TEST BANK for Guyton and Hall Textbook of Medical Physiology (Guyton Physiology) 14th Edition by Joh

Guyton and Hall Textbook of Medical Physiology 14th Edition Hall Test Bank

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Chapter 1. Functional Organization of the Human Body and Control of the “Internal Environment”

The most abundant type of cell in the human body is which of the following?

A. Neuron B. Epithelial cell C. Red blood cell D. White blood cell E. Vascular smooth muscle cell F. Skeletal muscle cell

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Test Bank

The most abundant substance in the human body and the approximate percentage of that substance in the body is which of the following?

A. Protein, 30% B. Protein, 60% C. Water, 30% D. Water, 60% E. Carbohydrate, 30% F. Carbohydrate, 60%

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ANS: C

ANS: D 3.

A large volume of blood is transfused to a person whose baroreceptor blood pressure control system is not functioning and arterial blood pressure rises from the normal level of 100 to 160 mm Hg. If the same volume of blood is infused into the same person when the baroreceptor system is functioning and this time the arterial pressure increases from the normal level from 100 mm Hg up to 120 mm Hg, calculate the gain of the baroreceptor system in this person.

A. -3 B. -2 C. -1 D. 0

E. +1 F. +2 G. +3 ANS: B Which of the following substances has the highest extracellular fluid to intracellular fluid concentration ratio for most mammalian cells?

A. Sodium ions B. Potassium ions C. Carbon dioxide D. Glucose E. Protein

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Exchange of substances between the cardiovascular system and the interstitial fluid occurs mainly in which of the following?

A. Arteries B. Arterioles C. Capillaries D. Venules E. Veins

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ANS: A

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Which of the following is the approximate distance from the capillaries to most cells of the body?

A. Less than 50 angstroms B. Less than 50 microns C. Less than 50 millimeters D. Less than 100 angstroms E. Less than 100 microns F. Less than 100 millimeters

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ANS: C

ANS: A 7.

When a person is at rest, how much time is required for the blood in the circulation to traverse the entire circulatory circuit?

A. 1 second B. 1 minute C. 3 minutes D. 4 minutes E. 5 minutes

ANS: B

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______ feedback is often referred to as a "vicious cycle" because it leads to _______ instability and sometimes death.

A. Postitive, progressive B. Positive, diminished C. Negative, progressive D. Negative, diminished E. Adaptive, progressive

ANS: A Which of the following is an example of positive feedback in the body?

A. Clotting of blood B. Return of blood pressure toward normal after a hemorrhage C. Increased respiration rate caused by accumulation of carbon dioxide in the blood D. Decreased sympathetic nervous system activity that occurs in response to increased blood pressure

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ANS: A

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Chapter 2. The Cell and Its Functions

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Test Bank

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Refer to the following list to answer questions 1-3:

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A. Nucleolus B. Nucleus C. Agranular endoplasmic reticulum D. Granular endoplasmic reticulum E. Golgi apparatus F. Endosomes G. Peroxisomes H. Lysosomes I. Cytosol Identify the cellular location for each of the following steps involved in the synthesis and packaging of a secreted protein.

Initiation of translation.

ANS: I

Protein sorting and packaging.

ANS: E Gene transcription.

ANS: B Which of the following is true for both pinocytosis and phagocytosis?

A. Involves the recruitment of actin filaments B. Occurs spontaneously and non-selectively C. Permits the uptake of bacterium into the cytosol D. Is only observed in macrophages and neutrophils E. Does not require ATP

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ANS: A

The cell membrane is LEAST permeable to which of the following?

A. Sodium B. Oxygen C. Ethanol D. Carbon Dioxide E. Water

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The term “glycocalyx” refers to: A. The negatively charged carbohydrate chains that protrude into the cytosol from glycolipids and integral glycoproteins B. The negatively charged carbohydrate layer on the outer cell surface C. The layer of anions aligned on the cytosolic surface of the plasma membrane D. The large glycogen stores found in “fast” muscles E. A mechanism of cell-cell attachment

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ANS: B

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ANS: A

Proteins are sorted for their delivery to lysosomes, secretory vesicles and the plasma membrane in the: A. Golgi apparatus B. smooth endoplasmic reticulum C. nucleus D. endocytotic vesicle

ANS: A 8.

Ubiquinone, an electron acceptor in the electron transport chain (oxidative phosphorylation), is found in the:

A. Inner mitochondrial membrane B. Mitochondrial matrix C. Outer mitochondrial membrane D. Nucleus ANS: A The citric acid cycle or Kreb’s cycle, takes place in the: A. Mitochondrial matrix B. Inner mitochondrial membrane C. Outer mitochondrial membrane D. Inner mitochondrial space

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Which of the following processes is NOT ATP-dependent?

A. Ciliary movement B. Positive chemotaxis C. Movement of carbon dioxide across a lipid bilayer D. Endocytosis E. Smooth muscle contraction

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ANS: A

ANS: C

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This cytoskeletal element plays a role in certain forms of cell movement and is an essential component of the mitotic spindle: A. Phospholipids B. Glycocalyx C. F-actin D. Microtubules E. Clathrin

Lipid synthesis occurs in the: A. Trans-Golgi network B. Granular or “rough” endoplasmic reticulum C. Agranular or “smooth” endoplasmic reticulum D. Nucleus E. Lysosome

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ANS: D

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ANS: C 13.

This cytoskeletal element plays a role in certain forms of cell movement and is an essential component of the mitotic spindle: A. Phospholipids B. Glycocalyx

C. F-actin D. Microtubules E. Clathrin ANS: D The abnormal cleavage of mannose residues during the post-translational processing of glycoproteins has been shown to result in the development of a lupus-like autoimmune disease in mice. The abnormal cleavage is due to a mutation of the enzyme -mannosidase II. Based on your understanding of the processing of membrane proteins, you would predict this enzyme to be localized to the: A. Nucleus B. Cytosol C. Golgi apparatus D. Lysosomes E. Peroxisomes

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The observation that abnormal cleavage of mannose residues from glycoproteins causes an autoimmune disease in mice is most consistent with the role of which of the following structures in the normal immune response?

A. Cytoskeleton B. Glycocalyx C. Peroxisomes D. Lysosomes E. Microtubules

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ANS: C

ANS: B

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A pure phospholipid bilayer is most permeable to: A. Sodium B. Calcium C. Chloride D. Water E. Oxygen

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ANS: E

Chapter 3. Genetic Control of Protein Synthesis, cell function, and cell reproduction

Test Bank Facioscapulohumeral muscular dystrophy (FSHD) is characterized by the deletion of a DNA sequence on chromosome 4q35. This deletion correlates with both the inability of a specific protein complex to bind to the DNA and an overexpression of the genes upstream of the deletion. The sequence deleted in FSHD most likely functions normally as: A. An activator protein B. A repressor protein C. An activator element D. A repressor element E. A promoter sequence

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In comparing two cell types from the same person (e.g. a neuron and an epithelial cell) the variation in their proteomes, or the proteins expressed by each cell type, reflects: A. Differences in the DNA contained in the nucleus of each cell B. Variation in the numbers of copies of specific genes in their respective genomes C. Cell-dependent expression and/or repression of specific genes D. Differences in the number of chromosomes in each cell E. The loss of genes from each genome over time

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ANS: D

Which of the following correctly describes the sequence of events that occur during the synthesis and packaging of a secreted protein?

A. The gene is transcribed in the cytosol; mRNA is translated by ribosomes bound to “rough” endoplasmic reticulum; the protein is packaged for secretion in the transGolgi network B. The gene is transcribed in the nucleus; RNA polymerase binds to the start codon; the protein is packaged for secretion in the trans-Golgi network C. Translation is initiated in the cytosol; the protein is carried in membrane-bound vesicles to the cis-Golgi apparatus; the protein is packaged for secretion in the transGolgi network D. Translation is initiated in the cytosol; new polypeptide is co-transported with Na+

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ANS: C

across the outer ER membrane; the protein is glycosylated in the Golgi apparatus E. Translation is initiated by small ribosomal subunits anchored to the ER membrane; protein is glycosylated in the Golgi apparatus; the protein is packaged into lysosomes ANS: C

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Which of the following does NOT play a direct role in the process of transcription?

A. Helicase B. RNA polymerase

C. A chain terminating sequence D. “Activated” RNA molecules E. A promoter sequence ANS: A “Redundancy” or “degeneration” of the genetic code occurs during which of the following steps of protein synthesis?

A. DNA replication B. Transcription C. Post-transcriptional modification D. Translation E. Protein glycosylation

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Which of the following bases is NOT present in RNA? A. Cytosine B. Thymine C. Adenine D. Guanine

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ANS: B

ANS: B

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The process of translation takes place: A. In the cytosol and on the surface of the “rough” endoplasmic reticulum B. In the nucleus and on the surface of the “rough” endoplasmic reticulum C. In the cytosol and the trans-Golgi network (TGN) D. In the nucleus and on the outer mitochondrial membrane

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Which of the following statements about translation is NOT true?

A. Multiple ribosomes can simultaneously translate a single mRNA molecule B. Each codon codes for one amino acid C. One mRNA molecule can code for multiple proteins, depending on which start codon is recognized by the small ribosomal subunit D. Translation is terminated when the release factor binds to the stop codon

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ANS: A

ANS: C 9.

The following statements accurately describe the process of DNA replication EXCEPT: A. The entire genome is replicated only once per cell cycle B. It occurs during the M phase of the cell cycle C. Nucleotides are incorporated into the growing DNA strand at the 3’ end

D. DNA “proofreading” is performed by DNA polymerase ANS: C 10.

The mechanism by which allolactose regulates the transcription of the betagalactosidase gene is best described as: A. De-repression B. Repression C. Activation D. Negative feedback E. Positive feedback

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Which of the following does NOT occur during the process of mitosis?

A. Replication of the genome B. Condensation of the chromosomes C. Fragmentation of the nuclear envelope D. Alignment of the chromatids along the equatorial plate E. Separation of the chromatids into two sets of 46 “daughter” chromosomes

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ANS: A

ANS: A

“Redundancy” or “degeneration” of the genetic code occurs during which of the following steps of protein synthesis: A. DNA replication B. Transcription C. Post-transcriptional modification D. Translation E. Protein glycosylation

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The appearance of which of the following distinguishes eukaryotic cells from lower units of life like bacteria and viruses?

A. DNA B. RNA C. Membranes D. Protein E. Nucleus

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ANS: B

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ANS: E

Chapter 4. Transport of Substances Through Cell Membranes

Test Bank

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1. An artificial membrane is created consisting of a lipid bilayer without protein molecules in the membrane. The lipid composition of the membrane is essentially the same as that of a normal, biological membrane. Which of the following substances permeates the membrane more readily than water molecules?

A. Carbon Dioxide B. Glucose C. Glycerol D. Sodium E. Urea

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ANS: A

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2. A cell is equilibrated in an aqueous solution of 300 mOsm/L sodium chloride. Which of the following best describes what will happen to cell volume when the cell is placed in an aqueous solution of 300 mOsm/L calcium chloride?

A. Decrease B. Decrease and then increase C. Increase D. Increase and then decrease E. No change

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ANS: E

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3. The intracellular calcium ion concentration of ventricular muscle cells averages 10-4 mmol/L during diastole. The calcium ion concentration in transverse tubules (T-tubules) averages 2.5 mmol/L at rest. A protein transporter on the membrane of the T-tubule exchanges sodium for calcium. The transporter uses the transmembrane sodium gradient to fuel the exchange. Which of the following transport mechanisms best describes this type of transporter?

A. Facilitated diffusion B. Primary active transport C. Secondary active co-transport D. Secondary active counter-transport E. Simple diffusion ANS: D

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4. Human red blood cells (RBCs) and rabbit RBCs are equilibrated in separate solutions of isotonic saline (300 mOsm/L NaCl). The human RBCs are then placed in a solution of 300 mOsm/L glycerol, which causes them to swell and burst. However, rabbit RBCs placed in 300 mOsm/L glycerol neither swell nor shrink. Based on this information, which of the following can be concluded about a 300 mOsm/L solution of glycerol for the different cell types?

Human RBCs Rabbit RBCs A. Hypertonic and hyperosmotic Hypotonic and hypoosmotic B. Hypotonic and hypoosmotic Hypertonic and hyperosmotic C. Hypotonic and isoosmotic Isotonic and isoosmotic D. Isotonic and hypoosmotic Isotonic and hyperosmotic E. Isotonic and isoosmotic Hypotonic and isoosmotic F. Isotonic and hyperosmotic Isotonic and isoosmotic ANS: C

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5. The molarity of a 2% solution of NaCl is 340 mmol/L. The molecular weight of NaCl is 58.5. What is the osmolarity of a 2% solution of NaCl (in mOsm/L)?

A. 170 B. 340 C. 510 D. 680

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ANS: D

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6. Secondary active transport typically moves which of the following substances against a concentration gradient?

Glucose Amino acids Sodium ions A. No No No B. No No Yes C. Yes No Yes D. Yes Yes No E. Yes Yes Yes ANS: D

7. Which of the following transport mechanisms can move sodium ions across a cell membrane?

Primary active Secondary active Simple transport transport diffusion No No No No Yes Yes Yes No Yes Yes Yes No Yes Yes Yes

ANS: E 8. The diagram illustrates possible changes in red blood cell volume resulting from a change in extracellular fluid composition for a cell equilibrated in a 150 mmol/L solution of sodium chloride (NaCl) at time zero. Which curve best illustrates the volume change caused by immersion of the cell in an aqueous solution of 300 mOsm/L calcium chloride (CaCl2)?

ANS: C

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9. The diagram illustrates possible changes in red blood cell volume resulting from a change in extracellular fluid composition for a cell equilibrated in a 150 mmol/L solution of sodium chloride (NaCl) at time zero. Which curve best illustrates the volume change caused by immersion of the cell in an aqueous solution of 200 mOsm/L NaCl and 200 mOsm/L glycerol?

ANS: B

300 mOsm/L urea 300 mOsm/L NaCl 300 mOsm/L urea

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300 mOsm/L glucose 300 mOsm/L glycerol 300 mOsm/L glycerol

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C. D. E.

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10. Which of the following pairs of aqueous solutions will exert equal osmotic pressures across a normal cell membrane after steady-state conditions have been established?

Solution A Solution B A. 10% albumin 10% IgG B. 100 mmol/L NaCl 200 mmol/L CaCl2

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ANS: E

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11. Two compartments (X and Y) are separated by a typical biological membrane (i.e., lipid bilayer). The concentrations of a permeant solute (i.e., urea) at time zero are shown.

Which of the drawings below represents the volumes of X and Y when the system reaches equilibrium?

ANS: A 12. The diagram illustrates possible changes in red blood cell volume resulting from a change in extracellular fluid composition for a cell equilibrated in 150 mmol/L NaCl at

time zero. Which curve best illustrates the volume caused by immersion of the cell in an aqueous solution of 150 mmol/L CaCl2?

ANS: E

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13. Two compartments (X and Y) are separated by a typical biological membrane (lipid bilayer). The concentrations of a non-permeant molecule (glucose) at time zero are shown. Which of the drawings below represents the volumes of X and Y when the system reaches equilibrium?

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ANS: B

14. The diagram shows a model cell that transports substance X across the cell membrane.

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The cell is equipped with a Na-K-ATPase pump as shown. Substance X enters the cell by a coupled transport mechanism and exits the cell by carrier-mediated diffusion.

Treatment with a substance that inhibits the Na-K-ATPase pump inhibits the transport of X by which of the following mechanisms?

A. Decreasing intracellular K+ concentration

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B. Decreasing intracellular Na+ concentration C. Increasing intracellular K+ concentration

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ANS: D

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+ D. Increasing intracellular Na concentration

15. The diagram shows a bag (with permeability characteristics similar to that of a normal cell) that contains a 100 mM solution of urea at time zero. The bag is placed in a beaker containing 100 mM glucose. Which of the following best describes the tonicity and osmolarity of the glucose solution as well as any changes in bag volume (assume that the bag volume is infinitely small compared to beaker volume)?

Osmolarity Tonicity Bag volume A. Hyperosmotic Hypertonic Decreases B. Hyperosmotic Hypotonic Increases C. Hyperosmotic Isotonic No change D. Hypoosmotic Hypotonic Decreases

E. Hypoosmotic Isotonic F. Hypoosmotic Hypertonic G. Isoosmotic Hypertonic H. Isoosmotic Hypotonic I. Isoosmotic Isotonic

Increases No change Decreases Increases No change

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Chapter 5. Membrane Potentials and Action Potentials

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Test Bank

The diagram shows compound action potentials recorded percutaneously from a single site a certain distance from a stimulating electrode indicated by the arrow. Which peak is most likely to represent action potentials from small, non-myelinated motor neurons?

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A 42-year-old woman decides to lose weight on a diet prescribed by an anorexic friend. She loses about 30 pounds in 45 days, but her serum potassium level falls to 2.1 mmol/L (normal: 3.5 to 5.0 mmol/L). Which of the following changes is most likely to occur in this young woman?

A. Depolarization of the resting membrane potential B. Hyperpolarization of the resting membrane potential C. Increased intracellular potassium concentration D. Potassium equilibrium potential becomes less negative

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ANS: D

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ANS: G

ANS: B 3.

An 22-year-old man is admitted to the emergency department after an automobile accident. He has not lost a large amount of blood, but he suffers from a severe crush injury to his right leg. He is conscious and exhibits flaccid paralysis. Electrocardiogram

results show a shortened QT interval and an increase in the P-R interval (i.e., decreased duration of action potential and decreased conduction velocity). Laboratory results indicate that his serum potassium level has increased to a value of 6.5 mEq/L (normal: 3.5 to 5.0 mEq/L). This increase in serum potassium causes which of the following?

A. A decreased net driving force for potassium from cells B. Decreased intracellular potassium concentration C. Hyperpolarization of the resting membrane potential D. More negative Nernst potential for potassium E. More negative resting membrane potential

An 88-year-old nursing home resident has diabetes mellitus and is taking diuretics for hypertension. His blood glucose concentration has recently been greater than 350 mg/dL. He is disoriented and has had limited oral intake for about five days. His vital signs include a temperature of 100.5°F, a supine blood pressure and pulse of 150/90 mm Hg and 100 beats per minute, and an upright blood pressure and pulse of 130/88 mm Hg and 118 beats per minute. The findings on examination of the heart are normal, and his axillae are dry. The table shows serum Na+ and K+ values before and after the dehydration that

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ANS: A

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A 44-year-old man is recovering from third degree burns over 50% of his body surface area. His serum potassium level is low (2.9 mEq/L). He exhibits postural hypotension and skeletal muscle weakness. If the equilibrium potential for K+ in a

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A. −100 millivolts B. −50 millivolts C. −60 millivolts D. −70 millivolts E. −90 millivolts

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has occurred in this patient. The resting membrane potential of a cardiac myocyte was about −70 millivolts before dehydration occurred. What is the resting membrane potential of a cardiac myocyte after dehydration occurred, assuming no change in membrane conductance or intracellular concentrations of Na+ or K+ ions?

+ neuron is −105 mV and the equilibrium potential for Na is +55 mV, what would be an approximate value for the resting membrane potential for a neuron in this man?

A. +20 mV B. +48 mV C. +80 mV D. −25 mV E. −48 mV F. −96 mV ANS: F

A 23-year-old man receives a crush injury to his right leg in an automobile accident. + His serum potassium level is 6.4 mEq/L. The equilibrium potential for K in a + motoneuron is −73 mV, and the equilibrium potential for Na is +59 mV. Which of the following best describes the resting membrane potential (in mV) for a typical motoneuron in this man?

A. +62 B. +90 C. −13 D. −67 E. −84

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A 56-year-old woman is referred to the neurology clinic for evaluation of her longterm problem of a stumbling gait and a tendency to fall. Her visual acuity also seems to change periodically. Neurological findings suggest multiple sclerosis. This diagnosis is further supported by magnetic resonance imaging, which shows of areas of demyelination in the central nervous system. Other tests show the presence of oligoclonal bands in the spinal fluid. The loss of myelin from a nerve fiber has which of the following effects?

A. Decreased conduction velocity of action potential or no action potential B. Decreased energy requirement for successful action potentials C. Increased conduction velocity of action potential D. Increased velocity of salutatory conduction

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ANS: D

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ANS: A

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8. The diagram shows an action potential for a nerve fiber. What is the threshold potential for this neuron?

A. −15 mV B. −50 to −60 mV C. −60 to −70 mV D. −70 to −80 mV E. −80 mV ANS: C

9. In the diagram shown, Em represents the measured initial membrane potential for a hypothetical cell in vivo. In relation to this membrane potential, the equilibrium potentials

of three ions (X, Y, Z) are represented. Pick the path most likely taken by the membrane potential when membrane conductance for ion Y is increased.

ANS: B 10. In the diagram shown, Pmemb represents the initial membrane potential for a hypothetical cell. In relation to this membrane potential, the equilibrium potentials of three ions (Q, R, S) are represented. Pick the path most likely taken by the membrane potential when membrane conductance for ion Q and ion S are increased simultaneously by 1000-fold.

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ANS: C

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11. The diagram shows compound action potentials recorded percutaneously from a single site at a certain distance from a stimulating electrode (S) indicated by the ARROW. What can be concluded from the diagram concerning action potential velocity for the various categories of neurons?

A. W = X = Y = Z B. W > X > Y > Z C. W > Y > X D. Y > W > Z E. Z > Y > X > W

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ANS: B

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12. Five hypothetical neurons are shown below. Neurons A and B are myelinated, whereas neurons C, D, and E are not myelinated. Which neuron is most likely to have the fastest conduction velocity?

B. C. D. E.

ANS: B

13. In the following graph, Em represents the measured initial membrane potential for a hypothetical cell in vivo. In relation to this membrane potential, the equilibrium potentials of three ions (Q, R, S) are represented. During resting conditions, the conductance for Q and S ions is the same, which is 1000 times greater than that of ion R. Pick the path most likely taken by the membrane potential when membrane conductance to ion Q is 2 decreased to 0 mmho/cm .

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ANS: D

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ANS: C

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14. A 63-year-old man is dehydrated after three days of alcohol abuse. His serum sodium level has increased from a normal value of 140 mEq/L to 147 mEq/L. The resting membrane potential of a typical neuron was −80 mV before dehydration. What is the most likely resting membrane potential of a typical neuron after the dehydration, assuming no change in resting sodium conductance?

A. −72 mV B. −74 mV C. −80 mV D. −88 mV E. −98 mV

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15. A 24-year-old soldier suffers a burn injury over 60% of his body surface area, which leads to a decrease in the serum K+ concentration from a normal value of 4 mEq/L to a value of 2.5 mEq/L. Which of the following sets of changes best describe the resting membrane potential and the K+ Nernst potential in a cardiac myocyte after the injury?

Resting membrane potential A. Less negative B. Less negative C. More negative D. More negative E. No change ANS: D

+ K Nernst potential Less negative More negative Less negative More negative No change

16. The diagram shows an action potential for a nerve fiber. Use the diagram to answer the question. Where on the curve does potassium conductance exceed sodium conductance?

A. V and Z B. V, W, and X C. V, X, and Z D. W, X, and Y E. X, Y, and Z

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ANS: A

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17. Consider the action potential shown. Which of the following changes in membrane conductances for Ca+ and K+ best account for the prolonged plateau (assume normal

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conductances for both ions during resting conditions, i.e., only the changes in conductances are important)?

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ANS: A

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18. A neuron from an extraterrestrial being has the intracellular and extracellular sodium and potassium concentrations shown in the table (in mM). During resting conditions, the sodium conductance is 100-fold greater compared to the potassium conductance. Which of the following (in mV) best describes the resting membrane potential (Vm) in this alien neuron (assume that Vm is dictated mainly by sodium and potassium conductances and that the Nernst equation applies)?

A. +150 B. +55 C. 0 D. −55 E. −150 ANS: B

19. The intracellular concentration of ion Z is 100 milliequivalents per liter (mEq/L), and the extracellular concentration is 5 mEq/L. The molecular weight of molecule Z is ~40 daltons. This relatively high intracellular concentration of molecule Z is best explained by which of the following?

A. Exocytosis B. Extracellular assembly C. Facilitative diffusion D. Intracellular production E. Primary active transport F. Simple diffusion

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ANS: E

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20. Equilibrium potentials for Na, K, and Cl are shown. Assume that a cell is permeable to all three ions and has a resting membrane potential of −85 mV. Which of the following best describes the net movement of the various ions across the cell membrane by way of passive diffusion?

Sodium Potassium Chloride A. Inward Inward Inward B. Inward Inward Outward C. Inward Outward Inward D. Inward Outward Outward E. Outward Inward Inward F. Outward Inward Outward G. Outward Outward Inward H. Outward Outward Outward

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ANS: D

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Test Bank

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Chapter 6. Contraction of Skeletal Muscle

1. A 28-year-old man has been training as a distance runner for the past six years.

Compared with a sprinter, which of the following is decreased in the skeletal muscles of this athlete during resting conditions?

A. Capillary density B. Glycolytic enzyme content C. Mitochondrial volume density D. Myoglobin content E. Oxidative capacity ANS: A

2. A physiology experiment is conducted in which a skeletal muscle twitch is initiated using an electrical stimulator. Which factor contributes to the termination of a typical skeletal muscle twitch?

A. Calcium uptake by sarcoplasmic reticulum B. Closure of transverse tubules C. Depletion of calcium stores from sarcoplasmic reticulum D. Exhaustion of muscle ATP stores E. Stimulation of dihydropyridine (DHP) receptors ANS: A

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3. A 24-year-old medical student goes to the local gym to lift weights. She begins by benchpressing 100 pounds as a warm-up procedure and then gradually increases the weight.

Which of the following occurs as she adds more weight?

A. Decreased frequency of motor nerve action potentials B. Decreased velocity of motor nerve action potentials C. Increased frequency of motor nerve action potentials D. Increased velocity of motor nerve action potential E. Involvement of fewer motor units ANS: C

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4. A 24-year-old woman is admitted to the emergency department after an automobile accident in which lacerations to the left wrist severed a major tendon. The severed ends of the tendon were overlapped by 6 cm to facilitate suturing and reattachment. Which of the following characteristics would be expected after six weeks compared with the preinjured muscle? Assume that series growth of sarcomeres cannot be completed within six weeks.

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Passive tension A. Decrease B. Decrease C. Increase D. Increase E. No change

Maximal active tension Decrease Increase Increase Decrease No change

ANS: D 5. During the contraction of a skeletal muscle fiber, the actin and myosin filaments slide past each other. Which of the following represent expected changes in the widths of Ibands and A-bands during the contraction process?

I-band width A-band width A. ↑ ↔ B. ↓ ↑ C. ↓ ↓

D. E.

↓ ↔

↔ ↑

ANS: D 6. When a person lifts a 25-pound weight, what type or types of muscle contraction are involved?

Isometric contraction only Isotonic contraction only Isometric contraction followed by isotonic contraction Isotonic contraction followed by isometric contraction

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The length-tension diagram shown was obtained from a skeletal muscle with equal numbers of red and white fibers. Supramaximal tetanic stimuli were used to initiate an isometric contraction at each muscle length studied. The resting length was 20 cm. What is the maximum amount of active tension this muscle is capable of generating at a preload of 100 grams?

A. 145 to 155 grams B. 25 to 35 grams C. 55 to 65 grams D. 95 to105 grams E. Cannot be determined

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ANS: C

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ANS: C

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ANS: C

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8. The diagram shows the relationship between muscle tension and sarcomere length for muscle. Which point on the curve represents tension development at a normal resting length for skeletal muscle?

9. The diagram shows the relationship between muscle tension and sarcomere length for muscle. Which point on the curve represents tension development at a normal resting length for cardiac muscle?

ANS: B

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10. A 29-year-old woman has been training as a distance runner for the past five years.

Which set of changes best describes the skeletal muscles of this woman compared with a sprinter?

Capillary density Oxidative capacity Myoglobin content Fiber diameter A. Decreased Decreased Decreased Decreased B. Decreased Decreased Increased Increased C. Increased Increased Decreased Decreased D. Increased Increased Increased Decreased E. Increased Increased Increased Increased

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ANS: D

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Active tension 200 300 250 100 200

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ANS: A

Total tension 300 200 300 300 300

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Preload 100 100 150 200 200

A. B. C. D. E.

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11. The length-tension diagram shown on the right was obtained from a skeletal muscle with equal numbers of red and white fibers. Supramaximal tetanic stimuli were used to initiate an isometric contraction at each muscle length studied. What are the values in grams of preload, active tension, and total tension when the muscle length is 60 cm?

12. A 45-year-old man goes to the local gym to lift weights. He begins by bench-pressing 130 pounds as a warm-up procedure and then gradually increases the weight. Which of the following sets of changes occur as he adds more weight?

Activation of motor units Frequency of motor nerve action potentials A. Decreased Decreased B. Decreased Increased C. Decreased No change D. Increased Decreased E. Increased Increased F. Increased No change ANS: E

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13. The skeletal muscle sarcomere normally has a narrow range of lengths in vivo, but sarcomere length can vary greatly in vitro under non-physiological conditions. The diagram shows sarcomeres at various lengths. At which length can the sarcomere exert its maximum force during an isometric contraction?

A. 1.6 µm B. 2.1 µm C. 2.8 µm D. 3.0 µm E. 3.5 µm

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ANS: B

14. The diagram shows the relationship between contraction velocity and force. Which of the

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following muscles is most likely to correspond to muscle number 1 shown on the diagram (assume that all muscles shown are at their normal resting lengths).

B.

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A.

C. D. E. ANS: E

15. The diagram shows the relationship between contraction velocity and force. Which of the following muscles is most likely to correspond to muscle number 2 shown on the diagram (assume that all muscles shown are at their normal resting lengths)?

A.

B. C.

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E. ANS: D

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16. The diagram shows force-velocity relationships for three different skeletal muscles.

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Which of the following curves most likely correspond to glycolytic, oxidative, and mixed muscle types?

Glycolytic Oxidative Mixed A. X Y Z B. X Z Y C. Y X Z D. Y Z X E. Z X Y F. Z Y X ANS: B

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17. The dark color of red skeletal muscle (slow twitch muscle) can be attributed to a relative abundance of which of the following compared to white skeletal muscle (fast twitch muscle)?

A. Blood capillaries B. Mitochondria C. Myoglobin D. Myosin ATPase E. Oxidative enzymes ANS: C

Chapter 7. Excitation of Skeletal Muscle: Neuromuscular Transmission and

Excitation-Contraction Coupling

Test Bank A 45-year-old man has botulinum toxin (Botox®) injections in the frontalis muscles.

Which of the following sets of changes are most likely to occur in the treated muscles with repeated injections over a period of ten years?

Fiber diameter Fiber number Contraction velocity A. decreased decreased decreased B. decreased decreased increased C. decreased increased increased D. increased decreased decreased E. increased decreased increased F. increased increased increased

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ANS: A

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2. Which of the following represents the correct temporal order of events for skeletal muscle?

First Second Third A. End plate potential Muscle action potential Nerve action potential B. End plate potential Nerve action potential Muscle action potential C. Muscle action potential End plate potential Nerve action potential D. Muscle action potential Nerve action potential End plate potential E. Nerve action potential End plate potential Muscle action potential F. Nerve action potential Muscle action potential End plate potential

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ANS: E

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3. Myasthenia gravis is an autoimmune disease in which antibodies damage which of the following?

Acetylcholine Ligand-gated channels on postsynaptic membrane Ligand-gated channels on presynaptic membrane Voltage-gated channels on postsynaptic membrane Voltage-gated channels on presynaptic membrane ANS: B 4. Lambert-Eaton myasthenic syndrome is an autoimmune disease in which antibodies damage which of the following?

A. Acetylcholine B. Ligand-gated channels on postsynaptic membrane C. Ligand-gated channels on presynaptic membrane

D. Voltage-gated channels on postsynaptic membrane E. Voltage-gated channels on presynaptic membrane ANS: E

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5. A 59-year-old college professor visits his physician because of muscle fatigue that worsens later in the day. The physician notices that the man has droopy eyelids and seems to have an overall weakness in his muscles. After the intravenous administration of Tensilon®, which blocks degradation of acetylcholine, the droopy eyelids and symptoms of muscle weakness appear to subside. Which of the following best describes the patient’s condition?

A. Encephalitis B. Fibromyalgia C. Flaccid paralysis D. Myasthenia gravis E. Poliomyelitis

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ANS: D

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ANS: D

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6. A 3-year-old child is admitted to the emergency department of University Hospital. The child exhibits extreme salivation, lacrimation, tremors, and tachycardia. The slight erythema and mild edema found on the child's hand suggest a spider bite. The mother acknowledges that the child has a fascination with spiders and has seen black widow spiders in the yard. The neurotoxic venom of the black widow spider (i.e., latrotoxin or latrophilin) can increase the flux of calcium ions into the presynaptic terminal. What is the likely outcome of a black widow spider bite?

A. Decreased acetylcholine release from nerve terminals B. Hyperpolarization of postsynaptic membranes C. Hyperpolarization of presynaptic membranes D. Increased acetylcholine release from nerve terminals E. Inhibition of acetylcholinesterase

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7. An apparently healthy 12-year-old boy dies during a minor surgical procedure while under general anesthesia. An uncle had also died during a surgical procedure. Results of a halothane contracture test indicate that the child had malignant hyperthermia (MH). The MH crisis is associated with which of the following?

A. Decreased anaerobic metabolism B. Decreased CO2 production by muscles C. Decreased lactic acid production by muscles D. Defective ryanodine receptors E. Decreased usage of ATP in muscles ANS: D

8. Skeletal muscle and cardiac muscle contract when calcium binds to which structure or molecule?

Active sites Calmodulin Myosin head Tropomyosin Troponin-C ANS: E

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9. Which of the following represents the correct temporal order of events for skeletal muscle?

First Second Third Muscle action potential Muscle contraction Nerve action potential Muscle action potential Nerve action potential Muscle contraction Muscle contraction Muscle action potential Nerve action potential Muscle contraction Nerve action potential Muscle action potential Nerve action potential Muscle action potential Muscle contraction Nerve action potential Muscle contraction Muscle action potential ANS: E

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ANS: D

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10. Binding of calcium to which structure or molecule initiates a contraction in smooth muscle, skeletal muscle, and cardiac muscle?

Smooth muscle Skeletal muscle Cardiac muscle A. Active sites Calmodulin Troponin B. Active sites Troponin Calmodulin C. Calmodulin Tropomyosin Active sites D. Calmodulin Troponin Troponin E. Myosin heads Tropomyosin Troponin F. Myosin heads Troponin Tropomyosin

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11. A 23-year-old man loses consciousness while driving, hits a tree, and dies within 15 minutes. The police find his stiff body five hours later. Rigor mortis is caused by a decrease in which of the following?

A. Acetylcholine B. Actin-myosin cross-bridges C. Myoplasmic calcium levels D. Interstitial lactate levels E. Muscle ATP levels ANS: E 12. A father and his 10-year-old daughter died suddenly of suffocation after ingesting smoked whitefish chubs from the Great Lakes. Three other family members are sick,

complaining of dry mouths despite drinking copious amounts of fluids. Their upper eyelids droop. Their vision is clear, but their pupils are wide and do not narrow when a light is flashed. Two of them require artificial respiration. The suspect is botulism (Clostridium botulinum). The surviving patients begin improving soon after receiving the only treatment available, E antitoxin. The deadly effect of botulinum toxin results from which of the following?

A. Decreased release of acetylcholine B. Decreased release of norepinephrine C. Depletion of muscle calcium stores D. Skeletal muscle tetany E. Stimulation of ryanodine receptors

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ANS: A

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13. Which of the following best describes the dynamics of calcium release and calcium uptake during the development of frequency-induced muscle tetany?

A. Release from longitudinal tubules exceeds uptake by terminal cisternae B. Release from longitudinal tubules exceeds uptake by T-tubules C. Release from terminal cisternae exceeds uptake by longitudinal tubules D. Release from terminal cisternae exceeds uptake by T-tubules E. Release from T-tubules exceeds uptake by longitudinal tubules F. Release from T-tubules exceeds uptake by terminal cisternae

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ANS: C

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14. Which of the following best describes the correct temporal order of events for the opening of nicotinic acetylcholine (nACh) channels on the muscle membrane, the opening of voltage-gated sodium channels on the muscle membrane, and initiation of presynaptic action potentials (AP)?

First Second Third A. nACh channels Presynaptic AP Voltage gated Na channels B. nACh channels Voltage gated Na channels Presynaptic AP C. Presynaptic AP nACh channels Voltage gated Na channels D. Presynaptic AP Voltage gated Na channels nACh channels E. Voltage gated Na channels nACh channels Presynaptic AP F. Voltage gated Na channels nACh channels Presynaptic AP ANS: C

Chapter 8. Excitation and Contraction of Smooth Muscle Test Bank

1. The contraction of smooth muscle can be attenuated even when intracellular calcium levels are high. This unique ability of smooth muscle can be attributed to variations in the activity of which of the following?

A. Actin B. Adenosine triphosphate (ATP) C. Calcium-calmodulin complex D. Calmodulin E. Myosin light chain phosphatase ANS: E

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2. Multiple elements can regulate the contraction of smooth muscle, including endocrine, neurocrine, and paracrine factors. This level of diversity in the control of smooth muscle contraction can be attributed to a diversity of which of the following?

A. Actin-myosin arrangement B. Calcium sensitivities C. Cell-surface receptors D. Motor end plates E. Subneural cleft architecture ANS: C

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3. The effect of autonomic nerve stimulation on smooth muscle contractile behavior depends on the types of receptors on the smooth muscle fibers. Which of the following best describes the effects of acetylcholine and norepinephrine on various types of smooth muscle?

Acetylcholine Norepinephrine A. Contraction only Relaxation or contraction B. Contraction only Relaxation only C. Relaxation only Contraction only D. Relaxation only Relaxation only E. Relaxation or contraction Contraction only F. Relaxation or contraction Relaxation or contraction ANS: F

4. Unlike skeletal muscle, the contraction of smooth muscle requires which of the following?

A. Activation of ryanodine receptors B. Phosphorylation of myosin light chains C. The presence of intracellular calcium D. Troponin binding of calcium E. Voltage activation of dihydropyridine receptors ANS: B

5. Which of the following factors are important for initiating smooth muscle contractions?

Hormones Paracrine factors Autonomic nervous system A. No No No B. No No Yes C. Yes No Yes D. Yes Yes No E. Yes Yes Yes ANS: E

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6. The sensitivity of the smooth muscle contractile apparatus to calcium can increase. This increase in calcium sensitivity can be attributed to a decrease in the levels of which of the following substances?

A. Actin B. Adenosine triphosphate (ATP) C. Calcium-calmodulin complex D. Calmodulin E. Myosin light chain phosphatase ANS: E

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7. Which of the following is the correct temporal order of events for the smooth muscle?

A. Myosin light chain (MLC) dephosphorylation, contraction, relaxation, MLC phosphorylation B. MLC dephosphorylation, contraction, MLC phosphorylation, relaxation C. MLC dephosphorylation, relaxation, MLC phosphorylation, relaxation D. MLC phosphorylation, contraction, MLC dephosphorylation, relaxation E. MLC phosphorylation, contraction, relaxation, MLC dephosphorylation F. MLC phosphorylation, MLC dephosphorylation, contraction, relaxation

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ANS: D

Chapter 9. Cardiac Muscle; The Heart as a Pump and Function of the Heart Valves

Questions 1-3: A fifty-year-old man has a body weight of 110 kg, resting heart rate is 90 beats/minute, arterial pressure is 120/70 mmHg, arterial hematocrit is 35% and body temperature is normal. His pressure-volume diagram of the left ventricle is shown below.

1.

What is his resting cardiac output in ml/minute?

A. 900 B. 8,000 C. 9,000 D. 10,000 E. 15,000 ANS: C

What event occurs at point D in the man’s pressure-volume relationship?

