of lung volume

A

False. As lung volume is reduced, airway resistance increases markedly. At low lung volumes, small airways may close completely, especially in dependent parts of the lung.

69
Q

Airway resistance:

Is increased in forced expiration

A

True. Airway compression occurs with increasing intra-thoracic pressure.

70
Q

Airway resistance:

Is independent of flow

A

False. Airway resistance increases as flow changes from laminar to turbulent.

71
Q

A subject acutely exposed to an inspired oxygen concentration of 10% at sea level will:

Develop respiratory alkalosis

A

True. PaCO2 decreases secondary to hyperventilation.

72
Q

A subject acutely exposed to an inspired oxygen concentration of 10% at sea level will:

Secrete a more acid urine

A

False. CO2 is reduce due to hyperventilation. pH = pka + log10[HCO3-]/aPaCO2.
To compensate for the respiratory alkalosis, hydrogen ion is conserved and bicarbonate is excreted in urine, decreasing plasma bicarbonate concentration to maintain the bicarbonate/CO2 concentration ratio and restore plasma pH towards normal.

73
Q

A subject acutely exposed to an inspired oxygen concentration of 10% at sea level will:

Have increased pulmonary vasoconstriction

A

True. Hypoxia causes an increase in pulmonary vascular resistance (hypoxic pulmonary vasoconstriction).

74
Q

A subject acutely exposed to an inspired oxygen concentration of 10% at sea level will:

Have an increased cardiac output

A

True. In an attempt to maintain oxygen delivery or flux.

75
Q

A subject acutely exposed to an inspired oxygen concentration of 10% at sea level will:

Respond immediately by increasing erythropoietin production

A

False. This is a longer term response.

76
Q

Important determinants of myocardial oxygen consumption include:

Heart rate

A

True. Myocardial oxygen consumption is determined primarily by heart rate, contractility and intra-myocardial tension.

77
Q

Important determinants of myocardial oxygen consumption include:

Ventricular wall tension

A

True. Ventricular work correlates with oxygen consumption. Myocardial oxygen consumption is determined primarily by heart rate, contractility and intra-myocardial tension.

77
Q

Important determinants of myocardial oxygen consumption include:

Myocardial contractility

A

True. Ventricular work correlates with oxygen consumption. Myocardial oxygen consumption is determined primarily by heart rate, contractility and intra-myocardial tension.

78
Q

Important determinants of myocardial oxygen consumption include:

Left ventricular end-diastolic volume

A

True. This can substitute for fibre length in Starling’s Law of the heart.

79
Q

Important determinants of myocardial oxygen consumption include:

Pulmonary capillary wedge pressure

A

True. An increase in PCWP corresponds to an increase in preload. Ventricular work correlates with oxygen consumption. Myocardial oxygen consumption is determined primarily by heart rate, contractility and intra-myocardial tension.

80
Q

Blood vessels that contribute to physiological shunt include the:

Coronary sinus

A

False. The coronary sinus drains into the right atrium.

81
Q

Blood vessels that contribute to physiological shunt include the:

Thebesian veins

A

True. Some Thebesian veins drain directly into the left side of the heart.

82
Q

Blood vessels that contribute to physiological shunt include the:

Anterior cardiac vein

A

False. The anterior cardiac veins drain the anterior part of the right ventricle, opening into the right atrium.

83
Q

Blood vessels that contribute to physiological shunt include the:

Bronchial venous drainage

A

True. Although the bronchial veins drain into the azygous systems, the majority of bronchial venous drainage is via the pulmonary veins, thus contributing to shunt.

84
Q

Blood vessels that contribute to physiological shunt include the:

Ductus venosus

A

False. The ductus venous is an embryological structure connecting the umbilical vein to the inferior vena cava, allowing about 50% of oxygenated blood to bypass the liver.

85
Q

Intracranial pressure:

Is decreased by hypoxia

A

False. Hypoxia increases intracranial pressure and is a cause of secondary brain injury.

86
Q

Intracranial pressure:

Can be reduced by hyperventilation

A

True. Intracranial pressure increases as PaCO2 increases.

87
Q

Intracranial pressure:

Is lower when intra-thoracic pressure is low

A

True. Coughing and straining increase intracranial pressure.

88
Q

Intracranial pressure:

Rises following head injury and should be treated with systemic steroids

A

False.

89
Q

Intracranial pressure:

May be estimated by the Kety-Schmidt method

A

False. This technique is used to measure cerebral blood flow.

90
Q

Urinary osmolality increases in response to:

Aldosterone

A

False. Aldosterone promotes both sodium and water reabsorption thereby reducing urine amount, but not the concentration.

91
Q

Urinary osmolality increases in response to:

Vasopressin

A

True. ADH increases water reabsorption in collecting ducts.

92
Q

Urinary osmolality increases in response to:

Cortisol

A

False. Cortisol has weak mineralocorticoid activity. Mineralocorticoid activity promotes re-absorption of both sodium and water, thereby reducing urine amount, but not the concentration.

93
Q

Urinary osmolality increases in response to:

Dehydration

A

True. Dehydration increases ADH secretion from the posterior pituitary in response to increased hypothalamic osmoreceptor activity.

94
Q

Urinary osmolality increases in response to:

Increased dietary protein

A

True. Urinary nitrogen excretion is increased, increasing the number of osmotically active particles.

95
Q

The tendon jerks in the lower limb are reduced if, fifty days previously, the:

Lumbo-sacral anterior horn cells are damaged

A

True. This is a lower motor neurone lesion. Intact anterior horn cells are required for the efferent limb of the tendon reflex.

96
Q

The tendon jerks in the lower limb are reduced if, fifty days previously, the:

Ipsilateral pyramidal tract is interrupted in the spinal cord

A

False. Corticospinal tract damage is an upper motor neurone (UMN) lesion, leading to weakness, increased muscle tone and increase in tendon reflexes.

97
Q

The tendon jerks in the lower limb are reduced if, fifty days previously, the:

Contralateral internal capsule is damaged

A

False. This UMN lesion would cause an increase in tendon jerks and in muscle tone (e.g. following a stroke).

98
Q

The tendon jerks in the lower limb are reduced if, fifty days previously, the:

Motor cortex is damaged on the contralateral side

A

False. This UMN lesion would cause an increase in tendon jerks and in muscle tone (e.g. following a stroke).

99
Q

The tendon jerks in the lower limb are reduced if, fifty days previously, the:

Ipsilateral spinothalamic tract is interrupted by disease

A

False. These are ascending sensory fibres.

E-lfh FRCA Primary: Physiology Exam Prep Questions (6 decks)

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