Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

TABLE OF CONTENTS Chapter 01: Principles of Cell Function Chapter 02: Homeostasis of Body Fluids Chapter 03: Signal Transduction, Membrane Receptors, Second Messengers, and Regulation of Gene Expression Chapter 04: The Nervous System: Introduction to Cells and Systems Chapter 05: Generation and Conduction of Action Potentials Chapter 06: Synaptic Transmission Chapter 07: The Somatosensory System Chapter 08: The Special Senses Chapter 09: Organization of Motor Function Chapter 10: Higher Functions of the Nervous System Chapter 11: The Autonomic Nervous System and Its Central Control Chapter 12: Skeletal Muscle Physiology Chapter 13: Cardiac Muscle Chapter 14: Smooth Muscle Chapter 15: Overview of Circulation Chapter 16: Elements of Cardiac Function Chapter 17: Properties of the Vasculature Chapter 18: Regulation of the Heart and Vasculature Chapter 19: Integrated Control of the Cardiovascular System Chapter 20: Structure and Function of the Respiratory System

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Chapter 21: Static Lung and Chest Wall Mechanics Chapter 22: Dynamic Lung and Chest Wall Mechanics Chapter 23: Ventilation, Perfusion, and Relationships Chapter 24: Oxygen and Carbon Dioxide Transport Chapter 25: Control of Respiration Chapter 26: Non-Physiologic Functions of the Lung: Host Defense Chapter 27: Functional Anatomy and General Principles of Regulation in the Gastrointestinal Tract Chapter 28: The Cephalic, Oral, and Phases of the Integrated Response to a Meal Chapter 29: The Gastric Phase of the Integrated Response to a Meal Chapter 30: The Small Intestinal Phase of the Integrated Response to a Chapter 31: The Colonic Phase of the Integrated Response to a Meal Chapter 32: Transport and Metabolic Functions of the Liver Chapter 33: Elements of Renal Function Chapter 34: Solute and Water Transport along the Nephron: Tubular Function Chapter 35: Control of Body Fluid Osmolality and Volume Chapter 36: Potassium, Calcium, and Phosphate Homeostasis Chapter 37: Role of the Kidneys in the Regulation of Acid Chapter 38: Introduction to the Endocrine System Chapter 39: Hormonal Regulation of Energy Metabolism Chapter 40: Hormonal Regulation of Calcium and Phosphate Metabolism Chapter 41: The Hypothalamus and Pituitary Gland Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Chapter 42: The Thyroid Gland Chapter 43: The Adrenal Glands Chapter 44: The Male and Female Reproductive Systems

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Berne and Levy Physiology 7th Edition Koeppen Test Bank Koeppen: Berne and Levy Physiology, 7th Edition Chapter 01: Principles of Cell Function Test Bank Multiple Choice 1.

The subcellular structure that degrades proteins is called the:

A. B. C. D. E.

Tight junction Mitochondria Lysosome Plasma membrane Ribosome

ANS: C

2.

An experiment is done to measure the uptake of an amino acid into a cell. The following data are obtained:

N

If Na+ is removed from the extracellular bathing solution, or if a drug is added that prevents the cell from making adenosine triphosphate (ATP), the uptake of amino acid into the cell is markedly reduced. According to this information, which of the following mechanisms is probably responsible for the transport of the amino acid into the cell?

A. B. C. D. E.

Passive diffusion through the lipid bilayer Uniporter Transport ATPase Na+ symporter Na+ antiporter

ANS: D Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

3.

A membrane permeable by only Na+ separates two compartments containing Na2SO4, shown as follows:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Electrodes are placed in both compartments, and a voltage is applied (that of compartment A is held at 0 mV). What voltage applied to compartment B would result in no net movement of Na+ across the membrane separating the compartments?

A. –60 mV B. –30 mV C. 0 mV D. +30 mV E. +60 mV ANS: E

4.