A. A-V valves close B. Aortic valve opens C. Aortic valve closes D. A-V valves open E. Third heart sound

ANS: C

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What is his ventricular ejection fraction?

A. 33% B. 50% C. 60% D. 67% E. 80%

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ANS: D

Which of the following will result in spastic contraction of the heart?

A. Excess calcium ions in the blood B. Excess potassium ions in the blood C. Excess sodium ions in the blood D. Decreased sympathetic stimulation E. Decreased norepinephrine concentration in the blood

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ANS: A

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2.

Questions 5-7: A sixty-year-old woman has a body weight of 110 kg, resting cardiac output is 9,000 ml/minute, arterial pressure is 90/50 mmHg, arterial hematocrit is 25% and body temperature is normal. Her pressure-volume diagram of the left ventricle is shown below.

5.

What is her resting heart rate in beats/minute?

A. 70 B. 80 C. 90 D. 100 E. 110

ANS: C 6.

What event occurs at point A in the woman’s pressure-volume relationship?

A. A-V valves close B. Aortic valve opens C. Aortic valve closes D. A-V valves open E. Third heart sound

ANS: D If the woman is given a 500 ml whole blood transfusion over a 15 minute period, her ventricular preload will increase. One minute after the transfusion is complete, what will the new stroke volume be assuming her heart is normal?

A. 70 ml B. 80 ml C. 90 ml D. 100 ml E. 120 ml

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7.

ANS: A

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When does the third heart sound occur in the ventricular pressure-volume relationship?

A. At point D B. Between point A and point B C. Between point B and point C D. Between point C and point D E. Between point D and point A

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ANS: B

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Questions 8-9: A fifty-year-old man has a body weight of 110 kg, resting heart rate is 90 beats/minute, arterial pressure is 120/70 mmHg, arterial hematocrit is 35% and body temperature is normal. His pressure-volume diagram of the left ventricle is shown below.

When does the second heart sound occur in the ventricular pressure-volume relationship?

A. At point D B. Between point A and point B C. Between point B and point C D. Between point C and point D E. Between point D and point A

ANS: A

Chapter 10. Rhythmical Excitation of the Heart

Test Bank If the sinus node stops discharging, what is the expected heart rate (in beats/minute) if the A-V node takes over as the cardiac pacemaker?

A. 15 B. 20 C. 35 D. 50 E. 72

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If the S-A node discharges at 0.00 seconds, when will the action potential normally arrive at the A-V node?

A. 0.03 seconds B. 0.09 seconds C. 0.12 seconds D. 0.16 seconds E. 0.80 seconds

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ANS: D

Which of the following conditions at the S-A node will cause a decrease in heart rate?

A. Increased sodium permeability B. Decreased acetylcholine levels C. Increased norepinephrine levels D. Increased potassium permeability E. Increased calcium permeability

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ANS: A

ANS: D 4.

In which phase of the ventricular muscle action potential is the potassium permeability the highest?

A. 0 B. 1 C. 2 D. 3

E. 4 ANS: D 5.

If the S-A node discharges at 0.00 seconds, when will the action potential normally arrive at the A-V bundle?

A. 0.80 seconds B. 0.16 seconds C. 0.12 seconds D. 0.09 seconds E. 0.03 seconds

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A patient entered the local emergency room and had an EKG taken. The attending physician stated that the patient had an A-V nodal rhythm. What is the likely heart rate?

A. 30/min B. 50/min C. 65/min D. 75/min E. 85/min

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ANS: C

ANS: B

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Which of the following conditions at the S-A node will cause a decrease in heart rate?

A. Increased sodium permeability B. Increased acetylcholine levels C. Increased norepinephrine levels D. Decreased potassium permeability E. Increased calcium permeability

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Which of the following conditions at the A-V node will cause a decrease in heart rate?

A. Increased sodium permeability B. Decreased acetylcholine levels C. Increased norepinephrine levels D. Increased potassium permeability E. Increased calcium permeability

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ANS: B

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7.

ANS: D 9.

If the S-A node discharges at 0.00 seconds, when will the action potential normally arrive at the ventricular septum?

A. 0.22 seconds B. 0.16 seconds

C. 0.12 seconds D. 0.09 seconds E. 0.03 seconds ANS: B What is the normal total delay of the cardiac impulse in the A-V node + bundle?

A. 0.22 seconds B. 0.18 seconds C. 0.16 seconds D. 0.13 seconds E. 0.09 seconds

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Which of the following are caused by acetylcholine?

A. Hyperpolarization of the S-A node B. Depolarization of the A-V node C. Decreased permeability of the S-A node to potassium ions D. Increased heart rate E. Increased permeability of the cardiac muscle to calcium ions

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ANS: D

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If the sinus node stops discharging, what is the expected heart rate (in beats/minute) if the A-V node takes over as the cardiac pacemaker?

A. 5 B. 30 C. 50 D. 70 E. 90

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ANS: C

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ANS: A

13.

Sympathetic stimulation of the heart: A. Releases acetylcholine at the sympathetic endings B. Decreases sinus nodal discharge rate C. Decreases excitability of the heart D. Releases norepinephrine at the sympathetic endings E. Decreases cardiac contractility

ANS: D

Chapter 11. The Normal Electrocardiogram

Test Bank The Q-T interval is the time that approximates the time of ventricular contraction.

The normal Q-T interval is: A. 0.04 seconds B. 0.08 seconds C. 0.16 seconds D. 0.20 seconds E. 0.35 seconds

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ANS: E

What is her heart rate in beats/minute?

A. 68 B. 78 C. 84 D. 94 E. 104

According to Einthoven’s Law, if the QRS voltage in her lead III is 0.5 mV, what is the QRS voltage in Lead I? A. 0.05 mV B. 0.50 mV C. 1.05 mV D. 1.25 mV E. 2.05 mV

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ANS: A

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Questions 2-3: A seventy-year old female had an electrocardiogram performed at her annual checkup, and the following lead II recording was made.

ANS: B 4.

The P-R interval is the time between the beginning of atrial depolarization and ventricular depolarization. The normal P-R interval is: A. 0.04 seconds

B. 0.08 seconds C. 0.16 seconds D. 0.20 seconds E. 0.35 seconds ANS: C When recording lead I on an EKG, the right arm is the negative electrode and the positive electrode is the: A. Left arm B. Left leg C. Right leg D. Left arm + left leg E. Right arm + left leg

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ANS: A

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Chapter 12. Electrocardiographic Interpretation of Cardiac Muscle and Coronary Blood Flow Abnormalities: Vectorial Analysis

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A ventricular depolarization wave when traveling 210 in the frontal plane will cause a large positive deflection in: A. aVR B. aVL C. Lead II D. Lead III E. aVF

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Test Bank

ANS: A Questions 2-4: A 60-year-old woman had the following EKG recorded at a local emergency room following an automobile accident. Her weight was 70 kg and her aortic blood pressure was 140/80 mmHg.

2.

What is the mean electrical axis calculated from standard leads I, II, and III shown in the woman’s EKG?

A. −90 B. −50 C. −12 D. +105 E. +170

What is the heart rate using lead I for the calculation?

A. 70 B. 88 C. 100 D. 112 E. 148

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What is her likely diagnosis?

A. Mitral valve stenosis B. Left bundle branch block C. Pulmonary valve stenosis D. Right bundle branch block E. Left ventricular hypertrophy

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A seventy-five year-old woman came into a local emergency room complaining of chest pain and shortness of breath. Blood samples were taken for cardiac enzyme measurements, and an EKG was quickly taken. Based on the EKG tracing shown below, what is the likely diagnosis?

A. Left bundle branch block B. Acute anterior wall infarction in the base of the heart C. Acute anterior wall infarction in the apex of the heart D. Acute posterior infarction in the base of the heart E. Acute posterior infarction in the apex of the heart

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ANS: D

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ANS: A 4.

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ANS: D

ANS: D

6.

A ventricular depolarization wave when traveling 90 in the frontal plane will cause a large positive deflection in: A. aVR B. aVL C. Lead II D. Lead III E. aVF

ANS: A Questions 7-9: A 70-year-old man had the following EKG recorded at his doctor’s office. His weight was 80 kg and his blood pressure was 160/90 mmHg. He complained that he gets tired easily.

What is the mean electrical axis calculated from standard leads I, II, and III shown in the man’s EKG? A. −90 B. −60 C. −15 D. +60 E. +170

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7.

ANS: C

What is the heart rate using lead I for the calculation?

A. 75 B. 88 C. 100 D. 112 E. 148

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What is his likely diagnosis?

A. Tricuspid valve stenosis B. Complete left bundle branch block C. Pulmonary valve stenosis D. Pulmonary valve regurgitation E. Left ventricular hypertrophy

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ANS: E

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ANS: B

A seventy-year-old woman came into the local emergency room complaining of chest pain and shortness of breath. Blood samples were taken for cardiac enzyme measurements, and an EKG was quickly taken. Based on the EKG tracing shown below, what is the likely diagnosis?

A. Left bundle branch block B. Acute anterior wall infarction in the left ventricle C. Acute anterior wall infarction in the right ventricle D. Acute posterior infarction in the left ventricle E. Acute posterior infarction in the right ventricle

ANS: B

Questions 11-12: A 65-year-old man went for an annual checkup and had the following EKG recorded at his physician's office.

What is the mean electrical axis calculated from standard leads I, II, and III shown in his EKG? A. −50 B. −15 C. 0 D. +15 E. +50

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11.

What is the most likely diagnosis?

A. Right ventricular hypertrophy B. Left bundle branch block C. Pulmonary valve insufficiency D. Right bundle branch block E. Systemic hypertension

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ANS: B

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ANS: E

What is her heart rate? Use lead I for the calculation.

A. 56 B. 66 C. 76 D. 103 E. 152

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Questions 13-14. A 50-year-old woman was admitted to a local emergency room following a motorcycle accident, and the following EKG was taken.

ANS: D 14.

What is the most likely diagnosis?

A. Aortic valve insufficiency B. Left bundle branch block C. Pulmonary valve stenosis D. Right bundle branch block E. Systemic hypertension

ANS: C 15.

During the TP interval in an electrocardiogram of a patient with a damaged cardiac muscle: A. The entire heart is depolarized B. All the heart is depolarized except for the damaged cardiac muscle C. About half the heart is depolarized D. All of the heart is repolarized E. All of the heart is repolarized except for the damaged cardiac muscle

A 30-year-old woman had an EKG taken, and her QRS complex had a width of 0.20 seconds, her T wave was inverted in lead I, and the R wave had a large negative deflection in lead III. What is her diagnosis?

A. Right ventricular hypertrophy B. Left bundle branch block C. Pulmonary valve stenosis D. Right bundle branch block E. Left ventricular hypertrophy

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ANS: E

ANS: E

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A ventricular depolarization wave when traveling −30 in the frontal plane will cause a large positive deflection in: A. aVR B. aVL C. Lead II D. Lead III E. aVF

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ANS: B

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Questions 18-19: A 6-year-old boy had the following EKG recorded at his physician's office.

He had little energy, and during light exercise his respiratory would increase rapidly.

18.

What is his mean electrical axis calculated from standard leads I, II, and III shown in his EKG? A. −100 B. −20 C. 0 D. +90 E. +170

ANS: E 19.

What is his diagnosis?

A. Left ventricular hypertrophy B. Left bundle branch block C. Tricuspid stenosis D. Right bundle branch block E. Tetralogy of Fallot

ANS: E

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Mr. Smith had his EKG measured at UMC, but they lost his records. The EKG technician remembered that the QRS deflection was large and negative in Lead aVF and 0 in Lead I. His mean electrical axis in the frontal plane is A. 90 B. 60 C. 0 D. −60 E. −90

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E

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ANS: E

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Chapter 13.Cardiac Arrhythmias and Their Electrocardiographic Interpretation

A forty-year-old man reported to his cardiologist that he had unusual feelings in his chest after drinking his fourth cup of coffee in the morning. The cardiologist recorded the following EKG during an exercise stress test. Leads II and III are shown. What is the likely diagnosis?

A. Premature contraction originating in the atrium B. Premature contraction originating high in the A-V node C. Premature contraction originating low in the A-V node D. Premature contraction originating in the apex of the ventricle E. Premature contraction originating in the base of the ventricle

ANS: EE

2.

A ninety-year-old man had an EKG taken at his local doctor’s office, and the diagnosis was atrial fibrillation. Which of the following statements are likely conditions in someone with atrial fibrillation?

A. Ventricular fibrillation normally accompanies atrial fibrillation B. The P waves of the EKG are strong C. The rate of ventricular contraction is irregular and fast D. The atrial “a” wave is normal E. The atria have a smaller volume than normal

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Circus movements in the ventricle can lead to ventricular fibrillation. Which of the following conditions in the ventricular muscle will increase the tendency for circus movements?

A. Decreased refractory period B. Low extracellular potassium concentration C. Increased refractory period D. Shorter conduction pathway (decreased ventricular volume) E. Increase in parasympathetic impulses to the heart

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ANS: C

A 55-year-old woman had the following EKG recorded at her annual physical. She reported to her doctor that sometimes her pulse rate feels strong and at other times it feels weak. Standard limb lead II is shown.

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ANS: A

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What is her likely diagnosis?

A. Atrial paroxysmal tachycardia B. First degree A-V block C. Second degree A-V block, Mobitz type I (Wenckebach) D. Second degree A-V block, Mobitz type II E. Third degree A-V block ANS: D 5.

A fifty-year-old man has been having fainting “spells” for about two weeks. During the fainting episodes, his EKG shows a ventricular beat of 25 per minute and 100 P waves per minute. After about 30 seconds of fainting a normal sinus rhythm reoccurs.

What is his likely diagnosis?

A. Atrial flutter B. First degree A-V block C. Second degree A-V block

D. Third degree A-V block E. Stokes-Adams syndrome ANS: E A 65-year-old woman had the following EKG recorded at her annual physical. She reported to her doctor that sometimes her pulse rate feels a little irregular. Standard limb lead III is shown. What is her likely diagnosis?

A. Atrial paroxysmal tachycardia B. First degree A-V block C. Second degree A-V block, Mobitz type I (Wenckebach) D. Normal sinus rhythm E. Third degree A-V block

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Circus movements in the ventricle can lead to ventricular fibrillation. Which of the following conditions in the ventricular muscle will increase the tendency for circus movements?

A. Decreased conduction velocity B. Low extracellular potassium concentration C. Increased refractory period D. Shorter conduction pathway (decreased ventricular volume) E. Increase in parasympathetic impulses to the heart

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ANS: EE

Which of the following statements about a premature atrial contraction is true?

A. The radial artery pulse associated with the premature contraction will be weak B. Stroke volume associated with the premature contraction will be increased C. The P wave is never seen D. The probability of these premature contractions occurring is decreased in people with a large caffeine intake E. It causes the QRS interval to be lengthened.

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ANS: AA

ANS: A A 9.

A 65-year-old man reported some unusual sensations in his chest. His blood pressure is 135/85 mmHg, and he weighs 200 pounds. He had an EKG taken, and it is shown below. What is his likely diagnosis?

A. Atrial paroxysmal tachycardia B. First degree A-V block C. Second degree A-V block D. Premature atrial contractions E. Premature ventricular contractions

ANS: DD

Questions 10-11: A sixty-year-old female was admitted to the UMC emergency room following an automobile accident, and the following EKG was taken. Chest lead V2 is

ANS: B What is her diagnosis?

A. Atrial paroxysmal tachycardia B. First degree A-V block C. Second degree A-V block D. Third degree A-V block E. Atrial flutter

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What is her heart rate in beats/minute?

A. 40 B. 60 C. 75 D. 100 E. 150

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10.

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shown.

Which of the following will usually result in an inverted P wave that occurs after the QRS complex?

A. Premature contraction originating in the atrium B. Premature contraction originating high in the A-V junction C. Premature contraction originating in the middle of the A-V junction D. Premature contraction originating low in the A-V junction E. atrial fibrillation

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ANS: B

ANS: D 13.

A fifty-year-old man has a blood pressure of 140/85 and weighs 200 lbs. He reports that he is not feeling well, his EKG has no P waves, and he has a heart rate of 42. What is his condition?

A. First degree heart block B. Second degree heart block C. Third degree heart block

D. Sinoatrial heart block E. Sinus bradycardia ANS: D A 48-year-old man had unusual sensations in his chest during exercise. His EKG is shown below, and lead aVF is shown. What is the diagnosis?

A. Premature contraction originating in the atrium B. Premature contraction originating high in the A-V node C. Premature contraction originating low in the A-V node D. Premature contraction originating in the inferior part of the ventricle E. Premature contraction originating in the base of the ventricle

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14.

Which of the following decrease the risk of occurrence of ventricular fibrillation?

A. An enlarged ventricle B. A lengthened ventricular refractory period C. Decreased electrical conduction velocity D. Exposure of the heart to 60-cycle alternating current E. Epinephrine administration

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15.

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ANS: DD

st

Which of the following occur after electrical shock of the heart with a 60-cycle alternating current?

A. A normal arterial pressure B. A lengthened ventricular refractory period C. Decreased electrical conduction velocity D. A shortened conduction pathway around the heart E. Normal cardiac output

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ANS: C

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ANS: D

Chapter 14. Overview of the Circulation; Biophysics of Pressure, Flow, and Resistance

1.

A 50-year-old woman has a renal blood flow of 1,000 mL/min and hematocrit of 50.

Her arterial pressure is 120 mmHg and her renal venous pressure is 20 mmHg. She also has a plasma colloid osmotic pressure of 25 mmHg. Which of the following is the total renal vascular resistance (in mmHg/mL/min) in this woman?

A. 0.10 B. 0.20 C. 0.50 D. 1.00 E. 1.50 ANS: A Under control conditions, flow through a blood vessel is 10 mL/min under a pressure gradient of 100 mmHg. An increase in which of the following would occur in response to a twofold increase in the diameter of the vessel and the pressure gradient was maintained at 100 mmHg? A. Vascular resistance B. Hematocrit C. Vascular conductance D. Blood viscosity E. Plasma oncotic pressure

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2.

ANS: C

A decrease in the diameter of an arteriole would most likely result in which of the following sets of changes in the microcirculation?

Conductance Blood Flow Resistance A. B. C. D. E. F. G. H.

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3.

ANS: F

4.

Which vessel has the highest vascular resistance?

Vessel Blood Flow (mL/min) Pressure Gradient (mmHg) A. 1,000 100 B. 1,200 60 C. 1,400 20 D. 1,600 80 E. 1,800 40

ANS: A 5.

Which one the following would tend to cause an increase in blood flow?

A. An increase in hematocrit B. A decrease in arterial pressure C. A twofold increase in arteriole diameter D. A twofold increase in blood viscosity

ANS: C The table below depicts the pressure gradient, radius, and viscosity in various vessels of the same length. Which vessel has the greatest flow?

Vessel Pressure Gradient Radius Viscosity A. 100 1 10 B. 50 2 5 C. 25 4 2 D. 10 6 1

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6.

ANS: D

If the blood flow through the kidney is 1,200 mL/min and the renal artery pressure is 100 mmHg and the renal venous pressure is 0 mmHg, which of the following is the conductance (in mL/min/mmHg) of the renal vessel?

A. 2 B. 4 C. 8 D. 12 E. 16

A 78-year-old woman has a mean arterial pressure of 120 mmHg and a heart rate of 60 bpm. She has a stroke volume of 50 mL, cardiac output of 3,000 mL/min and a right atrial pressure of 0 mmHg. What is the total peripheral resistance (in mmHg/mL/min) in this woman?

A. 0.01 B. 0.02 C. 0.04 D. 0.08 E. 0.10

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ANS: D

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7.

ANS: D 9.

An increase in which one of the following would decrease blood flow across a vessel?

A. Hydrostatic pressure gradient B. Diameter of vessel C. Blood viscosity D. Plasma colloid osmotic pressure ANS: CB

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Chapter 15. Vascular Distensibility and Functions of the Arterial and Venous Systems

Test Bank

A 65-year-old woman visits her family practitioner for an examination. She has a mean blood pressure of 95 mmHg and a heart rate of 74 bpm. Further tests by a cardiologist revealed that the patient has moderate aortic regurgitation. Which one of the set of changes would be expected in this patient?

Pulse Pressure Stroke Volume Systolic Pressure A. B. C. D. E. F. G. H.

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Which one of the following would increase venous hydrostatic pressure in the legs?

A. A decrease in right atrial pressure B. Pregnancy C. Movement of leg muscles D. Hemorrhage

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2.

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ANS: AE

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1.

ANS: B 3.

Which one of the following parts of the circulation has the highest compliance?

A. Capillaries B. Venules C. Veins D. Aorta E. Arteries

ANS: C A 60-year-old man visits his family practitioner for his yearly examination. He has a blood pressure of 180/100 mmHg, a heart rate of 78 bpm, and a pulse pressure of 80 mmHg. His plasma cholesterol level is in the upper 25th percentile. A decrease in which of the following is the most likely explanation for the high pulse pressure in this patient?

A. Stroke volume B. Arterial pressure C. Heart rate D. Arterial compliance E. Total peripheral resistance

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4.

Which one of the following would tend to decrease pulse pressure?

A. An increase in metabolic rate B. An increase in stroke volume C. An increase in arterial compliance D. An increase in venous return E. An increase plasma volume

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ANS: D

ANS: C

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A 65-year-old man is suffering from congestive heart failure. He has a cardiac output of 4.0 L/min, arterial pressure of 115/85, and a heart rate of 90 bpm. Further tests by a cardiologist reveal that the patient has a right atrial pressure of 10 mmHg. An increase in which of the following would be expected in this patient?

A. plasma colloid osmotic pressure B. interstitial colloid osmotic pressure C. arterial pressure D. cardiac output E. vena cava hydrostatic pressure

7.

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ANS: E

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6.

Which of the following components of the circulatory system has the largest distribution of blood volume?

A. Arteries B. Capillaries C. Veins D. Pulmonary circulation E. Heart

ANS: C 8.

A 35-year-old woman visits her family practitioner for an examination. She has a

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mean blood pressure of 105 mmHg and a heart rate of 74 bpm. Further tests by a cardiologist revealed that the patient has moderate aortic valve stenosis. Which one of the set of changes would be expected in this patient?

Pulse Pressure Stroke Volume Systolic Pressure A. B. C. D. E. F. G. H.

A 36-year-old female cash register attendant visits her physician complaining about the large surface veins in her legs. Her blood pressure is 125/94 mmHg and she has a heart rate of 78 bpm. She is 5’3” tall and weighs 125 lbs. As a part of her weight loss program, she has been jogging two miles each day for the past two months. Which of the following is the most likely cause of the varicose veins in this woman?

A. Hypertension B. Obesity C. Tachycardia D. Excessive jogging on a hard surface E. Chronic exposure to excess venous pressures in her legs

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ANS: H

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ANS: E

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Chapter 16. The Microcirculation and Lymphatic System: Capillary Fluid Exchange, Interstitial Fluid, and Lymph Flow

Test Bank 1.

Which one of the following substances in plasma does not contribute to plasma colloid osmotic pressure?

A. Globulins B. Fibrinogen C. Albumin D. NaCl

ANS: D A decrease in arteriole diameter would most likely result in which of the following sets of changes in a microcirculatory bed?

Interstitial Hydrostatic Capillary Hydrostatic Lymph Pressure Pressure Flow A. B. C. D. E. F.

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2.

A decrease in which one of the following would tend to decrease filtration rate across a capillary wall?

A. Plasma colloid osmotic pressure B. Hydraulic conductivity of the wall C. Plasma albumin concentration D. Interstitial hydrostatic pressure E. Arteriole resistance

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3.

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ANS: D

st

Utilizing the data below, calculate the filtration coefficient for the capillary bed. (in mL/min/mmHg): Plasma colloid osmotic pressure = 30 Capillary hydrostatic pressure = 40 Interstitial hydrostatic pressure = 5 Interstitial colloid osmotic pressure = 5 Filtration rate = 150 mL/min Venous hydrostatic pressure = 10 mmHg A. 10 B. 15 C. 20 D. 25 E. 30

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ANS: B

ANS: B 5.

An increase in which one of the following would tend to decrease lymph flow?

A. Hydraulic conductivity of the capillary wall B. Plasma colloid osmotic pressure C. Capillary hydrostatic pressure D. Precapillary arteriole diameter

E. Interstitial colloid osmotic pressure ANS: B Utilizing the data below, calculate the rate of net fluid movement (in mL/min) across the capillary wall.

Plasma colloid osmotic pressure = 40 mmHg Capillary hydrostatic pressure = 10 mmHg Venous hydrostatic pressure = 5 mmHg Arterial pressure = 80 mmHg Interstitial hydrostatic pressure = 5 mmHg Interstitial colloid osmotic pressure = 5 mmHg Filtration coefficient = 10 mL/min/mmHg A. 100 (Filtration) B. 200 (Reabsorption) C. 200 (Filtration) D. 300 (Filtration) E. 300 (Reabsorption)

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6.

ANS: E

Listed below are the hydrostatic and oncotic pressures across a muscle capillary wall.

Venous hydrostatic pressure = 5 mmHg Arterial pressure = 100 mmHg Capillary hydrostatic pressure = 35 mmHg Plasma colloid osmotic pressure = 25 mmHg Interstitial colloid osmotic pressure = 10 mmHg Interstitial hydrostatic pressure = -5 mmHg What is the net filtration pressure (in mmHg) for fluid movement across the capillary wall?

A. 0 B. 5 C. 10 D. 15 E. 25

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7.

ANS: E 8.

A decrease in which one of the following would tend to increase filtration rate across a capillary wall?

A. Arterial pressure B. Hydraulic conductivity of the wall C. Interstitial albumin concentration D. Capillary hydrostatic pressure E. Arteriole resistance

ANS: E

Which of the following set of changes would be expected to increase the net movement of sodium across a muscle capillary wall?

Wall Permeability Wall Surface Area Concentration Difference to Sodium Across Wall A. B. C. D. E. F. G. H.

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9.

A healthy 20-year-old medical student has an exercise stress test. Which of the following sets of changes would be expected to occur in the student’s skeletal muscles during exercise?

Vascular Capillary Lymph Resistance Hydrostatic Pressure Flow A. B. C. D. E. F. G. H.

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ANS: A

Plasma colloid osmotic pressure: A. Is less than interstitial colloid osmotic pressure B. Decreases by 50% in the muscle capillaries as blood flows from the arteriole end to the venous end C. Is primarily caused by the presence of substances in the plasma such as sodium and potassium D. Increases in response to an increase in plasma albumin concentration

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ANS: G

ANS: D 12.

A 65-year-old woman has a 20-year history of alcoholism and liver disease. He visits his physician complaining of swelling of his extremities. A decrease in which of the following is one of the most likely cause of the ascites?

A. Capillary hydrostatic pressure B. Arteriole conductance

C. Interstitial hydrostatic pressure D. Plasma colloid osmotic pressure E. Interstitial colloid osmotic pressure ANS: D An increase in which one of the following would tend to decrease filtration rate across a capillary wall?

A. Arteriole diameter B. Hydraulic conductivity of the wall C. Interstitial albumin concentration D. Capillary hydrostatic pressure E. Plasma colloid osmotic pressure

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13.

An increase in which of the following would tend to decrease lymph flow?

A. Interstitial hydrostatic pressure B. Plasma colloid osmotic pressure C. Capillary hydrostatic pressure D. Interstitial colloid osmotic pressure E. Capillary hydraulic permeability

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ANS: E

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ANS: B

A healthy 25-year-old male medical student has an exercise stress test at a local health club. Which of the following set of physiological changes is most likely to occur in this man’s skeletal muscles during exercise?

Arteriole Diameter Adenosine Concentration Tissue Metabolism

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Test Bank

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Chapter 17. Local and Humoral Control of Tissue Blood Flow

A. B. C. D. E. F. G.

H. ANS: A The arterial pressure of an isolated perfused muscle is increased from 100 to 140 mmHg. Blood flow to the muscle at 100 mmHg is 5 ml/min/100 g and 5.1 ml/min/100 g at 140 mmHg. The maintenance of blood flow despite the large elevation in arterial pressure is due to an increase in which of the following?

A. arterial conductance B. adenosine concentration C. arteriolar resistance D. lactic acid concentration E. nitric oxide concentration

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2.

Autoregulation of tissue blood flow in response to an increase in arterial pressure occurs as a result of A. a decrease in vascular resistance B. an initial decrease in vascular wall tension C. excess delivery of nutrients such as oxygen to the tissues D. a decrease in tissue metabolism

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ANS: C

Histamine is injected into the brachial artery of a 25-year-old man. Which of the following sets of changes would be expected to occur in response to histamine?

Vascular Vascular Capillary Resistance Conductance Filtration A. B. C. D. E.

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ANS: C

ANS: D 5.

A 72-year-old male had surgery to remove an abdominal tumor. Pathohistological studies reveal that the tumor mass contains a large number of vessels. An increase in which of the following is the most likely stimulus for the growth of vessels in a solid tumor?

A. growth hormone B. plasma glucose concentration C. angiostatin growth factor D. tissue oxygen concentration

E. vascular endothelial growth factor ANS: E 6.

An increase in shear stress in a blood vessel would result in which of the following changes?

A. decreased endothelin production B. increased cyclic GMP production C. decreased nitric oxide release D. increased renin production E. decreased prostacyclin production

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Reducing arterial pressure in a muscle artery from 100 to 80 mmHg would result A. in a long-term reduction in blood flow B. in a reduction in arteriole diameter and increase in blood flow C. a reduction in arteriole resistance and maintenance of normal blood flow D. a decrease in vascular conductance

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ANS: B

ANS: C

The diameter of a precapillary arteriole is increased in a muscle vascular bed. A decrease in which of the following would be expected?

A. capillary filtration rate B. vascular conductance C. capillary blood flow D. capillary hydrostatic pressure E. arteriole resistance

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8.

A decrease in tissue metabolism results in A. an decrease in arteriole resistance B. an increase in arteriole diameter C. an increase in capillary hydrostatic pressure D. decrease in nutrient delivery to the tissues and tissue blood flow

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ANS: E

ANS: D 10.

Which one of the following would tend to decrease blood flow?

A. an increase in tissue carbon dioxide concentration B. an increase in tissue lactic acid concentration C. an increase in tissue metabolism D. an increase in tissue oxygen concentration

ANS: D

11.

Exercising on a treadmill results in significant increases in skeletal blood flow. A change in which of the following sets of muscle tissue concentrations is the most likely explanation for the increases in muscle blood flow?

Carbon Dioxide pH Adenosine

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A. B. C. D. E. F. G. H.

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ANS: BB

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Chapter 18. Nervous Regulation of the Circulation and Rapid Control of Arterial Pressure

Blood is withdrawn from a 56-year-old male with a five year history of congestive heart failure. Plasma concentrations of angiotensin II, aldosterone and atrial natriuretic peptide are elevated. An increase in which of the following is the most likely explanation for the increase in plasma levels of atrial natriuretic peptide?

A. Arterial pressure B. Renal vascular resistance C. Venous hydrostatic pressure D. Atrial pressure E. Cardiac output

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Test Bank

ANS: D 2.

A 22-year-old male enters the hospital emergency room after severing a major artery during a motorcycle accident. It is estimated that the patient lost approximately 700 mL of blood. His blood pressure is 90/55 mmHg. A decrease in which of the following would be expected in response to hemorrhage in this man?

A. Heart rate B. Sympathetic nerve activity C. Total peripheral resistance

D. Plasma renin activity E. Number of impulses from the carotid sinus ANS: E Which one of the following sets of physiological changes would be expected to occur in a person who stands up from a supine position?

Venous Hydrostatic Parasympathetic Renal Blood Pressure in Legs Nerve Activity Flow A. B. C. D. E. F.

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3.

ANS: C

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A tie is placed around a carotid artery and then pulled to partially constrict the vessel.

Constriction of the carotid artery would most likely result in which one of the following sets of physiological changes?

Number of Impulses Heart Total From the Carotid Sinus Rate Peripheral Resistance A. B. C. D. E. F.

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4.

An increase in atrial pressure results in which one of the following?

A. A decrease in plasma atrial natriuritic peptide (ANP) B. An increase in plasma angiotensin II concentration C. An increase in plasma aldosterone concentration D. An increase in sodium excretion

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ANS: F

ANS: D 6.

A tie is placed around a carotid artery and then pulled to partially constrict the vessel.

Constriction of the carotid artery would most likely result in which one of the following sets of physiological changes?

Vagal Heart Venous Tone Rate Compliance A. B.

C. D. E. F. G. H. ANS: H A 25-year-old male enters the hospital emergency room after severing a major artery during a farm accident. It is estimated that the patient lost approximately 800 mL of blood. His mean blood pressure is 65 mmHg. His heart rate is elevated as a result of activation of the chemoreceptor reflex. Which of the following set of changes in plasma concentration would be expected to activate the chemoreceptor reflex?

Oxygen Carbon Dioxide Hydrogen A. B. C. D. E. F. G. H.

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Which one of the following sets of physiological changes would be expected to occur in a person who stands up from a supine position?

Sympathetic Nerve Heart Total Peripheral Activity Rate Resistance A. B. C. D. E. F. G. H.

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ANS: G

ANS: A 9.

A balloon catheter is advanced from the superior vena cava into the heart and inflated to increase atrial pressure by 10 mmHg. Which one of the following set of physiological changes would be expected to occur in response to the elevated atrial pressure?

Renal Sympathetic Atrial Natriuretic Peptide Sodium Excretion Nerve Activity A.

B. C. D. E. F. G. H. ANS: G A healthy 30-year-old man stands up from a supine position. Which of the following set of cardiovascular changes is most likely to have occurred?

Total Peripheral Heart Rate Sympathetic Nerve Resistance Activity A. B. C. D. E. F. G. H.

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10.

Which one of the following would be expected to occur during a Cushing reaction?

A. An increase in parasympathetic activity B. A decrease in arterial pressure C. A decrease in heart rate D. An increase in sympathetic activity

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ANS: D

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ANS: A

Chapter 19. Role of the Kidneys in Long-Term Control of Arterial Pressure and in Hypertension: The Integrated System for Aterial Pressure Regulation Test Bank 1.

A 65-year-old female with a 10-year history of essential hypertension visits her physician for an examination. Laboratory test results indicate that the patient has a plasma rennin activity 2-3 times higher than normal. The patient is given a prescription for an angiotensin type 1 receptor blocker (ARB). Which one of the following would you

expect to occur in this patient following administration of the ARB? A. Increase in total peripheral resistance B. Increase in arterial pressure C. Increase in plasma renin activity D. Increase in aldosterone E. Decrease in kidney’s ability to excrete sodium ANS: C A 55-year-old female with a five year history of hypertension visits her physician for an examination. Laboratory test results indicate that the patient has a plasma rennin activity 3-4 times higher than normal. The patient is given a prescription for Captopen, an angiotensin II converting enzyme (ACE) inhibitor. An increase in which one of the following would you expect to occur in this patient following administration of the ACE inhibitor?

A. Total peripheral resistance B. Arterial pressure C. Angiotensin I D. Aldosterone E. Atrial natriuretic peptide

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2.

ANS: C

Which of the following set of changes would be expected to decrease sodium excretion by the kidney?

Nitric Oxide Renal Sympathetic Angiotensin II Nerve Activity A. B. C. D. E. F. G. H.

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3.

ANS: G 4.

A healthy 22-year-old female medical student with normal kidneys increases her sodium intake by 300% for a period of two months. Which of the following is expected to occur in response to the increase in sodium intake?

A. A decrease in arterial pressure B. A decrease in plasma renin activity C. A decrease in sodium excretion D. A decrease in nitric oxide E. A decrease in atrial natriuretic peptide

ANS: B A 55-year-old female is diagnosed with a juxtaglomerular cell rennin-secreting tumor.

Lab tests reveal a plasma concentration of angiotensin II five times above normal. Which of the following set of findings would be expected in this man?

Blood Pressure Blood Volume Renal Blood Flow A. B. C. D. E. F. G. H.

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5.

ANS: C

A 45-year-old male with a history of normal health visits his physician for a check up.

During his physical exam, it was revealed that his blood pressure was 170/98 mmHg. Further tests indicated that he had renovascular hypertension as a result of a stenosis in the left kidney. Which of the following set of findings would be most likely expected in this man with renovascular hypertension?

Renal Bood Flow Plasma Renin Aldosterone A. B. C. D. E. F. G. H.

A 50-year-old male has a three year history of hypertension. He has been on several medications without ever having good blood pressure control. He has been off medications entirely for the last six months. He complains of fatigue and occasional muscle cramps. There is no family history of hypertension. The patient has not had any other significant medical problems in the past. Examination reveals a blood pressure of 168/104 mmHg. Additional laboratory tests indicate that the patient has primary hyperaldosteronism. Which of the following set of findings would be most likely expected in this man with primary hyperaldosteronism?

Extracellular Fluid Plasma Renin Activity Plasma K Volume Concentration A. B. C.

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ANS: G

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6.

D. E. F. G. H. ANS: C

A decrease in which one of the following would best explain the increase in blood pressure in this patient?

A. Angiotensin II B. Aldosterone C. Sympathetic nerve activity D. Glomerular filtration rate E. Endothelin

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An increase in which one of the following would most likely result in chronic hypertension?

A. Dopamine B. Senal sympathetic nerve activity C. Bradykinin D. Nitric oxide

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ANS: D

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Questions 8-9: A 40-year-old female with a history of diabetes mellitus for 16 years visited the emergency room with a blood pressure of 270/110. She had her blood pressure measured many times in the past and has never been noted to be hypertensive. She also complains of pedal edema which has been gradually progressive. She denies polyuria, polydypsia or symptoms of hypoglycemia. Her insulin regimen is Humulin, 20 units in the morning and 10 units in the afternoon. Laboratory tests revealed the following values (range of normal values in parentheses): BUN 33 (9-20 mg/dl) Creatinine 2.7 (0.7-1.4 mg/dl) Glucose 296 (74-106 mg/dl) Total protein 6.2 (6.3-8.2 g/dl) Albumin 3.0 (3.5-5.1 g/dl) Cholesterol 320 (120-199 mg/dl) Urinalysis 3+ proteinuria

ANS: B 10.

A 45-year-old female was seen by her physician for an upper respiratory infection.

Blood pressure on that visit was noted to be 158/94 mmHg. She was asked to return for two other visits, separated by one week each, for measurement of blood pressure. Repeat measures were similar. She has no previous history of hypertension. She denies any previous significant medical problems. There is a positive family history for

hypertension. The rest of her history is unremarkable. Other than moderate obesity and the elevated blood pressure, her physical examination was completely normal. All routine laboratory studies were normal. Which of the following diagnoses would you predict for this woman?

A. Renovascular hypertension B. Primary hyperaldosteronism C. Essential hypertension D. Pheochromocytoma E. Moderate aortic valve regurgitation ANS: C

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A 55-year-old male with a history of normal health visits his physician for a check up.

During his physical exam, it was revealed that his blood pressure was 170/98 mmHg. Further tests indicated that he had renovascular hypertension as a result of a stenosis in the left kidney. Which of the following set of findings would be most likely expected in this man with renovascular hypertension?

Total peripheral resistance Plasma Renin Aldosterone A. B. C. D. E. F. G. H.

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11.

An angiotensin-converting enzyme inhibitor (CEI) is administered to a 65-year-old male with a 20-year history of hypertension. The drug lowered arterial pressure and increased plasma levels of renin and bradykinin. An increase in which of the following would best explain the decline in blood pressure?

A. Preprobradykinin B. Conversion of angiotensin I to angiotensin II C. Angiotensin II D. Kallikrein E. Renal sodium excretory function

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ANS: A

ANS: E 13.

A healthy 22-year-old female medical student with normal kidneys increases her sodium intake by 200% for a period of two months. A decrease in which of the following is expected to occur in response to the increase in sodium intake?

