Physiology Tests Awesome

DIRECTIONS: Choose the single best answer.
PHYSIOLOGY
Module 1 General Concepts I

NONE
Module 2 General Concepts II

PHYSIOLOGY > Exams > 2005 Phys P4 Exam (#1-30)
Module 3 Cardiovascular/Respiratory
PHYSIOLOGY > Exams > 2005 Phys P4 Exam (#31-60 [cardio.])
PHYSIOLOGY > Exams > 2005 Phys P5 Exam (#1-20, 50 [resp.])
PHYSIOLOGY > Exams > 2004 Phys P2 Exam (#1-20 [resp.])
PHYSIOLOGY > Exams > 2003 Phys P2 Exam (#1-20 [resp.])
Module 4 Gastrointestinal/Renal
PHYSIOLOGY > Exams > 2005 Phys P5 Exam (#21-49 [renal])
PHYSIOLOGY > Exams > 2005 Phys P6 Exam (#1-20 [GI])
Module 5 Endocrine/Reproductive
PHYSIOLOGY > Exams > 2005 Phys P6 Exam (#21-45 [endo.])
PHYSIOLOGY > Exams > 2004 Phys P3 Exam (#1-20 [endo.])
PHYSIOLOGY > Exams > 2003 Phys P3 Exam (#11-45 [endo. + repro.])
Module 6 Musculoskeletal
NONE
Module 7 Neuroscience
NONE
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Directions: Choose the single best answer. While alternative answers

may be partially correct, only one is fully correct.
_______1. Respiratory distress syndrome (RDS) in prematurely delivered infants is

characterized by progressive collapse of alveoli and respiratory failure.
The primary deficiency is a lack of surfactant production. This is
associated with
a. decreased work of breathing.

b. increased surface tension forces at he air/liquid interface in alveoli.
c. overproduction of phosphatidylglycerol (PG) by Type II epithelial
cells of the alveoli.
d. increased numbers of Type I cells in alveoli.
e. all of the above.
_______2. An elderly patient has emphysema and his physician decides to

characterize his lung volumes and capacities. Spirometry reveals tidal
volume = 0.5L; expiratory reserve volume = 1.5L; inspiratory reserve
volume = 2L. The patient then quietly breathes gas from a spirometer
(volume 3L) which contains helium (He) at an initial concentration of
10%. After 3 minutes of breathing, the concentration of He at the end of
quiet expiration was 5%. From these measurements his vital capacity
(VC) and total lung capacity (TLC) in liters are (respectively):
a. 4.0; 5.5
b. 5.0; 5.5
c. 3.0; 5.0
d. 2.0; 4.0
e. none of the above.
_______3. Compare the alveolar ventilation rate of a patient breathing quietly at

10/minute, (tidal volume 0.5L), with that of the same individual breathing
rapidly at 20/minute (tidal volume 0.3L). This individual has a
physiologic dead space of 0.2L and vital capacity of 3L. The respective
alveolar ventilation rates are (quiet breathing; rapid breathing) in
L/minute:
a. 5; 6
b. 1.5; 4
c. 3.5; 6
d. 4; 3
e. 3; 2
54

_______4. Intrapleural pressure plays a central role in breathing in a healthy

individual. This pressure in such an individual is
a. always less than atmospheric pressure (PB).

b. equal to PB at the end of the quiet inspiration.
c. less than PB at the end of quiet expiration.
d. greater than (more positive value) alveolar pressure (P A) at the peak of
inspiration.
e. greater than PB during all phases of quiet breathing.
_______5.
The figure shows the relation between rate of flow of air and lung volume, with positive
flow = exhalation and negative flow = inhalation. Which of the following statements is
correct?
a. Point “C” represents an effort-independent region of the breathing

cycle.
b. EFGHA is the path of exhalation from maximum lung volume.
c. “B’ represents a region in which air flow is limited by airway collapse.
d. Maximum rate of flow during exhalation is attained at low lung
volumes, rather than high lung volumes.
e. Point “D” represents a region in which rate of airflow is effort-
independent.
55

_______6. A healthy individual quietly inhales starting at functional residual capacity

(FRC). For such a breath
a. less of the inhaled gas goes to alveoli at the apex of the lung than to
alveoli at the base of the lung
b. alveoli at the base of the lung are smaller than those of the apex of the
lung.
c. alveoli at the base of the lung are more compliant than those at the
apex of the lung.
d. alveoli having large time constants ( = RC) will fill more slowly than
those having small time constants.
e. all of the above are correct.
_______7. When a healthy individual inhales 2L of air starting from the FRC, her
pleural pressure decreases from –4cm H2O to –14cm H2O. If she has an
FRC of 2L, the specific compliance of her lungs is (in CM H2O –1)
a. 10
b. 1.0
c. 0.1
d. 0.2
e. 0.02
_______8. A healthy individual breathes out forcefully, at the end of quiet

inspiration. Which of the following statements is correct?
a. Internal intercostal muscles are activated.

b. Rectus abdominus muscle is activated.
c. Transverse abdominus muscle is activated.
d. All of the above muscles are activated.
e. No muscles are activated, since expiration is a passive process.
_______9. In advanced stages of chronic obstructive pulmonary disease such as

emphysema
a. alveolar and capillary walls are progressively destroyed.

b. lung compliance is increased.
c. the equal pressure point moves along the airways towards the alveoli.
d. total lung capacity is increased.
e. all of the above occur.
56

______10. The flow of air in small airways (respiratory bronchioles) during usual
breathing.
a. is laminar.
b. is associated with a Reynolds number less than 2000.
c. will not provide any breath sounds on a stethoscope.
d. provides little (less than 20%) of the total resistance to airflow due to
frictional forces.
e. is accurately described by all of the above.
______11. A clinician suspects that a patient may have a diffusion problem in the
lungs due to fibrosis. She measures the diffusing capacity of the patient’s
lungs (DL) using inhalation of carbon monoxide (CO) gas. CO is used
rather than O2 because
a. the PO2 of alveolar gas cannot be measured.