A. Arterial pressure B. Plasma renin activity

C. Sodium excretion D. Nitric oxide E. Atrial natriuretic peptide ANS: B

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Chapter 20. Cardiac Output, Venous Return, and Their Regulation

DIRECTIONS: Choose the BEST answer.

For the cardiac output curve defined by the solid line and the venous return curve defined by the dashed line (with equilibrium at point B), what is the resistance to venous return in units of mmHg/L/min?

A. 1.70 B. 1.40 C. 1.23 D. 0.65 E. 0.35

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Test Bank

A 40-year-old woman is hospitalized and has a severe anemia. This patient has a cardiac output of 12.5 L/min, oxygen consumption is 250 mL/min, and pulmonary artery oxygen concentration is 160 mL/L of blood, what is the pulmonary vein oxygen concentration in units of mL/L of blood?

A. 140 B. 150 C. 160 D. 180 E. 200

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ANS: DD

ANS: DD 3.

Which of the following will cause a leftward shift in the cardiac output curve?

A. Surgically opening the thoracic cage B. Placing a patient on a mechanical ventilator C. Cardiac tamponade D. Decreasing intrapleural pressure to -6.0 mmHg

E. Positive pressure breathing ANS: DD 4.

Which of the following is normally associated with a decreased resistance to venous return?

A. Hyperthyroidism B. Increased venous resistance C. Increased arteriolar resistance D. Increased sympathetic output E. Obstruction of veins

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A 60-year-old woman is in the intensive care unit of a hospital and has a large A-V fistula. If this patient has a cardiac output of 10 L/min, oxygen consumption is 250 mL/ min, and pulmonary vein oxygen concentration is 180 mL/L of blood, what is the pulmonary artery oxygen concentration in units of mL/L of blood?

A. 145 B. 155 C. 165 D. 185 E. 205

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ANS: A

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Which of the following conditions is normally associated with an increased mean systemic filling pressure?

A. Decreased blood volume B. Increased venous compliance C. Increased arterial compliance D. Congestive heart failure E. Hypothyroidism

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ANS: D

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ANS: B

Which of the following is normally associated with an increased cardiac output?

A. Cardiac tamponade B. Increased venous compliance C. Moderate anemia D. Severe aortic stenosis E. Surgically opening the chest

ANS: C 8.

A patient with a resting cardiac output of 4 L/min is exercised maximally and cardiac output increases to 8 L/min. What is the cardiac reserve?

A. 250% B. 200% C. 150% D. 100% E. 50% ANS: DD Which of the following conditions would be expected to decrease mean systemic filling pressure?

A. Norepinephrine administration B. Increased blood volume C. Increased sympathetic stimulation D. Increased venous compliance E. Skeletal muscle contraction

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ANS: D D 10.

Which of the following will usually increase the plateau level of the cardiac output curve?

A. Myocarditis B. Severe cardiac tamponade C. Decreased parasympathetic stimulation of the heart D. Myocardial infarction E. Mitral stenosis

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In the following graph, for the cardiac output and venous return curves defined by the solid lines (with the equilibrium at A), which of the following is true?

A. Mean systemic filling pressure is 12 mmHg B. Right atrial pressure is 2 mmHg C. Resistance to venous return is 1.4 mmHg/L/min D. Pulmonary arterial flow is approximately 7 L/min E. Resistance to venous return is 0.71 mmHg/L/min

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ANS: CC

ANS: CC

This is Figure 20-16 from Guyton and Hall 12.

Which of the following will elevate the plateau of the cardiac output curve?

A. Surgically opening the thoracic cage B. Placing a patient on a mechanical ventilator C. Cardiac tamponade D. Decreasing parasympathetic stimulation of the heart

E. Decreasing sympathetic stimulation of the heart ANS: D D Which of the following normally cause the cardiac output curve to shift to the right along the right atrial pressure axis?

A. Decreasing intrapleural pressure to -6 mmHg B. Increasing mean systemic filling pressure C. Taking a patient off a mechanical ventilator and allowing normal respiration D. Surgically opening the chest E. Breathing against a negative pressure

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ANS: DD

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Chapter 21. Muscle Blood Flow and Cardiac Output During Exercise; the Coronary Circulation and Ischemic Heart Disease Test Bank

ba

Which of the following normally causes vasodilation of skeletal muscle arterioles during exercise?

A. Decreased plasma osmolality B. Decreased plasma nitric oxide concentration C. Increased plasma potassium concentration D. Decreased plasma adenosine concentration E. Increased plasma histamine concentration

The majority of venous blood flow leaves the heart muscle through the: A. Anterior cardiac veins B. Azygos vein C. Bronchial veins D. Coronary sinus E. Thebesian veins

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ANS: CC

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1.

ANS: DD 3.

A healthy 40-year-old man has been exercising maximally for 15 minutes. Which of the following conditions is likely to be present?

A. Arteriolar resistance in the gastrointestinal bed is increased by 200% B. Cerebral blood flow is decreased to 50% of normal

C. Heart rate is unchanged D. Cardiac output is increased 5% E. Right atrial pressure is increased to 10 mmHg ANS: A Which of the following is normally associated with an increased tendency for the heart to fibrillate following a myocardial infarction?

A. Current of injury from ischemic cardiac muscle B. Decreased extracellular potassium concentration C. Decreased sympathetic stimulation D. Increased extracellular sodium concentration E. Decrease in cardiac volume

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4.

Which of the following vascular beds experiences the most vasoconstriction in a person near the end of a five mile run?

A. Cerebral B. Coronary C. Exercising muscle D. Intestinal E. Skin

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ANS: A

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Which is usually the most important controller of coronary blood flow?

A. Adenosine B. Bradykinin C. Prostaglandins D. Carbon dioxide E. Potassium ions

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ANS: A

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ANS: DD

The mass sympathetic discharge at the beginning of exercise causes which of the following?

A. Decreased cerebral blood flow B. Decreased coronary blood flow C. Increased parasympathetic impulses to the heart D. Reverse stress relaxation E. Venoconstriction

ANS: E 8.

Which of the following will elevate the plateau of the cardiac output curve?

A. Surgically opening the thoracic cage

B. Placing a patient on a mechanical ventilator C. Cardiac tamponade D. Increasing parasympathetic stimulation of the heart E. Increasing sympathetic stimulation of the heart ANS: E Which of the following normally cause the cardiac output curve to shift to the right along the right atrial pressure axis?

A. Decreasing intrapleural pressure to -6 mmHg B. Increasing mean systemic filling pressure C. Taking a patient off a mechanical ventilator and allowing normal respiration D. Surgically opening the chest E. Breathing against a negative pressure

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9.

ANS: DD

Which of the following increase the risk of adverse cardiac events?

A. Decreased blood levels of LDL B. Decreased blood levels of HDL C. Female gender D. Moderate hypotension E. Decreased blood triglycerides

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A 70-year-old man with a weight of 100 kg and a blood pressure of 160/90 has been told by his doctor that he has angina pain caused by myocardial ischemia. Which of the following treatments would be beneficial to this man?

A. Increased dietary calcium B. Isometric exercise C. Give a beta-1 receptor stimulator D. Acetylcholine infusion E. Nitroglycerin

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ANS: B B

ANS: EE 12.

During mild exertion a 70-year-old man experiences an ischemia-induced myocardial infarction and dies from ventricular fibrillation. In this patient, which factor was most likely to increase the tendency of the heart to fibrillate after the infarction?

A. Increased parasympathetic stimulation of the heart B. A decrease in ventricular diameter C. Low potassium concentration in the heart extracellular fluid D. A more negative ventricular membrane potential E. Current of injury from the damaged area

ANS: EE

Chapter 22. Cardiac Failure

Test Bank

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A 70-year-old woman has had difficulty in breathing. She has been diagnosed with acute pulmonary edema. Which of the following therapies is most beneficial?

A. Place tourniquets on all four limbs B. Infuse red blood cells and fresh frozen plasma C. Infuse saline D. Infuse dobutamine E. Infuse norepinephrine

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ANS: A A

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Which of the following normally causes renal sodium retention during compensated heart failure?

A. Increased angiotensin II formation B. Increased atrial natriuretic factor release C. Sympathetic vasodilation of the afferent arterioles D. Increased glomerular filtration rate E. Increased ADH formation

Which of the following is normally associated with the chronic stages of compensated heart failure? Assume the patient is resting.

A. Dyspnea B. Decreased right atrial pressure C. Decreased heart rate D. Sweating E. Increased mean systemic filling pressure

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ANS: A A

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ANS: AE 4.

Which of the following normally occur in unilateral right heart failure?

A. Increased mean pulmonary filling pressure B. Increased left atrial pressure

C. Peripheral edema D. Pulmonary edema E. Increased pulmonary artery pressure ANS: C Which of the following is normally associated with the chronic stages of compensated heart failure? Assume the patient is resting.

A. Decreased mean systemic filling pressure B. Increased right atrial pressure C. Increased heart rate D. Sweating E. Dyspnea

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Which of the following normally causes either renal sodium or water retention during compensated heart failure?

A. Decreased angiotensin II formation B. Decreased aldosterone formation C. Sympathetic vasodilation of the afferent arterioles D. Increased glomerular filtration rate E. Increased ADH formation

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ANS: B

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Which of the following would normally be the most beneficial for a patient with acute pulmonary edema?

A. Place tourniquets on all four limbs B. Infuse dobutamine C. Infuse saline D. Infuse norepinephrine E. Infuse whole blood

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ANS: A

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ANS: EE

A 60-year-old man had a heart attack two days ago, and his blood pressure has continued to decrease. He is now in cardiogenic shock. Which of the following therapies is most beneficial?

A. Place tourniquets on all four limbs B. Give a sympathetic inhibitor C. Give furosemide D. Give a blood volume expander E. Increase dietary sodium

ANS: D

9.

Which of the following often occur in decompensated heart failure?

A. Edema of the heart muscle B. Increased norepinephrine in cardiac sympathetic nerves C. Increased calcium in the sarcoplasmic reticulum of cardiac muscle cells D. Decreased right atrial pressure E. Increased arterial pressure

ANS: A A Which of the following is normally associated with the chronic stages of compensated heart failure? Assume the patient is resting.

A. Dyspnea B. Decreased right atrial pressure C. Decreased heart rate D. Sweating E. Increased mean systemic filling pressure

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ANS: EE

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Chapter 23. Heart Valves and Heart Sounds; Valvular and Congenital Heart Defects

Test Bank

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An echocardiogram was performed on a 5-year-old male child. The results indicated thickened right and left ventricles. Arterial oxygen concentration is normal. What condition does the boy have?

A. Tetralogy of Fallot B. Mild aortic insufficiency C. Patent ductus arteriosus D. Tricuspid stenosis E. Mild mitral stenosis

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1.

ANS: CC 2.

The second heart sound is associated with which of the following?

A. In-rushing of blood into the ventricles due to atrial contraction B. Closing of the A-V valves C. Closing of the pulmonary valve D. Opening of the A-V valves

E. In-rushing of blood into the ventricles in the early to middle part of diastole ANS: CC 3.

Which of the following heart murmurs is heard during diastole?

A. Patent ductus arteriosus B. Aortic stenosis C. Tricuspid valve regurgitation D. Interventricular septal defect E. Mitral regurgitation

An echocardiogram was performed on a 6-year-old child. The results indicated a thickened right ventricle. Other data indicated that the patient had severely decreased arterial oxygen content and equal systolic pressures in both cardiac ventricles. What condition does the child have?

A. Interventricular septal defect B. Tetralogy of Fallot C. Pulmonary valve stenosis D. Pulmonary valve regurgitation E. Patent ductus arteriosus

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ANS: AA

The fourth heart sound is associated with which of the following?

A. In-rushing of blood into the ventricles due to atrial contraction B. Closing of the A-V valves C. Closing of the pulmonary valve D. Opening of the A-V valves E. In-rushing of blood into the ventricles in the early to middle part of diastole

Which of the following heart murmurs is heard only during diastole?

A. Patent ductus arteriosus B. Aortic stenosis C. Tricuspid valve stenosis D. Interventricular septal defect E. Mitral regurgitation

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ANS: A

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ANS: B

ANS: C 7.

The third heart sound is associated with which of the following?

A. In-rushing of blood into the ventricles due to atrial contraction B. Closing of the A-V valves C. Closing of the pulmonary valve

D. Opening of the A-V valves E. In-rushing of blood into the ventricles in the early to middle part of diastole ANS: EE Which one of the following heart murmurs is heard during systole?

A. Interventricular septal defect B. Mitral stenosis C. Aortic regurgitation D. Tricuspid stenosis E. Pulmonary valve regurgitation

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8.

An increase in left atrial pressure is most likely to occur in which of the following heart murmurs?

A. Tricuspid stenosis B. Pulmonary valve regurgitation C. Mitral regurgitation D. Tricuspid regurgitation

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ANS: AA

ANS: CC

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An 80-year-old male patient at UMC has been diagnosed with a heart murmur. A chest x-ray shows an enlarged heart but no edema fluid in the lungs. The mean QRS axis of his EKG is 170. Pulmonary wedge pressure is normal. What is the diagnosis?

A. Mitral stenosis B. Aortic stenosis C. Pulmonary valve stenosis D. Tricuspid stenosis E. Mitral regurgitation

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ANS: CC

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10.

A 50-year-old female patient at UMC has been diagnosed with a heart murmur. A murmur of relatively low pitch is heard maximally over the second intercostal space to the right of the sternum. The chest x-ray shows an enlarged heart. The mean QRS axis of the EKG is -45. The diagnosis is: A. Mitral valve stenosis B. Aortic valve stenosis C. Pulmonary valve stenosis D. Tricuspid valve stenosis E. Tricuspid valve regurgitation

ANS: BB

12.

Which of the following heart murmurs is heard during systole?

A. Aortic valve regurgitation B. Pulmonary valve regurgitation C. Tricuspid valve stenosis D. Mitral valve stenosis E. Patent ductus arteriosus

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Chapter 24. Circulatory Shock and Its Treatment

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Test Bank

Which of the following conditions often occurs in compensated hemorrhagic shock?

A. Decreased heart rate B. Stress relaxation of veins C. Decreased ADH release D. Decreased absorption of interstitial fluid through the capillaries E. CNS ischemic response

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ANS: E E

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In which of the following conditions would you expect to find increased left atrial pressure?

A. Tricuspid stenosis B. Tricuspid regurgitation C. Pulmonary valve stenosis D. Pulmonary valve regurgitation E. Severe aortic stenosis

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ANS: EE

ANS: E 3.

Release of which of the following causes vasodilation during anaphylactic shock?

A. Histamine B. Bradykinin C. Nitric oxide D. Atrial natriuretic factor E. Adenosine

ANS: A 4.

A 50-year-old female received an overdose of furosemide and arterial pressure decreased to 70/40. Heart rate is 120 and the respiratory rate is 30/min. What therapy would you recommend?

A. Whole blood infusion B. Plasma infusion C. Infusion of a balanced electrolyte solution D. Infusion of a sympathomimetic drug E. Administration of a glucocorticoid

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If a patient undergoing spinal anesthesia experiences a large decrease in arterial pressure and goes into shock, which of the following would be the therapy of choice?

A. Plasma infusion B. Blood infusion C. Saline infusion D. Glucocorticoid infusion E. Infusion of sympathomimetic drug

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5.

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ANS: CC

ANS: EE

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A patient in the hospital received an overdose of furosemide and arterial pressure decreased to 70/40. Heart rate is 120 and the respiratory rate is 30/min. What therapy would you recommend?

A. Whole blood infusion B. Plasma infusion C. Infusion of a balanced electrolyte solution D. Infusion of a sympathomimetic drug E. Administration of a glucocorticoid

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ANS: C

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6.

Which kind of shock is often associated with an increased cardiac output?

A. Hemorrhagic shock B. Anaphylactic shock C. Septic shock D. Neurogenic shock E. Shock due to dehydration

ANS: C 8.

A 10-year-old female in the hospital had an intestinal obstruction and arterial pressure decreased to 70/40. Heart rate is 120 and the respiratory rate is 30/min. Which of the following therapies would the physician recommend?

A. Blood infusion B. Plasma infusion C. Infusion of a balanced electrolyte solution D. Infusion of a sympathomimetic drug E. Administration of a glucocorticoid ANS: BB Which of the following conditions often occurs in progressive hemorrhagic shock?

A. Vasomotor center failure B. Increased urine output C. Tissue alkalosis D. Decreased capillary permeability E. Increased mean systemic filling pressure

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9.

ANS: A A

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A 30-year-old female enters the UMC emergency room and has been experiencing severe vomiting. She has pale skin, tachycardia and an arterial pressure of 80/50 and has trouble walking. What therapy do you recommend to prevent shock?

A. Packed red cell infusion B. Administration of an antihistamine C. Infusion of a balanced electrolyte solution D. Infusion of a sympathomimetic drug E. Administration of a glucocorticoid

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ANS: CC

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Chapter 25. The Body Fluid Compartments: Extracellular and Intracellular Fluids; Edema Chapter 26. The Urinary System: Functional Anatomy and Urine Formation by the Kidneys Chapter 27. Glomerular Filtration, Renal Blood Flow, and Their Control Chapter 28. Renal Tubular Reabsorption and Secretion Chapter 29. Urine Concentration and Dilution; Regulation of Extracellular Fluid Osmolarity and Sodium Concentration Chapter 30. Renal Regulation of Potassium, Calcium, Phosphate, and Magnesium; Integration of Renal Mechanisms for Control of Blood Volume and Extracellular Fluid Volume Chapter 31. Acid-Base Regulation Chapter 25: The Body Fluid Compartments: Extracellular and Intracellular Fluids;

Edema and Chapter 26: Urine Formation by the Kidneys: I. Glomerular Filtration, Renal Blood Flow, and Their Control and Chapter 27: Urine Formation by the Kidneys: II. Tubular Reabsorption and Secretion and Chapter 28: Urine Concentration and Dilution; Regulation of Extracellular Fluid Osmolarity and Sodium Concentration and Chapter 29: Renal Regulation of Potassium, Calcium, Phosphate, and Magnesium; Integration of Renal Mechanisms for Control of Blood Volume and Extracellular Fluid Volume and Chapter 30: Acid-Base Regulation and Chapter 31: Diuretics, Kidney Diseases Test Bank

1.

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Questions 1-3: The diagrams represent various states of abnormal hydration. In each diagram, the normal state (solid lines) is superimposed on the abnormal state (dashed lines) to illustrate the shifts in the volumes (width of rectangles) and total osmolarities (height of rectangles) of the extracellular fluid and intracellular fluid compartments.

Which of the diagrams represents the changes (after osmotic equilibrium) in extracellular and intracellular fluid volumes and osmolarities after infusion of a 2% solution of glucose (molecular weight of glucose = 180 g/mol)?

A. B. C. D.

ANS: B 2.

Which of the diagrams represents the changes (after osmotic equilibrium) in extracellular and intracellular fluid volumes and osmolarities in a patient with

inappropriate secretion of antidiuretic hormone syndrome (i.e., excessive secretion of ADH)?

A. B. C. D. ANS: B Which of the diagrams shown above would represent the changes (after osmotic equilibrium) in extracellular and intracellular fluid volumes and osmolarities after infusion of 4.0% dextrose (molecular weight of dextrose = 180 g/mol)?

A. B. C. D.

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3.

A 22-year-old male runs a 10 km race on a 90 °F day. If he loses three liters of sweat and also drinks 3 liters of water during the race, which of the following changes would you expect, compared to normal, after absorption of the water?

Intracellular Intracellular Extracellular Extracellular Volume Osmolarity Volume Osmolarity

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ANS: B

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A 60-year-old female patient appears to be dehydrated, with a hematocrit of 0.55 (55%) and a plasma protein concentration of 8.8 g percent (normal ~ 7.0). After obtaining a plasma sample, you find that she has hyponatremia, with a plasma sodium concentration of 110 mmol/L and a plasma osmolarity of 240 mOsm/L. You decide to administer 2.0 L of 3% sodium chloride. Her body weight was 80 kg before giving the fluid. Assume that: intracellular fluid volume = 40% of body weight before fluid administration extracellular fluid volume = 20% of body weight before fluid administration molecular weight of NaCl = 58.5 g/mol no excretion of water or electrolytes Calculate her approximate plasma osmolarity after administration of the NaCl solution and after osmotic equilibrium.

A. 240 mOsm/L B. 251 mOsm/L

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ANS: B

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A. B. C. D. E.

C. 265 mOsm/L D. 271 mOsm/L E. 286 mOsm/L ANS: D Calculate the approximate intracellular fluid volume in the patient in question 3 after administration of the 3% NaCl solution and after osmotic equilibrium.

A. 16.0 L B. 19.6 L C. 22.7 L D. 28.3 L E. 30.6 L F. 34.0 L

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ANS: D

A 55-year-old woman arrives at your office complaining that she has recently experienced rapid weight gain and marked fluid retention. Her lab values reveal a plasma protein concentration of 3.3 g percent (normal = 7.0) and her blood pressure is 110/70.

She has 4+ protein in her urine. Which of the following changes would you expect to find, compared with normal?

Thoracic Interstitial Capillary Interstitial Fluid Lymph Flow Fluid Hydrostatic Fluid Protein Concentration Pressure Filtration A. B. C. D. E.

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If a person has a kidney transport maximum for glucose of 150 mg/min, a glomerular filtration rate (GFR) of 100 mL/min, a plasma glucose level of 250 mg/100 mL, and a urine flow rate of 2.0 mL/min, what would be the approximate rate of glucose excretion, assuming normal kidneys?

A. Glucose excretion rate cannot be estimated from this data B. 0 mg/min C. 50 mg/min D. 100 mg/min E. 150 mg/min F. 250 mg/min

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ANS: B

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7.

ANS: D 9.

You wish to evaluate kidney function in a 55-year-old, obese man with type II

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diabetes, and you ask him to collect his urine over a 24 hour period. He returns to you 4,320 mL of urine, which was collected over the preceding 24 hours. The clinical laboratory returns the following results from analysis of his urine and plasma samples: Plasma creatinine = 3.0 mg/100 mL Urine creatinine = 40 mg/100 mL Plasma potassium = 5.0 mmol/L Urine potassium = 20 mmol/L What is his approximate GFR, assuming that he collected all of his urine in the 24 hour period?

A. 10 mL/min B. 20 mL/min C. 30 mL/min D. 40 mL/min E. 80 mL/min ANS: D

What is the net renal tubular reabsorption rate of potassium in the patient described in question 7?

A. 0.280 mmol/min B. 0.140 mmol/min C. 0.060 mmol/min D. 0.030 mmol/min E. Potassium is not reabsorbed in this example.

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10.

A 22-year-old female patient complaining of headaches presents to your office. An examination reveals that her blood pressure is 180/118 mmHg, and laboratory tests give the following results: Plasma renin activity = 14.5 (normal = 1.0) Plasma Na+ = 142 mmol/L

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ANS: B

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+ Plasma K = 2.9 mmol/L Magnetic resonance imaging of the kidneys suggests that she has a renin-secreting tumor in her left kidney. Compared with normal, which one of the following sets of conditions would you expect?

Renal Glomerular Capillary Filtration Peritubular Capillary Blood Flow Hydrostatic Pressure Fraction Hydrostatic Pressure A. B. C. D. E. ANS: B

12.

Which of the following substances would be filtered most readily by the glomerular capillaries?

A. Neutral dextran with a molecular weight of 25,000 B. Polycationic dextran with a molecular weight of 25,000 C. Polyanionic dextran with a molecular weight of 25,000 D. Albumin in plasma E. Red blood cells

ANS: B Compared with normal conditions, which one of the following sets of changes would you expect to find in a patient with acute proximal tubular necrosis and marked reduction of proximal tubular sodium chloride reabsorption?

GFR AfferentArteriolar Renal Blood Loop of Henle Sodium Reabsorption Resistance Flow A. B. C. D. E.

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13.

ANS: A

If the average hydrostatic pressure in the glomerular capillaries is 55 mmHg, the hydrostatic pressure in Bowman's space is 15 mmHg, the average colloid osmotic pressure in the glomerular capillaries is 30 mmHg, and there is no protein in the glomerular ultrafiltrate, what is the net pressure driving glomerular filtration in this example?

A. 0 mmHg B. 5 mmHg C. 10 mmHg D. 15 mmHg E. 25 mmHg F. 45 mmHg

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ANS: C 15.

Which of the following changes would you expect to find after administration of a vasodilator that selectively reduced afferent arteriolar resistance Renal GFR Glomerular Peritubular Blood Flow Capillary Capillary Hydrostatic Hydrostatic Pressure Pressure A. B. C. D.

E. F. ANS: C Which of the following changes would you expect to find in a newly diagnosed 12year-old patient with type I diabetes and uncontrolled hyperglycemia (plasma glucose = 400 mg/dL).

Afferent Arteriolar Thirst Urine Resistance GFR (Water Intake) Volume A. B. C. D. E. F.

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ANS: C

Questions 17 to19: Choose the appropriate nephron site in the diagram.

17.

In a person on a very low (20 mmol/day) potassium diet, which part of the nephron would be expected to reabsorb the most potassium?

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In a patient with severe "central" diabetes insipidus, caused by lack of ADH secretion, which part of the tubule would have the lowest tubular fluid osmolarity?

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ANS: A

ANS: E

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Which part of the nephron normally reabsorbs the most urea?

20.

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ANS: A

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19.

If the tubular fluid/plasma creatinine concentration ratio in the collecting duct is 100, what is the approximate percentage of the filtered water that remains at that point?

A. 0% B. 1% C. 10% D. 50% E. 100%

ANS: B 21.

You are following a patient in your nephrology clinic whose serum creatinine concentration has risen from 1.0 to 4.0 mg/dLover a period of five years. Which of the

following additional changes, compared with normal, would you expect to find in this patient? Assume steady-state conditions and that he has maintained the same diet.

A. Decreased filtered load of creatinine B. Decreased renal sodium excretion C. Decreased maximal urine concentrating ability D. Alkalosis E. Increased renal blood flow ANS: C Given the following measurements, calculate the filtration fraction: glomerular capillary hydrostatic pressure = 50 mmHg; Bowman’s space hydrostatic pressure = 10 mmHg; colloid osmotic pressure in the glomerular capillaries = 30 mmHg; glomerular capillary filtration coefficient (Kf) = 8 mL/min/mmHg; renal plasma flow = 500 mL/min.

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22.

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A. 0.16 B. 0.20 C. 0.25 D. 0.30 E. 0.35 F. 0.40 ANS: A

Which of the following changes would tend to reduce glomerular filtration rate?

A. Decreased afferent arteriolar resistance B. Increased glomerular capillary filtration coefficient C. Increased proximal tubular sodium reabsorption D. Decreased efferent arteriolar resistance E. Increased collecting tubule sodium reabsorption

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You begin treatment of a hypertensive patient with a large dose of a powerful diuretic (Lasix) that inhibits tubular reabsorption of NaCl by the loop of Henle. He returns to your office for a follow-up examination two weeks later. Compared with the patient's status before treatment, which one of the following sets of conditions would you expect to find?

Urine Na+ Arterial Extracellular Plasma

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ANS: D

Excretion A. B. C. D. E. F. ANS: C

Pressure

Fluid Volume

Renin Concentration

25.

Which of the following would cause the greatest degree of hypokalemia?

A. Chronic treatment with a diuretic such as spironolactone that inhibits the action of aldosterone B. Chronic treatment with a diuretic such as amiloride that inhibits sodium reabsorption in the late collecting ducts C. Chronic treatment with a diuretic such as furosemide that inhibits loop of Henle Na+-2Cl- K+ co-transport

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D. An increase in sodium intake from 150 to 300 mmol/day E. A reduction in potassium intake from 160 to 80 mmol/day in a person with normal kidneys and normal aldosterone system

Which of the following statements is correct?

A. Urea reabsorption in the inner medullary collecting tubule is less than in the distal convoluted tubule during antidiuresis B. Urea concentration in the interstitial fluid of the renal cortex is greater than in the interstitial fluid of the renal medulla during antidiuresis C. The thick ascending limb of Henle's loop reabsorbs more urea than the inner medullary collecting tubule during antidiuresis D. A chronic low protein diet tends to increase urine-concentrating ability E. The inner medullary collecting duct is more permeable to urea than is the cortical collecting tubule

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26.

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ANS: C

Evaluation of kidney function in a 46-year-old obese male with type II diabetes reveals the following: Urine volume = 5760 mL of urine, collected over the preceding 24 hours Plasma creatinine = 3 mg/100 mL Urine creatinine = 30 mg/100 mL Plasma potassium = 4.0 mmol/L Urine potassium = 20 mmol/L What is his approximate glomerular filtration rate (GFR), assuming that he collected all of his urine in the 24 hour period?

A. 10 mL/min B. 20 mL/min C. 30 mL/min D. 40 mL/min E. 80 mL/min

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ANS: E

ANS: D 28.

What is the net renal tubular reabsorption rate of potassium in the patient described in question 27?

A. 0.080 mmol/min B. 0.100 mmol/min C. 0.200 mmol/min D. 0.030 mmol/min E. 0.040 mmol/min F. Potassium is not reabsorbed in this example ANS: A Which of the following would tend to cause hyperkalemia by shifting potassium from the intracellular fluid into the extracellular fluid?

A. Aldosterone excess B. Acidosis C. Beta-adrenergic stimulation D. Increased insulin E. Decreased extracellular fluid osmolarity

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29.

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ANS: B

Questions 30 to 32: Match each of the patients in questions 30 to 32 with the correct set of blood values in the table. The same values may be used for more than one patient.

HCO3

(mmHg) 50 30 28 48 20

(mmol/L) 144 143 142 146 143

(mmol/L) 102 117 102 100 111

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Which patient has diabetic ketoacidosis and normal lungs?

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ANS: C 31.

Na+

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(mmol/L) 14 14 12 38 22

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pH 7.07 7.29 7.25 7.52 7.66

A. B. C. D. E.

pCO2

Which patient has an aspirin overdose and emphysema?

ANS: A 32.

Which patient has renal tubular acidosis?

ANS: B 33.

The clinical laboratory returns the following arterial blood values for a patient: pH = 7.2; plasma HCO3 = 29 mmol/L; plasma pCO2 = 75 mmHg. What is this patient's acidbase disorder?

A. Acute respiratory acidosis without renal compensation

B. Respiratory acidosis with partial renal compensation C. Acute metabolic acidosis without respiratory compensation D. Metabolic acidosis with partial respiratory compensation ANS: B In the patient described in question 33, compared with normal, which of the following laboratory values are you likely to find?

Urine Excretion New Renal Urine Excretion Urine pH + of NH4 HCO3 Produced of HCO3 A. B. C. D. E.

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34.

A patient’s urine was collected for four hours and the total volume was 960 mL during this time. Her urine osmolarity was 140 mOsm/L and her plasma osmolarity was 280 mOsm/L. What was her “free water clearance”? +4.0 mL/min +2.0 mL/min 0.0 mL/min –2.0 mL/min –4.0 mL/min None of the above

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ANS: C

ANS: B

Metabolic alkalosis tends to

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36.

intracellular K+ concentration and

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+ K secretion by the cortical collecting tubules.

A. Increase, increase B. Increase, decrease C. Decrease, increase D. Decrease, decrease E. Cause no change in, increase F. Cause no change in, cause no change in ANS: A 37.

In a patient with chronic excess aldosterone secretion (i.e., primary aldosteronism), you would expect to find which one of the following sets of conditions (compared with normal) under steady-state conditions, assuming that intake of electrolytes remained constant?

Arterial Pressure

Urine K+ Excretion Rate

Plasma K+ Conc.

Plasma Renin Conc.

Urine Na+ Excretion Rate

A. B. C. D. E. F.

Which one of the following sets of changes, compared with normal, would you expect to find in a patient with diabetes insipidus due to lack of ADH secretion and who has free access to plenty of water to drink?

Plasma Plasma Na+ Plasma Urine Water Osmolarity

Conc.

Protein Conc. Volume

ba

ANS: C

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w

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.te

st

Potassium secretion: A. Increases during acute acidosis B. Increases markedly when sodium intake is increased C. Is decreased by aldosterone D. Is decreased when plasma potassium concentration is increased E. Is increased when tubular sodium delivery to the collecting tubule is increased F. None of the above

ANS: E 40.

Intake

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A. B. C. D. E.

39.

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38.

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ANS: B

A patient has the following laboratory values: Arterial pH = 7.55 Plasma HCO3- = 40 mEq/L Plasma chloride concentration = 101 mEq/L Arterial pCO2 = 48 mmHg Plasma sodium = 150 mEq/L What is the most likely cause for his abnormal acid-base status?

A. Abnormal lung function (e.g., pneumonia) B. Excessive aldosterone secretion

C. Impaired renal tubular HCO3 reabsorption D. Chronic renal failure E. Diarrhea ANS: B Which of the following diuretics inhibits NaCl co-transport in the distal tubules as its primary action?

A. Thiazide diuretic B. Furosemide C. Carbonic anhydrase inhibitor D. Osmotic diuretic E. Amiloride F. Spironolactone

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41.

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ANS: A

Chapter 32. Diuretics, Kidney Diseases

st

Bleeding time (template) Erythrocyte count

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Test Bank

2–7 minutes

Platelet count

150,000–400,000/uL

Leukocyte count and differential Leukocyte count Neutrophils Eosinophils Basophils Lymphocytes Monocytes

4500–11,000/uL 54–62% 1–3% 0–0.75% 25–33% 3–7%

Partial thromboplastin time (activated) Prothrombin time

25–40 seconds 11–15 seconds

.te

Mean corpuscular hemoglobin Mean corpuscular hemoglobin concentration Mean corpuscular volume Reticulocyte count

Male: 4.3–5.9 million/uL Female: 3.5–5.5 million/uL Male: 41–53% Female: 36–46% Male: 13.5–17.5 g/dL Female: 12.0–16.0 g/dL 25.4–34.6 pg/cell 31–36% Hb/cell 80–100 fL 0.5–1.5% of red cells

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Hematocrit

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Hemoglobin, blood

Leukocyte count and differential Leukocyte count Neutrophils Eosinophils Basophils Lymphocytes Monocytes

4500–11,000/uL 54–62% 1–3% 0–0.75% 25–33% 3–7%

Partial thromboplastin time (activated) Prothrombin time Bleeding time

25–40 seconds 11–15 seconds 2–7 minutes

A 52-year-old female with type 1 diabetes has had progressive renal failure over the past three years. She is not on dialysis and her examination shows no abnormalities. Her hemoglobin level is 9 g/dL, hematocrit is 29%, and mean corpuscular volume is 92 fL, and a blood smear shows normocytic, normochromic cells. Which of the following is the most likely cause of the anemia?

A. Acute blood loss B. Pernicious anemia C. Sickle cell disease D. Erythropoietin deficiency E. Hemolytic anemia F. Polycythemia vera

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1.

ANS: D

Which of the following anemias has normocytic RBCs? A. Hemolytic anemia B. Vitamin B12 deficiency

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C. Folate deficiency D. Anemia of chronic disease

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2.

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ANS: A

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Olympic marathon runner.

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3.

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Questions 3 – 5: Which point on the graph most closely defines the following conditions?

Normal erythropoietin (EPO) levels are approximately 10.

ANS: D 4.

Polycythemia vera.

ANS: B 5.

Chronic disease.

ANS: E 6.

A healthy 3-year-old girl is brought to the emergency department because of severe uncontrolled nosebleed. She has a history of ear infections that have improved after

treatment. Her temperature is elevated. She has numerous small bruises on her arms and legs. Her laboratory studies show: Hemoglobin 4.6 g/dL Leukocyte count 3,000/mm3 Reticulocyte count

0.1%

m

Platelet count 12,000/mm3 Which of the following is the most likely explanation for these findings?

A. Anemia due to blood loss B. Aplastic anemia C. Sickle cell disease D. Mononucleosis

In the 5 month (middle trimester) fetus hematopoiesis is most active in the: A. Yolk sac B. Spleen C. Liver D. Bone marrow

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7.

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ANS: B

ANS: C

Following the donation of a unit of blood, how long before hematocrit begins to increase?

A. One hour B. Two hours C. 24 hours D. Five days E. Two weeks

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How would a cell that has a diameter of 9 m and an MCV of 106 be classified?

A. Macrocyte B. Microcyte C. Normal D. Either normal or slightly microcytic

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9.

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ANS: DC

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8.

ANS: A 10.

What are the laboratory findings in polycythemia vera?

A. Decreased hemoglobin and/or hematocrit, increased RBCs and granulocytes, decreased platelets B. Increased hemoglobin and/or hematocrit; increased RBCs, granulocytes, and platelets C. Normal hemoglobin and hematocrit, normal RBCs, increased granulocytes and platelets

D. Increased hemoglobin and/or hematocrit, increased RBCs, decreased granulocytes and platelets ANS: D Regarding erythropoietin, choose the correct answer: A. Erythropoietin is mainly secreted by the liver B. Injection of erythropoietin leads to a rapid increase in the number of circulating red blood cells within the next 48 hours C. Excessive exposure to x-rays with destruction of the bone marrow leads to an increased erythropoietin secretion D. Erythropoietin also acts on the spleen by decreasing red blood cell destruction

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11.

What is the safest and least expensive treatment for patients with polycythemia vera?

A. High altitude B. Decrease of iron levels C. Therapeutic phlebotomy D. Decrease of erythropoietin levels

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12.

k. co

ANS: C

ba

ANS: C

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Chapter 33. Red Blood Cells, Anemia, and Polycythemia

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Test Bank

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Bleeding time (template) Erythrocyte count

2–7 minutes

Platelet count

150,000–400,000/uL

Leukocyte count and differential Leukocyte count Neutrophils Eosinophils Basophils

4500–11,000/uL 54–62% 1–3% 0–0.75%

w

Mean corpuscular hemoglobin Mean corpuscular hemoglobin concentration Mean corpuscular volume Reticulocyte count

Male: 4.3–5.9 million/uL Female: 3.5–5.5 million/uL Male: 41–53% Female: 36–46% Male: 13.5–17.5 g/dL Female: 12.0–16.0 g/dL 25.4–34.6 pg/cell 31–36% Hb/cell 80–100 fL 0.5–1.5% of red cells

Hematocrit

Hemoglobin, blood

80–100 fL 0.5–1.5% of red cells

Platelet count

150,000–400,000/uL

Leukocyte count and differential Leukocyte count Neutrophils Eosinophils Basophils Lymphocytes Monocytes

4500–11,000/uL 54–62% 1–3% 0–0.75% 25–33% 3–7%

Partial thromboplastin time (activated) Prothrombin time Bleeding time

25–40 seconds 11–15 seconds 2–7 minutes

A 52-year-old female with type 1 diabetes has had progressive renal failure over the past three years. She is not on dialysis and her examination shows no abnormalities. Her hemoglobin level is 9 g/dL, hematocrit is 29%, and mean corpuscular volume is 92 fL, and a blood smear shows normocytic, normochromic cells. Which of the following is the most likely cause of the anemia?

A. Acute blood loss B. Pernicious anemia C. Sickle cell disease D. Erythropoietin deficiency E. Hemolytic anemia F. Polycythemia vera

ba

nk ta n

k. co

1.

m

Mean corpuscular volume Reticulocyte count

ANS: D

st

Which of the following anemias has normocytic RBCs? A. Hemolytic anemia B. Vitamin B12 deficiency

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2.

w

ANS: A

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C. Folate deficiency D. Anemia of chronic disease

Questions 3 – 5: Which point on the graph most closely defines the following conditions?

Normal erythropoietin (EPO) levels are approximately 10.

3.

Olympic marathon runner.

ANS: D 4.

Polycythemia vera.

ANS: B 5.

Chronic disease.

ANS: E 6.