b. the Pco of capillary blood remains close to zero since CO doesn’t
dissolve easily in capillary membranes.
c. CO has low solubility in blood.
d. the rate of CO equilibration across the alveolar /capillary boundary is
very rapid.
e. the only limitation for CO diffusion is the equilibration of CO with
alveolar gas when air is inhaled.
______12. In a 100-meter race, runners frequently do not breathe for the

approximately 10 second duration of the race. Given the fact that such
vigorous exercise greatly increases metabolic rate, it is probable that,
during such a race
a. PA02 decreases.
b. PAC02 decreases.
c. VA increases.
d. pH increases.
e. all of the above occur.
57

______13. A “anatomical shunt” in the lungs
a. is an example of a “left-to-right” shunt

b. can be fully corrected clinically by administering 100% oxygen o the
patient.
c. results in a lowering of the AaD02 i.e. the difference in P02 between
alveoli and arterial blood is decreased.
d. is accurately described by all of the above.
e. occurs when some mixed venous blood by passes the alveoli and goes
directly into oxygenated arterial blood.
______14. Ventilation/Perfusion inequalities may contribute significantly to

differences in alveolar/arterial oxygen (AaD02). In a healthy individual
standing upright
a. The VA/Q ratio is uniformly equal to 1.0 throughout the lungs.

b. The VA/Q ratio is greatest at the base of the lungs.
c. The ventilation is greater at the apex than at the base of the lungs.
d. Both ventilation and perfusion are greater at the base than at the apex
of the lungs.
e. Exercise increases the differences in VA/Q ratio between base and apex
of lungs.
______15. Which of the following statements is incorrect?
a. Fetal hemoglobin (Hb) has a greater affinity for O2 than does adult Hb.
b. The concentration of Hb in the blood greatly affects the P 02 of that
blood.
c. The affinity of Hb for O2 is increased by the presence of carbon
monoxide (CO).
d. CO has greater affinity for Hb than does O2 .
e. Decreased temperature and increased pH result in increased affinity of
Hb for O2 (i.e. a shift of the Hb – PO2 curve to the left).
58

______16. CO2 is transported in the blood
a. in smaller amounts than is O2

b. at lower values of partial pressure in arterial blood than is O2.
c. mainly in the form of CO2 dissolved in plasma, since CO2 is 20 times
more soluble in plasma than is O2.
d. independently of the values of PC02 of arterial and venous blood.
______17. Ventilation rate
a. increases if PaC02 decreases in the presence of constant Pa02.

b. increases if Pa02 increases, in the presence of constant PaC02.
c. will change more rapidly (i.e. is more sensitive) in response to changes
in PaC02, if Pa02 increases.
d. is more sensitive to change in Pa02 if Pa C02 is elevated.
e. is usually more sensitive to changes in Pa02 than to changes in Pa C02.
______18. Peripheral and central chemoreceptors of the pulmonary system
a. provide direct excitatory input to centers located in the medulla.

b. mainly provide direct inhibitory input to centers located in the pons.
c. provide sensory input to the same group of neurons that receive
sensory input from the vagal stretch receptors and pneumotaxic center.
d. are most sensitive to changes in arterial P02 in usual quiet breathing.
e. are activated by stretch receptors located in large airways.
______19. Sustained exercise at an intensity beyond the anaerobic threshold results in
a. increased blood pH.

b. increased arterial P C02
c. increased arterial P02.
d. decreased VC02.
59

______20. A patient with pneumonia has a difference in alveolar/arterial oxygen

(AaD02 = PA02 –Pa02) of 30 mms Hg. He is given 50% supplemental oxygen
to breathe using a facemask. He is lying down quietly on a bed and has
steady measured rates of oxygen consumption (V02) and carbon dioxide
production (VC02) of 250 ml/min and 250 ml/min respectively. Atmospheric
pressure is 747 mms Hg. Use the alveolar air equation (given below) to
calculate what his new AaD02 is following the supplemental O2 therapy,
given that arterial blood sampling reveals a Pa02 = 80 mms Hg.
Alveolar air equation: PA02 = F I02 (PB-PH20) – PAC02/ R,
Where FI02 = fraction of O2 in inspired gas (0.5).

PH20 = partial pressure of saturated water vapor at body temperature. 7 mms
Hg)
PAC02 = partial pressure of C02 in alveolar air (40 mms Hg).
R = Respiratory Exchange Ratio (VC02/V02)
On the basis of these measurements, his AaD02 is
a. 30 mms Hg
b. 230 mms Hg
c. 350 mms Hg
d. 100 mms Hg
e. 10 mms Hg
______21. X is freely filtered and secreted. If 50% of X binds to plasma protein

during circulation. Which of the following is true?
a. Cx = Cin
b. Cx = CPAH
c. Cx < CPAH
d. Cx = 0
e. Cx < Cin
______22. The filtered load of X is 120 mg/min. If urine volume is 2 ml/min. and the
concentration of X in the urine is 100 mg/ml. and GFR is 120 ml/min.
What is clearance of X?
a. 20 ml/min
b. 100 ml/min
c. 120 ml/min
d. 200 ml/min
e. 220 ml/min
60

______23. Contraction of the afferent arteriole will do all of the following except
__________.
a. decrease RPF
b. increase oncotic pressure in the peritubular capillary
c. decrease GFR
d. increase mean arterial pressure
______24. Pete has polydipsia: a psychosis associated with uncontrolled intake of

pure water. He is constantly drinking water. After drinking lots of water,
his plasma osmolarity will initially be ___________ resulting in
_____________ ADH release followed by __________ in urine
osmolarity and ___________ urine flow rate (urine volume per time).
a. decreased, more, decreases, decreased

b. decreased, less, decreases, no change
c. increased, no change in, increases, increased
d. increased, more, no change, decreased
e. decreased, less, decreased, increased
______25. Which of the following is critical to creation of the hyperosmotic medulla?
a. Active NaCl reabsorption at the TAL

b. ADH
c. passive urea reabsorption at the collecting duct
d. counter current flow in the vasa recta
e. all of the above are necessary
______26. Congential diseases resulting in formation of glomerular basal lamina that

have few negatively charged proteoglycans forming this meshwork results
in all of the following except ______________.
a. proteinuria
b. a relative increase in medium sized (6-8 nm) neutral proteins in the urine
c. a decrease in peritubular oncotic pressure
d. increase in the oncotic pressure of urine
e. increase in urinary flow rate
61