A healthy 3-year-old girl is brought to the emergency department because of severe uncontrolled nosebleed. She has a history of ear infections that have improved after treatment. Her temperature is elevated. She has numerous small bruises on her arms and legs. Her laboratory studies show: Hemoglobin 4.6 g/dL Leukocyte count 3,000/mm3 Reticulocyte count

0.1%

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m

Platelet count 12,000/mm3 Which of the following is the most likely explanation for these findings?

A. Anemia due to blood loss B. Aplastic anemia C. Sickle cell disease D. Mononucleosis

In the 5 month (middle trimester) fetus hematopoiesis is most active in the: A. Yolk sac B. Spleen C. Liver D. Bone marrow

ba

7.

nk ta n

ANS: B

.te

Following the donation of a unit of blood, how long before hematocrit begins to increase?

A. One hour B. Two hours C. 24 hours D. Five days E. Two weeks

w

w

w

8.

st

ANS: C

ANS: DC 9.

How would a cell that has a diameter of 9 m and an MCV of 106 be classified?

A. Macrocyte B. Microcyte C. Normal D. Either normal or slightly microcytic

ANS: A 10.

What are the laboratory findings in polycythemia vera?

A. Decreased hemoglobin and/or hematocrit, increased RBCs and granulocytes, decreased platelets B. Increased hemoglobin and/or hematocrit; increased RBCs, granulocytes, and platelets C. Normal hemoglobin and hematocrit, normal RBCs, increased granulocytes and platelets D. Increased hemoglobin and/or hematocrit, increased RBCs, decreased granulocytes and platelets ANS: D Regarding erythropoietin, choose the correct answer: A. Erythropoietin is mainly secreted by the liver B. Injection of erythropoietin leads to a rapid increase in the number of circulating red blood cells within the next 48 hours C. Excessive exposure to x-rays with destruction of the bone marrow leads to an increased erythropoietin secretion D. Erythropoietin also acts on the spleen by decreasing red blood cell destruction

k. co

m

11.

What is the safest and least expensive treatment for patients with polycythemia vera?

A. High altitude B. Decrease of iron levels C. Therapeutic phlebotomy D. Decrease of erythropoietin levels

ba

12.

nk ta n

ANS: C

.te

st

ANS: C

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Chapter 34. Resistance of the Body to Infection: I. Leukocytes, Granulocytes, the Monocyte-Macrophage System, and Inflammation

Test Bank 1.

How long do monocytes/macrophages remain in the tissue?

A. Several minutes B. Several hours C. Several days D. Several months to years

ANS: D 2.

A patient visits his physician for the examination of a sore on the patient’s lip. There

was no pain or drainage from the sore. The patient was subsequently admitted to the hospital with a fever. His lab values were: HCT 34%, platelets 300,000/uL, WBC 4200/ uL, with 68% lymphocytes, 20% neutrophils.

What is the diagnosis of this patient?

A. A mild, non-treatable, infection B. Agranulocytosis C. Aplastic anemia D. Acute leukemia E. Hemolytic anemia ANS: B

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A 20-year-old man presents to the emergency room with a two week history of diarrhea following a trip out of the country. He is admitted to the hospital for dehydration. His stool specimen is positive for parasitic eggs. Which type of WBCs would have an elevated number?

A. Eosinophils B. Neutrophils C. T lymphocytes D. B lymphocytes E. Monocytes

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k. co

3.

ANS: A

ba

What occurs following activation of basophils?

A. Decreased diapedesis of neutrophils B. Decreased ameboid motion C. Contraction of blood vessels D. Increased capillary permeability

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4.

Neutrophils are capable of all of the following except?

A. Diapedesis B. Phagocytosis of whole red blood cells C. Ameboid motion D. Production of proteolytic enzymes for digestion of bacteria

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5.

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ANS: D

ANS: B 6.

Which of the following is true regarding white blood cells?

A. Granulocytes released from the bone marrow spend usually 10 to 20 days in the blood before entering the interstitial tissues B. Granulocytes are normally formed only in the bone marrow C. There are more granulocytes in the bone marrow than in the entire blood D. The concentration of neutrophils in the blood is half the concentration of lymphocytes

ANS: B 7.

Adhesion of WBC to the endothelium is: A. Due to a decrease in selectins B. Dependent on activation of integrins C. Due to the inhibition of histamine release D. Greater on the arterial than venous side of the circulation

ANS: B In a normal healthy person which of the following blood components has the longest life span?

A. Macrophages B. T cells C. Erythrocytes D. Platelets

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8.

Activation of basophils results in: A. Decreased diapedesis of neutrophils B. Decreased ameboid motion C. The prevention of clotting to allow diapedesis D. Decrease in capillary permeability

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9.

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ANS: A

During an inflammatory response, which is the correct order for cellular events?

A. Infiltration of monocytes from blood, increased production of neutrophils, activation of tissue macrophage, infiltration of neutrophils from the blood B. Activation of tissue macrophage, infiltration of neutrophils from the blood, infiltration of monocytes from blood, increased production of neutrophils C. Increased production of neutrophils, activation of tissue macrophage, infiltration of neutrophils from the blood, infiltration of monocytes from blood D. Infiltration of neutrophils from the blood, activation of tissue macrophage, infiltration of monocytes from blood, increased production of neutrophils

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10.

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ANS: C

ANS: B 11.

Basophils share functional and morphological characteristics with: Monocytes Macrophages Mast cells Myelocytes

ANS: C

Chapter 35.-CJapter 36 Resistance of the Body to Infection: II. Immunity and AllergyChapter 36. Blood Types; Transfusion; Tissue and Organ Transplantation

A mother of blood type A+ who has always been perfectly healthy just delivered her second child. The father is of blood group O-. Knowing that the child is of blood group O- (O, Rh-), what would you expect to find in this child?

A. The child will suffer from erythroblastosis fetalis due to rhesus incompatibility B. The child will suffer from erythroblastosis fetalis due to ABO blood group incompatibility C. The child will suffer from both A and B D. The child has no chance of developing HDN

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1.

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Test Bank

ANS: D

ba

Erythroblastosis fetalis due to Rhesus incompatibility can, in the newborn, lead to all of the following conditions EXCEPT: A. Severe anemia B. Jaundice due to increased circulating levels of bilirubin C. Mental retardation D. Atrophy of the spleen and the liver

w

Which couple cannot be the biological parents of a child with blood group AB? A. Mother AB, father AB B. Mother AB, father OO C. Mother OB, father AA D. Mother AA, father BB E. Mother OA, father OB

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3.

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ANS: D

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2.

ANS: B 4.

Which of the following transfusions will result in an immediate transfusion reaction?

A. O Rh- blood to an AB Rh+ patient B. B Rh+ blood to a A Rh+ patient C. AB Rh- blood to an AB Rh+ patient D. B Rh- blood to an B Rh- patient

ANS: B 5.

Which of the following is true concerning erythroblastosis fetalis?

A. There is a decrease in vitamin B12 in the fetus B. There are increased numbers of granulocytes in the mother C. The erythropoietin level of the fetus is decreased D. The free hemoglobin level in the fetus is elevated

ANS: D

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Which of the following is a true statement?

A. In a transfusion reaction there is agglutination of the donor blood B. Shutdown of the kidneys following a transfusion reaction takes several weeks C. Blood transfusion of Rh+ blood into any Rh- recipient will always result in an transfusion reaction D. A person with type O blood is considered a universal donor

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6.

A pregnant woman comes in for a visit. She is AB Rh+ and her husband is A Rh-.

This is her second child. What should be done at this time?

A. Nothing B. Administer anti-D immunoglobulin to the mother at this time C. Administer anti-D immunoglobulin to the child after delivery D. Administer anti-D immunoglobulin to the child if the child is Rh+

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7.

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ANS: A

A previously healthy, blood type O+, 22-year-old woman is admitted to the hospital because of gastrointestinal bleeding. She has a hematocrit of 25%. She receives three units of blood. During administration of a fourth unit, she develops severe back pain, shortness of breath, fever, decreased blood pressure and reddish brown urine. Which of the following is the most likely result of these findings?

A. ABO incompatibility B. Bacterial contamination of the blood C. Rh factor incompatibility D. Elevated IgE immunoglobins

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8.

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ANS: A

ANS: A 9.

A 45-year-old male, blood type O, is undergoing chemotherapy. The chemotherapy results in a decrease in his platelet count, resulting in a needed platelet transfusion.

Which of the following blood groups would be suitable platelet donors?

A. Type AB only B. Type O only

C. Types A, B, AB, and O D. Types A and B only E. Types A, B, and AB only ANS: B Which agglutinogens are present in a person with A+ blood?

A. A, B, D B. A, D C. D D. A E. None

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10.

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ANS: B

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Chapter 37. Hemostasis and Blood Coagulation

Test Bank

What is the proper pathway for the extrinsic clotting pathway?

A. Contact of blood with collagen, formation of prothrombin activator, conversion of prothrombin into thrombin, conversion of fibrinogen into fibrin threads B. Tissue trauma, formation of prothrombin activator, conversion of prothrombin into thrombin, conversion of fibrinogen into fibrin threads C. Activation of platelets, formation of prothrombin activator, conversion of D. Prothrombin into thrombin, conversion of fibrinogen into fibrin threads.

E. Trauma to the blood, formation of prothrombin activator, conversion of F. Prothrombin into thrombin, conversion of fibrinogen into fibrin threads

2.

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ANS: B

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.te

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ba

1.

What condition leads to a deficiency in factor IX that can be corrected by an intravenous injection of vitamin K? A. Classic hemophilia B. Hepatitis B C. Bile duct obstruction D. Genetic deficiency in antithrombin III

ANS: C 3.

A 2-year-old boy bruises easily and has a history of nosebleeds. His physical examination shows several small bruises on the legs. You would suspect that this patient

has a deficiency of which coagulation factor?

A. Prothrombin activator B. Factor II C. Factor VIII D. Factor X ANS: C Which one of the following substances cannot prevent coagulation when added to a blood sample (i.e., in the test tube)?

A. Heparin B. Coumarin C. Citrate D. Calcium chelators

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4.

ANS: B

All of the following statements regarding heparin are correct EXCEPT: A. Heparin acts by increasing the effectiveness of antithrombin III B. The concentration of heparin in the blood is normally very slight C. Heparin can be an effective anticoagulant even in the absence of antithrombin III D. Heparin is a powerful anticoagulant E. Heparin can be produced and released by basophils and mast cells

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5.

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Which of the following is a function of thrombin?

A. Activation of factor XIII to stabilize fibrinolysis B. Conversion of factor VII to VIIa C. Conversion of fibrinogen to fibrin D. Enhancement of factor V, VIII, and XI activity

What is the purpose of the PT test in monitoring hemostasis?

A. Measures factors of the extrinsic pathway B. Detects platelet dysfunction C. Detects presence of aspirin D. Monitors heparin function

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7.

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ANS: C

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6.

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ANS: C

ANS: A 8.

A patient presents with a platelet count of 212 x 103/µL and a bleeding time of 12 minutes. These results suggest: A. Decreased platelet production B. Defective platelet function

C. Increased platelet production D. Increased platelet destruction ANS: B 9.

Which of the following will not result in an increased bleeding tendency?

A. Liver disease B. Vitamin A deficiency C. Warfarin overdose D. Chronic aspirin medication

The excessive bleeding of a hemophiliac A (classical hemophilia) is usually caused

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by: A. An excessive endogenous secretion of heparin B. A genetic lack of factor VIII C. An inability to absorb vitamin K D. A moderate thrombocytopenia E. A genetic lack of factor IX ANS: B

In a disorder called scurvy: Bleeding abnormalities are unusual Plasma ascorbic acid levels are usually decreased Factor VIII is decreased A dietary Vitamin C deficiency is the cause

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11.

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10.

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ANS: BB

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ANS: D

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Chapter 38. Pulmonary Ventilation

Test Bank 1.

Which of the following lung volumes or capacities cannot be determined with a simple spirometer?

A. Vital capacity B. Expiratory reserve volume C. Inspiratory reserve volume D. Tidal volume

E. Functional residual capacity ANS: E Calculate the minute ventilation and the alveolar ventilation for a patient with a respiratory rate of 10 breaths/minute, a tidal volume of 600 mL, and a dead space of 150 mL. Minute Ventilation (L/min) Alveolar Ventilation (L/min) A. 4.5 3.0 B. 6.0 4.5 C. 8 6.5 D. 10 8.5 E. 12 10.5

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2.

Before inspiration, alveolar pressure is 0 and intrapleural pressure is -5 cm H O. At 2 the end of an inspiration in a healthy person, with the glottis open, these readings would be: A. Alveolar pressure of +2, intrapleural pressure of -8 cm H O 2 B. Alveolar pressure of -2, intrapleural pressure of -8 cm H O 2 C. Alveolar pressure of 0, intrapleural pressure of +5 cm H O 2 D. Alveolar pressure of 0, intrapleural pressure of -5 cm H O 2 E. Alveolar pressure of 0, intrapleural pressure of -8 cm H O 2

st

ba

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3.

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ANS: B

A 50-year-old man participates in a marathon. Which muscle(s) are being used for inspiration during the marathon?

A. Gastrocnemius B. Internal intercostals C. Abdominals D. External intercostals

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4.

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ANS: E

ANS: DD 5.

Pulmonary surfactant is formed by: A. Alveolar macrophages B. Goblet cells C. Type I alveolar cells D. Type II alveolar cells

ANS: D

6.

Which of the following would be expected to increase the measured airway resistance?

A. Stimulation of parasympathetic nerves to the lungs B. Low lung volumes C. Release of histamine by mast cells D. Forced expirations E. All of the above

Which of the following tend to decrease airway resistance?

A. Asthma B. Stimulation by sympathetic fibers C. Treatment with acetylcholine D. Exhalation to residual volume

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7.

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ANS: B When the abdominals contract: A. Intrapleural pressure becomes more negative B. Alveolar pressure decreases C. The recoil tendency of the lung increases D. Functional residual capacity decreases

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8.

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ANS: EE

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ANS: D B 9.

The most accurate statement about airway pressures during normal quiet breathing (as measured in the upper airway) is: A. At the end of expiration there is a slight amount of positive airway pressure, between 3 and 5 mmHg above atmospheric B. At the end of expiration airway pressure is the same as atmospheric C. At the end of inspiration there is a slight negative airway pressure, between -3 and -5 mmHg D. Airway pressure is atmospheric throughout the breathing cycle E. Airway pressure is below atmospheric throughout the breathing cycle ANS: B Questions 10-12: Use the following figure for questions 10-12.

10.

Assuming a respiratory rate of 12 breaths/min calculate the minute ventilation.

A. 1 L/min B. 2 L/min C. 4 L/min

D. 5 L/min E. 6 L/min ANS: E Assuming the same respiratory rate of 12 breaths/min calculate the alveolar ventilation.

A. 3 L/min B. 4 L/min C. 6 L/min D. 12 L/min E. Do not have enough information to calculate alveolar ventilation

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11.

What is the residual volume?

A. 1,000 mL B. 1,500 mL C. 2,000 mL D. 2,500 mL E. 5,000 mL

Residual volume: A. Is part of the expiratory reserve volume B. Is part of vital capacity C. Cannot be measured directly with a spirometer D. Represents the resting volume of the lungs E. Is the volume at which the lungs tend to recoil outward

A group of students is trying to see who can generate the highest expiratory flow.

Which muscle is most effective at producing a maximal effort?

A. Diaphragm B. Internal intercostals C. External intercostals.

D. Rectus abdominus E. Sternocleidomastoid

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14.

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ANS: C

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13.

ba

ANS: A

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12.

k. co

ANS: E

ANS: D

Chapter 39. Pulmonary Circulation, Pulmonary Edema, Pleural Fluid

Test Bank 1.

A person with normal lungs has an oxygen consumption of 750 mL O2/min. The

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hemoglobin concentration is 15 g/dL. The mixed venous saturation is 25%. What is the cardiac output?

A. 2,500 mL/min B. 5,000 mL/min C. 7,500 mL/min D. 10,000 mL/min E. 20,000 mL/min ANS: B

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Which of the following situations would be expected to decrease pulmonary vascular resistance?

A. Ascent to 15,000 ft above sea level B. Stimulation of the sympathetics C. Expiration to the residual volume D. Moderate exercise

ba

2.

With a slow decrease in left heart function, which of the following will reduce the formation of pulmonary edema?

A. An increase in plasma protein concentration due to fluid loss B. Increase in the negative interstitial hydrostatic pressure.

C. Increased pumping of lymphatics D. Increase in the concentration of interstitial proteins

4.

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ANS: C

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3.

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ANS: D

Which of the following circumstances might be expected to contribute to the formation of pulmonary edema?

A. Overtransfusion with plasma B. Occlusion of the lymphatic drainage of an area of the lung C. Right ventricular failure D. High concentration of plasma proteins

ANS: B 5.

During exercise: A. Blood flow is uniform throughout the lung

B. Lung diffusing capacity increases because blood flow is continuous in all pulmonary capillaries C. Pulmonary blood volume decreases D. The transit time of blood in the pulmonary capillaries does not change from rest ANS: B Blood flow in the lung: A. Is uniform in apical and basal regions in the supine position B. Not affected by positive pressure breathing C. Is not influenced by left atrial pressure D. Is independent of nervous system control

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6.

A 54-year-old woman with advanced emphysema due to long-term cigarette smoking is admitted to hospital due to shortness of breath. She is diagnosed with pulmonary hypertension. Her arterial blood gases are: pO2 = 55 mmHg pCO2 = 75 mmHg

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7.

k. co

ANS: D

pH = 7.3 What is the cause of the pulmonary hypertension in this person?

A. Increased alveolar pCO2

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ba

B. Increased sympathetic tone C. Decreased parasympathetic tone D. Decreased alveolar pO2

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E. Increased thoracic volume

Following a mild left-sided heart attack the lack of a formation of pulmonary edema would be due to: A. A decrease in lymphatic pumping B. A washout of the interstitial proteins C. An increase in interstitial colloid osmotic pressure D. A decrease in pulmonary capillary pressure

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8.

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ANS: D

ANS: B 9.

Going from a quiet, standing position to climbing a set of stairs which of the following conditions will be present?

Apical Flow Basal Flow A. B. C.

D. E. F. ANS: A A cardiac catheterization is done in a healthy person. The blood sample withdrawn from the catheter shows 60% oxygen saturation, and the pressure recording shows oscillations from a maximum of 26 mmHg to a minimum of 14 mmHg. Where was the catheter tip located?

A. Ductus arteriosus B. Foramen ovale C. Left atrium D. Pulmonary artery E. Right atrium

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10.

Within zone II, flow occurs: A. During diastole only B. During systole only C. During systole and diastole D. Periodically during diastole

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11.

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ANS: B

Pulmonary edema forms preferentially at the base of the lung because: A. pO2 is less at the base

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12.

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ANS: D Answer D Right atrial pressure has a ~0 mmmHg diastolic pressure.

B. pCO2 is higher at the base

13.

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ANS: C

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C. Intravascular pressure is greater at the base D. Vascular resistance is higher at the base

If the mean pulmonary arterial and left atrial pressures are 20 and 8 mmHg, respectively, and total blood flow is 5 L/min, what is the pulmonary vascular resistance?

A. 0.4 mmHg/L/min B. 1.2 mmHg/L/min C. 2.4 mmHg/L/min D. 3.6 mmHg/L/min

ANS: C 14.

Blood flow to the lungs is best described as being: A. Finely regulated by the parasympathetic nervous system

B. Finely regulated by the sympathetic nervous system C. Higher at the base than at the apex of the upright lung D. Directed mainly to areas that are hypoxic E. Constant throughout the duration of the respiratory cycle ANS: C A 25-year-old man has suffered a gun shot wound to his abdomen and has a dropping blood pressure due to hemorrhage. Which of the following statements about his condition is correct?

A. As his cardiac output and blood pressure drop, he will decrease the number of zone I regions in his lung B. If he sits upright, he will decrease the number of zone I regions in his lung C. The V/Q in the zone I regions of his lung is very low D. His physiologic dead space is increasing because of an increase in zone I regions of his lung

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15.

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ANS: D

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Chapter 40. Principles of Gas Exchange; Diffusion of Oxygen and Carbon Dioxide Through the Respiratory Membrane

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A. B. C. D. E.

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A child has been eating M&Ms (plain) and inhaled one down his airway, blocking his left bronchiole. Which of the following will describe the changes that occur?

Left Lung Alveolar pCO2 Left Lung Alveolar pO2 Systemic Arterial pO2

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1.

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Test Bank

ANS: C 2.

If alveolar pO2 is 300 mmHg and alveolar pCO2 is 40 mmHg, what is the piO2 (humidified inspired pO2)?

A. 250 mmHg B. 300 mmHg C. 350 mmHg D. 400 mmHg

E. 760 mmHg ANS: C 3.

Match the following with the letter indicating the most appropriate ANS: pO2 = 116 mmHg, pCO2 = 27 mmHg.

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A. Atmospheric air B. Alveolar air C. Blood in the left heart D. Blood in the right heart E. Expired air

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ANS: E

Twin patients, X and Y, both have respirations of 12/min, tidal volumes of 500 mL, and dead space of 100 mL. Patient X decreases the respiratory rate by half, and doubles the tidal volume. Patient Y doubles the respiratory rate and cuts the tidal volume in half.

After two minutes, what conditions would best describe their alveolar gases, as compared to normal.

Patient X Alveolar ventilation Patient Y Alveolar ventilation Alveolar pO2 Alveolar pCO2 Alveolar pO2 Alveolar pCO2

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4.

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A. B. C. D. E. ANS: C

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In an individual, the pO2 and pCO2 in different alveoli varies as follows:

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5.

pO2

pCO2

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Alveolus A 100 40 Alveolus B 40 45 Alveolus C 150 0 Which of the following statements is true?

A. Alveolus B is indicative of a dead space ventilation B. Alveolus C is indicative of pulmonary shunt C. Breathing 100% O2 would increase PO2 in alveolus C D. Hyperventilation would increase PO2 in alveolus B ANS: C 6.

A person with normal lungs at sea level (760 mmHg) is breathing 50% oxygen. What

is the approximate alveolar pO2?

A. 100 B. 159 C. 310 D. 330 E. 380 ANS: D If a lung having a normal ventilation-perfusion ratio (=1) SUDDENLY develops ventilation-perfusion ratio <1, which of the following will occur?

A. A decrease in arterial pO2

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7.

B. An increase in alveolar pO2

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C. A decrease in cardiac output D. A decrease in arterial pCO2

8.

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ANS: B

A 16-year-old girl is found unconscious in the street. She has no visible injuries and is taking shallow breaths of 6-8/min. An arterial blood gas shows a pO2 of 55 mmHg and her pCO2 is 75 mmHg. The cause of the hypoxemia is:

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A. Low V/Q ratio B. Intrapulmonary shunt C. Increased dead space ventilation D. Alveolar hypoventilation E. Elevated V/Q ratio ANS: D

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Questions 9-11: Consider a patient with an anatomical dead space of 100 mL, a normal respiratory rate of 12 breaths per minute and a normal tidal volume of 600 mL under resting conditions. Match each of the conditions in questions 9-11 with the correct set of respiratory rate, tidal volume, and metabolic changes. Answers may be used more than once.

Respiratory Rate Tidal Volume Metabolic Rate A. 6 1,100 normal B. 24 500 normal C. 16 400 4 times normal 9. Systemic arterial pO2 >120 mmHg. ANS: B 10. Systemic arterial pO2 of approximately 100 mmHg.

ANS: A 11. Systemic arterial pCO2 > normal.

ANS: C 12.

Perfusion of capillaries without ventilation of an alveolus: A. Results in an decrease in alveolar pO2 B. Results in an increase in systemic arterial pO2 C. Results in an increase in alveolar pCO2

13.

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ANS: D

For a patient at sea level (barometric pressure = 760 mmHg) and breathing 40%, oxygen calculate alveolar pO2 is:

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A. 149 B. 159 C. 235 D. 285 E. 304

st

ba

ANS: C

While lying supine in bed eating, a child aspirates a peanut into the left lung. What would be the V/Q ratio in the left Lung?

A. 0 B. 0.8 C. ∞

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ANS: A

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14.

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D. Results in a increase in systemic arterial pCO2

Chapter 41. Transport of Oxygen and Carbon Dioxide in Blood and Tissue Fluids

1.

A patient with no respiratory problems is given a blood transfusion. Which of the following will occur?

A. Arterial pO2 will increase

B. Arterial pCO2 will decrease C. Arterial saturation will increase D. Arterial oxygen content will decrease E. Arterial oxygen content will increase ANS: E 2.

Which of the following should decrease the affinity of hemoglobin for oxygen?

A. Low pCO2

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B. Alkalosis C. Acidosis D. Decreased body temperature

3.

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ANS: C

A person with anemia has a Hb concentration of 12 g/dL. He starts exercising and uses 12 mL O2/dL. What is the mixed venous pO2?

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A. 0 mmHg B. 10 mmHg C. 20 mmHg D. 40 mmHg E. 100 mmHg

A man fell asleep in his running car one evening. He was brought into the ER unconscious. His arterial pO2 was 95 mmHg. His arterial pCO2 was 40 mmHg. With

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4.

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ANS: B

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carbon monoxide poisoning you would expect his arterial oxygen saturation would be _______ while his venous oxygen saturation would be ______ .

A. Normal, decreased B. Decreased, decreased C. Increased, normal D. Increased, normal ANS: B 5.

An otherwise normal person has lost enough blood to decrease his body's hemoglobin concentration from 15 g/100 mL blood to 12 g/100 mL blood. Which of the following would be expected to decrease?

A. Arterial pO 2 B. Blood oxygen-carrying capacity C. Arterial hemoglobin saturation D. Arterial carbon dioxide content

ANS: B

6.

Using the following values calculate saturation: Hemoglobin concentration = 11 g/dL Oxygen content = 12 mL/dL A. 100% B. 81% C. 65% D. 56% E. 43%

ANS: C

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Acute hemorrhage causes a reduction of Hb concentration to 60% of normal in an otherwise health individual. If the alveolar ventilation and oxygen consumption rates remain the same as before the hemorrhage, which of the following will occur after the hemorrhage?

A. Normal arterial pO2, normal venous pO2

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B. Low arterial pO2, normal venous pO2

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7.

C. Low arterial pO2, Low venous pO2

D. Normal arterial pO2, low venous pO2

E. High arterial pO2, normal venous pO2

Initial conditions for a normal female subject (12 g Hb/100 mL blood) are the following (in the steady state).

Arterial pO2 = 100 mmHg

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8.

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ANS: D

Arterial O2 saturation = 90%

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Venous O2 saturation = 28%

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Venous pO2 = 25 mmHg

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Cardiac output = 5,000 mL/min Oxygen consumption = 500 mL/min If you ignore the contribution of dissolved O2 to the total O2 content, what is the venous O2 content?

A. 3.3 mL O2/100 mL blood B. 4.5 mL O2/100 mL blood C. 5.6 mL O2/100 mL blood D. 7.5 mL O2/100 mL blood ANS: B

9.

An increase in carbon monoxide will: A. Increase firing from the peripheral chemoreceptors B. Increase pCO2 C. Decrease arterial pO2 D. Decrease in arterial oxygen content

ANS: D

Coronary sinus blood.

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10.

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Question 10-13: Using the following figure determine which points will describe the following conditions? The same point may describe more than one condition.

Arterial blood in a person with end stage renal disease.

12.

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ANS: C

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11.

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ANS: A

Arterial blood in a normal person.

ANS: D 13.

Mixed venous blood of person at 500 ft above sea level.

ANS: B 14.

Arterial pO2 is 100 mmHg and arterial pCO2 is 40 mmHg. Total blood flow to all muscle is 700 mL/min. There is a sympathetic activation resulting in a decrease in blood flow to 350 mL/min. Which of the following will occur?

Venous pO2

Venous pCO2

A. ↑ B. ↓ C. ↓ D. ↔ E. ↑ F. ↓ G. ↔

↓ ↑ ↔ ↑ ↑ ↓ ↔

ANS: B

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A 22-year-old man was involved in a fight and received a blow to the head. On arrival to emergency department he was unconscious and was receiving assisted ventilation via a manual bag. His blood gases were: pO2 = 45 mmHg

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15.

pCO2 = 80 mmHg

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pH = 7.05 HCO3 = 27 mM In which form was most CO2 being transported in this patient?

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A. Dissolved B. Bicarbonate ions C. Carbaminohemoglobin compounds D. CO2 bound to plasma proteins

If the blood lacked red blood cells but the lungs were functioning normally: A. The arterial pO2 would be normal

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ANS: B

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B. The oxygen content of arterial blood would be normal C. Both A and B would apply D. Neither A nor B would apply ANS: A

Chapter 42. Regulation of Respiration

Test Bank 1.

Five hours after an uneventful knee surgery, a conscious 50-year-old woman has

minor heart pains and a decrease in systolic blood pressure from 110 to 90 mmHg. Arterial blood gas analysis on her breathing room air shows: pH 7.30 pCO2 52 mmHg pO2

58 mmHg

ANS: A Voluntary apnea (breath-holding) for 60 seconds will: A. Decrease alveolar pCO2

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2.

ANS: D

Which of the following play a part in the increase in ventilation with moderate exercise?

A. Reflexes from moving limbs B. Decrease in body temperature C. Fall in arterial pO2

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A 9-year-old boy decided to find out how long he could breathe into and out of a paper bag. After ~2 minutes his friends noticed that he was breathing very rapidly and forced him to stop. Which of the following was the most potent stimulus for the boy’s hyperventilation?

A. Decreased arterial PO2

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ANS: A

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D. Rise in arterial pCO2

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3.

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B. Increase arterial pO2 C. Inhibit the arterial chemoreceptors D. Increase alveolar pCO2

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Which of the following is the most likely cause of these findings?

A. Alveolar hypoventilation B. Cardiac failure C. Hypoxia due to anesthetic gases D. Pulmonary hypertension

B. Increased arterial PO2 C. Increased arterial PCO2 D. Decreased arterial PCO2 E. Increased pH ANS: C 5.

Which of the following conditions would be expected to stimulate the arterial

chemoreceptors?

A. Mild anemia B. Normal breathing C. Hypoxia due to ascent to high altitude D. Hyperventilation E. Exposure to carbon monoxide ANS: C 6.

Hyperventilation will result from: A. A decrease in arterial pCO2 to less than 30 mmHg

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B. Direct stimulation of the medulla chemosensitive area caused by an increase in pH C. An increase in alveolar pCO2

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D. An increase in alveolar pO2 ANS: C

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Which of the following would result in a decrease in nerve activity from the peripheral chemoreceptors?

A. A decrease in arterial oxygen content B. A decrease in blood pH C. A decrease in arterial blood pressure D. An increase in arterial pO2

ba

7.

While playing ball, a child fell and injured his head, producing a lesion in the respiratory center. As a result, he is hypoventilating. Twenty minutes after the accident the data that would best fit his condition are: pH pCO2 pO2 30 60 60 70 50

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A. 7.50 B. 7.35 C. 7.25 D. 7.30 E. 7.40

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8.

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ANS: D

60 100 60 80 90

ANS: C 9.

The main reason that respiratory compensation occurs in metabolic acidosis is due to stimulation of: A. The carotid bodies by CO2 B. The carotid bodies by H+ C. The central chemoreceptors by CO2

+ D. The central chemoreceptors by H E. The central chemoreceptors by O2 ANS: C

A. ↑ B. ↔ C. ↓ D. ↓ E. ↓ F. ↔

↔ ↔ ↔ ↓ ↓ ↓

↔ ↔ ↑ ↓ ↑ ↑

11.

During moderate aerobic exercise: A. Arterial pO2 increases B. Arterial pCO2 increases

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C. Arterial pH increases D. Blood lactate level decreases ANS: A

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Peripheral and central chemoreceptors may both contribute to the increased ventilation that occurs as a result of: A. A decrease in arterial oxygen content B. A decrease in arterial blood pressure C. An increase in arterial carbon dioxide tension D. A decrease in arterial oxygen tension E. An increase in arterial pH

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ANS: C

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ANS: B

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Which is the following occurs with carbon monoxide inhalation?

Alveolar pO2 Alveolar pCO2 Peripheral Chemoreceptor Activity

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10.

Chapter 43. Respiratory Insufficiency – Pathophysiology, Diagnosis, Oxygen Therapy

Test Bank

1.

In patients with a chronic hypercapnia (elevated pCO2), the normal ______ drive to breathe is replace with a ________ drive.

A. Hypoxic, hypercapnic B. Hypercapnic, hypoxic C. Apneustic, pneumotaxic D. Pneumotaxic, apneustic

ANS: B 2.

A chronic smoker has an arterial pO2 of 60 mmHg and an arterial pCO2 of 48. What will happen to arterial pO2 and pCO2 if the patient is placed on 100% O2?

Arterial pCO2

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A. B. C. D.

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ANS: C

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Which parameter decreases with emphysema?

A. Alveolar pCO2 B. Cardiac output C. Diffusion area D. Pulmonary artery pressure

Oxygen therapy is most beneficial in which of the following situations? Lung function is normal.

A. Anemia B. CO2 retention (COPD)

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4.

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ANS: C 3.

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Arterial pO2

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C. Cyanide poisoning D. High altitude ANS: D 5.

During severe pulmonary disease a stimulus for control of respiration is: A. A decrease in arterial oxygen content B. A decrease in arterial pCO2 C. A decrease in arterial pO2 D. An increase in arterial pH

ANS: C

6.

Many patients with ventilation-perfusion inequality have low blood pO2 but no CO2 retention because: A. The O2 and CO2 dissociation curves have different shapes B. These patients have an increased blood flow C. The diffusing capacity of CO2 is much higher than O2 D. There is hyperventilation due to the elevated pCO2

What is the most common cause of COPD? A. Smoking B. Occupational exposure C. Environmental exposure D. Genetic E. Restrictive lung diseases

8.

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ANS: A

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7.

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ANS: C

When a resting person breathes 100% oxygen in place of room air: A. The oxygen content in normal blood is more than doubled B. Systemic venous pO2 is higher than 40 mmHg C. Mixed venous pO2 will be more than 100 mmHg

ba

D. The quantity of CO2 added to the blood in systemic capillaries is significantly

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reduced

A patient complaints of shortness of breath; during the history you discover that he is exposed to a variety of environmental insults at his job. Which of the following diseases do you suspect?

A. Occupational asthma B. Pulmonary fibrosis C. Restrictive lung disease D. We cannot tell without pulmonary function tests

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ANS: C

ANS: D 10.

A COPD patient, while breathing room air, has a systemic pCO2 of 65 mmHg and a pO2 of 40 mmHg. Supplemental oxygen is administered at a rate to increase pO2 to 55 mmHg, which resulted in pCO2 increasing to 70 mmHg. The supplemental O2: A. Restored arterial dissolved O2 to normal B. Did not change breathing C. Reduced hypoxic stimulation of breathing

D. Increased the pulmonary excretion of CO2 ANS: C

Chapter 44. Aviation, High Altitude, and Space Physiology

A. 500 B. 28 C. 120 D. 33 E. 124

35 30 25 80 50

85% 60% 99% 45% 98%

An astronaut is exercising in space. He has an increase in cardiac output from 4 to 15 L/min. Blood flow in his lungs would be in ______ at rest and ______ during exercise.

A. Zone III, zone III B. Zone II, zone II C. Zone I, zone III D. Zone II, zone II

A tourist left New York and flew to Switzerland to climb Mt. Blanc in the Swiss Alps, which is 15,771 feet above sea level, barometric pressure = 420 mmHg. His physician had suggested that he take acetazolamide, a carbonic anhydrase inhibitor before and throughout his trip. IF he had taken this what would be the expected response?

A. Return of pH to normal B. Normal ventilation C. Hypoventilation D. Normal arterial blood gases

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ANS: A

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2.

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ANS: B

7.4 7.5 7.2 7.0 7.35

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Which of the following sets of data best describe a normal person breathing air at an altitude of 18,000 ft? pO2 pCO2 Saturation Arterial pH

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1.

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Test Bank

ANS: A 4.

Upon their return to earth after two weeks in space, an astronaut will exhibit: A. An increased blood pressure

B. An increased urinary output C. A decreased muscle tone D. An elevated cardiac output E. A normal blood volume ANS: C Which of the following will return toward normal during acclimatization to high altitude (12,000 ft)?

A. Arterial carbon dioxide tension B. Arterial hydrogen ion concentration C. Arterial hemoglobin concentration D. Alveolar ventilation

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5.

Compared with normal values at sea level, an acute (two-hour) expose to high altitude (15,000 ft) will result in which of the following?

A. Increase in blood hemoglobin to 22 g% B. Decrease in arterial pCO2 C. Blood acidosis D. Normal arterial oxygen saturation

B. Inspired pO2

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Between sea level and 10,000 ft altitude, which of the following will not different?

A. Fractional percentage of O2

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ANS: B

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6.

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ANS: B

C. Dissolved O2 in the blood

8.

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ANS: A

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D. Dissolved CO2 in the blood

Relative to sea level residents who have been at altitude for three days, high altitude natives have a lower: A. Systemic arterial pCO2 B. Systemic arterial pO2 C. Systemic arterial O2 bound to hemoglobin D. Resistance to O2 diffusion in the lungs

ANS: A 9.

A person is flying at 6,000 ft (barometric pressure 638 mmHg) in an unpressurized

airplane, breathing air. If alveolar ventilation is normal what would be his arterial pO2?

A. 50 mmHg B. 60 mmHg C. 75 mmHg D. 85 mmHg E. 99 mmHg ANS: C In an acclimatized person at high altitudes, oxygen delivery to the tissues may be adequate at rest because of: A. An increase in hemoglobin concentration B. The presence of an acidosis C. A decrease in the number of tissue capillaries D. The presence of a normal arterial pO2 E. The presence of a lower-than-normal arterial pCO2

A pilot is flying a pressured commercial airplane at 35,000 ft and is breathing normal air. There will be: A. A hypoxic vasoconstriction in his/her lungs B. A decrease in his/her alveolar pCO2

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11.

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ANS: A

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10.

C. An increase in his/her arterial pO2

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D. A hyperventilation due to increased pCO2

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E. A normal ventilation and normal blood gases ANS: E

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A non-acclimatized person is breathing air at an altitude of 15,000 ft (barometric pressure = 483). The person is walking and has a doubled alveolar ventilation and a doubled metabolism. What is the pO2 in the alveoli?

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A. 42 B. 66 C. 91 D. 152 E. 383

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12.

ANS: A

Chapter 45. Physiology of Deep-Sea Diving and Other Hyperbaric

Conditions

Test Bank 1.

A diver is breathing 21% O2 while suspended motionless at a depth of 99 feet. What is the alveolar pO2?

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m

A. 100 mmHg B. 149 mmHg C. 419 mmHg D. 578 mmHg E. 3,000 mmHg D ANS: D

A. ↑ B. ↔ C. ↓ D. ↓ E. ↓ F. ↔

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ANS: A

The partial pressure of oxygen in dry air (21% O ) inhaled by divers at a depth of 2 100 feet below sea level (4 atmospheres) is approximately: A. 160 mm Hg B. 320 mm Hg C. 640 mm Hg D. 1,280 mm Hg

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3.

↔ ↔ ↑ ↓ ↑ ↑

st

↔ ↔ ↔ ↓ ↓ ↓

nk ta n

Which of the following occurs during scuba diving?

Alveolar pO2 Alveolar pCO2 Peripheral Chemoreceptor Activity

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2.

ANS: C 4.

Regarding a healthy recreational scuba diver at a depth of 66 feet in the Caribbean Sea, which statement is true?

A. Her lungs are smaller than normal B. She has an elevated arterial pO2 and a normal pCO2 C. All gas partial pressures in her blood (oxygen, nitrogen, carbon dioxide and water vapor) are elevated D. There are increases in both fraction of inspired oxygen (FiO2) and inspired nitrogen

(FiN2) ANS: B A scuba diver is diving from the surface to 100 ft. He has an increase in cardiac output from 5 to15 L/min. As he swims downward, the blood flow in the base of his lungs will be in ______ and at the apex will be at ______.