______27. Sally has chronic renal failure with progressive loss of functional renal
capacity. Her doctors have been following plasma creatinine levels as an
indication of her decreasing GFR. What would happen to P cr (compared to
Pcr in the disease stater) if Sally was given a drug that reversed all adverse
effects of her renal failure.
a. Pcr would rise

b. Pcr would decrease
c. Pcr would not change
d. Pcr would stop decreasing and stay stable
e. Pcr would stop increasing and stay stable
______28. Glutamine metabolism in the kidney plays an essential role in

__________________.
a. acid-base balance
b. secretion of organic anions
c. production of ammonium in the proximal tubule
d. regeneration of bicarbonate by the proximal tubule
e. all of the above
______29. Bill’s filtration fraction is 0.16. His C creatinine = 100 ml/min. His urine
volume and urinary PAH concentration are 2 ml/min and 625 mg/ml,
respectively. What is Bill’s PAH secretion rate?
a. 10 mg/min
b. 600 mg/min
c. 805 mg/min
d. 1050 mg/min
e. cannot determine
62

For questions 30-35 use the following answer choices (where V = urine volume/time,
COsm = osmolar clearance, and CH2O = free water clearance):
A. V = COsm
B. V > COsm
C. COsm = 0
D. CH2O < 0
E. COsm = CH2O
______30. Which answer choice best describes a person taking a loop diuretic?
______31. Which answer best describes a person that has diabetes mellitus (saturation of
glucose reabsorption in the PT)?
______32. Which answer best describes a person that has central diabetes insipudus
(not making ADH)?
______33. Which person is responding to dehydration?
______34. Which of the above relationships A-E can never happen?
______35. If V is equal under all conditions, which scenario would decrease plasma
volume the greatest?
______36. If Jake’s plasma pH is 7.4 and he has a pCO 2 < 40 mmHg, Jake must
have?
a. acidosis
b. alkalosis
c. both
d. neither
e. cannot determine
63

______37. Substance X is freely filtered and not bound to plasma protein and
completely reabsorbed. Betty is given an experimental drug that decreases
Cx but has no affect on Cin. What does this experimental drug do?
a. decreases GFR
b. increases GFR
c. block reabsorption of X
d. increase reabsorption of X
e. decrease RPF
______38. Which patient has respiratory alkalosis?

patient [HCO3-] PCO2 PH
A. 15 40 7.26
B. 14 20 7.47
C. 24 40 7.4
D. 26 60 7.26
E. 30 40 7.5
______39. Paul’s pCO2 is 16.7 mmHg and his [HCO3-] is 10 mM. What is his pH?
a. 6.2
b. 7.2
c. 7.4
d. 8.2
e. cannot determine
______40. Which of the following is secreted in to the proximal tubule:
a. Na+
b. organic anions
c. glucose
d. inulin
e. bicarbonate
64

______41. Jake’s osmolar and free water clearances are 4 and –2 L/min, respectively.
After setting his plasma inulin levels to 1.0 mg/ml, his inulin clearance
was 120 ml/min. Calculate his inulin excretion rate.
a. 1 mg/min
b. 6 mg/min
c. 10 mg/min
d. 60 mg/min
e. 120 mg/min
______42. An increase in filtration fraction will _____________ Na+ reabsorption at

the proximal tubule.
a. decrease
b. increase
c. not change
d. all of the above
______43. Ms. Dubya has congestive heart failure. She has pulmonary edema and
has been treated with a loop diruetic that blocks the tri-transporter and a K
supplement. Dr. Bob comes along and decides to give Ms. Dubya another
diuretic in addition to her other medications. Shortly after administering
this second diuretic in addition to the first diuretic and K supplement, Ms.
Dubya has a heart attack and dies. What type of diuretic did Dr. Bob most
likely and inappropriately add to Ms. Dubya’ therapy?
a. a carbonic anhydrase inhibitor

b. mannitol
c. a Na/Cl cotransporter inhibitor
d. an inhibitor of the Na channel in the collecting duct
e. cannot say
65

______44. Which of the following anatomical arrangements of the renal vasculature

make the kidney unique?
a. the kidney vasculature includes two capillary beds in series

b. the vasa recta system runs in counter-current
c. the glomerular capillary is surrounded by two contractile arterioles
d. the glomerular capillary is made by fenestrated endothelial cells
e. all of the above
______45. Which vascular element in the kidney presents the majority of resistance
to blood flow?
a. vasa recta
b. afferent arteriole
c. efferent arteriole
d. glomerular capillary
e. b and c
For questions 46 – 49 use the following data set:

patient Urine flow UOsm POsm
(ml/min) (mOsm/kg) (mOsm/kg)
A 6 100 300
B 6 200 300
C 6 300 300
D 0.5 600 300
E 2 1200 300
______46. Which patient is excreting the most free water?
______47. Which patient is most likely taking a diuretic that blocks the ADH receptor?
______48. Which patient has the highest osmolar clearance?
______49. Which patient might have a liver disease that washes out the medullary
hyperosmotic gradient due to aberrant protein metabolism?
66

______50. Glomerulotubular balance happens because?
a. RPF sets oncotic pressure

b. plasma protein levels set oncotic pressure
c. filtration at the glomerulus concentrates plasma proteins
d. filtration is isoosmotic
e. all of the above
67
MEDICAL PHYSIOLOGY PHASE 2 EXAMINATION

KEY
APRIL 12, 2004
1. B 28. E
2. A 29. D
3. E 30. A
4. C 31. A
5. E 32. B
6. E 33. D
7. C 34. C
8. D 35. D
9. E 36. C
10. E 37. C
11. B 38. B
12. A 39. C
13. E 40. B
14. D 41. E
15. B 42. B
16. B 43. D
17. D 44. E
18. A 45. E
19. C 46. A
20. B 47. A
21. C 48. E
22. D 49. C
23. B 50. C
24. E
25. E
26. B
27. B
68

_______1. An individual drinks 500ml of hypertonic saline. Within a short time (say
20 minutes), assuming all of this fluid is still in his body:
f. there will be increased volume of the extracellular fluid compartment.

g. there will be an increase in volume of the intracellular compartment
h. there will be a decrease in volume of the vascular compartment.
i. the volume of the interstitial fluid compartment will be unchanged.
j. the volume of the vascular compartment will be unchanged.
_______2. Intrinsic membrane proteins
f. are usually held in place in the membrane by means of charge

interactions with lipid molecules.
g. may be removed from membranes by solubilizing them using
detergents.
h. are always distributed symmetrically across the bi-lipid layer.
i. are usually linked to carbohydrate molecules as glycoproteins on the
inner face (intracellular side) of the membrane.
j. are accurately described by all of the above.
_______3. In comparison with skeletal muscle fibers, smooth muscle cells have
f. more troponin molecules.

g. higher myosin concentration.
h. less concentration of actin molecules
i. all of the above.
j. no sarcomeres.
69

_______4.
Sarcomere Length
The diagram above was obtained from a single muscle fiber and represents the passive
and active tensions the fiber is capable of generating at particular sarcomere lengths.
Which of the following statements is correct for a muscle which is stimulated to contract
starting at the sarcomere length given by point D?
f. Under isometric conditions, the path of the contraction is given by

XY1 B A.
g. Under afterloaded isotonic conditions (load given by: A) the path is
XY1 Z C.
h. Under eccentric conditions of contraction the path would be XY2Z.
i. Shortening of the active muscle under load A will be greater than that
under load E.
j. Under after-loaded isotonic conditions (load: E) the path of the
contraction would be XF.
_______5. Diffusion is an effective process for the movement of nutrients and other
molecules only over small distances because
f. the rate of diffusion is directly proportional to the distance traveled.

g. the diffusion coefficient is directly proportional to the square of the
molecular weight of the molecule.
70
h. the time of diffusion increases as the square of the distance over which
the diffusion takes place.
i. large molecules only move small distances by diffusion.
j. the diffusion coefficient is proportional to distance.

_______6. The osmolarity of a solution, as defined by the Van’t Hoff equation,
f. is independent of temperature.
g. depends upon the degree of dissociation of the solute.
h. is proportional to the osmotic coefficient ().
i. is proportional to the molar concentration of the solute.
j. is accurately described by all of the above.
_______7. Red blood cells (having an osmolarity of 0.290 osmoles/liter) are placed in
a solution of particles X, having an osmotic pressure of 0.4 osmoles/liter.
Which of the following statements is true?
f. The cells will increase in volume if molecules X cannot penetrate cell

membranes.
g. The cells will not change in volume if the molecules X are able to
freely penetrate the cell membranes.
h. The solution of molecules X is hypo-osmotic in comparison with the
intracellular contents of the cells
i. The cells will increase in volume in the steady state, if molecules X
can freely penetrate the cell membranes.
j. The cells will shrink in volume in the steady state if X easily
penetrates cell membranes.
_______8. L-glucose exhibits movement characteristics across muscle cell

membranes which are very different from those of D–glucose. For
example, the rate of transport of L-glucose into muscle cells is not affected
by the presence of metabolic inhibitors, is not affected by competitive
inhibition from other molecules of similar structure and does not exhibit
saturation kinetics. It is known that D–glucose is transported into muscle
cells by facilitated diffusion. From these facts, we may conclude that L–
glucose movement across muscle cell membranes is
f. by secondary active transport.

g. by primary active transport.
71
h. probably much faster than that of D-glucose.

i. probably by simple diffusion.
j. occurring by facilitated diffusion.
72

_______9. Many cells import neutral, hydrophilic amino acids against their own
concentration gradient. This transport mechanism:
f. utilizes the energy of the Na+ concentration gradient.

g. is an example of secondary active transport.
h. would be enhanced by increasing extracellular Na+ concentration.
i. would be inhibited by agents which decrease cellular metabolism.
j. is accurately described by all of the above.
______10. The Na+ - H+ exchange transport protein protects cells from acidification
because affinity of the protein for H+ increases, and extracellular Na+ is
exchanged for intracellular H+, when the pH decreases. A similar
increased affinity of the protein for H+ is induced by tumor promoters,
growth factors and mitogens. When these agents are present:
f. there will be increased outflux of Na+ from cells.

g. the intracellular H+ concentration will increase.
h. intracellular pH will decrease
i. the Na+/ K+ - ATP-ase pump system will be inhibited.
j. there will be a net outflux of H+ ions from the cells.
______11. The tight junctions joining the epithelial cells of the small intestine and
proximal tubule of the kidney
f. are leaky to water, small water-soluble molecules and ions.

g. are leaky to glucose and neutral amino acids.
h. permit the movement of Na+ / K+ -ATP-ase molecules from the
basolateral to the brush border membranes of the cells.
i. contain the transport proteins responsible for facilitated diffusion of
glucose across the epithelial cells.
j. are impermeable to water and water-soluble molecules.
______12. The electrochemical potential energy (x) of a charged molecule X+ in

solution
f. is independent of the concentration of X+.

g. is directly proportional to the concentration of X+.
h. will decrease if the electrical charge, or valence, of X+ increases.
i. determines if X+ will move to a region where the potential energy is
different.
j. is correctly described by all of the above.
73

______13. The equilibrium potential of X- is
f. the transmembrane voltage difference required to produce an electrical

force equal and opposite to the chemical concentration force for X -
across the cell membrane.
g. the potential at which there is no movement of X - across the membrane
in either direction.
h. the chemical concentration of X- which balances osmotic forces across
the membrane.
i. equal to the cellular membrane potential.
j. equal to the balance of cell-ions across the membrane.
______14. The two compartments A and B are separated by a membrane permeable

only to X- ions. A voltage of –60mV is maintained across the membrane.
Use the Nernst equation to select the correct answer, assuming the
temperature is held at 29.2 C:
f. X- is in equilibrium across the membrane.

g. There will be a net movement of X- from B to A.
h. The electrical energy gradient is less than the chemical energy
gradient.
i. There will be a net movement of X- from A to B.
j. The equilibrium potential for X- in this situation is –100mV.
74

______15. The drug digitalis inhibits the cell membrane Na +/ K+ - ATP-ase. If this
drug is added to muscle cells in vivo:
f. There will be increased intracellular concentration of Na+ ions.

g. There will be a depolarization of the resting membrane potential.
h. There will be decreased intracellular concentration of K+ ions.
i. The muscle membranes will exhibit increased excitability.
j. All of the above will occur.
______16. If extracellular K+ concentration is increased in the fluid surrounding nerve

and muscle fibers
f. the magnitude (size) of subsequent action potentials will be decreased.