A. Zone III, zone III B. Zone II, zone II C. Zone I, zone III D. Zone II, zone II

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5.

A 44-year-old male is scuba diving at 60 feet and loses track of the time. Upon return to the surface he notices pain in his knees. This pain is the result of: A. Nitrogen narcosis B. Excess generation of oxygen free radicals C. Decompression sickness D. Increase arterial pCO2

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6.

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ANS: A

ANS: C

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A scuba diver at a depth of 130 feet below the surface of the ocean has a minute respiratory volume of 5 L/min. Expressed as a sea level equivalent, the rate of air use from his tank is: A. 5 L/min B. 10 L/min C. 15 L/min D. 25 L/min

A diver at a depth of 500 feet will have a normal tidal volume to: A. Remove carbon dioxide from the blood B. To remove excess nitrogen C. Allow adequate diffusion of oxygen to blood D. To prevent collapse of the lungs

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ANS: D

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7.

ANS: A 9.

At a depth of 100 feet, a scuba diver inhales fully to achieve a lung volume of 6 liters.

As he rises to the surface, he continually exhales so that when he gets to the surface he still has a lung volume of 6 liters. How much air did he exhale?

A. 2 liters B. 10 liters

C. 14 liters D. 18 liters ANS: D 10.

A person is scuba diving at 100 feet breathing compressed air. What is the approximate alveolar pCO2?

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A. 10 mmHg B. 20 mmHg C. 40 mmHg D. 80 mmHg E. 160 mmHg

11.

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ANS: C

A diver is breathing 10% O2 at a pressure of 1,500 mmHg. The diver’s body temperature is 37 C, and pCO2 = 32 mmHg. What is the alveolar pO2?

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A. 63 mmHg B. 105 mmHg C. 150 mmHg D. 203 mmHg

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ANS: B

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Chapter 46. Organization of the Nervous System, Basic Functions of Synapses, and Neurotransmitters

Test Bank

Choose the best answer 1.

Prolonged changes in neuronal activity are achieved through the activation of: A. Voltage gated chloride channels B. Transmitter gated sodium channels C. G-protein coupled channels D. Voltage gated potassium channels

ANS: C

2.

In a neuron with a resting membrane potential of -65 mV, the distribution of which ion across the neuronal membrane represents the greatest potential electromotive force (EMF)?

A. Potassium B. Chloride C. Sodium D. Calcium

Inhibition of neuronal activity can be achieved by: A. Allowing calcium to enter the presynaptic membrane B. Opening sodium channels C. Opening sodium and chloride channels simultaneously D. Opening postsynaptic calcium channels

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3.

ANS: C

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Transmission of the electrical signal from the dendrites to the soma of a neuron occurs by: A. Short circuit current flow B. An action potential mechanism C. Electrotonic conduction D. Capacitive discharge

ba

4.

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ANS: C

Post-tetanic facilitation is thought to be the result of: A. Opening voltage-gated sodium channels B. Opening transmitter gated potassium channels C. A build up of calcium in the presynaptic terminal D. Electrotonic conduction

6.

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ANS: C

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5.

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ANS: C

Hypoventilation has which effect on neuronal activity?

A. Hypoventilation depress neuronal activity B. Hypoventilation increases neuronal activity C. Hypoventilation increases synaptic delay D. Hypoventilation decreases neurotransmitter release

ANS: A 7.

The opening of which of the following ion channels would have the least effect on the resting membrane potential of an average neuron?

A. Sodium B. Potassium

C. Chloride D. The opening of any of the above ion channels would effect the resting membrane potential to a similar degree ANS: C An excitatory postsynaptic potential (EPSP): A. Results from the simultaneous opening of sodium and chloride channels B. Results from the opening of potassium channels C. Results from the opening of sodium channels D. Results from the opening of calcium channels

ANS: C

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An inhibitory postsynaptic potential (IPSP): A. Results from the opening of potassium channels B. Results from the opening of sodium channels C. Results from the opening of voltage-gated sodium channels D. Results from the opening of voltage-gated calcium channels

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9.

ANS: A

Which of the following statements best describes the role of calcium in the release of a neurotransmitter substance from the presynaptic nerve terminal?

A. Calcium entry into the presynaptic terminal prevents the release of the neurotransmitter B. Calcium entry into the presynaptic terminal is necessary for the release of the neurotransmitter C. Calcium induces the opening of calcium-dependant sodium channels on the presynaptic terminal D. Calcium entry into the presynaptic terminal results in the formation of cAMP which induces a conformational change in the presynaptic sodium channel that leads to the release of neurotransmitter

11.

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ANS: B

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10.

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8.

Which of the following neurotransmitters is thought to be involved in the phenomenon of presynaptic inhibition?

A. GABA B. Serotonin C. Norepinephrine D. Acetylcholine

ANS: A 12.

Forced rapid breathing results in alkalization of the blood which would lead to which of the following changes in neuronal activity?

A. A decrease in neuronal activity B. An increase in neuronal activity C. An initial decrease followed by an increase D. No change in neuronal activity ANS: B In a neuron with a resting membrane potential of -65 mV, the distribution of which ion across the neuronal membrane represents the least potential electromotive force (EMF)?

A. Potassium B. Chloride C. Sodium D. Calcium

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13.

nk ta n

ANS: B

Choose the best answer.

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Which figure below represents the response of the most rapidly adapting receptor to the stimulus?

A. B. C.

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1.

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Test Bank

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Chapter 47. Sensory Receptors, Neuronal Circuits for Processing Information

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response stimulus

ANS: B 2.

Which figure below represents the response of the most slowly adapting receptor to a stimulus?

A. B. C.

response stimulus ANS: B Which of the following represents a rapidly adapting receptor?

A. Muscle spindle receptor B. Ruffini endings C. Meissner’s corpuscle D. Merkel discs

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3.

Which of the following statements best describes the receptor potential?

A. The receptor potential is always constant B. The greater the intensity of the stimulus, the greater the change in receptor potential C. Any change in the receptor potential will induce an action potential D. Receptor excitation always involves depolarization of the receptor

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4.

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ANS: C

ANS: B

Signal amplification can be achieved by which of the following neuronal pool schemes?

A. Divergence in the same tract B. convergence from multiple sources C. through lateral inhibition D. through a reverberating circuit

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5.

Which of the following types of sensory nerve fibers has the fastest transmission rate for action potentials?

A. Type C B. Type Aγ C. Type Aβ D. Type Aδ

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6.

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ANS: A

ANS: C 7.

In the various types of neuronal circuits, signal sharpening is achieved by which of the following?

A. A diverging circuit B. A converging circuit C. A reverberating circuit D. A circuit with lateral inhibition

ANS: D 8.

Which of the following types of sensory nerve fibers has the slowest rate of transmission nerve impulses?

A. Type C B. Type Aγ C. Type Aβ D. Type Aδ

Which of the following represents a slowly adapting receptor?

A. Pacinian corpuscle B. Semicircular canal receptor C. Meissner’s corpuscle D. Merkel discs

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9.

nk ta n

ANS: D

Which of the following types of neuronal circuits is self-stimulating once activated?

A. Converging B. Reverberating C. Diverging D. One that incorporates lateral inhibition

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10.

st

ANS: B

.te

Which of the following statements concerning the mechanoreceptive receptor potential are true?

A. An increase in stimulus energy results in an increase in receptor potential B. When receptor potential rises above a certain threshold, action potentials will appear in the neuron attached to the receptor C. The number of action potentials generated in the neuron attached to the receptor is proportional to the receptor potential D. All of the above are correct

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11.

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ANS: A

ANS: D 12.

Which of the following is a characteristic of almost all sensory receptors?

A. The ability to perceive a mechanical force B. The ability to be modulated by a change in temperature C. The ability to be excited by the application of a chemical irritant D. The ability to adapt to the stimulus

ANS: D

Chapter 48. Somatic Sensations: I. General Organization, the Tactile and Position Senses

Choose the best answer.

For a sensory nerve fiber that is connected to a Pacinian corpuscle located on the palmer surface of the right hand, the synaptic connection with the next neuron in the appropriate sensory pathway is located in: A. The right dorsal column nucleus B. The left dorsal column nucleus C. The dorsal horn of the right side of the spinal cord D. The dorsal horn of the left side of the spinal cord

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1.

ANS: A

For a sensory nerve fiber that is connected to a free nerve ending located on the left hand, the synaptic connection with the next neuron in the appropriate sensory pathway is located in: A. The right dorsal column nucleus B. The dorsal horn of the right side of the spinal cord C. The left dorsal column nucleus D. The dorsal horn of the left side of the spinal cord

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st

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2.

ANS: B

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The second neuron in the appropriate sensory pathway that connects a Meissner’s corpuscle in the left palm to the somatosensory cortex travels in the: A. The contralateral lateral lemniscus B. The ipsilateral anterolateral column C. The ipsilateral medial lemniscus D. The contralateral medial lemniscus

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3.

ANS: D 4.

The second neuron in the appropriate sensory pathway that connects a free nerve ending in the left thumb to the somatosensory cortex travels in the: A. The ipsilateral anterolateral column B. The ipsilateral medial lemniscus C. The contralateral anterolateral column D. The contralateral medial lemniscus

ANS: C Questions 5 – 8: A 36-year-old male was involved in a motor vehicle collision and received an injury to the spine at the C-7 level. The injury transected exactly half (anterior to posterior) of the spinal cord on the patient’s right side.

During the physical examination of this patient, two-point discrimination (fine touch) would: A. Be absent on the left side of the body B. Be absent on the right side of the body C. Not be affected by the injury D. Be enhanced on the right side

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5.

On which side of the patient would you expect pain and temperature sensations to be absent?

A. The left side B. The right side C. Pain and temperature sensations would not be affected on either side of the body D. Both sides

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6.

k. co

ANS: B

ANS: A

ba

On which side of this patient would you expect vibration sense to be absent?

A. The left side B. The right side C. Vibration sensation would be not be affected D. Both sides

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st

7.

On which side of this patient would the position sensation (proprioception) be absent?

A. The left side B. The right side C. Proprioceptive sensation would not be affected D. Both sides

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8.

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ANS: B

ANS: B Questions 9 – 12: An individual was brought into the emergency department following a motor vehicle collision. This individual is conscious and reports no loss of consciousness during the incident. There is no physical evidence of any head trauma. However, upon examination of this individual, the following sensory deficits are noted: loss of fine touch and vibration sense in both the left arm and leg including the hand and foot, loss of pain and temperature sense in the right arm and leg including the hand and foot.

9.

In the description above, the loss of fine touch and vibration sense involves which of the following nerve tracts?

A. The anterolateral system B. The dorsal column system C. The corticospinal tract D. The medial forebrain bundle

ANS: B In the description above, the loss of pain and temperature sense involves which of the following nerve tracts?

A. The corticospinal tract B. The pontocerebellar tract C. The dorsal column system D. The anterolateral system

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10.

ANS: D

nk ta n

In the description above, one can rule out a lesion in which of the following areas of the nervous system?

A. The cortex B. The brainstem C. The peripheral nerves D. The spinal cord

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11.

Which of the following is the most likely location of the injury to the nervous system in the above example?

A. The left side of the cervical spinal cord B. The right side of the cervical spinal cord C. The brain stem involving the left medial lemniscus D. The left side of the lumbar spinal cord

13.

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ANS: A

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12.

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ANS: A

Which of the following areas of the body has the greatest representation in the primary somatosensory cortex?

A. The foot B. The face C. The trunk D. The forearm

ANS: C 14.

Which of the following nerve structures carries axons from the dorsal column nuclei to the thalamus?

A. The spinothalamic tract B. The lateral lemniscus C. The mammillothalamic tract D. The medial lemniscus ANS: D

Test Bank The neospinothalamic tract: A. Transmits vibration sense B. Transmits proprioceptive information C. Transmits fast pain impulses D. Transmits slow pain impulses

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1.

ANS: C

ba

Stimulation of neurons in the nucleus raphe magnus: A. Can inhibit pain fibers at the level of the spinal cord B. Results in the activation of the periventricular region C. Results in the direct release of enkephalin from the raphe magnus neurons D. Both A and C are correct

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2.

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m

Chapter 49. Somatic sensations: II. Pain, Headache, and Thermal Sensations

Stimulation of which brain area can modulate the sensation of pain?

A. The superior olivary complex B. The locus coeruleus C. The periaqueductal gray D. The amygdala

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3.

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ANS: A

ANS: C 4.

Which of the following sensory modalities uses unmyelinated fibers to convey information to the central nervous system?

A. Proprioception B. Vision C. Vibration D. Pain

ANS: D 5.

Neurons located in which of the following areas release serotonin as their neurotransmitter?

A. The periaqueductal gray area B. The interneurons of the spinal cord C. The periventricular area D. The nucleus raphe magnus

ANS: D Which of the following is paired correctly?

A. Dorsal column system – pain and temperature sensation B. Layers I and II of somatosensory cortex – incoming signals from the thalamus C. Free nerve ending – type C fiber D. Large representation on post central gyrus – the foot

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6.

The highest degree of pain localization comes from: A. Simultaneous stimulation of free nerve endings and tactile fibers B. Stimulation of free nerve endings by bradykinin C. Nerve fibers traveling to the thalamus by way of the paleospinothalamic tract D. Stimulation of type Aδ fibers

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7.

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ANS: C

Which of the following are paired correctly?

A. Nucleus raphe magnus – β-endorphin B. Periaqueductal gray – serotonin C. Enkephalin – presynaptic inhibition of type Aδ fibers D. Intracranial headache – eye strain

9.

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ANS: C

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8.

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ANS: A

Massaging the skin or application of an irritant to the skin can suppress the transmission of pain signals from the corresponding body area by suppressing the sensory fibers transmitting the pain signal. Which of the following best describes this phenomenon?

A. Release of enkephalin from local neurons in the spinal cord B. Pre- and post-synaptic inhibition of type C fibers by serotonin C. Lateral inhibition of pain fibers by tactile fibers from adjacent skin areas D. Activation of periaqueductal gray neurons

ANS: C 10.

The “paleospinothalamic tract”:

A. Contains type Aβ nerve fibers B. Terminates exclusively in the thalamus C. Transmits the “fast pain” sensation D. Terminates predominantly in the lower brain regions ANS: D Which substance is responsible for activating pain receptors?

A. GABA B. Serotonin C. Bradykinin Δ. β-endorphin

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11.

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Chapter 50. The Eye: I. Optics of Vision

Test Bank

ba

Most of the refractive power of the eye is located in which of the following structures?

A. The iris B. The lens C. The retina D. The cornea

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1.

k. co

ANS: C

w

Accommodation for near vision (focusing on an object close at hand) requires which of the following?

A. Constriction of the pupil of the eye B. Dilation of the pupil of the eye C. Causing the lens of the eye to have more curvature (making it fatter) D. Causing the lens of the eye to have less curvature (making it thinner)

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2.

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ANS: D

ANS: C 3.

Accommodation will not occur if which of the following nerves is damaged?

A. The facial nerve B. The vagus nerve C. The oculomotor nerve D. The glossopharyngeal nerve

ANS: C 4.

Which of the following refractive problems most closely resembles presbyopia?

A. Myopia B. Astigmatism C. Hyperopia D. Cataracts

ANS: C Which of the following lenses has the greatest refractive power?

A. A 59 diopter lens B. A 25 diopter lens C. A 200 diopter lens D. A 100 diopter lens

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5.

Myopia is usually corrected by which type of lens?

A. A convex lens B. A concave lens C. A spherical lens D. A Newtonian lens

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6.

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ANS: C

During the process of accommodation, to focus on an object close at hand: A. The ciliary muscle relaxes B. The tension on the lens resulting from the suspensory ligament increases C. The lens becomes thinner D. The tension on the lens resulting form the suspensory ligament decreases

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ANS: B

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7.

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ANS: C

Which of the following are paired correctly?

A. An increase in resistance to flow through the canal of Schlemm – a decrease in intraocular pressure B. Myopia – focal point in front of the retina C. Hyperopia – correction by a concave lens D. All of the above are paired correctly

ANS: B 9.

Hyperopia usually results from: A. An unequal curvature of the cornea B. A lens that is too powerful for the globe of the eye

C. An eyeball that is too short D. An increase in intraocular pressure ANS: C 10.

Which of the following is the most important determinant of intraocular pressure?

A. The rate of production of aqueous humor B. The rate of production of vitreous humor C. The stiffness of the cornea D. The resistance to outflow of aqueous humor in the canal of Schlemm

ANS: B

Astigmatism usually results from: A. An unequal curvature of the cornea B. A lens that is too powerful for the globe of the eye C. A lens that is too weak for the globe of the eye D. An unequal curvature of the retina

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12.

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The condition of hyperopia is usually corrected by: A. A concave lens B. A convex lens C. A spherical lens D. A Schmidt-Cassegrain lens

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11.

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ANS: D

Cataracts are usually the result of which of the following?

A. Denaturation of the proteins in lens of the eye B. An eye globe that is elongated C. An unresponsive and dilated pupil D. Coagulation of the proteins in the lens of the eye

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ANS: A

ANS: D 14.

Astigmatism is usually corrected by: A. A concave lens B. A cylindrical lens C. A convex lens D. A spherical lens

ANS: B 15.

Accommodation for far vision (focusing on an object at a distance) requires which of the following?

A. Constriction of the pupil of the eye B. Dilation of the pupil of the eye C. Causing the lens of the eye to have more curvature (making it fatter) D. Causing the lens of the eye to have less curvature (making it thinner) ANS: D

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m

Chapter 51. The Eye: II. Receptor and Neural Function of the Retina

Test Bank

Which compound is responsible for activation of transducin during photoreception?

A. cGMP B. All-trans-retinal C. Rhodopsin D. Metarhodopsin II

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1.

During photoreception all of the following increase except: A. cGMP phosphodiesterase B. Transducin C. Metarhodopsin II D. Sodium influx into the outer segment of the rod

Which of the following statements is correct?

A. The total number of cones in the retina is much greater than the total number of rods B. Each individual cone responds to all wavelengths of light C. Activation of photoreceptors (rods and cones) results in hyperpolarization D. The central fovea contains only rods

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3.

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ANS: D

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2.

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ANS: D

ANS: C 4.

Which best describes the function of the horizontal cells of the retina?

A. The horizontal cells prevent the lateral spread of excitation caused by light on the retina B. Horizontal cells generate action potentials and transmit this activity to the lateral geniculate nucleus

C. Horizontal cells connect the photoreceptors to the ganglion cells D. Horizontal cells begin the analysis of the visual seen ANS: A Which of the following statements best describes the relatively poor visual acuity in humans at night compared to daylight?

A. The central fovea is the area of greatest visual acuity and this area contains only rods B. The central fovea is the area of greatest visual acuity and this area contains only cones C. The central fovea contains rods that have a connection ratio of 1:1 with ganglion cells D. The central fovea, the area of greatest visual acuity, is the exit point for ganglion cell axons which results in greater activation of photoreceptors in this area

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5.

In the retina the activation of adjacent rods and cones is prevented by the phenomenon of lateral inhibition. Which cell type is thought to be responsible for this process?

A. Bipolar cells B. Horizontal cells C. Ganglion cells D. Amacrine cells

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6.

k. co

ANS: B

st

Which of the following correctly explains the events that lead to the change in receptor potential in the rod photoreceptor during photoactivation?

A. cGMP dependent sodium channels in the outer segment of the rod open resulting in hyperpolarization of the receptor B. cGMP levels increase which results in depolarization of the receptor C. cGMP levels increase which results in an increase in the sodium influx into the outer segment of the rod and the receptor hyperpolarizes D. cGMP levels decrease which results in a decrease in sodium influx into the outer segment of the rod and the receptor hyperpolarizes

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7.

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ANS: B

ANS: D 8.

Which of the following statements is correct?

A. The total number of rods in the retina is much greater than the total number of cones B. Each individual cone responds to all wavelengths of light C. Activation of photoreceptors (rods and cones) results in depolarization D. The central fovea contains only rods

ANS: A 9.

Which of the following statements are true?

A. An individual rod can respond to all wavelengths of light B. In conditions of normal daylight, the level of cGMP is sufficient to keep open the sodium channels in the outer segment of the photoreceptors C. Light causes the outer segments of the photoreceptors to depolarize D. All of the above ANS: A Which area of the retina is responsible for the greatest visual acuity in humans?

A. The fovea B. The optic disc C. The pigment layer D. The central fovea

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10.

Under low or reduced light conditions, which of the following is responsible for the inward directed sodium current in the outer segments of the photoreceptors?

A. Metarhodopsin II B. cGMP C. cis-retinal D. cAMP

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11.

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ANS: D

Which cell types in the retina exhibit axon potentials?

A. Ganglion cells B. Amacrine cells C. Bipolar cells D. Horizontal cells

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ANS: A

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12.

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ANS: B

Chapter 52. The Eye: III. Central Neurophysiology of Vision

Test Bank 1.

Which of the following statements best describes the function of the lateral geniculate nucleus (LGN)?

A. The LGN is the site of convergence of the signals from the two eyes B. The LGN controls the involuntary fixation process C. The LGN controls the voluntary fixation process

D. The LGN provides a “gate control” for information destined to be received by the primary visual cortex ANS: D 2.

Ganglion cells attached to photoreceptors located on the nasal portion of each retina terminate in which of the following structures?

A. The contralateral lateral geniculate nucleus B. The calcarine fissure of the occipital cortex C. The contralateral medial geniculate nucleus D. The ipsilateral lateral geniculate nucleus

k. co

Injury to the superior cervical ganglion on the left side of the neck could result in which of the following symptoms?

A. Presbyopia in the left eye B. A dilated pupil in the left eye C. Blindness in the left eye D. A constricted pupil in the left eye

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3.

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ANS: A

ANS: D

The women of ancient Egypt who put an extract from the Belladonna plant into their eyes for cosmetic reasons would most likely have experienced the following decrement is visual function?

A. Difficulty in seeing objects close at hand B. Difficulty in seeing objects at a distance C. Difficulty in adjusting to low light conditions D. Difficulty in moving their eyes in a coordinated fashion

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Ganglion cells attached to photoreceptors located on the temporal portion of the retina project to which of the following structures?

A. The contralateral lateral geniculate nucleus B. The ipsilateral lateral geniculate nucleus C. The ipsilateral medial geniculate nucleus D. The calcarine fissure

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5.

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ANS: A

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4.

ANS: B 6.

Which of the following are paired correctly?

A. Layers 1 and 2 of the lateral geniculate nucleus – magnocellular pathway to primary visual cortex B. Layers 1, 4, and 6 of the lateral geniculate nucleus – input from ipsilateral ganglion cells

C. Layers 2, 3, and 5 of the lateral geniculate nucleus – input from contralateral ganglion cells D. All of the above are paired correctly ANS: A Consider the situation in which an individual is turning their head to the left about the axis of the neck. The motion begins while the chin is directly over the right shoulder and ends with the chin directly over the left shoulder. Which of the following best describes the eye movements associated with this type of head rotation in a normal individual?

A. While the head is turning, the eyes will be moving to the right and saccadic eye motion will be to the left B. While the head is turning, the eyes will be moving in the same direction as the head rotation and the saccadic eye motion will be to the left C. While the head is turning, the eyes will be moving to the right and the saccadic eye motion will be to the right D. While the head is turning, the eyes will remain stationary within the orbits and the saccadic eye motion will be to the right

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7.

ANS: A

The primary visual cortex is located: A. In the occipital lobe B. In the temporal lobe C. In the post-central gyrus D. In the parietal lobe

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8.

In which of the following cells of the retina are action potentials generated as a result of exposure to light: A. Horizontal cells B. Amacrine cells C. Bipolar cells D. Ganglion cells

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ANS: A

ANS: D 10.

Damage to the VIth cranial nerve will produce which of the following deficits in eye movement?

A. An inability to move the eyes in a vertical up and down motion B. An inability to rotate the eyes within the eye socket C. An inability to move the eyes laterally towards the midline D. An inability to move the eyes laterally away from the midline

ANS: D

11.

Fibers from which area of the retina converge on the left lateral geniculate nucleus?

A. The temporal portion of the left eye and the nasal portion of the right eye B. The temporal portion of the right eye and nasal portion of the left eye C. The nasal portion of the left eye and the temporal portion of the left eye D. The nasal portion of the right eye and the temporal portion of the right eye

The blind spot of the eye: A. Is located 15 degrees lateral to the central point of vision B. Is the exit point of the optic nerve C. Contains no rods or cones D. All of the above

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12.

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ANS: A

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ANS: D

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Chapter 53. The Sense of Hearing

Test Bank

st

Low frequency sound causes which portion of the basilar membrane to vibrate?

A. The portion close to the oval window B. The middle portion of the basilar membrane C. Low frequency sound induces vibration all along the length of the basilar membrane D. The portion close to the helicotrema

How many rows of outer hair cells are present in the human organ of Corti?

A. One B. Two C. Three D. Four

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2.

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ANS: D

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1.

ANS: C 3.

The function of the inner hair cells of the organ of Corti is best described as?

A. The inner hair cells transduce the auditory signal B. The inner hair cells adjust the sensitivity of the outer hair cells to stimulation C. The inner hair cells send inhibitory signals to the lateral geniculate nucleus

D. The inner hair cells stabilize the basilar membrane ANS: A 4.

Which structure within the central auditory pathway is involved in determining the direction of sound?

A. The trapezoid body B. The superior olivary nucleus C. The auditory cortex D. The inferior colliculus

High frequency sound causes which portion of the basilar membrane to vibrate?

A. The portion close to the oval window B. The middle portion of the basilar membrane C. Low frequency sound induces vibration all along the length of the basilar membrane D. The portion close to the helicotrema

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5.

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ANS: B

ANS: A

Damage to the inner hair cells of the organ of Corti located from the midpoint of the basilar membrane to the helicotrema will most likely result in which of the following?

A. A loss of the ability to perceive high frequency sounds B. A loss of the ability to taste all but the bitter taste sensation C. A loss of the ability to appreciate the floral scent D. A loss of the ability to perceive mid and low frequency sounds

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6.

The function of the rows of outer hair cells in the organ of Corti is to: A. Adjust the sensitivity of the inner hair cells to stimulation B. Transduce the auditory signal itself C. Determine the direction of sound D. Adjust the stiffness of the basilar membrane through reflex activity

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ANS: D

ANS: A 8.

In the central auditory system, nerve fibers from the superior olivary nucleus: A. Project to the medial geniculate nucleus via the medial lemniscus B. Project to the auditory cortex via the superior colliculus C. Project to the superior colliculus via the trapezoid body D. Project to the inferior colliculus via the lateral lemniscus

ANS: D 9.

Which of the following makes a direct connection with the round window?

A. The incus B. The stapes C. The malleus D. None of the above ANS: D Which of the following makes a direct connection with the oval window?

A. The tympanic membrane B. The stapes C. The malleus D. The incus

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10.

Which of the following is correct?

A. The amplitude of sound is determined by the position of displacement along the basement membrane of the cochlea B. The outer hair cells of the organ of Corti transduce the sound signal C. Amplitude of sound is determined by the amount of displacement of the basement membrane of the cochlea D. Frequency of sound is determined by the amount of displacement along the basement membrane of the cochlea

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11.

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ANS: B

st

In the central auditory pathway which of the following represents the correct sequence of structures in the pathway?

A. Cochlear nuclei – superior olive – inferior colliculus via the lateral lemniscus medial geniculate – auditory cortex B. Cochlear nuclei – inferior olive – inferior colliculus via the medial lemniscus - medial geniculate – auditory cortex C. Cochlear nuclei – superior olive – superior colliculus via the lateral lemniscus lateral geniculate – auditory cortex D. Cochlear nuclei – inferior olive – inferior colliculus via the lateral lemniscus - lateral geniculate – auditory cortex

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12.

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ANS: C

ANS: A 13.

The function of the round window can best be described by which of the following statements?

A. The round window provides the connection point for the stapes B. The round window serves to damp out low frequency sounds such as your own voice C. The round window transmits the frequency information into the cochlea from the tympanic membrane D. The round window serves as the pressure relief valve for the cochlea

ANS: D 14.

Which structure in the central auditory pathway is involved in determining the direction of sound?

A. The medial geniculate nucleus B. The superior olivary nucleus C. The lateral lemniscus D. Trapezoid body

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Chapter 54. The Chemical Senses – Taste and Smell

nk ta n

Test Bank

Glutamate is thought to be the primary source of stimulation of which of the following taste sensations?

A. Umami B. Sour C. Salty D. Bitter

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1.

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ANS: A

.te

Which of the following occurs during olfactory signal transduction?

A. The oderant molecule binds to the mucus layer covering the olfactory cilia which results in activation of voltage gated potassium channels B. The oderant molecule binds directly to an oderant gated ion channel C. The oderant molecule binds to an oderant binding protein which results in the activation of a G protein that induces the formation of cGMP which opens an ion channel D. The oderant molecule binds to an oderant binding protein which results in the activation of a G protein that induces the formation of cAMP which opens an ion channel

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2.

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ANS: C

ANS: D 3.

Damage to which of these cranial nerves would impair the bitter taste sensation?

A. The hypoglossal nerve B. The facial nerve C. The glossopharyngeal nerve D. The trigeminal nerve

ANS: C 4.

The sour taste sensation is the result of stimulation of the appropriate taste receptor by?

A. Long chain organic substances containing nitrogen B. Ionized salts C. Hydrogen ions D. Complex organic molecules

ANS: C

m

The bitter taste sensation is the result of stimulation of the appropriate taste receptor by?

A. Long chain organic substances containing nitrogen B. Ionized salts C. Hydrogen ions D. Complex organic molecules

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5.

ANS: A

Which of the following is not considered to be a primary sensation of smell?

A. Ethereal B. Floral C. Camphoraceous D. Umami

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ba

6.

The first central synapse for neurons transmitting the sweet taste sensation is in which of the following structures?

A. The nucleus of the vagus nerve B. The nucleus of the solitary tract C. The nucleus of the olfactory nerve D. The nucleus of the hypoglossal nerve

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ANS: D

ANS: B 8.

The facial nerve is responsible for the innervation of which of the following as it relates to the taste sensation?

A. The posterior portion of the tongue B. The extraglossal portion of the mouth C. The anterior portion of the tongue D. The lateral aspects of the posterior portion of the tongue

ANS: C

9.

The rapid adaptation of the taste sensation is thought to be a phenomenon: A. Related to the taste buds themselves B. Related to the area from which the taste buds are located on the tongue C. Related to a mechanism in the central nervous system D. Related to the type of taste sensation

ANS: C Which chemical properties must be at least partially present in a substance for it to be perceived by the olfactory system as an odor?

A. It must be water soluble B. It must be lipid soluble C. It must be volatile D. All of the above

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10.

ANS: D

Which of the following statements concerning the sensation of smell is correct?

A. The sensation of smell is not well developed in humans B. The sensation of smell does not adapt to continuous stimulation C. The sensation of smell is transmitted in the solitary tract of the brain stem D. All of the above are correct

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11.

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ANS: A

In a muscle spindle receptor, which fiber is responsible for the dynamic response?

A. The extrafusal muscle fiber B. The static nuclear bag fiber C. The nuclear chain fiber D. The dynamic nuclear bag fiber

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1.

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Test Bank

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Chapter 55. Motor Functions of the Spinal Cord; the Cord Reflexes

ANS: D 2.

Type II sensory afferents from the muscle spindle receptor are attached to which of the following structures?

A. The extrafusal muscle fiber B. The dynamic nuclear bag fiber C. The nuclear chain fiber

D. The gamma S fiber ANS: C 3.

Which of the following will increase the sensitivity of the stretch reflex?

A. Cutting the dorsal root fibers associated with the muscle in which the stretch reflex is being examined B. Increasing the activity of the medullary reticular nuclei C. Bending the head forward D. Increased activity in the fusimotor (gamma motor neuron) system

Activation of a type 1b sensory neuron will have which of the following effects?

A. Contraction of the muscle fiber associated with this neuron B. An initiation of a complex spike output signal C. Central nystagmus D. Inhibition of muscle contraction in the muscle fiber associated with this neuron

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4.

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ANS: D

ANS: A

Assuming all sensory, motor, and reflex neuronal pathways are intact, skeletal muscle contraction can be caused by stimulation of which of the following?

A. Type 1a sensory nerve endings B. Type 1b sensory nerve endings C. Neurons in the ventromedial hypothalamus D. Preganglionic parasympathetic vagal nerves

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5.

The dynamic response of the muscle spindle receptor can best be described as: A. An increase in the activity of the nuclear chain fibers as a result of the change in length of the muscle fiber B. An increase on activity of the group II sensory afferents in response to the rate of change in length of the muscle fiber C. A decrease in the activity of the group 1a sensory afferents in response to a change in length of the muscle fiber D. An increase in the activity of the muscle spindle receptor that is proportional to the rate of change in length of the muscle fiber

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ANS: A

ANS: D 7.

Stimulation of type II sensory fibers innervating a muscle spindle: A. Will inhibit muscle contraction B. Will activate an inhibitory interneuron in the anterior horn of the spinal cord and lead to inhibition of Golgi tendon response C. Will activate a gamma motor neuron connected to the muscle containing the spindle

receptor D. Will activate an alpha motor neuron connected to the muscle containing the spindle receptor ANS: D The function of the Golgi tendon organ is: A. To sense the length of the muscle tendon in which it is located B. To provide the cerebellum with feedback information concerning which motor impulses have arrived at the anterior motor neurons of the spinal cord C. To transmit muscle stretch information to higher brain centers D. To sense muscle tension and equalize the contractile force exerted by groups of muscle fibers in a muscle

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8.

Assuming all sensory, motor, and reflex pathways are intact, muscle contraction can be caused by stimulation of which of the following types of neurons?

A. Alpha motor neurons B. Gamma motor neurons C. Type 1a sensory endings from a nuclear bag fiber D. All of the above

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9.

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ANS: D

Type 1a afferents innervate which of the following types of receptors in the muscle spindle apparatus?

A. Nuclear chain fibers B. Static nuclear bag C. Dynamic nuclear bag fibers D. All of the above

The sensitivity of the stretch reflex can be altered by: A. The activity in the olivocerebellar tract B. Simultaneous stimulation of the primary motor cortex and the supplemental motor area of the cortex C. The activity of the pontine reticular nuclei D. The activity of the corticospinal tract

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11.

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ANS: D

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10.

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ANS: D

ANS: C 12.

The stretch reflex initiated by tapping on the patellar tendon causes muscle contraction by which of the following mechanisms?

A. Activation of type Ia sensory fibers B. Activation of type Ib sensory fibers

C. Activation of gamma motor neurons D. Activation of inhibitory interneurons ANS: A 13.

Under normal conditions, activation of which of the following can lead to muscle contraction?

A. Free nerve endings B. Type Ia sensory fibers C. Nuclear chain fibers D. All of the above

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ANS: B

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Chapter 56. Cortical and Brain Stem Control of Motor Function Test Bank

Fine motor movement of the index finger can be elicited by stimulation of which of the following brain areas?

A. The primary motor cortex B. The lateral cerebellar hemisphere C. The premotor cortex D. The supplemental motor area

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1.

Decerebrate rigidity caused by simultaneous contraction of both the agonist and antagonist muscles in a limb can be alleviated by which of the following maneuvers?

A. Turning the head sharply toward the limb B. Bending the head forward C. Stimulating the pontine reticular formation by lightly stroking the palms of the hand D. Cutting the dorsal roots associated with the affected limb

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2.

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ANS: A

ANS: D 3.

The stretch reflex is used clinically to: A. Assess the integrity of the corticospinal tract B. Assess the function of the vestibulo-occular reflex C. Assess the level of activity of the gamma motor system D. Assess the function of the vestibular system

ANS: C

4.

In the right horizontal semicircular canal, rapid rotation of the head in the clockwise direction will cause the endolymph to move in which relative direction?

A. In a clockwise direction B. In a counterclockwise direction C. In an upward direction D. In a downward direction

Which of the following is paired correctly?

A. Gamma motor neuron – extrafusal muscle fiber B. Alpha motor neuron – intrafusal muscle fiber C. Betz cells – corticospinal tract D. Utricle – angular acceleration detection

The figure above represents the response of a hair cell in the crista ampullaris of the semicircular canal to stimulation by rotation in a human subject. With the subject’s eyes closed, the subjective sensation of rotation will be absent at which point/s indicated by the letters A through C? A. Point A B. Point B C. Point C D. Points A and C

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6.

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ANS: C

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5.

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ANS: B

ANS: B 7.

Which of the following structures in the vestibular apparatus is responsible for the detection of angular acceleration?

A. The statoconia B. The macula C. The semicircular canals D. The saccule ANS: C Which of the following brain regions contribute fibers to the corticospinal tract?

A. The somatic sensory cortex B. The supplemental motor area C. The primary motor cortex D. All of the above

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8.

The rubrospinal tract originates from which area of the brain?

A. The magnocellular area of the red nucleus B. The superior olivary nucleus C. The pontine reticular formation D. The nucleus raphe magnus

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9.

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ANS: D

ANS: A

The phenomenon of decerebrate rigidity can be explained, at least in part, by which of the following?

A. Stimulation of gamma motor neurons B. Loss of cerebellar inputs to the red nucleus C. Overactivity of the medullary reticular nuclei involved in motor control D. All of the above can explain the phenomenon of decerebrate rigidity

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10.

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ANS: A

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Chapter 57. Contributions of the Cerebellum and Basal Ganglia to Overall Motor Control

Test Bank 1.

Which of the following are paired correctly?

A. Lateral cerebellar hemisphere – coordination of axial muscles B. Spinocerebellum – sequencing and timing of motor movements C. Purkinje cells – inhibitory input to deep nuclear cells of cerebellum D. Cerebellar dysfunction – athetosis

ANS: C 2.

Stimulation of a complex spike pattern in the Purkinje cells of the cerebellum can be initiated by: A. Stimulation of the inferior olivary complex B. Stimulation of brain stem reticular nuclei C. Stimulation of neurons in the red nucleus D. Stimulation of the superior olivary complex

ANS: A

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Neurological disease associated with the cerebellum produces which of the following types of symptoms?

A. Resting tremor B. Athetosis C. Rigidity D. Ataxia

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3.

ANS: D

Purkinje cell input to the deep nuclear cells of the cerebellum: A. Is always stimulatory B. Is always inhibitory C. Is stimulatory only if it originates from the inferior olivary complex D. Is stimulatory only if it originates from mossy fibers

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4.

Which circuit in the basal ganglia is thought to be involved in the cognitive control of motor functions?

A. The caudate circuit B. The putamen circuit C. The Papez circuit D. The nigropallidal thalamic circuit

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ANS: B

ANS: A 6.

Chorea and choreiform movement is a sign of dysfunction in which brain region?

A. The substantia nigra B. The caudate nucleus and putamen C. The subthalamic nucleus D. The thalamus

ANS: B 7.

Parkinson’s disease is the result of:

A. Disruption of the putamen circuit B. Loss of GABA input from caudate nucleus and putaman to the substantia nigra C. Loss of dopaminergic input from substantia nigra to the caudate nucleus and the putamen D. Loss of serotonin input from subtantia nigra to the thalamus and subthalamus ANS: C Efferent fibers from the cerebellum originate in: A. The deep nuclear cell layer of the cerebellum B. The Purkinje cell layer of the cerebellar cortex C. The granular cell layer of the cerebellar cortex D. The molecular cell layer of the cerebellar cortex

Neurological disease associated with the globus pallidus produces which type of symptom?

A. Rigidity B. Chorea C. Hemiballismus D. Athetosis

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ANS: A

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ANS: D

Which of the following structures is not considered to be part of the basal ganglia?

A. The caudate nucleus B. The red nucleus C. The substantia nigra D. The putamen

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ANS: B

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10.

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8.