g. the resting membrane potential will be depolarized.
h. the nerve and muscle fibers will be more easily excitable.
i. all of the above will occur.
j. the membrane potential will be hyperpolarized.
______17. The drug TTX (tetrodotoxin) specifically blocks Na+ channels. Adding
this drug to the fluid surrounding nerve fibers will, according to the Chord
Conductance equation, cause:
f. decreased K+ conductance.
g. depolarization of the membrane potential.
h. no change in membrane potential.
i. increased Na+ conductance.
j. hyperpolarization of the membrane potential.
______18. The process of accommodation in nerve and muscle fibers:
f. affects both Na+ and K+ channels.

g. decreases K+ conductance (gK).
h. increases the number of Na+ channels open at a given time.
i. occurs in response to a rapid depolarization.
j. renders the cell membranes hyper excitable.
75

______19. The relative refactory period of the action potential is associated with
f. depolarization of the cell membrane.

g. mainly inactivation of Na+ channels.
h. mainly hyperpolarization of the cell membrane.
i. decreased K+ membrane conductance.
j. increased Na+ membrane conductance.
______20. The increased speed of conduction of action potentials along myelinated

nerve fibers occurs in part because myelin:
b. decreases the length constant () of the axon.

c. decreases the capacitance of the axon.
d. enables generation of the action potential to occur at any point along
the axon.
e. increases the diameter of the axon.
f. increases the intracellular electrical resistance along the axon.
______21. The end plate potential (EPP) of the nerve-muscle junction
f. results in the generation of muscle fiber action potentials within the

synaptic cleft.
g. occurs because the action of acetyl choline is to open K+ channels
only in the synaptic cleft of the post synaptic membrane.
h. is the consequence of the opening of voltage-gated channels present in
the muscle membrane of the synaptic cleft.
i. is accurately described by all of the above.
j. occurs because of the opening of ligand-gated channels in the muscle
membrane of the synaptic cleft.
______22. In the Lambert-Eaton syndrome, patients exhibit muscle weakness

because they produce anti-bodies against membrane Ca++ channels. These
channels
f. are present in the motor nerve terminals of the nerve-muscle junction.

g. are located in the post-synaptic muscle membrane.
h. are necessary for the outflow of Ca++ from nerve terminals which
causes the release of vesicles of acetyl choline from the terminals.
i. are also the channels through which the movement of Na+ and K+
occurs across the post-synaptic muscle membrane.
j. are directly responsible for the effects of anti-cholinesterase drugs.
76

______23. A motor unit of a skeletal muscle
a. consists of a motor nerve and all of the muscle fibers it innervates.

b. would be expected to contain many muscle fibers (say, 2000 fibers) if
the unit is necessary for fine (or precise) control of movement, as in
the case of muscles of the eye.
c. can contain fibers of several different types, such as fast (type 2) and
slow (Type 1) fibers.
d. would be recruited first, if the unit contains fast, fatigable (type 2B)
fibers.
______24. Increased skeletal muscle performance can be obtained in vivo by the

process of summation. In this process
a. intracellular Ca++ levels are rapidly decreased by increasing the speed

of the sarcoplasmic reticulum Ca++/ATP-ase pumps.
b. intracellular Ca++ levels are sustained at a high level as a consequence
of repetitive stimulation.
c. maximum tetanic contraction is obtained via low frequency
stimulation when the muscle is routinely activated under usual daily
conditions.
d. there is increased binding of Ca++ ions to thick filaments.
e. activity of the DHPR receptors (of the transverse tubules) and RYR
receptors (of the sarcoplasmic reticulum) is decreased below resting
values.
______25. A skeletal muscle fiber which is required to shorten rapidly over large
distances but not required to develop large active tensions, would be
expected to
a. contain many myofibrils in parallel.

b. contain many sarcomeres in parallel.
c. contain many sarcomeres in series
d. be classified as a Type I fiber.
e. have a very large (> 100m) fiber diameter.
77

______26. The speed of contraction of a skeletal muscle fiber is
a. determined mainly by the speed of the myosin ATP-ase of that fiber.

b. independent of the load on that fiber.
c. greater if the fiber is undergoing an eccentric contraction than when
undergoing a lightly-loaded after loaded isotonic contraction.
d. determined mainly by the number of myofibrils in parallel rather than
in series in that fiber.
e. not accurately described by any of the above.
______27. In malignant hyperthermia (MH), patients exhibit severe muscle

contractions and rigidity in response to administration of anesthetics such
as halothane and ether. This situation may be caused by
a. uncontrolled release of Ca++ ions from the sarcoplasmic reticulum (SR)

into the sarcoplasm.
b. sustained activation of the RYR channel of the SR.
c. sustained activation of the DHPR receptor of the transverse tubule.
d. inability of the SR Ca++ ATP-ase pumps to remove elevated levels of
Ca++ from the sarcoplasm.
______28. Fatigue of skeletal muscle fibers is
f. associated with greatly reduced levels of intracellular ATP.

g. associated with greatly reduced pH (about 6.0) during repetitive
exercise of low intensity.
h. often associated with increased inorganic phosphate ions in the
sarcoplasm (to almost 20 times the resting level in working muscles).
i. most often associated with failure of the Type I muscle fibers to
continue contracting.
j. accurately described by all of the above.
78

______29. The energy cost of contraction is much less in smooth muscles than in
skeletal muscles. This is because
f. ATP- hydrolysis occurs in order for Ca++ bind to troponin, but not for
Ca++ binding to calmodulin.
g. phosphorylation of myosin light chains is necessary to activate the
sliding filament mechanism in smooth muscles but not in skeletal
muscles.
h. crossbridge cycling is much slower in active smooth muscles than in
active skeletal muscles.
i. Ca++ ions are not removed from the sarcoplasm in smooth muscle cells
by the action of Ca++/ATP-ase pumps.
j. all of the above are correct.
______30. Crossbridge cycling in smooth muscle cells decreases when the

crossbridges are dephosphorylated. This occurs when
a. Ca++ concentration increases.

b. myosin light chain kinase (MLCK) becomes active.
c. myosin phosphatase dephosphorylates the myosin light chain.
d. all of the above occur.
e. the Na+/K+- ATP-ase pump restores the balance of Na+ and K+ across
the cell membrane.
79
In the following cardiovascular questions

(#31-60), the common cardiovascular
variables are represented by the following
abbreviations:
Heart Rate: HR
Stroke Volume: SV
Cardiac Output: CO
Mean Arterial Pressure: MAP
Total Peripheral Resistance: TPR
80

______31. In a recumbent person with a normal cardiovascular system, which of the

following about blood pressure is true?
a. Mean blood pressures in the major arteries of the systemic and

pulmonary circulations are identical.
b. MAP = TPR ÷ CO.
c. The blood pressure difference between the large arteries and the right
atrium is virtually the same across most organs of the systemic
circulation.
d. The largest pressure drop in a systemic organ circulation is usually
across the veins.
e. Both b and c.
______32. Blood flow through an organ in the systemic circulation:
a. Is caused by mean arterial pressure being greater than right atrial pressure.
b. Increases when organ vascular resistance increases.
c. Decreases when arteriolar smooth muscle tone increases.
d. Decreases when arteriolar radii increases.
e. Both a and c.
______33. Before an experimental intervention a patient’s HR = 67 bpm, SV = 75 ml

and MAP = 90 mmHg. The intervention caused HR to increase to 100
bpm without a change in either SV or MAP. In response to the
intervention, how did TPR change to maintain MAP at 90 mmHg?
a. TPR increased by about 3 mmHg/L/min.

b. TPR decreased by about 6 mmHg/L/min.
c. TPR decreased by about 20 mmHg/L/min.
d. TPR did not change.
e. Question cannot be answered from the given information.
______34. Using the end of ventricular diastole as the starting time, what is the correct
open/close sequence of the atrioventricular (AV) and semilumar (SL) valves
during a heart beat?
a. SL open, AV open, SL close, AV close.

b. SL close, SL open, AV close, AV open.
c. AV close, SL open, AV open, SL close.
d. AV close, SL open, SL close, AV open.
e. AV open, SL open, SL close, AV close.
81

______35. In cardiac muscle, conduction of an action potential to an adjacent fiber:
a. Occurs in part because of pathways with low electrical resistance in the

intercalated disk regions.
b. Is due primarily to stimulation of ß-adrenergic receptors in the gap
junction regions of the adjacent fiber.
c. Occurs most readily when the Na+-channel inactivation mechanism is
completely “turned off” in the adjacent fiber.
d. Occurs at a higher velocity in the atrioventricular node than in the Purkinje
fibers.
e. Both a and c.
82

Drawn below is a recording of two successive “fast response” ventricular action

potentials in a normal heart. Use this drawing to answer questions 36 and 37.
+30
C
Membrane
0
•
Potential
(mv) •B • B2
-50
•D
E
-100 • A
• • A2
0 150 300 450 600 750
Time (msec)
______36. Identify the true statement about mechanisms underlying this membrane
potential recording:
f. The resting membrane potential between E and A2 is about -90 mv

because Na+-channel conductance is much higher than K+-channel
conductance.
g. Inward Ca++ flux (current) is much higher between E and A2 than at C.
h. The rapid depolarization at B is due primarily to a rapid increase in
“slow channel” conductance.
i. K+-channel conductance at C is much higher than at A.
j. The Na+-channel inactivation mechanism is “turning off” between D
and E.
______37. Which mechanisms and events are correctly associated with these
membrane potential changes?
f. The P-wave of the electrocardiogram is produced by the depolarization

at B.
g. Between E and A2 an action potential was generated in the sinoatrial
node.
h. The sarcolemma is in its absolute refractory period between D and A2.
i. Between D and E the predominant activity of the sarcoplasmic
reticulum is release of Ca++ into the cytosol.
j. The maximum contractile tension generated by the first action
potential occurs around B2.
83

______38. The diastolic (phase 4) depolarization between action potentials in

sinoatrial node fibers:
a. Is due in part to gradual increase in K+-channel conductance.

b. Is due in part to a gradual increase in Ca++ influx.
c. Is caused by stimulation of ß-adrenergic receptors by norepinephrine.
d. Normally occurs in atrial fibers also.
e. Normally occurs at a slower rate than in atrioventricular node fibers.
______39. Action potentials in sinoatrial node fibers:
f. Normally occur before those in the right and left bundle branches
during a heart beat.
g. Are not conducted to adjacent atrial fibers.
h. Normally occur at a lower frequency than heart rate.
i. Have a rapid depolarization phase (phase 0) that is caused primarily by
increased conductance of fast Na+-channels.
j. Increase in frequency in response to increased stimulation of
muscarinic cholinergic receptors.
______40. Which statement about Ca++ during a heart beat is true?
a. The sarcolemmal Ca++ influx during an action potential is normally

sufficient to fully saturate the Ca++-binding sites on troponin C.
b. Ca++ release from the sarcoplasmic reticulum is triggered by the Na+
influx during an action potential.
c. The increase in cytosolic [Ca++] produces contraction only after Ca++
binds to calmodulin.
d. The increase in cytosolic [Ca++] in response to an action potential is
enhanced when sarcolemmal ß-adrenergic receptors are stimulated.
e. The recovery of cytosolic [Ca++] after its initial increase is due
primarily to diffusion of Ca++ from cytosol to extracellular fluid.
84

______41. Using the left ventricular pressure-volume loop for one cardiac cycle
drawn below, identify the correct statement about the cardiac cycle.
E
•
F •
•D
Left Ventricular
Pressure (mmHg)
B •C
A • •
Left Ventricular
Volume (ml)
f. The second heart sound begins at D.

g. The mitral and aortic valves are both closed between C and D.
h. The mitral and aortic valves are both open between F and A.
i. By definition, ventricular end-systolic volume is the ventricular
volume at E.
j. Left atrial systole accounts for the volume increase between A and B.
85

Drawn below is aortic blood pressure associated with 3 successive heart beats. Use
this drawing to answer questions 42 and 43.
120 C
• •D •E
Arterial 80 A•• •F
Pressure B
(mmHg)
40
0
0
Time (sec)
______42. Which cardiac event is correctly associated with these aortic pressure
tracings?
e. The first heart sound begins between A and B.