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11. Hemiballismus is associated with damage or dysfunction of which of the following structures?

A. The thalamus B. The caudate nucleus C. The subthalamus D. The red nucleus ANS: C 12. The structure in the motor system which compares intended motion with the actual motion and initiates corrective changes if the two are mismatched is: A. The flocculus of the cerebellum B. The pontine reticular nuclei C. The subthalamus

D. The inferior olive ANS: D 13. The flocculonodular lobe of the cerebellum is associated most closely with: A. The vestibular apparatus B. The subthalamic nucleus C. The rubrospinal tract D. the superior olivary nucleus ANS: A

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m

14. Afferent signals from the periphery of the body travel to the cerebellum in which of the following nerve tracts?

A. The ventral spinocerebellar tract B. The fastigioreticular tract C. The vestibulocerebellar tract D. The reticulocerebellar tract ANS: A

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Chapter 58. Cerebral Cortex, Intellectual Functions of the Brain, Learning, and Memory

Test Bank

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An inability to properly vocalize words without a loss of understanding of the meaning of the written word as well as the thought conveyed by the word might be associated with damage to which brain structure?

A. The arcuate fasciculus B. Wernicke’s area C. The amygdale D. The thalamus

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ANS: A

Questions 2-5: use the figure above to answer the questions.

2.

Which structure connects brain areas D and B? A. The medial forebrain bundle

B. The corpus callosum C. The dorsal longitudinal fasciculus D. The arcuate fasciculus ANS: D Which brain area is associated with verbal and symbolic intelligence?

A. A B. B C. D D. E

ANS: C

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Which brain area is associated with the elaboration of thought?

A. A B. C C. D D. E

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4.

ANS: A

Which area of the brain contributes to our understanding of the spacial coordinates of the body and its surroundings?

A. A B. B C. C D. E

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5.

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3.

ANS: D

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Which type of memory is thought to involve the potentiation of synaptic transmission through the accumulation of calcium in the presynaptic membrane?

A. Immediate memory B. Short-term memory C. Lifelong memory D. Long-term memory

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6.

ANS: A 7.

The main function of Broca’s area of the cortex is: A. To recognize a sound pattern as a word B. To interpret the sound as a word and the underlying intellectual meaning that is expressed by the word C. To control the thinking mind D. To activate and control the motor programs used in the vocalization of words

ANS: D 8.

Retrograde amnesia is usually the result of damage to, or dysfunction of which of the following structures?

A. The hippocampus B. The subthalamus C. The hypothalamus D. The thalamus

The creation of memory can be interrupted by: A. phosphorylation of a potassium channel to block it’s activity B. activation of adenylate cyclase C. an unnatural loss of consciousness D. enhancing protein synthesis

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9.

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ANS: C

Damage to Broca’s area on the dominant side of the brain results in which of the following neurological symptoms?

A. Anterograde amnesia B. Intension tremor C. Ataxia D. Aphasia

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ANS: D

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Which of the following structures provides the connection between Wernicke’s area and Broca’s area in the cerebral cortex?

A. The medial lemniscus B. The medial forebrain bundle C. The corpus callosum D. The arcuate fasciculus

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ANS: D

ANS: D 12.

Damage to the hippocamus may result in: A. An inability to form new memories (i.e., anterograde amnesia) B. A deficit in the sense of smell C. An inability to recall past memories (i.e., retrograde amnesia) D. Dysdiadochokinesia

ANS: A 13.

Long-term memory differs from other types of memory in which of the following ways?

A. It is not destroyed by temporary cessation of consciousness B. It can last for months or years C. It requires a period of consolidation D. All of the above ANS: D The two hemispheres of the brain are connected by which nerve fibers or pathways?

A. The lateral lemniscus B. Corticofugal fibers C. The corpus callosum D. The arcuate fasciculus

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14.

How are thalamic structures involved in memory?

A. The thalamus is involved in the creation of memory B. The thalamus provides the drive to consolidate memory C. Thalamic structures are important for recalling memories D. Thalamic structures are involved in determining which sensory experiences are important and which ones are not

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15.

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ANS: C

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ANS: C

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Chapter 59. Behavioral and Motivational Mechanisms of the Brain – The Limbic System and the Hypothalamus

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Chapter 60. States of Brain Activity – Sleep, Brain Waves, Epilepsy, Psychoses, and Dementia

Test Bank 1.

In an otherwise normal individual, dysfunction of which brain area will lead to behavior which is not appropriate for the given social occasion?

A. The ventromedial nucleus of the hypothalamus B. The amygdala C. The corpus callosum D. The fornix

ANS: B

2.

In which structure does the major output from the limbic system originate?

A. The hypothalamus B. The hippocampus C. The amygdala D. The mammillary body

ANS: A Which neuropsychiatric disorder is thought to be the result of an excess of the neurotransmitter dopamine?

A. Schizophrenia B. Major depressive disorder C. Mania D. Bipolar disorder

ANS: A Which of the following are paired correctly?

A. Major depressive disorder – locus coeruleus B. Schizophrenia – raphe nucleus C. Excess dopamine – mania D. All of the above are paired correctly

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ANS: A

Which of the statements concerning the function of the amygdala are correct?

A. The amygdala functions in behavior awareness at the semiconscious level B. The amygdala functions to project into the limbic system an individual’s status with respect to the surroundings and current thoughts C. The amygdala helps to pattern behavior appropriate for each occasion D. All of the above are correct concerning the function of the amygdala

The reward center is located in which of the following structures: A. The amygdala B. The dorsal raphe nucleus C. The periaqueductal gray region D. The tissue surrounding the medial forebrain bundle

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ANS: D

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3.

ANS: D 7.

The punishment center is located in which of the following structures?

A. The amygdala B. The dorsal raphe nucleus C. The periaqueductal gray region D. The tissue surrounding the medial forebrain bundle

ANS: D 8.

A lesion of the lateral area of the hypothalamus would be expected to result in which of the following conditions or symptoms?

A. Weight loss B. Weight gain C. Hyperaldosteronism D. Temperature dysregulation

ANS: A

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Stimulation of the periventricular nucleus in an animal will result in which type of neurological response?

A. Fear and punishment reactions B. An increase in appetite C. Decreased vegetative functions D. Coma

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9.

ANS: A

The gigantocellular neurons of the reticular formation release which of the following neurotransmitters?

A. Norepinephrine B. Serotonin C. Dopamine D. Acetylcholine

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10.

The neurons located in the locus coeruleus release which of the following neurotransmitter?

A. Norepinephrine B. Serotonin C. Dopamine D. Acetylcholine

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ANS: D

ANS: A

Chapter 61. The Autonomic Nervous System and the Adrenal Medulla

Test Bank 1.

Which of the following receptors is found in both the sympathetic and parasympathetic ganglia?

A. Nicotinic B. Muscarinic C. Adrenergic D. Dopaminergic

ANS: A

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The application of a solution containing atropine to the eye will result in which of the following?

A. Pupillary constriction B. An inability to focus on objects close at hand C. Ptosis D. Amblyopia

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2.

ANS: B

Selective bilateral damage to the gray ramus from T-1 to T-6 would most likely produce which of the following effects?

A. Bilaterally constricted pupils B. A lower than normal heart rate C. An increase in intestinal motility D. All of the above

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3.

Which of the following nerve fibers are contained in the gray ramus?

A. Postganglionic sympathetic fibers B. Preganglionic parasympathetic fibers C. Postganglionic parasympathetic fibers D. Preganglionic sympathetic fibers

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ANS: D

ANS: A 5.

Selective destruction of the right superior cervical ganglion would result in which of the following?

A. A dilated pupil in the right eye B. A dilated pupil in the left eye C. A fixed non-accommodating lens in the right eye D. A constricted pupil in the right eye

ANS: D

6.

Nicotinic receptors are found on which of the following nerve cells?

A. Sympathetic effector cells B. Sympathetic ganglionic cells C. Parasympathetic effector cells D. All of the above

ANS: B Which of the following is the neurotransmitter in autonomic ganglia?

A. Acetylcholine B. Norepinephrine C. Epinephrine D. Dopamine

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7.

Which of the following receptor types mediates an increase in heart rate and contractility?

A. Alpha1 receptors

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ANS: A

B. Alpha2 receptors C. Beta1 receptors

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D. Beta2 receptors ANS: C

Which drug stimulates beta1 and beta2 receptors?

10.

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ANS: C

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A. Phenoxybenzamine B. Albuterol C. Isoproterenol D. Reserpine

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9.

Beta2 receptor agonists are used to treat which of the following conditions?

A. Asthma B. Myasthenia gravis C. Heart failure D. Insecticide poisoning ANS: A

Chapter 62. Cerebral Blood Flow, Cerebrospinal Fluid, and Brain

Metabolism

Test Bank Which of the following best describes the major function of cerebrospinal fluid?

A. Cerebrospinal fluid is a major controller of brain glucose metabolism B. Cerebrospinal fluid delivers nutrients to deep brain structures C. Cerebrospinal fluid serves a protective role by cushioning the brain inside the bony vault of the skull D. All of the above are good descriptors of cerebrospinal fluid

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1.

Which of the following statements are correct?

A. The uptake of glucose into the brain is not insulin-dependant B. The increase in cerebral blood flow induced by CO2 is mediated by an increase in

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2.

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ANS: C

hydrogen ion concentration C. The brain accounts for approximately 15% of the total body metabolism and is highly oxygen-dependant D. All of the above

st

At mean arterial pressure levels between 140 mmHg and 170 mmHg, blood flow to the brain: A. Varies with the level of arterial pressure B. Is constant and not dependant on pressure C. Is independent of arterial pressure D. Is inversely proportional to arterial pressure

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ANS: A

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ANS: D

An increase in pCO2 from 40 mmHg to 80 mmHg would cause brain blood flow to:

A. Decrease by 50 percent B. Increase by 100 percent C. Increase by 50 percent D. Increase by 25 percent ANS: A 5.

Which of the following statements best describes the anaerobic capacity of the brain?

A. The brain can function well under anaerobic conditions because of its ability to use lactic acid as an energy source

B. The brain has very little anaerobic capacity C. The brain can function well under anaerobic conditions until the glycogen stores are depleted D. Both A and C are correct ANS: B Cerebrospinal fluid: A. Is produced by the choroid plexus of the lateral ventricles B. Is produced by the arachnoid villi C. Is absorbed by the aqueduct of Sylvius D. Is absorbed by the fourth ventricle

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7.

A patients pO2 is measured at 20 mmHg. What neurological effects would be seen in

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this patient?

A. Agitation and nervousness B. Normal responsiveness C. Comatose or unresponsive D. Somnolent but responsive to stimuli

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ANS: C

The total volume of cerebrospinal fluid in an adult human nervous system is approximately: A. 150 mL B. 500 mL C. 50 mL D. 300 mL

The total amount of cerebrospinal fluid produced each day by the choroid plexus of an adult human is approximately?

A. 150 mL B. 500 mL C. 50 mL D. 300 mL

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ANS: A

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ANS: A

ANS: B 10.

The normal cerebrospinal fluid pressure in an adult human is approximately?

A. 25 mmHg B. 15 – 20 mmHg C. 5 mmHg

D. 10 mmHg ANS: D

Chapter 63. General Principles of Gastrointestinal Function – Motility, Nervous Control, and Blood Circulation

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Most of the gastrin released following a meal is from which of the following structures?

A. Antrum B. Colon C. Duodenum D. Ileum E. Jejunum

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1.

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Test Bank

ANS: A

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An increase in intestinal blood flow is caused by a decrease in which of the following?

A. Adenosine levels B. CCK levels C. Gastrin levels D. Oxygen levels E. Secretin levels

Slow wave frequency is greatest in which of the following structures?

A. Duodenum B. External anal sphincter C. Ileum D. Jejunum E. Sigmoid colon

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ANS: D

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2.

ANS: A 4.

Gastrin, cholecystokinin, secretin, motilin, and glucose-dependent insulinotropic peptide are secreted from endocrine cells located in which of the following structures?

A. Antrum B. Colon

C. Duodenum D. Fundus E. Ileum ANS: C

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5. An oral glucose load is cleared from the circulation more rapidly compared with an intravenous glucose load. This interesting phenomenon can be attributed to the actions of which hormone?

A. Cholecystokinin (CCK) B. Gastrin C. Glucose-dependent insulinotropic peptide (GLIP) D. Motilin E. Secretin ANS: C

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6. The main excitatory neurotransmitter to gut smooth muscle is which of the following?

A. Acetylcholine B. Glucose-dependent insulinotropic peptide (GLIP) C. Noradrenalin D. Substance P E. Vasoactive intestinal peptide (VIP)

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ANS: A

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ANS: C

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7. Biopsies are taken from the antral and duodenal mucosa of a 45-year-old man. Which of the following hormones can be found in tissue homogenates from both locations?

A. Cholecystokinin (CCK) B. Glucose-dependent insulinotropic peptide (GLIP) C. Gastrin D. Motilin E. Secretin

8. If one cuts through a segment of small intestine from the outside into the lumen, in what order would the layers of the wall be cut?

A. Mucosa, submucosa, serosa, longitudinal smooth muscle, circular smooth muscle B. Longitudinal smooth muscle, submucosa, mucosa, serosa C. Mucosa, longitudinal smooth muscle, serosa, submucosa, circular smooth muscle D. Longitudinal smooth muscle, serosa, submucosa, mucosa, circular smooth muscle E. Serosa, longitudinal smooth muscle, myenteric plexus, submucosa, mucosa ANS: E 9. A 28-year-old medical student consumes a cheeseburger, fries, and chocolate shake. The

meal stimulates the release of several gastrointestinal hormones. The presence of fat, carbohydrate, or protein in the duodenum stimulates the release of which hormone from the duodenal mucosa?

A. Cholecystokinin (CCK) B. Glucose-dependent insulinotropic peptide (GLIP) C. Gastrin D. Motilin E. Secretin ANS: B

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10. The autonomic nervous system controls gut motility by changing which of the following?

A. Gastrin secretion B. Pacemaker discharge frequency C. Secretin secretion D. Slow wave frequency E. Spike potential frequency

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ANS: E

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11. An 87-year-old farmer has a breakfast of eggs, bacon, ham, grits with cheese, fried potatoes, biscuits with syrup, buttermilk, and coffee. Which of the following hormones is released by the presence of fat and protein in the small intestine and helps to decrease gastric emptying?

A. Cholecystokinin (CCK) B. Glucose-dependent insulinotropic peptide (GLIP) C. Gastrin D. Motilin E. Secretin

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ANS: A

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12. An increase in parasympathetic stimulation causes a decrease in smooth muscle contraction of which structure?

A. Duodenum B. Fundus C. Ileum D. Jejunum ANS: B 13. The endocrine or hormone secreting cells of the gastrointestinal tract are located in or closest to which layer of the gut wall?

A. Circular muscle B. Mucosa C. Muscularis mucosae D. Serosa

ANS: B

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14. A clinical experiment is conducted in which one group of subjects is given 20 grams of glucose intravenously and another group is given 20 grams of glucose orally. Which of the following factors can explain why the oral glucose load is cleared from the blood at a faster rate than the intravenous glucose load (CCK, cholecystokinin; GLIP, glucosedependent insulinotropic peptide; VIP, vasoactive intestinal peptide)?

A. CCK-induced insulin release B. CCK-induced VIP release C. GLIP-induced glucagon release D. GLIP-induced insulin release E. VIP-induced CCK release

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ANS: D

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15. At high concentrations, gastrin shares multiple effects with which gastrointestinal peptide?

A. Bombesin B. Cholecystokinin (CCK) C. Glucose-dependent insulinotropic peptide (GLIP) D. Secretin E. Motilin

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ANS: B

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ANS: A

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16. Slow wave frequency is highest at which of the following locations?

A. Duodenum B. Ileum C. Jejunum D. Stomach

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17. Which of the following regulates the frequency of slow waves in the small intestine?

Circadian rhythms Dietary intake of fiber Intrinsic pacemaker cells in the smooth muscle Parasympathetic nerve activity Sympathetic nerve activity ANS: C 18. The nervous system is directly involved in the release of which of the following GI hormones?

Gastrin Cholecystokinin Secretin GLIP Motilin A. no no no no no

B. no C. no D. no E. yes F. yes G. yes H. yes

no yes yes no no yes yes

yes yes yes no yes no yes

yes no yes no yes yes no

yes no no yes yes no no

ANS: E

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19. The stimulatory effects of gastrin on acid secretion are mediated in part by gastrininduced secretion of which of the following substances?

A. Acetylcholine B. Amino acids C. Gastrin-releasing peptide D. Histamine E. Somatostatin

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ANS: D

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20. Which of the following factors have a direct action on the parietal cell to stimulate acid secretion?

Gastrin Somatostatin Acetylcholine Histamine A. no no yes yes B. yes no no yes C. yes no yes yes D. yes yes yes yes E. yes yes no yes

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ANS: C

Chapter 64. Propulsion and Mixing of Food in the Alimentary Tract Test Bank 1. Which of the following would eliminate receptive relaxation of the lower esophageal sphincter and fundus portion of the stomach?

A. Increased serum gastrin B. Increased serum secretin C. Sympathectomy D. Sympathetic stimulation

E. Vagal stimulation F. Vagotomy ANS: F

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2. Which of the following elements of the defecation process require input from higher centers of the brain in a healthy person under normal conditions?

A. Peristaltic contractions of the sigmoid colon B. Rectal distention C. Rectal peristalsis D. Relaxation of external anal sphincter E. Relaxation of internal anal sphincter

Mass movements are often stimulated after a meal by distention of the stomach and distention of the duodenum. Mass movements often lead to which of the following?

A. Bowel movements B. Gastric movements C. Haustrations D. Esophageal contractions E. Pharyngeal peristalsis

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ANS: D

Achalasia is associated with which of the following at rest and during swallowing?

A. Higher than normal pressure at the lower esophageal sphincter B. Lower than normal pressure at the lower esophageal sphincter C. Higher than normal pressure at the upper esophageal sphincter D. Lower than normal pressure at the upper esophageal sphincter

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Distention of the rectum causes a reflex relaxation of which structure?

A. Abdominal muscle B. Diaphragm C. External anal sphincter D. Internal anal sphincter E. Sigmoid colon

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ANS: A

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ANS: A

ANS: D 6. Ileocecal sphincter tone decreases (relaxes) after distention of which structure?

A. Colon B. Esophagus C. Ileum D. Pharynx

E. Rectum ANS: C 7.

Mass movements are often stimulated after a meal by which reflex?

A. Coloileal reflex B. Enterogastric reflex C. Gastrocolic reflex D. Intestino-intestinal reflex E. Rectosphincteric reflex

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ANS: C

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8. The main mixing movement of the stomach is which of the following?

A. Primary peristalsis B. Receptive relaxation C. Retropulsion D. Segmentation contractions ANS: C

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9. A healthy 29-year-old man eats a breakfast of eggs, bacon, and toast. A decrease in which of the following delays gastric emptying in the man after eating the breakfast?

A. Intestinal peristalsis B. Pyloric tone C. Segmentation contractions in small intestine D. Tone of orad stomach

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ANS: D

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10. The swallowing center in the medulla has a critical role in totally inhibiting which of the following when food is swallowed?

A. Esophageal peristalsis B. Pharyngeal peristalsis C. Primary peristalsis D. Receptive relaxation E. Respiration (breathing) F. Secondary peristalsis ANS: E 11.

The primary purpose of migrating motility complexes is which of the following?

A. Move chyme through the small intestine during a meal B. Promote gastric emptying as a meal is digested C. Stimulation of mass movements D. Sweep undigested residue toward the colon

ANS: D Which one of the following manometric recordings illustrates normal function of the esophagus at mid-thoracic level before and after swallowing (arrow)? The dashed lines represent a pressure of 0 mmHg.

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12.

ANS: C

Migrating motility complexes are thought to be stimulated by which of the following?

A. Cholecystokinin (CCK) B. Gastrin C. Mass movements D. Motilin E. VIP

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13.

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ANS: D

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14. Which of the following structures is critical for determining whether a bolus of food is small enough to be swallowed?

A. Epiglottis B. Larynx C. Palatopharyngeal folds D. Soft palate E. Upper esophageal sphincter ANS: C 15.

Which one of the following manometric recordings illustrates normal function of the esophagus at a point below the diaphragm before and after swallowing (arrow)? The dashed lines represent a pressure of 0 mmHg.

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ANS: E

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A 20-year-old man severs his spinal cord at T6 in an automobile accident. He devises a method to distend the rectum to initiate the rectosphincteric reflex. Rectal distention causes which of the following in this man?

Relaxation of Internal Contraction of External Contraction Anal Sphincter Anal Sphincter of Rectum A. No No No B. No No Yes C. Yes No Yes D. Yes No No E. Yes Yes Yes

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16.

ANS: C

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A newborn boy does not pass meconium in the first 24 hours. His abdomen is distended, and he begins vomiting. Various other tests lead to a diagnosis of Hirschsprung's disease. An obstruction is most likely to be found in which portion of the gut?

A. Ascending colon B. Ileocecal sphincter C. Lower esophageal sphincter D. Pylorus E. Sigmoid colon

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w

17.

ANS: E 18.

Mass movements in the large intestine cause which of the following?

A. Contraction of internal anal sphincter B. Duodenal peristalsis C. Gastric retropulsion

D. Hunger sensations E. Rectal distention ANS: E Which of the following occur during the act of vomiting?

Lower Esophageal Upper Esophageal Abdominal Sphincter Sphincter Muscles A. Contract Contract Contract B. Contract Contract Relax C. Relax Contract Contract D. Relax Relax Contract E. Relax Relax Relax

Contract Relax Relax Contract Relax

k. co

ANS: D

Diaphragm

m

19.

Which of the following best describes the direct physiological effect of the various hormones on gastric emptying?

Gastrin Secretin CCK GIP Motilin A. Decrease Decrease Decrease Decrease Increase B. Increase Decrease None Decrease Increase C. None None Decrease Increase Increase D. None None Decrease None None E. None None Increase None None

ba

nk ta n

20.

st

ANS: D

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w

w

.te

21. A 39-year-old man suffers from chest pain when he eats, especially when he eats meat.

He also belches excessively and has heartburn. His wife complains about his bad breath.

The radiograph shows a dilated esophagus, and achalasia is suspected. Esophageal manometry confirms the diagnosis. Which one of the pressure tracings given below was taken at the lower esophageal sphincter of this patient before and after swallowing (arrow)? The dashed line represents a pressure of 0 mmHg.

ANS: C The ileocecal junction functions as a valve and a sphincter. Ileocecal sphincter tone increases after distention of which of the following?

A. Colon B. Esophagus C. Ileum D. Rectum E. Stomach

ANS: A

nk ta n

k. co

23. Receptive relaxation of the fundus is mediated by which substance?

A. Amino acids B. Gastrin C. Glucose-dependent insulinotropic peptide (GLIP) D. Secretin E. Vasoactive intestinal peptide (VIP)

m

22.

ANS: E

.te

st

ba

24. Conditions that tend to increase gastric emptying include which of the following?

A. Decreased peristalsis in stomach B. Increased tone of orad stomach C. Increased tone of pylorus D. Segmentation contractions in intestine ANS: B

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25. Which one of the pressure tracings given below illustrates normal function of the lower esophageal sphincter before and after swallowing (arrow)? The dashed line represents a pressure of 0 mmHg.

ANS: D

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m

26. A 2-year-old boy swallows a penny. The boy's mother checks his stool for several days, but the penny does not appear. Meanwhile, the boy has lost his appetite and seems to have difficulty eating. When a foreign object is swallowed, it often lodges at which portion of the gut?

A. Anus B. Duodenum C. Ileocecal sphincter D. Lower esophageal sphincter E. Pharynx F. Pyloric sphincter G. Rectum

nk ta n

ANS: D

st

ba

27. An 87-year-old man suffers a stroke that eliminates vagal nerve input to the gastrointestinal tract and severely curtains function of the glossopharyngeal nerve. Which of the following is operational in this man?

A. Pharyngeal phase of swallowing B. Primary peristalsis of the esophagus C. Receptive relaxation of the fundus D. Receptive relaxation of the lower esophageal sphincter E. Secondary peristalsis of the esophagus

.te

ANS: E

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w

w

28. Ileocecal sphincter tone decreases after distention of which of the following?

A. Colon B. Esophagus C. Ileum D. Rectum E. Stomach ANS: C 29.

A 44-year-old man severs his spinal cord at T1 in an automobile accident that leaves him a paraplegic. Chronic constipation becomes a problem. His physician advises him to distend the rectum digitally on a regular schedule to initiate the defecation reflex. Rectal distention causes which of the following in this patient?

A deep breath Closure of the glottis Contraction of external anal sphincter Contraction of internal anal sphincter

Increased abdominal pressure Increased peristaltic waves ANS: F A 43-year-old medical student suffers severe damage to the conus medullaris in an accident. He initiates defecation by inserting a balloon-tipped Foley catheter into his rectum and blowing up the balloon using a 50 mL syringe. Which reflex is stimulated by the balloon in this patient?

A. Duodenocolic reflex B. Enterogastric reflex C. Ileocecal reflex D. Intrinsic defecation reflex E. Spinal cord reflex

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30.

ANS: D

Which of the following reflexes results in the urge to defecate when the duodenum is distended?

A. Duodenocolic reflex B. Enterogastric reflex C. Gastrocolic reflex D. Ileocecal reflex E. Intestino-intestinal reflex

ba

nk ta n

31.

A newborn boy does not pass meconium in the first 24 hours. His abdomen is distended, and he begins vomiting. Hirschsprung’s disease is suspected. Which of the following is virtually absent from the constricted segment of the colon in this patient?

A. Blood flow B. Circular smooth muscle C. Ganglion cells D. Mucosa E. Serosa

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32.

st

ANS: A

ANS: C 33.

A 52-year-old man eats a healthy meal. Approximately 20 minutes later, the man has the urge to defecate. Which of the following reflexes results in the urge to defecate when the stomach is stretched?

A. Duodenocolic reflex B. Enterogastric reflex C. Gastrocolic reflex D. Ileocecal reflex E. Intestine-intestinal reflex

ANS: C 34.

A 36-year-old woman suffers severe damage to the conus medullaris in an automobile accident. Defecation requires the use of enemas. Which of the following does not occur in this woman?

A. Contraction of rectum B. Contraction of sigmoid colon C. Contraction of external anal sphincter D. Contraction of descending colon E. Relaxation of internal anal sphincter

The diagram shows manometric recordings from a patient before and after pelvic floor training. A balloon placed in the rectum was blown up (arrows) and deflated repeatedly. Tracing Z is a manometric recording obtained from the external anal sphincter before and after pelvic floor training. Which of the following best describe the origin of tracing X shown in the upper panel?

A. Distal rectum B. Ileocecal valve C. Internal anal sphincter D. Lower esophageal sphincter E. Proximal rectum

nk ta n

k. co

35.

m

ANS: C

st

The diagram shows manometric recordings from a patient before and after pelvic floor training. A balloon placed in the rectum was blown up (arrows) and deflated repeatedly. Tracing Z is a manometric recording obtained from the external anal sphincter before and after pelvic floor training. Which of the following best describes the condition for which the patient received pelvic floor training?

A. Anal fissure (i.e., tear or superficial laceration) B. Chronic type 7 stools C. Fecal incontinence (i.e., no control over defecation) D. Hemorrhoids E. Hirschsprung’s disease

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.te

36.

ba

ANS: C

ANS: C

Chapter 65. Secretory Functions of the Alimentary Tract Test Bank

1.

How does secretin stimulate the secretion of bicarbonate from the pancreas?

A. Closes potassium channels B. Closes sodium channels C. Decreases norepinephrine levels D. Increases acetylcholine levels E. Opens chloride channels

ANS: E A 67-year-old man has heartburn and stomach pain. Endoscopy shows several small gastric ulcers in the corpus. Biopsies were positive for H. pylori, which promotes gastric ulcer formation by damaging which of the following?

A. Circular muscle layer B. Gastric mucosal barrier C. G cells D. Myenteric plexus E. Parietal cells

nk ta n

k. co

m

2.

ANS: B

Which of the following decreases when salivary flow increases?

A. Bicarbonate concentration B. Chloride concentration C. Osmolarity D. Potassium concentration E. Sodium concentration

st

ba

3.

Which of the following leads to a decrease in salivary flow?

A. Chewing B. Fear C. Nausea D. Smooth objects in the mouth

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4.

.te

ANS: D

ANS: B 5.

The pH of the gastric contents is lowest under which condition?

A. After a fatty meal B. After a high protein meal C. After a starchy meal D. Between meals

ANS: D 6.

Which of the following substances secreted by the stomach is absolutely critical for

life?

A. Gastrin B. HCl C. Intrinsic factor D. Pepsin E. Rennin ANS: C A 44-year-old man underwent a cholecystectomy nine years ago. At that time, the liver was normal, but an enlarged pancreatic head was identified. Three years ago, he was admitted for upper gastrointestinal bleeding. Endoscopy revealed multiple ulcers in the duodenum. The serum gastrin level was 1,100 pg/mL (normal, 0 to 100 pg/mL).

Abdominal computed tomography revealed two masses in the pancreas and multiple liver metastases. The liver biopsy confirmed the presence of non-beta islet cell tumor tissue.

This patient is most likely to be suffering from which of the following diseases?

A. Achalasia B. Alcoholic cirrhosis C. Cystic fibrosis D. Diverticulosis E. Type II diabetes F. Zollinger-Ellison syndrome

nk ta n

k. co

m

7.

A 72-year-old man underwent a cholecystectomy seven years ago. At that time, the liver was normal, but an enlarged pancreatic head was identified. Three years ago, he was admitted for upper gastrointestinal bleeding. Endoscopy revealed multiple ulcers in the duodenum. The serum gastrin level was 1,000 pg/mL (normal, 0 to 100 pg/mL).

Abdominal computed tomography revealed two masses in the pancreas and multiple liver metastases. The liver biopsy confirmed the presence of non-beta islet cell tumor tissue.

Administration of which substance is useful in confirming the diagnosis in this man?

A. Cholecystokinin (CCK) B. Gastric inhibitory peptide (GIP) C. Pentagastrin D. Secretin E. Vasoactive intestinal peptide (VIP)

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.te

st

8.

ba

ANS: F

ANS: D 9.

Which one of the following sets of changes occurs in patients with pernicious anemia compared with the normal population?

Gastric Acid Output Serum Gastrin Levels A. B. C. D.

E. ANS: B Vagal stimulation tends to cause which of the following changes in the release of gastric-releasing peptide (GRP) and somatostatin?

GRP Somatostatin A. B. C. D. E.

m

10.

Intravenous administration of atropine causes which of the following changes in the ability of gastrin, acetylcholine, and histamine to stimulate acid secretion?

Gastrin Acetylcholine Histamine A. B. C. D. E.

nk ta n

11.

k. co

ANS: C

st

A 27-year-old woman eats a healthy dinner. The answer choices indicate the rate of acid secretion before and various times after the meal. At which time is the pH of the stomach contents the lowest?

Time Rate of Acid Secretion A. Before meal 2 mEq H+/hr

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.te

12.

ba

ANS: C

w

B. 30 mins after meal

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C. 60 mins after meal D. 90 mins after meal E. 120 mins after meal

35 mEq H+/hr 29 mEq H+/hr 20 mEq H+/hr 10 mEq H+/hr

ANS: A 13.

Which of the following can totally eliminate the cephalic phase of gastric secretion?

A. Antiacids (e.g., Rolaids) B. Anti-gastrin antibody C. Atropine D. Histamine H2 blocker E. Vagotomy

ANS: E A 65-year-old man with hematemesis and melena has a crescentic ulcer in the duodenum. Lavage dislodged the clot, revealing an underlying raised blood vessel, which was successfully eradicated by cautery with a bipolar gold probe. Which of the following factors are diagnostic for duodenal ulcer?

Endoscopy Plasma Gastrin Levels Rate of Acid Secretion A. No No No B. Yes No No C. Yes No Yes D. Yes Yes No E. Yes Yes Yes

m

14.

Which of the following factors stimulate the release of hormones or stimulate nervous reflexes, which can inhibit gastric acid secretion?

Acid Fatty Acids Hyperosmotic Solutions Isotonic Solutions A. No No Yes No B. No No Yes Yes C. Yes Yes No Yes D. Yes Yes Yes Yes E. Yes Yes Yes No

ba

nk ta n

15.

k. co

ANS: B

Most of the acid response to a meal occurs during which phase?

A. Cephalic phase B. Esophageal phase C. Gastric phase D. Intestinal phase

17.

w

ANS: C

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16.

st

ANS: E

Which of the following weakens the gastric mucosal barrier?

A. Bile salts B. Epidermal growth factor C. Gastrin D. Mucus

ANS: A 18.

The most common cause of chronic pancreatitis in adults is which of the following?

A. Alcoholism B. Celiac sprue C. Cystic fibrosis

D. Gallstones E. Malignancy ANS: A Which of the following is critical for stimulating bicarbonate excretion from the pancreas?

A. Acetylcholine B. CCK C. GIP D. Gastrin E. Secretin

m

19.

20.

k. co

ANS: E

Which of the following sets of changes occur as the rate of salivation increases?

Osmolarity Sodium Conc. Potassium Conc. Bicarbonate Conc.

nk ta n

A. B. C. D. E. F.

st

Which of the following can damage the gastric mucosal barrier and stimulate gastric acid secretion?

A. Bile salts B. Epidermal growth factor C. Gastrin D. Helicobacter pylori E. Mucus

22.

w

ANS: D

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.te

21.

ba

ANS: D

A 70-year-old woman undergoes a gastrectomy for Zollinger-Ellison syndrome. Her physician informs her that she will need to take intramuscular vitamin B12 shots for the rest of her life. Absence of which of the following cell types are responsible for this vitamin replacement requirement?

Chief cells G cells Goblet cells Mucous neck cells Parietal cells

ANS: E 23.

The stimulatory effects of gastrin on acid secretion are mediated in part by gastrininduced secretion of which substance?

A. Acetylcholine B. Amino acids C. Gastrin-releasing peptide D. Histamine E. Somatostatin

ANS: D

m

A 55-year-old woman with upper abdominal pain and blood in the stool had been taking NSAIDs for the pain. Endoscopy revealed global gastritis in the gastric fundus and body. A serious, potentially life-threatening, long-term problem is decreased secretion of which substance?

A. Gastrin B. HCl C. Intrinsic factor D. Pepsinogen E. Rennin

nk ta n

k. co

24.

ANS: C

ba

Which of the following is higher in saliva compared with blood plasma?

A. Chloride concentration B. Osmolarity C. Potassium concentration D. Protein concentration E. Sodium concentration

w

Acidification of the antrum diminishes amino acid–induced stimulation of gastrin secretion by increasing local levels of which substance?

A. Acetylcholine B. GRP C. Histamine D. Secretin E. Somatostatin

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26.

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ANS: C

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25.

ANS: E 27.

When does the pH of the gastric contents reach its lowest level?

A. 1.0 hour after a meal is taken B. 1.5 hours after a meal is taken C. 2.0 hours after a meal is taken

D. 2.5 hours after a meal is taken E. 3.0 hours after a meal is taken F. 4.0 hours after a meal is taken ANS: F Which of the following factors inhibit gastric acid secretion?

Somatostatin Secretin GIP Enterogastrones Nervous Reflexes A. No Yes Yes Yes No B. No Yes Yes Yes Yes C. Yes Yes No Yes Yes D. Yes Yes Yes No No E. Yes Yes Yes Yes Yes

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28.

ANS: E

A 48-year-old man with a recurrent history of ulcer disease associated with diarrhea and a strong family history of duodenal ulcer disease is suspected of having ZollingerEllison syndrome (i.e., gastrinoma). Secretin (1 unit/kg) was given as a rapid intravenous injection to test for gastrinoma. Which of the following results supports the existence of a gastrinoma after secretin administration?

A. Decreased serum gastrin B. Increased serum gastrin C. Inhibition of gastric acid secretion D. Inhibition of gastric emptying E. Stimulation of pancreatic HCO3 secretion

st

ba

nk ta n

29.

A 44-year-old woman with hematemesis has heartburn and stomach pain. Endoscopy shows inflammation involving the gastric body and antrum, as well as a small gastric ulcer. Biopsies were positive for H. pylori, which damages the gastric mucosa primarily by increasing mucosal levels of which substance?

A. Ammonium B. Bile salts C. Gastrin D. Nonsteroidal anti-inflammatory drugs (NSAIDs) E. Pepsin

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30.

.te

ANS: B

ANS: A 31.

A 61-year-old man is admitted as an emergency for upper gastrointestinal bleeding.

Endoscopy reveals multiple ulcers in the duodenum. Serum gastrin levels are eightfold higher compared with normal. Zollinger-Ellison syndrome (i.e., gastrinoma) is suspected.

Administration of which substance is useful in confirming the diagnosis in this man?

A. CCK B. GIP C. Motilin D. Pentagastrin E. Secretin F. VIP ANS: E Which of the following factors strengthen or weaken the gastric mucosal barrier?

Bile Salts Mucus NSAIDs Gastrin Ethanol Aspirin A. Strengthen Strengthen Weaken Weaken Strengthen Strengthen B. Strengthen Strengthen Weaken Weaken Weaken Strengthen C. Weaken Strengthen Strengthen Weaken Strengthen Weaken D. Weaken Strengthen Weaken Weaken Strengthen Weaken E. Weaken Weaken Weaken Strengthen Strengthen Weaken

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m

32.

Yes No Yes Yes Yes

Inhibitors Yes No No No Yes

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Blockers Yes Yes Yes Yes Yes

A 55-year-old man presents with abdominal pain and hematemesis. Findings of an abdominal examination were relatively benign, but abdominal radiographs suggested a perforated viscus. Endoscopy revealed a chronically perforated gastric ulcer, through which the liver was visible. Which of the following is a forerunner to gastric ulcer formation?

A. Back-leak of hydrogen ions B. Mucus secretion C. Proton pump inhibition D. Tight junctions between cells E. Vagotomy

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34.

w

ANS: C

No No No Yes Yes

.te

A. No B. Yes C. Yes D. Yes E. No

ba

A 54-year-old man with dyspepsia and a history of chronic gastric ulcer has abdominal pain. Endoscopy shows a large ulcer in the proximal gastric body. Biopsies were positive for H. pylori. Which of the following are used clinically for treatment of gastric ulcers of various causes?

Antibiotics NSAIDs H2 Proton Pump Pentagastrin

st

33.

nk ta n

ANS: D

ANS: A

35.

Administration of a histamine H2 receptor blocker causes which of the following changes in the ability of gastrin, acetylcholine, and histamine to stimulate acid secretion?

Gastrin Acetylcholine Histamine A. B. C. D. E.

ANS: D

m

What is the direct physiological effect of the various hormones on gastric acid secretion?

GastrinSecretin CCK GIP Motilin_ A. No effect Stimulate Stimulate No effect No effect B. Stimulate Inhibit No effect Inhibit No effect C. Stimulate Inhibit No effect No effect No effect D. Stimulate Inhibit Inhibit Stimulate Stimulate E. Stimulate Stimulate Inhibit Inhibit No effect

nk ta n

k. co

36.

ANS: B

A 77-year-old woman with upper abdominal pain and blood in the stool has been taking NSAIDs for arthritis. Endoscopy revealed patchy gastritis throughout the stomach.

Biopsies were negative for H. pylori. Pentagastrin administered intravenously led to a less than expected (i.e., less than normal) increase in which of the following?

A. Duodenal mucosal growth B. Gastric acid secretion C. Gastrin secretion D. Pancreatic enzyme secretion E. Pancreatic growth

Which of the following correctly pairs the secreted substance with the cell-type that secretes the substance?

Somatostatin/D-cell Cholecystokinin/I-cell Histamine/H-cell A. Correct Correct Incorrect B. Correct Correct Correct C. Correct Incorrect Incorrect D. Incorrect Correct Incorrect E. Incorrect Incorrect Correct F. Incorrect Incorrect Incorrect

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38.

w

ANS: B

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st

ba

37.