f. The left ventricle is filling at C.
g. The aortic valve opens at D.
h. Left ventricular pressure reaches its highest level between E and F.
i. The period of left ventricular ejection is from C to E.
______43. Which is true about aortic blood pressure as shown above and the events
associated with it?
f. By definition, aortic diastolic blood pressure is the value at D.

g. Aortic pulse pressure is about 120 mmHg.
h. MAP is between 85-95 mmHg.
i. Blood flow through the downstream arterioles is occurring between A
and D, but not between D and F.
j. The rise in aortic pressure between B and C is due to smooth muscle
contraction in the aorta and its major branches.
86

______44. Which mechanism normally contributes to the increase in HR produced by

increased sympathetic nerve stimulation in the sinoatrial node?
f. Increased rate of rise of the phase 4 depolarization.

g. Change in the membrane potential threshold for action potentials to a
more negative value.
h. Increased Na+ influx through “funny” channels during phase 4.
i. Decreased Ca++-channel conductance during phase 4.
j. Both a and c.
______45. The Frank-Starling mechanism that controls SV:
f. Will tend to decrease SV when venous return becomes greater than CO.
g. Is due in part to a change in the extent of interfering overlap of actin
filaments in a sarcomere when ventricular end-diastolic fiber length is
changed.
h. Is related to the intrinsic ventricular muscle mechanism that increases
contractile fiber shortening when preload is increased.
i. Requires stimulation of cardiac ß-adrenergic receptors to increase SV.
j. Both b and c.
______46. An increase in ventricular contractility in the normal heart:
a. Increases the peak pressure generated by an isvolumetrically contracting

ventricle from a given end-diastolic fiber length.
b. Is the cause of a fall in SV when ventricular afterload increases.
c. Is produced normally by a reduction in Ca++-binding to troponin C.
d. Causes SV to fall when it occurs without a simultaneous change in
ventricular preload and afterload.
e. Reduces myocardial O2 consumption.
87

______47. Drawn below is the left ventricular pressure-volume loop during a cardiac
cycle with end-diastolic volume and end-systolic volume labeled by 1 and 2,
respectively. Cardiac sympathetic nerve stimulation accompanies a fall in
arterial blood pressure in response to a cardiovascular challenge. However,
ventricular end-diastolic volume is not altered. Which point (a-e) represents
the new end-systolic volume?
• a
•
d
•2
LV Pressure c•
(mmHg)
•b • e
•1
LV Volume (ml)
______48. Pulse pressure in the major arteries of the systemic circulation:
a. Declines when SV increases.

b. Declines during hemorrhage.
c. Decreases with age because major artery compliance increases.
d. Is normally less than 10 mmHg.
e. Is, by definition, equal to (systolic blood pressure + diastolic blood
pressure).
______49. The tone of arteriolar smooth muscle increases when:
a. membrane hyperpolarization reduces Ca++-channel conductance.

b. the cytosolic concentration of the Ca++-calmodulin complex decreases.
c. an increase in -adrenergic receptor stimulation increases the cytosolic
concentration of inositol triphosphate (IP3).
d. an increase in endothelial release of nitric oxide increases cytosolic
[cGMP].
e. Both b and c.
88

______50. The metabolic mechanism that controls arteriolar resistance:
f. Involves a vasodilator influence of metabolites in the interstitial fluid on

arteriolar smooth muscle tone.
g. Causes arteriolar vascular resistance to increase in an organ when its
O2 demand increases above the initial O2 supply.
h. Causes coronary blood flow to fall when heart rate increases.
i. Is one cause of reactive hyperemia following release of blood flow
occlusion.
j. Both a and d.
______51. An event increased blood flow through an organ in the systemic

circulation even though there were no changes in MAP and right atrial
pressure. Each of the following could have been a cause of this increase
in blood flow through a direct action on arterioles EXCEPT:
a. Decreased action potential frequency in sympathetic vasoconstrictor

fibers.
b. Increased histamine release from mast cells.
c. Increased nitric oxide release from endothelial cells.
d. Increased plasma concentration of angiotensin II.
e. Increased release of prostaglandins E2 and I2 from endothelial cells.
______52. The sympathetic vasoconstrictor fiber control of arteriolar resistance:
a. Is mediated primarily by release of epinephrine from postganglionic

nerve terminals.
b. Primarily involves ß2-adrenergic receptor stimulation in arteriolar
smooth muscle.
c. Is an important moment-to-moment controller of TPR.
d. Changes organ blood flow in direct proportion to action potential
frequency.
e. Is the most important controller of blood flow through the cerebral
circulation
89

______53. An organ’s autoregulation of its steady state blood flow when MAP is
elevated:
a. Requires stimulation of sensory receptors in that organ which, in turn,

determines the activity of sympathetic vasoconstrictor fibers.
b. Is due in part to a myogenic relaxation of arteriolar smooth muscle
when the arteriolar vessel wall is stretched.
c. Is accomplished through local mechanisms that increase arteriolar
resistance.
d. Causes organ blood flow to increase in direct proportion to the
increase in MAP.
e. Both b and c.
______54. Net capillary filtration is occurring in an organ, but lymph flow is less than
the net filtration rate. The following values are measured:
Average capillary blood pressure (Pc): 28 mmHg

Plasma colloid osmotic pressure (πp): 24 mmHg
Interstitial fluid colloid osmotic pressure (πif): 5 mmHg
In this organ:
a. Capillary filtration coefficient = 0.

b. Interstitial fluid hydrostatic pressure (Pif) is less than 9 mmHg.
c. The net absorptive force due to proteins = 0.
d. Interstitial fluid volume is decreasing.
e. Both a and c.
______55. In a patient’s arm with surgically eliminated lymph outflow, there is

initially no net fluid movement across the capillary walls. Subsequently, a
perturbation increases average arm capillary blood pressure without any
change in plasma protein concentration. If the capillary filtration
coefficient is not 0, this perturbation will:
a. Initially change net transcapillary fluid movement to filtration.

b. Reduce interstitial fluid hydrostatic pressure (Pif).
c. Decrease interstitial fluid volume.
d. Produce a continuous net filtration in the new steady state.
e. Both c and d.
90