ANS: A

The control of gastric acid secretion in response to a meal involves several events that take place over a four or five hour period following the meal. These events include (1) a decrease in the pH of the gastric contents, (2) an increase in the rate of acid secretion, (3) a decrease in the rate of acid secretion, and (4) an increase in the pH of the gastric contents. Which of the following best describes the correct temporal order of events over a four or five hour period following a meal?

A. 4, 3, 2, 1 B. 3, 1, 4, 2 C. 3, 4, 1, 2 D. 2, 1, 4, 3 E. 4, 2, 1, 3 F. 1, 2, 3, 4 G. 2, 3, 1, 4 H. 1, 3, 2, 4

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39.

ANS: E

A 22-year-old male is fed intravenously for several weeks following a severe automobile accident. The intravenous feeding leads to atrophy of the gastrointestinal mucosa most likely because the blood level of which of the following hormones is reduced?

A. Cholecystokinin only B. Gastrin only C. Secretin only D. Gastrin and cholecystokinin E. Gastrin and secretin F. Secretin and cholecystokinin

st

ba

nk ta n

40.

Which of the following conditions in the stomach would most likely lead to the greatest amount of gastric acid secretion following a meal containing proteins?

Gastric pH Somatostatin A. ↑ ↓ B. ↑ ↑ C. ↓ ↓ D. ↓ ↑

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41.

.te

ANS: B

ANS: A

Chapter 66. Digestion and Absorption in the Gastrointestinal Tract

Test Bank A 35-year-old woman adds lots of high-fiber wheat and bran foods to her diet to reduce her cholesterol level. She had avoided eating wheat or rye foods since she was a child because her mother said they would make her sick. She loses 30 pounds on her new diet, but it has a number of undesirable side effects (i.e., stomach cramps, gas, and frequent diarrhea). She has also become weaker, finding it difficult to complete her morning walks. Her gastroenterologist diagnosed a malabsorption syndrome called gluten enteropathy or celiac disease (often referred to as celiac sprue). Which of the following is most likely to be increased in this woman?

A. Blood hemoglobin concentration B. Carbohydrate absorption C. Protein absorption D. Serum calcium E. Serum prothrombin F. Stool fat

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m

1.

What is the major form by which triglycerides are transported in lymph?

A. Apoproteins B. Chylomicrons C. Emulsified fat globules D. Free triglycerides E. Micelles

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ba

2.

nk ta n

ANS: F

.te

ANS: B

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3. Which of the following substances is digested only at the brush border of the small intestine by brush border enzymes?

A. Alanine B. Glucose polymers C. Lactose D. Polypeptides E. Triglycerides ANS: C 4.

Which of the following enzymes normally activates a proteolytic enzyme in the stomach?

A. Carboxypeptidase B. Lipase C. Pepsin D. Sucrase E. Trypsin

ANS: C 5.

The gastrointestinal hormone, secretin has a direct action to open which type of ion channel?

A. Calcium B. Chloride C. Magnesium D. Potassium E. Sodium

ANS: B

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m

6. Which of the following best describes the type of fat most abundant in the diet?

A. 2-monoglycerides B. Cholesterol C. Fatty acids D. Triglycerides

Which of the following best describes the mechanism by which monoglycerides and free fatty acids are transported from the gut lumen into enterocytes?

A. Co-transport with amino acids B. Co-transport with glucose C. Co-transport with sodium D. Facilitated diffusion E. Simple diffusion

st

ba

7.

nk ta n

ANS: D

.te

ANS: E

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w

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8. Which of the following enzymes initiates a cascade that activates all pancreatic proteases in the lumen of the small intestine?

A. Enterokinase B. Pancreatic amylase C. Pepsinogen D. Ptyalin E. Trypsin ANS: A 9. Which of the following is the most common cause of pancreatitis in children?

A. Alcoholism B. Celiac sprue C. Cystic fibrosis D. Gallstones E. Malignancy

ANS: C 10.

Which monosaccharides are bonded together to form a molecule of lactose?

A. Glucose and galactose B. Maltose and galactose C. Sucrose and glucose D. Two molecules of fructose E. Two molecules of glucose

ANS: A Fructose, galactose, and glucose are transported across the basolateral membrane of enterocytes by which hexose transporter?

A. GLUT 2 B. GLUT 3 C. GLUT 4 D. GLUT 5 E. GLUT 1

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k. co

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11.

ANS: A

Which cell type found in the liver removes nearly 99% of the bacteria in portal blood?

A. Blood endothelial cells B. Hepatocytes C. Kupffer cells D. Lymphatic endothelial cells E. Smooth muscle cells

st

ba

12.

Which of the following ions is most closely associated with fluid absorption from the gastrointestinal tract?

Calcium Chloride Phosphate Potassium Sodium

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13.

.te

ANS: C

ANS: E 14.

Which of the following ions is most closely associated with fluid secretion into the gastrointestinal tract?

A. Calcium B. Chloride C. Phosphate D. Potassium E. Sodium

ANS: B 15. The major constituent of chylomicrons is which of the following?

A. Cholesterol B. Free fatty acids C. Lipoproteins D. Phospholipids E. Triglycerides ANS: E

m

Which of the following best explains the mechanism of cystic fibrosis-induced pancreatitis?

A. Activation of enterokinase B. Activation of trypsin inhibitor C. Autodigestion of pancreas D. Excessive secretion of cholecystokinin (CCK) E. Gallstone obstruction

nk ta n

k. co

16.

ANS: C

.te

st

ba

17. Which of the following substances can be digested in the cytoplasm of enterocytes after its absorption from the intestinal lumen?

A. Amino acids B. Dipeptides C. Galactose D. Glucose ANS: B

w

A 23-year-old man consumes a meal containing a large amount of fat. At which of the following locations is bile salts most likely to be absorbed?

w

w

18.

ANS: D 19.

What is the major form by which free fatty acids and 2-monoglycerides are transported in chylomicrons?

A. 2-monoglyceride

B. Cholesterol esters C. Free fatty acids D. Glycerol E. Triglycerides ANS: E

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m

20. Which of the following substances is absorbed by enterocytes from the intestinal lumen by facilitated diffusion?

A. Free fatty acids B. 2-monoglyceride C. Fructose D. Galactose E. Glucose F. Oligopeptides ANS: C

nk ta n

Which of the following is the most abundant product of carbohydrate digestion?

A. Fructose B. Galactose C. Glucose D. Lactose E. Maltose

ba

21.

Cystic fibrosis causes a primary disruption in the transfer of which ion across cell membranes?

A. Calcium B. Chloride C. Phosphate D. Potassium E. Sodium

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.te

22.

st

ANS: C

ANS: B 23.

By which chemical process are carbohydrates, fats, and proteins digested into small enough components to be absorbed?

A. Deamination B. Decarboxylation C. Hydrolysis D. Oxidation E. Phosphorylation

ANS: C

A 10-year-old boy is admitted to the emergency department because of severe, watery diarrhea after consumption of polluted water. Cholera is suspected and later confirmed by the presence of V. cholerae in the stool. The diagram shows a secretory cell in the crypt of Lieberkühn of the small intestine. Cholera toxin exerts its effects by causing a primary upregulation of which step (labeled A to E) in the secretory mechanism?

nk ta n

k. co

m

24.

ANS: E

ba

Which of the following enzymes converts procarboxypeptidase-A to carboxypeptidase-A? A. Amylase B. Cholesterol esterase C. Enterokinase D. Lipase E. Trypsin

Activation of cystic fibrosis transmembrane conductance regulator (CFTR) channels leads to a primary increase in the secretion of which ion?

A. Calcium B. Chloride C. Magnesium D. Potassium E. Sodium

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26.

w

ANS: E

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.te

st

25.

ANS: B 27. Cholera toxin causes diarrhea by increasing intracellular levels of which of the following substances?

A. cAMP

B. Chloride C. Phosphodiesterase D. Sodium E. Water ANS: A

m

28. The most common cause of chronic pancreatitis in adults is which of the following?

A. Alcoholism B. Celiac sprue C. Cystic fibrosis D. Gallstones E. Malignancy

A 44-year-old woman adds lots of high-fiber wheat and bran foods to her diet to reduce her cholesterol level. She loses 30 pounds on her new diet, but she has a number of undesirable side effects (stomach cramps, flatulence, and frequent diarrhea). Her gastroenterologist diagnosed a malabsorption syndrome called gluten enteropathy or celiac disease. Which of the following is most likely to be decreased in this woman?

A. Fecal mass B. Microvilli C. Stool carbohydrates D. Stool Fat E. Stool nitrogen

st

ba

nk ta n

29.

k. co

ANS: A

.te

ANS: B

w

w

w

30. Cholera toxin causes severe diarrhea by increasing irreversibly the intracellular levels of cAMP. The increase in cAMP activates channels for which of the following ions?

A. Calcium B. Chloride C. Magnesium D. Potassium E. Sodium ANS: B 31. Various proteolytic enzymes are secreted in an inactive form into the lumen of the gastrointestinal tract. Which one of the following sets of substances is can activate one or more proteolytic enzymes?

Trypsin Enterokinase Pepsin A. No No No B. No No Yes C. No Yes No D. Yes Yes No

E. Yes

Yes

Yes

ANS: E 32.

Which of the following is a likely consequence of ileal resection?

A. Achalasia B. Atrophic gastritis C. Constipation D. Drooling E. Pernicious anemia

The establishment of an electrochemical gradient for which of the following substances is critical for absorption of nutrients from the small intestine?

A. Calcium B. Chloride C. Magnesium D. Potassium E. Sodium

nk ta n

k. co

33.

m

ANS: E

ANS: E

w w

ANS: B

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st

ba

34. Vibrio cholerae causes severe diarrhea by increasing irreversibly the intracellular levels of which substance?

A. Chloride ions B. Cyclic adenosine monophosphate (cAMP) C. Glucose D. Potassium ions E. Sodium ions

w

35. Which of the following best describes the length of time required for enterocytes to migrate from the crypt of Lieberkühn to the tip of a villus in the small intestine?

A. 1 day B. 5 days C. 10 days D. 50 days E. 120 days ANS: B 36.

Which of the following enzymes is attached to the plasma membrane of mature enterocytes of the small intestinal?

A. Amylase B. Chymotrypsin

C. Lipase D. Pepsin E. Sucrase F. Trypsin ANS: E The assimilation of fat includes (1) absorption of fat by enterocytes, (2) secretion of chylomicrons, (3) emulsification of fat, and (4) micelle formation. Which of the following best describes the correct temporal order of events?

A. 4, 3, 2, 1 B. 3, 1, 4, 2 C. 3, 4, 1, 2 D. 2, 1, 4, 3 E. 4, 2, 1, 3 F. 2, 4, 1, 3 G. 1, 2, 3, 4 H. 1, 3, 2, 4

nk ta n

k. co

m

37.

ANS: C

A 30-year-old woman visits her physician because of abdominal bloating, excessive flatus, and diarrhea. The physician notes the absence of surgical scars during a physical exam. The results of a 72-hour stool collection indicate excessive amounts of fat in the stool, and 90% of the stool fat consists of triglycerides. Which of the following best describes the nature of this patient’s problem?

A. Celiac disease B. Crohn’s disease C. Lactose intolerance D. Pancreatic disease E. Short bowel syndrome F. Ulcerative colitis

39.

w

ANS: D

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w

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st

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38.

A 19-year-old female visits her physician because of nausea, diarrhea, light headedness, and flatulence. The physician administers 50 grams of oral lactose at time zero, and measures breath hydrogen every 30 minutes for three hours using a handheld monitor. The results are shown. Which of the following best describes this patient’s condition?

A. Brush border lactase deficiency B. Brush border lactase excess C. Decreased pancreatic lactase D. Increased pancreatic lactase E. No digestive abnormality

ANS: A

40.

Which of the following best describes the origin of the hydrogen that is expired in the breath of a patient with lactose intolerance?

A. Colon B. Duodenum C. Ileum D. Jejunum E. Stomach

k. co

m

ANS: A

nk ta n

Chapter 67-Chapter 68. Physiology of Gastrointestinal DisordersChapter 68.

Metabolism of Carbohydrates and Formation of Adenosine Triphosphate

A high NAD+/NADH ratio in a cell would most likely facilitate which of the following?

A. Fatty acid oxidation B. Lactate formation C. Glucose oxidation D. Pyruvic acid formation

2.

w

w

ANS: C

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st

1.

ba

Test Bank

Which of the following best describes the fate of lactate produced in exercising skeletal muscle?

A. Converted to pyruvate in liver B. Converted to pyruvate in skeletal muscle C. Used as energy by liver D. Used as energy by skeletal muscle

ANS: A 3.

Which of the following enzymes enable the liver to export glucose?

A. Glucokinase B. Glucose-6-phosphatase

C. Glycogen phosphatase D. Hexokinase ANS: B 4.

Which of the following most likely contributes energy during anaerobic work in skeletal muscle?

A. Gluconeogenesis B. Fatty acid oxidation C. Phosphocreatine D. Oxidation of lactate to pyruvate

k. co

Which of the following best describes the substance that becomes the final common pathway for the transport of nearly all carbohydrates to cells in the body?

A. ATP B. Fructose C. Galactose D. Glucose E. NADPH

nk ta n

5.

m

ANS: C

ANS: D

ba

Which of the following mechanisms best describes how glucose is transported from the extracellular space to the interior of a muscle fiber?

A. Facilitated diffusion B. Primary active transport C. Secondary active transport D. Simple diffusion

w

If “C” represents the movement of glucose into skeletal muscle under control conditions, which curve would represent glucose transport after adding additional insulin?

w

7.

w

ANS: A

.te

st

6.

ANS: B

8.

Which of the following transporters facilitate insulin-sensitive, postprandial uptake of excess glucose from the bloodstream?

A. GLUT1 B. GLUT2 C. GLUT3 D. GLUT4

ANS: D Glucose transporter type 4 (GLUT4) is found mainly in which of the following tissues?

A. Adipose tissues only B. Adipose tissues, heart, liver, and skeletal muscle C. Heart only D. Heart, liver, and adipose tissues E. Liver only F. Skeletal muscle only G. Skeletal muscle, heart, and adipose tissues H. Skeletal muscle, heart, and liver

nk ta n

k. co

m

9.

ANS: G

Which of the following enzymes plays a critical role in capturing glucose intracellularly?

A. Citrate synthase B. Fumarase C. Glucokinase D. Glucose phosphatase E. Lactic dehydrogenase F. Succinic dehydrogenase

Which of the following best describes the process of glycogen formation?

A. Citric acid cycle B. Gluconeogenesis C. Glycogenesis D. Glycogenolysis

w

11.

w

ANS: C

w

.te

st

ba

10.

ANS: C 12.

Which of the following best describes the process by which stored glycogen is converted to glucose?

A. Citric acid cycle B. Gluconeogenesis C. Glycogenesis

D. Glycogenolysis ANS: D Which of the following substances can activate phosphorylase and thereby promote glycogenolysis?

A. Epinephrine and glucagon B. Epinephrine and insulin C. Epinephrine only D. Glucagon only E. Glucagon, insulin, and epinephrine F. Insulin only

m

13.

In glycolysis, one molecule of glucose is split to form two molecules of which of the following substances?

A. Fumaric acid B. Isocitric acid C. Lactic acid D. Pyruvic acid E. Succinic acid

nk ta n

14.

k. co

ANS: A

Which of the following best describes the amount of ATP produced from one mole of glucose by the glycolytic process (in moles)?

A. 0 B. 1 C. 2 D. 38 E. 4

16.

w

ANS: C

w

w

.te

st

15.

ba

ANS: D

Which of the following best describes the amount of ATP produced during the conversion of pyruvic acid to acetyl coenzyme A (in moles)?

A. 0 B. 1 C. 2 D. 38 E. 4

ANS: A 17.

The sequence of chemical reactions in the citric acid cycle occurs in which part of a cell?

A. Cytosol B. Golgi apparatus C. Lysosome D. Mitochondrion E. Vesicle ANS: D The citric acid cycle begins and ends with which of the following substances?

A. Acetyl coenzyme A B. Citric acid C. Isocitric acid D. Oxaloacetic acid E. Oxalosuccinic acid F. Succinic acid

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18.

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Chapter 69. Lipid Metabolism Test Bank

st

Which of the following best describes the major constituent of a typical chylomicron?

A. Apoprotein B B. Cholesterol C. Monoglycerides D. Phospholipids E. Triglycerides

2.

w

ANS: E

w

w

.te

1.

nk ta n

ANS: D

Which of the following enzymes is especially active in the capillary endothelium and hydrolyzes triglycerides of chylomicrons?

A. Cholesterolester hydrolase B. Lingual lipase C. Lipase-colipase D. Lipoprotein lipase E. Pancreatic lipase

ANS: D 3.

A 45-year-old man is diagnosed with familial lipoprotein lipase deficiency. Without

treatment, the patient is at risk for developing which of the following conditions?

A. Dermatomyositis B. Hypertriglyceridemia C. Myopathy D. Myositis ossificans E. Rhabdomyolysis ANS: B Which of the following lipoproteins contain the highest concentration of triglycerides?

A. High-density lipoproteins (HDL) B. Intermediate-density lipoproteins (IDL) C. Low-density lipoproteins (LDL) D. Very low-density lipoproteins (VLDL)

k. co

m

4.

ANS: D

nk ta n

An increase in which of the following will most likely increase mobilization of fatty acids from fat cells?

A. Glucagon B. Hormone-sensitive lipase activity C. Insulin D. Lipoprotein lipase activity

ba

5.

Excess protein intake can lead to synthesis of triglycerides in liver and fat cells. The first step of this process involves formation of which of the following substances?

A. Acetoacetic acid B. Acetone C. Acetyl coenzyme A D. Beta-hydroxybutyric acid E. Pyruvate

w

w

w

.te

6.

st

ANS: B

ANS: C 7.

Which of the following is mainly responsible for transporting triglycerides synthesized by the liver?

A. Chylomicrons B. LDL (low-density lipoproteins) C. Micelles D. VLDL (very low-density lipoproteins)

ANS: D 8.

Increased ethanol metabolism in the liver would be expected to increase which of the

following?

A. Fat synthesis B. Glycolytic activity C. Mitochondrial NAD+ levels D. Oxidation of fatty acids

Which of the following best describes fat storage in adipocytes?

A. Free fatty acids in liquid form B. Free fatty acids in solid form C. Lipoproteins in liquid form D. Lipoproteins in solid form E. Triglycerides in liquid form F. Triglycerides in solid form

k. co

9.

ANS: E

nk ta n

All of the following tissues can use fatty acids for energy EXCEPT one. Which one is this EXCEPTION? A. Brain B. Heart C. Kidney D. Liver E. Skeletal muscle

ba

10.

st

ANS: A

.te

Which of the following best describes the primary location of degradation and oxidation of fatty acids in cells?

A. Cytosol B. Cytosol C. Golgi apparatus D. Lysosome E. Mitochondrion

w

w

w

11.

m

ANS: A

ANS: E 12.

Which of the following best describes the product of beta-oxidation of fatty acids?

A. Acetyl coenzyme A B. Lactate C. NADH D. Oxaloacetic acid E. Pyruvate

ANS: A

13.

In the liver, two molecules of acetyl coenzyme A condense to form which of the following molecules?

A. Acetic acid B. Acetoacetic acid C. Acetone D. Beta-hydroxybutyric acid E. Oxaloacetic acid F. Pyruvate

ANS: B An 89-year-old man fails to eat for several days causing the formation of ketone bodies. Blood and interstitial fluid levels of which of the following substances are most likely to be increased in this man?

A. Acetoacetic acid and acetone only B. Acetoacetic acid only C. Acetoacetic acid, acetone, and beta-hydroxybutyric acid D. Acetone only E. Beta-hydroxybutyric acid F. Beta-hydroxybutyric acid and acetone only G. Pyruvate and acetone only H. Pyruvate only I. Pyruvate, acetone, and beta-hydroxybutyric acid

nk ta n

k. co

m

14.

st

Excess carbohydrate intake can lead to synthesis of triglycerides in liver and fat cells.

The first step of this process involves formation of which of the following substances?

A. Acetoacetic acid B. Acetone C. Acetyl coenzyme A D. Beta-hydroxybutyric acid E. Pyruvate

16.

w

ANS: C

w

w

.te

15.

ba

ANS: C

Which of the following best describes the substance(s) that cause activation of hormone-sensitive triglyceride lipase during heavy exercise?

A. Epinephrine and norepinephrine only B. Epinephrine only C. Epinephrine, norepinephrine, and insulin D. Insulin and epinephrine only E. Insulin and norepinephrine only F. Norepinephrine only

ANS: A

17.

All of the following factors tend to increase plasma cholesterol levels EXCEPT one.

Which one is this EXCEPTION? A. Decreased plasma insulin B. Highly unsaturated fat diet C. Increased dietary cholesterol D. Increased plasma thyroid hormone

ANS: B Which of the following blood profiles greatly decreases the likelihood of developing arteriosclerosis (HDL, high-density lipoproteins; IDL, intermediate-density lipoproteins; LDL, low-density lipoproteins; VLDL, very low-density lipoproteins)?

A. Decreased HDL:LDL ratio B. Decreased IDL:LDL ratio C. Decreased VLDL:LDL ratio D. Increased HDL:LDL ratio E. Increased IDL:LDL ratio F. Increased VLDL:LDL ratio

nk ta n

k. co

m

18.

ANS: A

The majority of cholesterol formed in the liver is converted to which of the following substances?

A. Acetyl coenzyme A B. Bile acids C. Estrogen D. Progesterone E. Testosterone

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st

ba

19.

ANS: B

w

The first stage in using triglycerides for energy is hydrolysis of the triglycerides to which of the following substance(s)?

A. Acetyl coenzyme A B. Cholesterol C. Glycerol 3-phosphate D. Glycerol and fatty acids E. Phospholipids

w

w

20.

ANS: D 21.

The fatty acid molecule is degraded in the mitochondria by progressive release of two-carbon segments in the form of which of the following substances?

A. Acetyl coenzyme A B. Carnitine C. Glycerol D. Glycerol 3-phosphate

E. Oxaloacetic acid ANS: A High levels of acetyl-CoA and NADH in the liver mitochondria can lead to gluconeogenesis, glycogen formation, lipid synthesis, or ketone body formation depending on hormonal status and substrate delivery. An increase in which of the following most likely would increase ketone body formation by the liver under these conditions?

A. Beta-oxidation of fatty acids B. Circulating glucose levels C. Hepatic cell glycolysis D. Insulin action on hepatocyte

m

22.

Which of the following is most likely to increase triglyceride synthesis in an adipose cell?

A. Decreased availability of free fatty acids B. Decreased lipoprotein lipase activity C. Increased adipose cell glycolysis D. Increased glycerol uptake by the adipose cell

nk ta n

23.

k. co

ANS: A

Which of the following helps the body mobilize and/or use fat for energy?

A. Activation of lipoprotein lipase B. Decreased hormone sensitive lipase activity C. Increased insulin levels D. Ketone body production by the liver

w

w

w

ANS: D

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st

24.

ba

ANS: C

Chapter 70. Protein Metabolism

Test Bank 1.

Which of the following best describes the source of the carbon skeleton for synthesizing non-essential amino acids?

A. Glutamate B. Acetyl coenzyme A

C. Carbohydrates D. Essential amino acids ANS: C 2.

The use of proteins for energy begins with which of the following processes?

A. Deamination B. Hydroxylation C. Oxidation D. Polymerization E. Reduction

k. co

A 56-year-old woman with chronic liver disease is brought to the physician because of confusion, a depressed level of consciousness, personality changes, and intellectual impairment. Laboratory tests support a diagnosis that the woman is suffering from liver encephalopathy. Which of the following blood factors is the most likely cause of this condition?

A. Ammonia B. Ammonium C. Arginine D. Citrulline E. Ornithine F. Urea

ba

nk ta n

3.

m

ANS: A

.te

Which of the following substances best describes deaminated alanine?

A. Acetoacetic acid B. Acetyl coenzyme A C. Glucose D. Lactic acid E. Pyruvic acid F. Urea

w

w

w

4.

st

ANS: A

ANS: E 5.

An increase in blood levels of which of the following substances promotes breakdown of proteins in most tissues?

A. Estrogen B. Glucocorticoid C. Growth hormone D. Insulin E. Testosterone

ANS: B

6.

Which of the following processes best describes synthesis of alanine from pyruvic acid?

A. Hydroxylation B. Oxidation C. Polymerization D. Reduction E. Transamination

Cirrhosis of the liver often leads to hyperbilirubinemia (jaundice). This increase in serum bilirubin levels in patients with alcoholic cirrhosis most often results from which of the following?

Decreased excretion of bilirubin into bile Increased uptake of bilirubin by hepatocytes Enhanced conjugation of bilirubin Excessive hemolysis

st

ba

1.

nk ta n

Test Bank

k. co

Chapter 71. The Liver as an Organ

m

ANS: B

.te

ANS: A

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w

w

2. A 77-year-old man has a 33-year history of alcoholism and liver disease. He visits his physician because of swelling in his legs. A decrease in which of the following is likely to contribute to the development of edema in his legs?

Capillary hydrostatic pressure Femoral vein pressure Interstitial fluid hydrostatic pressure Liver lymph flow Plasma albumin concentration ANS: E 3. Gallstone obstruction at the papilla of Vater can cause acute pancreatitis because of activation of which of the following substances?

Chymotrypsin Enterokinase Lipase Trypsin inhibitor

Trypsinogen ANS: E

m

4. An 82-year-old man has a 30-year history of alcoholism and liver disease. He visits his physician because of swelling in his abdomen. An increase in which of the following is a likely cause of the ascites?

Hepatic artery pressure Hepatic vein pressure Hydrostatic pressure of peritoneal fluid Plasma albumin concentration Portal vein pressure

k. co

ANS: E

nk ta n

5. Which portion of the gastrointestinal tract is essential for absorption of bile salts?

Colon Duodenum Ileum Jejunum Stomach ANS: C

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w

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6. A 45-year-old African-American male is admitted to the emergency department because of upper right quadrant pain. The man has a history of sickle cell disease. Laboratory tests show plasma bilirubin levels are three times greater compared to normal. Ultrasound studies confirm the presence of gallstones. Which of the following is the most likely composition of the gallstones in this patient?

A. Bile pigments B. Calcium C. Cholesterol D. Fatty acids E. Sugar ANS: A

7. The rate-limiting step in the addition of bilirubin to bile is which of the following?

Conjugation Elimination from phagocyte Excretion into bile Release from albumin Uptake by hepatocytes ANS: C 8. Which of the following cell types produce bile acids?

Canalicular epithelial cells Capillary endothelial cells Hepatocytes Kupffer cells ANS: C

k. co

m

9. A 55-year-old man has a 32-year history of alcoholism and liver disease. He visits his physician complaining of swelling in his feet and legs. A decrease in which of the following is the most likely cause of the edema?

Arteriolar dilation Capillary hydrostatic pressure Filtration coefficient Interstitial colloid osmotic pressure Interstitial fluid hydrostatic pressure Plasma colloid osmotic pressure

nk ta n

ANS: F

ba

10. Which component of bile is most abundant on a weight basis?

Bile salts Bilirubin Cholesterol Fatty acids Lecithin

st

ANS: A

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w

w

.te

11. A 44-year-old white man was brought to the emergency department in an inebriated state.

Physical examination revealed the following: blood pressure of 104/68 mmHg; pulse of 120 beats/min; respiration of 32 breaths/min, and temperature of 99 F. He was markedly pale with icteric conjunctiva and skin. His abdomen was distended and there was shifting dullness. The liver was enlarged and tender. The spleen could not be palpated. There was 2+ bilateral edema of his legs and feet. Which of the following values of direct and indirect bilirubin are most likely in this man (in mg/dL)?

Direct Indirect 1.0 1.3 1.4 2.1 1.8 6.4 2.3 2.4 5.0 1.7 6.8 7.5 ANS: E 12. A 54-year-old man has a 30-year history of alcoholism and liver disease. He visits the physician because of swelling in his feet and legs. A decrease in which of the following

most likely promotes edema formation in this patient?

Albumin production Capillary hydrostatic pressure Filtration coefficient Interstitial colloid osmotic pressure Interstitial fluid hydrostatic pressure Reflection coefficient

k. co

13. Which of the following is a forerunner to cirrhosis of the liver?

Colitis Gastritis Pancreatitis Steatohepatitis Tonsillitis

m

ANS: A

nk ta n

ANS: D

st

ba

14. Which of the following best describes the liver circulation?

Resistance Pressure Flow High High Low High High High High Low High Low Low High Low Low Low Low High Low

.te

ANS: D

w

w

15. A 65-year-old man with a history of alcohol abuse is admitted to the emergency department after being found lying unconscious in the street. His abdomen was distended, and there was shifting dullness indicating severe ascites. Which of the following values for plasma colloid osmotic pressure (PCOP: normal, 28 mmHg),

w

capillary hydrostatic pressure (PCAP: normal, 17 mmHg), and interstitial hydrostatic pressure (PISF: normal, 3 mmHg) are likely to be found in the splanchnic organs of this man (in mmHg)?

PCOP PCAP

PISF

A. 10 B. 12 C. 14 D. 16 E. 29 F. 34

0 0 +2 +1 2 4

12 7 17 21 16 22

ANS: D 16. The Kupffer cells of the liver are located primarily in which structure?

Bile canaliculi Portal vein Sinusoids Space of Disse Terminal lymphatics ANS: C

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ba

nk ta n

k. co

m

17. A 35-year-old woman is admitted to the emergency department because of severe upper right quadrant pain. The woman is 5 feet 2 inches tall and weighs 254 pounds (BMI = 46.5). She states that her stools are clay colored and that her urine is dark orange.

Physical examination shows an enlarged liver and icteric conjunctiva. Laboratory results show elevated serum bilirubin levels. Absorption of bile salts is most likely to be decreased to the greatest extent at which of the following locations in this patient?

.te

ANS: D

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w

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18. Elimination of bilirubin from the body requires several steps under normal conditions that include (1) conjugation of bilirubin with glucuronic acid, (2) carriage of bilirubin by albumin in plasma, (3) excretion of bilirubin into bile, and (4) uptake of free bilirubin by hepatocytes. Which of the following best describes the correct temporal order of events?

A. 4, 3, 2, 1 B. 3, 1, 4, 2 C. 3, 4, 1, 2 D. 2, 1, 4, 3 E. 4, 2, 1, 3 F. 2, 4, 1, 3 G. 1, 2, 3, 4 H. 1, 3, 2, 4 ANS: F 19. An experimental device containing hepatocytes is developed to provide effective support for patients with hepatic failure pending liver regeneration or liver transplantation.

Hepatocyte viability is best documented by an increase in which of the following?

A. Albumin output B. Carbon dioxide uptake C. Ethanol output D. Lactate dehydrogenase (LDH) uptake E. Oxygen output ANS: A

k. co

m

20. Which of the following best describes the rate-limiting step for the addition of bilirubin to bile?

Conjugation Elimination from phagocyte Excretion into bile Release from albumin Uptake by hepatocytes ANS: C

st

ba

nk ta n

21. A 45-year-old physician drinks himself into oblivion on a regular basis. What are the long-term complications of cirrhosis of the liver?

Jaundice Ascites Esophageal Varices Peripheral Edema A. No Yes Yes No B. No No Yes Yes C. Yes Yes No Yes D. Yes Yes Yes No E. Yes Yes Yes Yes

.te

ANS: E

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Chapter 72. Dietary Balances; Regulation of Feeding; Obesity and Starvation; Vitamins and Minerals

Test Bank 1.

A patient’s urinary nitrogen excretion is 10.0 grams in 24 hours. What is the approximate amount of protein breakdown in this patient for 24 hours?

A. 10.0 g B. 11.0 g C. 24.0 g D. 68.8 g E. 78.5 g

ANS: D 2.

If one’s respiratory quotient (RQ) was 0.8, which of the following conditions most likely would drive the RQ towards 1.0?

A. Eating a stick of butter B. Consumption of a protein supplementt C. Prolonged fasting D. Eating a bowl of Froot Loops (with skim milk)

Which of the following vitamins is water soluble?

A. E B. A C. B1 (thiamine) D. D

Several vitamins presented in the text are involved directly in the processes of carbohydrate, lipid, and protein oxidative metabolism outlined in lecture. Which of the following IS NOT one of those vitamins?

A. Riboflavin (B2)

st

B. Niacin (nicotinic acid) C. Pantothenic acid D. Folic acid

.te

ANS: D

Laboratory tests for a 10-year-old boy reveal a fasting plasma glucose concentration of 300 mg/100 mL and he has large amounts glucose in his urine. He is diagnosed as having type 1 diabetes and has not yet been treated with insulin. What would you expect his respiratory quotient (RQ) to be one hour after eating a mixed meal containing carbohydrates, fat, and protein?

A. 0.0 B. 0.5 C. 0.7 D. 0.8 E. 1.0

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w

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5.

ba

4.

nk ta n

ANS: C

k. co

3.

m

ANS: D

ANS: C 6.

Which of the following changes would be expected to stimulate hunger is a person who has to not eaten for 24 hours?

A. Increased neuropeptide Y in hypothalamus B. Increased leptin secretion

C. Increased peptide YY secretion D. Decreased ghrelin secretion E. Activation of hypothalamic proopiomelanocortin (POMC) neurons F. Increased cholecystokinin secretion ANS: A 7.

Deficiency of which of the following would cause pellagra in humans or black tongue in canines?

A. Vitamin A B. Vitamin B1

m

C. Vitamin B12

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D. Vitamin C E. Niacin

nk ta n

ANS: E

Chapter 73. Energetics and Metabolic Rate

st

Which of the following factors is most likely to cause the metabolic rate to decrease?

A. Fever B. Growth hormone C. Male sex hormones D. Malnutrition E. Sympathetic stimulation

2.

w

ANS: D

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w

.te

1.

ba

Test Bank

Which of the following provides the most accurate estimate of basal metabolic rate?

A. Blood volume B. Heart rate C. Oxygen consumption D. Percentage body fat E. Q10 effect

ANS: C 3.

Which of the following best describes the effects of fever, sleep, malnutrition, testosterone, and growth hormone on the basal metabolic rate?

Fever A. Decrease B. Decrease C. Decrease D. Decrease E. Increase F. Increase G. Increase H. Increase

Sleep Decrease Increase Increase Increase Decrease Decrease Decrease Increase

Malnutrition Increase Decrease Decrease Increase Decrease Decrease Increase Increase

Testosterone Increase Increase Increase Decrease Decrease Increase Decrease Decrease

Growth hormone Increase Decrease Increase Increase Increase Increase Decrease Increase

ANS: F

m

Which of the following best describes the group of individuals with the highest basal metabolic rate?

A. Old females B. Old males C. Young females D. Young males

nk ta n

k. co

4.

ANS: D

Which of the following correctly ranks the daily expenditure of energy in the average person (1 = sleeping metabolic rate; 2 = basal metabolic rate; 3 = thermic effect of food)?

A. 1 = 2 > 3 B. 1 > 2 > 3 C. 2 > 1 > 3 D. 2 > 3 > 1 E. 3 > 1 > 3 F. 3 > 2 > 1

.te

st

ba

5.

Which of the following sources of energy is most likely to be used first during a strenuous burst of activity in a typical skeletal muscle fiber?

A. Adenosine triphosphate B. Anaerobic glycolysis C. Oxidation of lactate D. Phosphocreatine

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w

6.

w

ANS: C

ANS: A 7.

Which of the following best describes the source of ATP in skeletal muscle during prolonged anaerobic work?

A. Beta-oxidation of fats B. Glycolysis C. Muscle ATP stores D. Phosphocreatine

ANS: B 8.

Skeletal muscle accounts for which of the following percentages of the basal metabolic rate during resting conditions in the average adult (in %)?

A. 10-20 B. 20-30 C. 30-40 D. 40-50 E. 50-60

The amount of ATP in skeletal muscle is sufficient to maintain a maximum contraction for which of the following periods of time (in seconds)?

A. 1-5 B. 5-10 C. 10-20 D. 20-40 E. 40-60

nk ta n

k. co

9.

m

ANS: B

ANS: A

The amount of phosphocreatine in skeletal muscle is sufficient to maintain a maximum contraction for which of the following periods of time (in seconds)?

A. 1-5 B. 5-10 C. 10-20 D. 20-40 E. 40-60

w

A 27-year-old man working on the Alaskan pipeline in winter produces heat by a non-shivering thermogenesis mechanism activated by cold stress. Which of the following best describes the mediator of non-shivering thermogenesis?

A. Cortisol B. Parasympathetic nervous system C. Substance P D. Sympathetic nervous system E. Thyroxin

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11.

w

ANS: B

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st

ba

10.

ANS: D 12.

Which of the following best describes the mechanism by which sympathetic stimulation can help to limit weight gain in adult persons who are obese?

A. Decreased plasma leptin

B. Increased blood flow C. Metabolism of brown fat D. Non-shivering thermogenesis E. Shivering thermogenesis ANS: D Ingestion of which of the following 12 ounce portions of food is likely to increase metabolic rate to the greatest extent in the average adult?

A. Cooked carrots B. Cooked pasta C. Cooked potatoes D. Rare beef filet E. Raw celery

k. co

m

13.

ANS: D

The calorie (which is one kilocalorie) is defined as the amount of heat required to raise which of the following volumes of water by 1 C (in mL)?

A. 1 B. 10 C. 100 D. 1,000 E. 10,000

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nk ta n

14.

w

w

.te

st

ANS: D

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Chapter 74. Body Temperature Regulation and Fever Test Bank 1.

Which of the following mechanisms of heat loss occur in a normal person when the environmental temperature is 105 F and the relative humidity is less than 20%?

A. Conduction B. Convection C. Evaporation D. Radiation

ANS: C 2.

A 29-year-old man sits nude in a room that has a temperature of 71 F and low humidity. He is 6 feet 2 inches tall and weighs 205 pounds (body mass index = 26.3). The greatest amount of body heat is most likely to be lost by which of the following mechanisms?

A. Conduction to air B. Conduction to objects C. Evaporation D. Radiation

Which of the following occurs after a fever has "broken" and the core temperature is falling?

Shivering only Sweating only Cutaneous vasoconstriction only Cutaneous vasodilation only Shivering and cutaneous vasoconstriction Sweating and cutaneous vasodilation

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ANS: D

ANS: F

ba

Which of the following occurs during the induction phase of a fever when the core temperature is rising?

A. Shivering only B. Sweating only C. Vasoconstriction only D. Vasodilation only E. Shivering and vasoconstriction F. Sweating and vasodilation

5.

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ANS: E

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4.

Which of the following occurs when a fever breaks (i.e., after the crisis)?

A. Epinephrine secretion B. Piloerection C. Shivering D. Sweating E. Vasoconstriction

ANS: D 6.

A scuba diver explores an underwater lava flow. The temperature of the water is 103 °F. Which one of the following sets of mechanisms of heat loss is effective in this man swimming in the 103 °F water?

Evaporation A. No B. No C. No D. No E. Yes

Radiation No No Yes Yes Yes

Convection No No No No Yes

Conduction Yes No Yes Yes Yes

ANS: B The hypothalamic set-point temperature normally averages about 98.6 F. Which of the following factors can alter the set-point level for core temperature control?

Skin Temperature Pyrogens Antipyretics Thyroxin A. No Yes Yes No B. No Yes Yes Yes C. Yes Yes Yes Yes D. Yes No No Yes E. Yes Yes Yes No

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7.

A 33-year-old woman is hiking through the desert. The temperature is 102 F, and the relative humidity is 68%. Which of the following mechanisms of heat loss is most effective in this woman hiking in the desert?

A. Conduction to air B. Conduction to objects C. Evaporation D. Radiation

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8.