______56. If the total blood flow entering the systemic veins of an intact circulation
is equal to CO in a person that is lying down, which event in the veins will
initially make venous return greater than CO?
a. An increase in sympathetic nerve activity to venous smooth muscle.

b. An increase in venous blood pressure due to arteriolar vasodilation.
c. An increase in leg venous blood volume caused by standing up.
d. All of the above.
e. Both a and b.
______57. In response to a sudden increase in MAP, the arterial baroreceptor reflex

will:
a. Reflexly cause a further increase in MAP.

b. Reduce cardiac vagal nerve nerve activity.
c. Reduce -adrenergic stimulation of arteriolar smooth muscle.
d. Increase ventricular contractility.
e. Increase HR.
______58. Which is true about the atrial baroreceptors and the reflex they initiate?
a. The atrial baroreceptors are the sensors of the arterial baroreceptor

reflex.
b. Atrial baroreceptor nerve activity increases when atrial blood volume
decreases.
c. An atrial receptor-sensed fall in atrial volume will reflexly increase sympathetic
nerve activity to cardiovascular effectors.
d. The atrial baroreceptor reflex is the most important mechanism in
long-term regulation of MAP.
e. The atrial baroreceptor reflex has no cardiovascular role during
hemorrhage.
______59. Relative to the pre-stimulus (control) level, a hemorrhaging individual

with falling MAP has:
a. an increased SV due to the Frank-Starling mechanism.

b. an elevated action potential frequency in arterial baroreceptor nerve
fibers.
c. a decreased sympathetic vasoconstrictor nerve activity to skin.
d. an increased kidney (renal) blood flow.
e. an increased TPR.
91

______60. Relative to rest, dynamic exercise:
a. increases HR but not CO.

b. increases active skeletal muscle blood flow primarily by reducing
sympathetic vasconstrictor nerve activity.
c. reduces coronary blood flow by elevating sympathetic vasoconstrictor
nerve activity.
d. increases ventricular contractility by elevating cardiac sympathetic
nerve activity.
e. increases gastrointestinal blood flow by reducing sympathetic vasoconstrictor
nerve activity.
92
1. a 32. e
2. b 33. b
3. e 34. d
4. e 35. e
5. c 36. e
6. e 37. b
7. d 38. b
8. d 39. a
9. e 40. d
10. e 41. b
11. a 42. a
12. d 43. c
13. a 44. e
14. B&C 45. e
15. e 46. a
16. d 47. c
17. e 48. b
18. a 49. c
19. c 50. e
20. b 51. d
21. e 52. c
22. a 53. c
23. a 54. b
24. b 55. a
25. c 56. a
26. a 57. c
27. e 58. c
28. c 59. e
29. c 60. d
30. c
31. c
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DIRECTIONS: Choose the single best answer.

Module 1 General Concepts I

Module 2 General Concepts II

Directions: Choose the single best answer. While alternative answers

_______1. Respiratory distress syndrome (RDS) in prematurely delivered infants is

a. decreased work of breathing.

_______2. An elderly patient has emphysema and his physician decides to

_______3. Compare the alveolar ventilation rate of a patient breathing quietly at

Directions: Choose the single best answer. While alternative answers

_______4. Intrapleural pressure plays a central role in breathing in a healthy

a. always less than atmospheric pressure (PB).

a. Point “C” represents an effort-independent region of the breathing

Directions: Choose the single best answer. While alternative answers

_______6. A healthy individual quietly inhales starting at functional residual capacity

_______8. A healthy individual breathes out forcefully, at the end of quiet

a. Internal intercostal muscles are activated.

_______9. In advanced stages of chronic obstructive pulmonary disease such as

a. alveolar and capillary walls are progressively destroyed.

Directions: Choose the single best answer. While alternative answers

a. the PO2 of alveolar gas cannot be measured.

______12. In a 100-meter race, runners frequently do not breathe for the

Directions: Choose the single best answer. While alternative answers

______13. A “anatomical shunt” in the lungs

a. is an example of a “left-to-right” shunt

______14. Ventilation/Perfusion inequalities may contribute significantly to

a. The VA/Q ratio is uniformly equal to 1.0 throughout the lungs.

______15. Which of the following statements is incorrect?

Directions: Choose the single best answer. While alternative answers

______16. CO2 is transported in the blood

a. in smaller amounts than is O2

______17. Ventilation rate

a. increases if PaC02 decreases in the presence of constant Pa02.

______18. Peripheral and central chemoreceptors of the pulmonary system

a. provide direct excitatory input to centers located in the medulla.

______19. Sustained exercise at an intensity beyond the anaerobic threshold results in

a. increased blood pH.

Directions: Choose the single best answer. While alternative answers

______20. A patient with pneumonia has a difference in alveolar/arterial oxygen

Alveolar air equation: PA02 = F I02 (PB-PH20) – PAC02/ R,

Where FI02 = fraction of O2 in inspired gas (0.5).

On the basis of these measurements, his AaD02 is

______21. X is freely filtered and secreted. If 50% of X binds to plasma protein

Directions: Choose the single best answer. While alternative answers

______24. Pete has polydipsia: a psychosis associated with uncontrolled intake of

a. decreased, more, decreases, decreased

______25. Which of the following is critical to creation of the hyperosmotic medulla?

a. Active NaCl reabsorption at the TAL

______26. Congential diseases resulting in formation of glomerular basal lamina that

Directions: Choose the single best answer. While alternative answers

a. Pcr would rise

______28. Glutamine metabolism in the kidney plays an essential role in

Directions: Choose the single best answer. While alternative answers

______33. Which person is responding to dehydration?

______34. Which of the above relationships A-E can never happen?

Directions: Choose the single best answer. While alternative answers

______38. Which patient has respiratory alkalosis?

______40. Which of the following is secreted in to the proximal tubule:

Directions: Choose the single best answer. While alternative answers

______42. An increase in filtration fraction will _____________ Na+ reabsorption at

a. a carbonic anhydrase inhibitor

Directions: Choose the single best answer. While alternative answers

______44. Which of the following anatomical arrangements of the renal vasculature

a. the kidney vasculature includes two capillary beds in series

For questions 46 – 49 use the following data set:

42. An increase in filtration fraction will _______ Na+ reabsorption at