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ANS: E

Which of the following is decreased when the hypothalamic set-point temperature is greater than the body temperature?

A. Piloerection B. Shivering C. Sweating D. Vasoconstriction

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9.

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ANS: C

ANS: C 10.

Most heat is lost from the body of a nude person at room temperature by which mechanism?

A. Conduction to air B. Conduction to objects C. Evaporation D. Radiation

ANS: D

11.

Which of the following is the only available method of heat transfer when the environmental temperature is greater than the body temperature?

A. Conduction B. Convection C. Evaporation D. Radiation

ANS: C

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Questions 12 – 14: The diagram shows the effects of changing the set-point of the hypothalamic temperature controller. The solid line is the body temperature. The dashed line is the hypothalamic set-point temperature. Use the diagram to answer the next three questions.

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ba

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12. Which of the following sets of changes occur at point W, compared to point V? Shivering Sweating Vasoconstriction Vasodilation A. No No No No B. No Yes No Yes C. No Yes Yes No D. Yes No No Yes E. Yes No Yes No F. Yes Yes Yes Yes

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ANS: E

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13. Which of the following sets of changes occur at point Y, compared to point V? Shivering Sweating Vasoconstriction Vasodilation A. No No No No B. No Yes No Yes C. No Yes Yes No D. Yes No No Yes E. Yes No Yes No F. Yes Yes Yes Yes ANS: B 14. Which of the following sets of changes occur at point X, compared to point V? Shivering Sweating Vasoconstriction Vasodilation A. No No No No B. No Yes No Yes C. No Yes Yes No D. Yes No No Yes E. Yes No Yes No

F. Yes

Yes

Yes

Yes

ANS: A

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15. A 74-year-old man is admitted as an emergency to University Hospital. He was found lying in his yard near a running lawnmower on a hot summer day. His body temperature is 106 °F, blood pressure is normal, and heart rate is 160 bpm. Which of the following sets of changes are most likely to be present in this man?

Sweating Hyperventilation Vasodilation of skin A. No No No B. No Yes Yes C. Yes Yes No D. Yes Yes No E. Yes No Yes F. Yes Yes Yes

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ANS: A

ba

Chapter 75. Introduction to Endocrinology

Test Bank

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Some cells secrete chemicals into the extracellular fluid that act on cells in the same tissue. Which of the following refer to this type of regulation?

A. Neural B. Endocrine C. Neuroendocrine D. Paracrine E. Autocrine

2.

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ANS: D

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1.

If a radioimmunoassay is properly conducted and the amount of radioactive hormone bound to antibody is low, this would indicate which of the following?

A. Plasma levels of endogenous hormone are high B. Plasma levels of endogenous hormone are low C. More antibody is needed D. Less radioactive hormone is needed

ANS: A 3.

An example of neuroendocrine secretion is the release of which of the following?

A. Somatostatin B. Cortisol C. Growth hormone D. Prolactin E. ACTH ANS: A Which of the following is an example of paracrine hormonal regulation?

A. Corticotropin releasing hormone: ACTH secretion B. ACTH: cortisol secretion C. Somatostatin: growth hormone secretion D. Somatostatin: glucagon secretion E. TSH: T4 secretion

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4.

ANS: D

Which of the following hormones is largely unbound to plasma proteins?

A. Aldosterone B. T4

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5.

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C. Oxytocin D. Estradiol E. Progesterone ANS: C

st

Which of the following hormones is not stored in its endocrine-producing gland?

A. T4

7.

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ANS: C

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B. PTH C. Aldosterone D. ACTH E. Insulin

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6.

Which of the following is true regarding hormone binding to plasma proteins?

A. It increases in the plasma clearance of the hormone B. It increases the half-life of the hormone C. It increases hormonal activity D. It is uncommon for steroid hormones E. It is uncommon for thyroid hormones

ANS: B 8.

Which of the following peptide-second messengers are incorrectly paired?

A. Glucagon:cAMP

B. Insulin:cAMP C. TSH:cAMP D. ACTH:cAMP E. ADH (V2 receptor):cAMP ANS: B Which of the following statements about peptide or protein hormones is usually true?

A. They have longer half-lives than steroid hormones B. They have receptors on the cell membrane C. They have a slower onset of action than both steroid and thyroid hormones D. They are not highly stored in endocrine producing glands

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9.

Which of the following hormones does not activate G protein-linked receptors when producing its predominate physiological effects?

A. TSH B. Glucagon C. ACTH D. ADH E. Aldosterone

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10.

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ANS: B

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ba

ANS: E

1.

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Test Bank

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Chapter 76-Chapter 77. Pituitary Hormones and Their Control by the HypopthalamusChapter 77. Thyroid Metabolic Hormones

A patient has a goiter associated with high plasma levels of both TRH and TSH. Heart rate is elevated. This patient most likely has which of the following?

A. Endemic goiter B. A hypothalamic tumor secreting large amounts of TRH C. A pituitary tumor secreting large amounts of TSH D. Graves’ disease E. A thyroid adenoma

ANS: B 2.

A 30-year-old female reports to the clinic for a routine physical examination. The

examination reveals that she is pregnant. Plasma levels of TSH are high but total thyroid hormone concentration is normal. Which of the following best reflects this patient’s clinical state?

A. Graves’ disease B. Hashimoto’s disease C. A pituitary tumor secreting TSH D. A hypothalamic tumor secreting TRH E. The patient is taking thyroid extract ANS: __

A patient has the following: elevated [plasma T4], low [plasma TSH], and a thyroid gland size below normal. Which of the following is the most likely explanation for these finding?

A. A lesion of the anterior pituitary that prevents TSH secretion B. The patient is taking propylthiouracil C. The patient is taking thyroid extract D. The patient is consuming large amounts of iodine E. Graves’ disease

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Answer: B

ANS: C

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↑ ↓ ↓ ↑ ↓

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ANS: D

↑ ↓ ↑ ↓ ↓

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A. ↑ B. ↑ C. ↓ D. ↓ E. ↓

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ba

A patient has myxedema. Which of the following sets of physiological changes would be expected?

Cardiac output Plasma [RT3] Plasma [cholesterol]

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4.

A patient has been completely thyroidectomized for the treatment of thyroid disease and is given oral thyroxine (T4) for substitution therapy. TSH levels are normal. Which of the following would be expected?

A. Low plasma levels of T4 B. Low plasma levels of T3 C. High plasma levels of RT3 D. A low rate of thyroglobulin synthesis E. A low rate of TBG synthesis

ANS: D

6.

A 37-year-old woman presents to her physician with an enlarged thyroid gland and high plasma levels of T4 and T3. Which of the following is likely to be decreased?

A. Heart rate B. Cardiac output C. Peripheral vascular resistance D. Ventilation rate E. Metabolic rate

ANS: _C

m

Administration of an inhibitor of thyroid peroxidase would cause an increase in which of the following?

A. Thyroid content of iodine B. Thyroid content of monoiodotyrosine C. Thyroid content of thyroxine D. TSH secretion E. Urinary excretion of diiodotyrosine

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7.

ANS: D

A chronic increase in the plasma concentration of thyroid-binding globulin would result in which of the following?

A. An increased delivery of T4 to target cells

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8.

B. A decrease in the free T4 level

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C. An increase in the conversion of T4 to T3 in peripheral tissues

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D. An increase in TSH secretion E. No change in metabolic rate

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A woman has puffy skin and is lethargic. Her plasma TSH is low. Which of the following most likely account for her symptoms?

A. Graves' disease B. She is taking thyroid extract C. Endemic goiter D. Chronic Hashimoto's disease E. Pituitary failure

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9.

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ANS: E

ANS: E 10. A patient has a pituitary tumor that secretes large amounts of TSH. Which of the following would you least expect?

A. High plasma levels of T4 B. High plasma levels of T3

C. Exophthalmos D. Increased respiratory rate E. Goiter ANS: C

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11. A patient has hyperthyroidism due to a pituitary tumor. Which of the following sets of physiological changes would be expected?

Thyroglobulin Synthesis Heart Rate Exopthalomos A. ↑ ↑ + B. ↑ ↑ C. ↑ ↓ + D. ↓ ↓ + E. ↓ ↓ F. ↓ ↑ -

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ANS: B

12. Mr. Smith has been diagnosed with pronounced nephrosis. He does not have a goiter but is feeling more tired than normal. However, you suspect he is euthyroid and order a blood sample. If he is euthyroid, which of the following would be expected?

Total Plasma T4

st .te w w

ANS: B

↑ ↔ ↓ ↑ ↔ ↓

ba

A. ↓ B. ↓ C. ↓ D. ↔ E. ↔ F. ↔

Plasma TSH

w

13. A patient has a goiter associated with high plasma levels of both TRH and TSH. Heart rate is elevated. The patient most likely has: A. Endemic goiter B. A hypothalamic tumor secreting large amounts of TRH C. A pituitary tumor secreting large amounts of TSH D. Graves’ disease ANS: B 14. Which of the following regarding T4 is false?

A. Secretion rate from thyroid exceeds that of T3 B. Secretion rate from thyroid is decreased by propylthiouracil

C. Plasma concentration is less than that of T3 D. Peripheral deiodination is the major source of circulating T3 ANS: C A pregnant patient has a normal hypothalamo-hypophysial axis. A blood sample reveals elevations in the concentrations of thyroxine-binding globulin and total thyroid hormones, and low plasma TSH concentration. Assuming steady state conditions one would expect: A. Graves’ disease B. Hypothyroidism C. Euthyroidism D. High plasma levels of thyrotropin releasing hormone

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15.

ANS: A

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16. A patient has a goiter and exhibits sweating and tachycardia. Plasma levels of TSH are elevated but plasma levels of thyrotropin releasing hormone are reduced. This patient probably has: A. Graves’ disease B. Hyperthyroidism due to a primary abnormality in the pituitary gland C. Hyperthyroidism due to a primary abnormality in the hypothalamus D. Hypothyroidism due to an abnormality in the thyroid gland ANS: B

st

A patient has a pronounced goiter associated with increased plasma levels of TSH. The patient complains of constipation and lethargy. Which of the following is the most likely explanation for these findings?

A. The patient is taking thyroid extract B. The patient is taking propylthiouracil C. The patient is consuming large amounts of iodine D. The patient has a pituitary adenoma E. The patient has Graves’ disease

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17.

ANS: B

18. Which of the following would be expected in a patient with a deficiency in iodine?

A. Weight loss B. Nervousness C. Increased sweating D. Increased synthesis of thyroglobulin E. Tachycardia ANS: D

Chapter 78. Adenocortical Hormones

Test Bank

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A patient is administered cortisone for the treatment of an autoimmune disease.

Which of the following is most likely to occur?

A. Increased insulin secretion B. Increased cortisol secretion C. Increased growth hormone secretion D. Hyperpigmentation E. Hypoglycemia between meals

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1.

ANS: A

Which of the following would not be expected to increase aldosterone secretion?

A. Hemorrhage B. A high sodium diet C. An acute increase in plasma [ANG II] D. A chronic increase in plasma [ANG II] E. A chronic increase in plasma [K]

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2.

ANS: B

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Over a period of several months, a patient has developed hyperpigmentation, hyperkalemia, and a tendency for blood glucose concentration to decrease between meals. However, blood pressure appears to be within the normal range. The patient most likely has which of the following?

A. Addison’s disease B. Cushing’s disease (pituitary adenoma) C. Cushing’s syndrome (adrenal adenoma) D. Panhypopituitarism E. An ectopic ACTH secreting adenoma

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3.

ANS: A 4.

Which of the following hormones increases hepatic glycogenolysis and promotes gluconeogenesis?

A. Glucagon B. Cortisol

C. Growth hormone D. Insulin ANS: A Cortisol and GH are most dissimilar in their metabolic effects on which of the following?

A. Plasma glucose concentration B. Lipolysis C. Gluconeogenesis D. Protein synthesis in muscle E. Glucose uptake in peripheral tissues

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5.

Which of the following sets of hormonal responses would be expected in a subject chronically maintained on a low sodium diet?

Plasma [Aldosterone] Plasma [ANP] Plasma [Cortisol] A. ↑ ↓ ↑ B. ↑ ↓ ↔ C. ↑ ↔ ↑ D. ↔ ↑ ↑ E. ↔ ↓ ↔

ba

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6.

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ANS: D

Compared to the late evening values typically observed in normal subjects, plasma levels of both ACTH and cortisol would be expected to be higher in which of the following conditions?

A. In normal subjects after waking in the morning B. In normal subjects administered dexamethasone C. In patients with Cushing's syndrome (adrenal adenoma) D. In patients with Addison's disease E. In patients with Conn's syndrome

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ANS: B

ANS: A 8.

A patient has Conn's syndrome. Which of the following sets of physiological changes would be expected?

Arterial Pressure Extracellular Fluid Volume Sodium Excretion A. B. C. D. E.

ANS: C 9.

Which of the following would be associated with parallel changes in aldosterone and cortisol secretion?

A. Addison’s disease B. Cushing’s disease C. Cushing’s syndrome (adrenal tumor) D. A low sodium diet E. Administration of a converting enzyme inhibitor

A sodium depleted subject is administered an angiotensin-converting enzyme inhibitor for two weeks. Which of the following sets of physiological changes would be expected after two weeks, compared to control conditions before drug administration?

Plasma [Aldosterone] Plasma [Cortisol] Sodium Excretion A. B. C. D. E.

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ANS: A

In humans, the major circulating adrenal steroids that produce the three main types of adrenal steroid actions are which of the following?

Glucocorticoid Mineralocorticoid Adrenal Androgen A. Cortisol Aldosterone DHEA B. Cortisone Deoxycorticosterone (DOC) Androstenedione C. Cortisol Aldosterone Testosterone D. Corticosterone Aldosterone Androstenedione E. Cortisol DOC Testosterone

12.

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ANS: A

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11.

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ANS: E

During a physical examination, a patient has been diagnosed with osteoporosis, hypertension, and hirsutism. There are no other apparent abnormalities. Which of the following is the most likely diagnosis?

A. Cushing’s disease B. A hypothalamic CRH secreting tumor C. An ectopic ACTH secreting tumor D. An adrenal adenoma E. Addison’s disease

ANS: D

Questions 13 – 15: Match each of the patients in questions 13-15 with the correct set of blood values in the table below (the same values may be used for only one patient). Normal values: plasma [aldosterone] = 5.0 ng/dL; plasma [cortisol] = 10 g/dL; plasma [K] = 4.5 mEq/L [aldo] [cortisol] A. 2.0 10.0 B. 5.0 30.0 C. 15.0 30.0 D. 2.0 5.0 E. 2.0 5.0

4.5 2.5 2.5 6.0 4.5

A patient with Addison’s disease.

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13.

[K]

14.

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ANS: D

A patient chronically administered a converting enzyme inhibitor.

15.

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ANS: A

A patient with Cushing’s disease (pituitary tumor).

Which of the following would be expected in a patient with Conn’s syndrome?

Normal values: [PNa] = 140 mEq/L; [PK] = 4.5 mEq/L; [P aldosterone] = 5.0 ng/dL;

st

16.

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ANS: B

PRA

mEq/L A. 142 B. 142 C. 135 D. 142 E. 135

ng ANG I/ml/h 1.0 0.5 3.0 0.5 0.5

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plasma renin activity = 1.0 ng ANG I/mL/h.

[PNa] [PK] [Paldo] mEq/L 3.3 6.5 6.5 3.3 3.5

ng/dL 5.0 2.5 2.5 25.0 25.0

ANS: D 17.

Which of the following sets of physiological changes would be expected in a nondiabetic patient with Cushing’s disease?

Plasma [Aldosterone] Plasma [Cortisol] Plasma [Insulin] A. ↑ ↑ ↑ B. ↑ ↑ ↔ C. ↑ ↔ ↔ D. ↔ ↔ ↑ E. ↔ ↑ ↔

F. ↔

↑

↑

ANS: F

Chapter 79. Insulin, Glucagon, and Diabetes Mellitus

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Test Bank

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1. A patient has uncontrolled type I diabetes. Which of the following is likely to be present?

A. Decreased plasma osmolality B. Increased plasma volume C. Increased plasma pH D. Increased release of glucose from the liver E. Decreased rate of lipolysis ANS: D

Which of the following are incorrectly paired?

A. Glucagon: increased glycogenolysis in liver B. Insulin: increased gluconeogenesis in liver C. Epinephrine: increased glycogenolysis in liver D. Epinephrine: increased glycogenolysis in muscle E. Cortisol: decreased glucose uptake in muscle

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2.

A 60-year-old man comes to the physician's office complaining of recent onset of fatigue and the need to urinate several times each night. He is 6' tall and weighs 300 lbs.

His blood pressure is 140/90. Laboratory data reveal a fasting blood glucose concentration of 270 mg/dL. Urinalysis reveals high urine glucose but no ketones. What is the most likely cause of this man's symptoms?

A. Type 1 diabetes mellitus B. Type 2 diabetes mellitus C. Addison's disease D. Cushing's disease E. Diabetes insipidus

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3.

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ANS: B

ANS: B 4.

Which of the following metabolic responses would be expected during the postprandial period, compared to the postabsorptive state?

Lipoprotein Lipase A. ↑ B. ↑ C. ↑ D. ↓ E. ↓ F. ↓

Hormone-Sensitive Lipase ↑ ↓ ↓ ↓ ↑ ↓

Glycogen Phosphorylase ↓ ↑ ↓ ↑ ↑ ↓

ANS: C Which of the following metabolic responses would be expected during the postabsorptive period, compared to the postprandial state?

Glucagon Secretion Hormone-Sensitive Lipase Adipocyte α-Glycerol Phosphate A. ↑ ↑ ↓ B. ↑ ↑ ↑ C. ↑ ↓ ↓ D. ↓ ↓ ↑ E. ↓ ↑ ↑ F. ↓ ↓ ↓

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5.

A large dose of insulin is administered intravenously. Which of the following sets of hormonal changes would be expected to occur in the plasma in response to the insulin injection?

Growth Hormone Glucagon Epinephrine A. B. C. D. E.

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ANS: C

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6.

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ANS: A

7.

Which of the following would most likely occur in the earliest stages of type II diabetes?

A. Increased insulin sensitivity B. High circulating levels of C-peptide C. Decreased hepatic glucose output D. Metabolic acidosis E. Hypovolemia

ANS: B

8.

Which of the following would produce opposite directional changes in insulin and glucagon secretion?

A. Amino acids B. Somatostatin C. Glucose D. -adrenergic stimulation

ANS: C Which of the following hormones is anabolic on muscle protein at physiological concentrations, but is catabolic at very high levels?

A. Insulin B. GH C. Testosterone D. T4

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9.

ANS: D

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Which of the following conditions result in stimulation of glucagon secretion?

A. Decreased plasma amino acid concentration B. Increased somatostatin secretion within the islets C. Intravenous infusion of glucose D. Intravenous infusion of insulin

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10.

ANS: D

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To evaluate whether the pancreas has recovered some beta cell secretory capability in an insulin-requiring type 2 diabetic, which of the following plasma measurements would be most useful?

A. Insulin in a glucose tolerance test B. C-peptide in a glucose tolerance test C. Insulin after injecting epinephrine D. Insulin after administration of amino acids

12.

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ANS: B

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11.

Which of the following does not play a role in the secretion of insulin from B-cells when plasma glucose concentration increases?

A. Glucose influx into B cells via GLUT2 transporters B. Oxidation of glucose and the generation of ATP C. Opening of ATP-sensitive potassium channels D. Depolarization of the cell membrane E. Opening of voltage gated calcium channels

ANS: C

13.

Which one of the following sets of physiological changes would be expected during the postabsorptive state, compared to the postprandial state?

Glycogenolysis Hormone-Sensitive Lipase Muscle Glucose Uptake A. B. C. D. E.

ANS: B Which one of the following sets of hormonal changes would be expected to occur in the plasma after a carbohydrate meal?

[Growth Hormone] [Insulin] [Glucagon] A. B. C. D. E.

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14.

ANS: E

Which of the following are incorrectly paired?

A. Epinephrine : increased glycogenolysis in skeletal muscle B. Glucagon : increased glycogenolysis in skeletal muscle C. Glucagon : increased gluconeogenesis D. Growth hormone : increased plasma glucose concentration E. Cortisol : increased plasma glucose concentration

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15.

ANS: B

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Which one of the following sets of curves would reflect responses in a normal individual and in most individuals with type I (IDDM) and type II (NIDDM) diabetes?

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16.

Normal A. 3 B. 1 C. 1 D. 2 E. 2

IDDM 2 2 3 1 3

NIDDM 1 3 2 3 1

ANS: E 17.

Cortisol and glucagon have similar effects on which of the following?

A. Blood glucose concentration

B. Protein synthesis in muscle C. Glycogenolysis D. Glucose uptake in peripheral tissues ANS: A Which of the following increase the secretion of insulin, growth hormone, and glucagon?

A. A protein meal B. A carbohydrate meal C. A fat meal D. Fasting

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ANS: A

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Chapter 80. Parathyroid Hormone, Calcitonin, Calcium and Phosphate Metabolism, Vitamin D, Bone, and Teeth

ba

Test Bank

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2+ 1. A man consumes a high Ca meal. Which of the following would be an appropriate compensatory response to the postprandial changes in plasma [Ca2+] concentration?

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A. Increased calcitonin secretion B. Increased formation of 1,25-(OH)2D3

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C. Increased osteoclastic activity 2+ D. Increased renal Ca reabsorption E. Increased osteocytic osteolysis ANS: A

2. Which of the following is not a direct effect of PTH? A. Increased renal Ca2+ reabsorption B. Decreased renal phosphate reabsorption C. Increased intestinal Ca2+ and phosphate absorption D. Increased Ca2+ and phosphate resorption from bone E. Increased renal production of 1,25-(OH)2D3 ANS: C

2+ 3. Which of the following would cause the most rapid increase in free ionized plasma Ca concentration?

A. Increased osteocytic osteolysis B. Increased osteoclastic activity C. Increased formation of 1,25-(OH)2D3 2+ D. Increased renal Ca reabsorption 2+ E. Increased intestinal Ca absorption

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ANS: A

Plasma [PTH]

Plasma [1,25-(OH)2D3]

Most patients with rickets.

ba

4.

st

ANS: C

A patient with renal failure.

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5.

ANS: B

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Most patients with osteomalacia.

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ANS: C

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6.

Plasma [Phosphate]

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A. B. C. D. E.

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Questions 4-6: Match each of the following patients in questions 4 and 6 with the following physiological changes.

7. A lethargic 60-year-old woman has complained of fatigue, depression, weakness, and constipation for several years. She has been taking several over-the-counter vitamin preparations for years. Abdominal x-rays reveal kidney stones and urine calcium is high.

Her PTH level is low. Which of the following is the most likely cause of her symptoms?

A. Vitamin D excess B. Primary hyperparathyroidism C. Secondary hyperparathyroidism D. Surgical hypoparathyroidism E. Poor exposure to sunlight ANS: A

8. Which of the following would not be a prominent response to PTH? 2+ A. Increased Ca reabsorption in the proximal tubule B. Increased osteocytic osteolysis C. Increased osteoclastic activity D. Increased formation of 1,25-(OH)2D3 in the proximal tubule E. Decreased phosphate reabsorption in the proximal tubule ANS: A Which of the following would be expected in a patient with parathyroid deficiency 10 days postoperatively after inadvertent damage to the parathyroid glands?

A. Low plasma phosphate and Ca2+ levels and tetany

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9.

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B. Low plasma [Ca2+] and increased muscular excitability C. High plasma phosphate and Ca2+ levels and bone demineralization

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2+ D. Increased muscular excitability, a high plasma Ca level, and bone demineralization E. Increased calcitonin secretion ANS: B

ba

10. Which of the following would tend to increase plasma levels of ionized Ca2+ A. Increased plasma protein concentration B. Increased osteoblastic activity C. 1,25-(OH)2D3

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ANS: C

st

D. Calcitonin

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11. The site of formation of 1,25-dihydroxycholecalciferol is in which of the following?

A. Adrenal cortex B. Skin C. Renal cortex D. Liver E. Parathyroid gland ANS: C 12. A 40-year-old woman comes to the emergency room with a fracture in the neck of the femur. Radiographs reveal generalized demineralization of the bone in the area. Her plasma calcium ion concentration is significantly greater than normal, 12.2 mg per cent.

Which of the following conditions is consistent with this presentation?

A. Osteoporosis B. Rickets C. Vitamin D deficiency

D. Hyperparathyroidism E. Renal failure ANS: D

m

13. Patients who are not exposed to ultraviolet light develop rickets for which of the following reasons?

A. Calcium absorption from the intestine is depressed B. Synthesis of parathyroid hormone is depressed C. Conversion of 25,hydroxycholecalciferol to 1,25,dihydroxycholecalciferol is depressed D. Osteoblastic activity is increased

k. co

ANS: A

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14. Which of the following cells secrete enzyme that break down collagen?

A. Osteocytes B. Osteoblasts C. Lymphocytes D. Osteoclasts ANS: D

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15. Which of the following is the source of 1,25-dihydroxycholecalciferol?

A. The renal cortex B. The parathyroid gland C. The liver D. The epithelium of the small intestine ANS: A

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Which of the following would be expected in a patient whose diet has been low in 2+ Ca for 2 months?

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16.

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A. Increased calbindin in the intestine B. Increased plasma [phosphate] C. Increased plasma [Ca2+] D. Decreased osteoclastic activity E. Decreased formation of 1,25(OH)2D3 ANS: A 17.

Which of the following would most likely occur in a patient with primary hyperparathyroidism?

A. Decreased synthesis [1,25(OH)2D3]

2+ B. Decreased plasma [Ca ] C. Tetany D. Increased plasma alkaline phosphatase activity E. Increased plasma [phosphate] ANS: D Which of the following is not a compensatory response to a fall in plasma [Ca2+]?

A. Increased PTH secretion B. Increased osteocytic osteolysis C. Increased formation of 1,25(OH)2D3

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18.

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D. Increased Ca2+ reabsorption E. Increased phosphate reabsorption

nk ta n

ANS: E

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Chapter 81. Reproductive and Hormonal Functions of the Male (and Function of the Pineal Gland)

.te

Which of the following cell types produce testosterone in the male?

A. Sertoli cells B. Glomerulosa cells C. Leydig cells D. Thecal cells

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ANS: C

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1.

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Test Bank

Questions 2-4: A 51-year-old male presented to his physician with a complaint of difficulty maintaining an erection during sexual intercourse. During the history and physical, he said he had been a diabetic since he was eight years old. He had some problems with retinopathy previously, and he was taking an angiotensin-converting enzyme inhibitor, a statin and insulin injections daily. He has six children, ages 7 - 22 years. His heart and lung sounds were within normal limits. His EKG showed normal sinus rhythm with a rate of 75 bpm.

His laboratory studies included blood sugar 120 mg/dL, BUN 16 mg/dL, serum creatinine 0.6 mg/dL, cholesterol 180 mg/dL, hematocrit 49%, Hgb A1c 7. His urine was positive for microalbuminuria, negative for glucose.

2.

It is likely that this individual is suffering from which condition?

A. Cryptorchidism B. Erectile dysfunction C. Premature ejaculation D. Hyperandrogenism

3.

A possible cause for his condition is which of the following?

A. Old age B. Medications C. Hypercholesterolemia D. Retinopathy

What treatment would you recommend for this individual?

A. An androgen receptor antagonist B. A 5-reductase inhibitor C. Androgen therapy D. A phosphodiesterase-5 inhibitor

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ANS: B

ANS: D

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What system controls penile erection in the male?

A. The sympathetic nervous system B. The parasympathetic nervous system C. The central nervous system D. The peripheral nervous system

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ANS: B

The anatomical structure of the spermatozoon that is important in producing enzymes that hydrolyze the zona pellucida for fertilization is: A. Centriole B. Flagellum C. Acrosome D. Corona radiata

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ANS: B

ANS: C 7.

When in spermatogenesis and/or oogenesis does "crossing over" of the chromosomes occur?

A. During mitosis B. During meiosis I C. During meiosis II D. Upon fertilization

ANS: B 8.

A man is taking a medication that interferes with the emission phase of the sexual act.

Which of the following would solve this problem?

A. A sympathetic nervous system transmitter blocker B. Viagra, which prolongs the duration of action of nitric oxide C. A drug which increases release of nitric oxide D. None of the above

The life span of a sperm in the woman’s reproductive tract is: A. One hour B. One to two days C. 4 hours D. 72 hours

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ANS: B

The purpose of the prostate gland is: A. To secrete testosterone B. To secrete fluid containing calcium and citrate to add to ejaculate C. To secrete dihydrotestosterone D. To secrete fluid containing sperm into ejaculate

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ANS: C

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The phosphodiesterase (PDE) 5 inhibitors aid in male impotence by what mechanism?

A. Protecting nitric oxide from being broken down B. Protecting cGMP from being broken down C. Protecting L-arginine from being broken down D. Protecting citrulline from being broken down

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ANS: B 12.

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ANS: A

Inhibin is important in control of: A. Estradiol secretion B. Progesterone secretion C. Follicular-stimulating hormone secretion D. Luteinizing hormone secretion

ANS: C

Chapter 82. Female Physiology Before Pregnancy and Female Hormones

The cells of the follicle that are capable of producing androgens for conversion of androgens to estrogens are: A. Cytotrophoblasts B. Syntiotrophoblasts C. Granulosa D. Thecal

ANS: D

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The hormones produced by the corpus luteum include: A. GnRH B. FSH C. LH D. Progesterone

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ANS: D

Along with estrogen, the hormone that is responsible for relaxing the pelvic ligament to increase softening and effacement of the cervix is: A. Progesterone B. Relaxin C. Inhibin D. Activin

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ANS: B

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The process which stimulates prolactin to be released by the anterior pituitary during lactation is: A. Suckling of the baby B. Vitamins C and D C. Release of oxytocin D. Release of progesterone

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ANS: A 5.

In the developing follicle, the cells that are closest to the ovum are the: A. Cytotrophoblasts B. Syntiotrophoblasts C. Blastocysts D. Granulosa

ANS: D

6.

The cells responsible for invasion of the decidua and spiral arteries are: A. Cytotrophoblasts B. Syntiotrophoblasts C. Blastocysts D. Granulosa

ANS: A In the hypothalamic-pituitary-gonadal axis of the female, what is the follicular cell type that produces inhibin: A. Cytotrophoblasts B. Syntiotrophoblasts C. Granulosa D. Thecal

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ANS: C

The hormones most responsible for the LH surge and ovulation in a normal woman

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are: A. Estradiol and progesterone B. Activin and inhibin C. GnRH and inhibin D. Estradiol and GnRH

At what time is the second meiotic division of oogenesis completed in the human female?

A. Prior to birth B. Upon ovulation C. Upon fertilization D. After menopause

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ANS: C

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ANS: D

10.

On day 21 of the female reproductive cycle, how do the following hormones change?

Estradiol Progesterone FSH LH Activin Inhibin

A. B. C. D. ANS: B 11.

How are the reproductive hormones changed in postmenopausal women?

Estradiol Progesterone FSH LH Inhibin

A. B. C. D. ANS: C Polycystic ovary syndrome is always characterized by which of the following: A. High blood pressue B. Hyperinsulinemia C. Hyperglycemia D. Hyperandrogenism

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12.

The consequence of chronic gonadotropin-releasing hormone treatment in women is: A. Lack of ovulation B. Ovulation C. Inhibition of aromatase D. Inhibition of 5-alpha-reductase

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ANS: D

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ANS: A

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Chapter 83. Pregnancy and Lactation

Which of the following blastocystic cells is responsible for invasion of the spiral arteries to begin development of the chorionic villus?

A. Sertoli cells B. Synciotrophoblast cells C. Cytotrophoblast cells D. Glomerulosa cells

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Test Bank

ANS: B 2.

What is the consequence of the lack of adequate chorionic gonadotropin after fertilization?

A. Spontaneous abortion B. Early labor C. Delayed labor D. Lack of ovulation

ANS: A 3.

The structure in the fetus that shunts oxygenated blood from the right atrium to the left atrium is: A. Ductus arteriosus B. Ductus venosus C. Inferior vena cava D. Foramen ovale

ANS: D

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Questions 4 - 5: A 35 year old woman is admitted to the Labor and Delivery Suite at 4:30 am.

Her amniotic membranes ruptured approximately 6 hrs earlier, but her contractions have decreased from one every 3 min to 1 every 5-7 min. She is a primipara. Upon physical examination she has a blood pressure of 140/85, pulse 100, sinus tachycardia rhythm. Her temperature is 98.6 degrees. Laboratory studies revealed: serum glucose 135 mg/dL. BUN 10 mg/dL, serum creatinine 0.4 mg/dL, hematocrit is 38%, serum HgA1c 6.0 mg/dL. The fetal

If the physician wants to increase the rate and strength of the contractions, which of the following would he/she give the woman?

A. Oxytocin B. Prostaglandin F2alpha C. Angiotensin II D. Endothelin-1

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heart rate is 120 bpm. The cervix is dilated to 3 cm. According to her previous records, she is at 41 weeks gestation and she has gestational diabetes.

Since the woman has gestational diabetes, which of the following would the physician expect?

A. A neonate that is small for gestational age B. A neonate that has hypobilirubinemia C. A neonate that is large for gestational age D. A neonate that is hyperglycemic

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ANS: A

ANS: C The labor proceeds well and the woman delivers a baby girl after eight more hours.

6.

Which of the following will cause an abortion?

A. Oxytocin B. Prostaglandin F2alpha C. Angiotensin II D. Progesterone

ANS: B 7.

Which of the following hormones is responsible for milk being expressed into the mammary ducts of the breast when the woman nurses her baby?

A. Progesterone B. Estradiol C. Prolactin D. Oxytocin

The hormone that is responsible for milk production is: A. Estradiol B. Prolactin C. Oxytocin D. Progesterone

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ANS: B

The mechanism by which the zona pellucida becomes “hardened” following penetration of a sperm cell is: A. A reduction in estradiol B. The proteins released from the acrosome of the sperm C. An increase in intracellular calcium in the oocyte D. An increase in testosterone that affects the sperm

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ANS: D

The fetus is incapable of producing which steroid: A. Testosterone B. Estradiol C. Progesterone D. Dehydroepiandrosterone sulfate

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ANS: C

ANS: C

Chapter 84. Fetal and Neonatal Physiology Test Bank 1.

When the neonate is born and the umbilical cord is tied, which of the following

happens?

A. The venous return increases B. The pulmonary hydrostatic pressure increases C. The pressure in the left atrium increases D. The pressure in the ductus arteriosus increases ANS: C The condition is the male child in which the testes do not descend into the scrotum is called what?

A. Capacitation B. Cryptorchidism C. Varicocele D. Thelarche

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ANS: B

After birth which of the following is greater than before birth?

A. Flow through the foramen ovale B. Pressure in the right atrium C. Flow through the ductus arteriosus D. Aortic pressure

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In the fetus, there are four shunts for blood flow. What is the name of the shunt from the pulmonary artery to the aorta?

A. Foramen ovale B. Ductus venosus C. Ductus arteriosus D. Umbilicus

What causes the reduction in pulmonary vascular resistance in the infant at birth?

A. Pressure in the pulmonary artery increases at birth B. The baby takes a breath and the lungs inflate C. The ductus arteriosus constricts D. The foramen ovale closes E. Pulmonary artery pO2 increases

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ANS: C

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ANS: D

ANS: C 6.

In the fetus prior to birth, where is the partial pressure of oxygen highest in the circulatory system?

A. The right ventricle

B. The left ventricle C. The umbilical vein D. The carotid artery ANS: C You have a patient who has type I diabetes mellitus. She delivers a child that weighs 12 lbs 9 oz and is 22 inches long. Shortly after birth you would expect the blood glucose level and the blood insulin level in the fetus to: Glucose Insulin A. B. C. D.

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ANS: D

Oxygenated blood from the placenta enters the fetus via which vessels?

A. The umbilical vein B. The umbilical artery C. The superior vena cava D. The ductus arteriosus

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ANS: A

The fact that the pO2 in the fetus is low is not problem to normal development. Why?

Which of the following plays a role in maintaining pulmonary vascular tone in the fetus?

A. Endothelin and thromboxane B. Bradykinin and nitric oxide C. Estradiol D. Chorionic gonadotropin

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ANS: B

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A. Red blood cells in the fetus bind less hemoglobin than in the mother B. Red blood cells in the fetus bind more hemoglobin than in the mother C. Red blood cells in the fetus don’t bind hemoglobin D. Hematocrit is more important in the fetus than hemoglobin

ANS: A 11.

Compare the level of blood pressure in the five-day-old neonate to a five-year-old child: A. Higher than the 5-year-old B. Lower than the 5-year-old

C. Same as the 5-year-old D. Not measurable ANS: C 12.

How long will it take after birth for the kidneys of a neonate to be fully developed?

A. One day B. One week C. One month D. One year E. They are completely developed at birth

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ANS: C

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Chapter 85. Sports Physiology

Test Bank

During exercise in a healthy person which of the following is TRUE? A. The number of open vessels decreases B. There is a pulmonary vasoconstriction due to a decrease in pO2 in the pulmonary

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arterial blood C. Blood flow is equal throughout all portions of the lung D. V/Q ratio becomes more normal (approaches 1)

Which of the following would be expected to occur as an untrained person begins to exercise?

A. Increased pulmonary vascular resistance B. Decreased cardiac output C. More homogenous ventilation-perfusion ratios throughout the lung D. Decreased diffusing capacity

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ANS: D

ANS: C 3.

During moderate aerobic exercise, A. Arterial pO increases to >120 mmHg 2 B. Arterial pCO decreases 2 C. Arterial pH decreases D. Alveolar ventilation increases

E. Blood lactate level increases ANS: D 4.

A 25-year-old female is comfortably running a 10 km race. At eight km, which of the following would describe her blood composition.

Arterial pO2 Arterial pCO2 Mixed Venous pO2

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A. B. C. D. E. F. G. H. ANS: A

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Which of the following is most likely to occur in a strenuously exercising person?

A. Decreased arterial hemoglobin saturation B. Venous hemoglobin saturation of less than 30% C. Increased pulmonary capillary transit time D. Pulmonary vasoconstriction due to hypoxia

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ANS: B

In an exercising person: Arterial Blood A. Figure 1 point C B. Figure 1 point C C. Figure 1 point D D. Figure 1 point D E. Figure 1 point E F. Figure 1 point E

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Use the two figures to pick which points answer the following question. Please read the figures carefully.

Venous Blood Figure 2 point A Figure 2 point B Figure 2 point C Figure 2 point B Figure 2 point C Figure 2 point B

ANS: D 7.

A 52-year-old male runner is trying to fight old age and increase his aerobic performance in the marathon. Which of the following would help the most?

A. Sodium bicarbonate B. Amphetamines C. Anabolic steroids

D. Erythropoietin ANS: D 8.

Which of the following occurs during exercise at aerobic levels?

A. Decreased arterial pO2 B. Increased alveolar pO2 C. Normal alveolar-arterial pO2 gradient

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D. Decreased alveolar-arterial pO2 gradient

A 46-year-old female is completing her exercise test. Which of the following will occur?

A. All areas of her lung will have the same blood flow B. The upper portion of the lung will have more flow than the lower portion C. The lower portion of the lung will have more flow than the upper portion D. Hypoxic vasoconstriction limits the maximal oxygen consumption

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ANS: C

ANS: C

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During muscular exercise: A. The stimulus for the increased ventilation originates from chemoreceptors in the lung.

B. Pulmonary vascular resistance increases C. Muscle proprioreceptors provide a stimulus to increase ventilation D. Ventilation increases are delayed following the increase in metabolic rate

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10.

Following the completion of an 80 mile bicycle race which of the following would replenish muscle glycogen the fastest?

A. No food intake B. Sweet and sour pork C. Fried catfish D. Pasta E. Steak

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ANS: C

ANS: D