The resting membrane potential is –85 mV.MThe intracellular and extracellular NUof RSaIcell NGTB.C concentrations of several ions are indicated in the following table, as is the calculated Nernst equilibrium potential (Ei) for each of these ions: Ion Na+ K+ Cl– Ca++

Concentration Inside Cell 12 mEq/L 150 mEq/L 30 mEq/L 0.0001 mmol/dL

Concentration Outside Cell 145 mEq/L 4 mEq/L 105 mEq/L 1 mmol/dL

Ei 66 mV –96 mV –33 mV 122 mV

The membrane has channels for Na+, K+, Cl–, and Ca++. The conductance of the membrane is the greatest for which ion?

A. B. C. D.

Na+ K+ Cl– Ca++

ANS: B

5.

A cell contains the following membrane transporters:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Na+ channel K+ channel Na+,K+-ATPase The resting membrane voltage of the cell is –80 mV, and the intracellular and extracellular ion concentrations are as follows: Ion Na+ K+

Intracellular Concentration 10 mEq/L 120 mEq/L

Extracellular Concentration 145 mEq/L 4 mEq/L

The cell is treated with a drug to inhibit the Na+,K+-ATPase. What would be the effect of this drug on the following parameters?

A. B. C. D. E.

Intracellular [Na+] Decrease Increase Increase Decrease Increase

Intracellular [K+] Decrease Decrease Increase Increase Increase

Cell Volume Decrease Increase Increase Decrease Decrease

Membrane Voltage Depolarize Depolarize No change Hyperpolarize Hyperpolarize

ANS: B 6.

Which of the labeled proteins (shaded) is attached to the membrane by a glycosylphosphatidylinositol (GPI) anchor?

ANS: E 7. A cell has channels for Na+, K+, and Cl– in its plasma membrane. The resting membrane potential is –60 mV (cell interior negative). The intracellular and extracellular concentrations for these ions, as well as the calculated Nernst potentials, are listed as follows:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Ion Na+ K+ Cl–

Intracellular Concentration 14 mEq/L 150 mEq/L 10 mEq/L

Extracellular Concentration 140 mEq/L 5 mEq/L 100 mEq/L

Ei 60 mV –89 mV –60 mV

A drug is applied to the cell that increases the permeability of the cell by Cl– (i.e., it opens Cl– channels). What effect will this drug have on the net movement of Cl– across the plasma membrane?

A. Net Cl– movement out of the cell will be increased.

B. Net Cl– movement into the cell will be increased.

C. There will be no change in the net movement of Cl–.

ANS: C

8.

Reducing the extracellular [K+] would be expected to have which of the following effects on the resting membrane potential and on the excitability of ventricular myocytes?

A. B. C. D. E.

Membrane Potential Excitability Unchanged Unchanged HyperpolarizedNURSIN G DT ecBre.aC seO dM Hyperpolarized Increased Depolarized Decreased Depolarized Increased

ANS: B

9.

A cell is bathed in an isotonic NaCl solution that contains 5 mmol/L of glucose. The intracellular concentration of glucose is 10 mmol/L. What is the most likely mechanism for the transport of glucose across the plasma membrane into this cell?

A. B. C. D.

Glucose uniporter Na+-glucose symporter Na+-glucose antiporter Diffusion of glucose through the lipid bilayer of the membrane

ANS: B 10. A blood sample is taken from an individual whose blood osmolality is 295 mOsm per kilogram of water. Red blood cells from this sample are then placed in the following solutions:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

1-5

Solution

1.

2.

3.

4.

5.

NaCl Fructose Urea CaCl2 KCl

Osmolality (mOsm/kg H2O)

300 300 300 100 150

Reflection Coefficient () of Solute 1 0.5 0 1 1

The red blood cells in which of these solutions will swell to the greatest degree?

A. B. C. D. E.

1 2 3 4 5

ANS: C

11. A solution that causes a cell to shrink is: A. Isotonic B. Hypotonic C. Hypertonic ANS: C

12. Osmosis is: A. B. C. D.

The active transport of water The number of solute particles in 1 kg of water The diffusion of water across cell membranes The defined as the weight of a volume of a solution divided by the weight of an equivalent volume of distilled water E. The amount of a substance relative to its molecular weight ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne and Levy Physiology, 7th Edition Chapter 02: Homeostasis of Body Fluids Test Bank Multiple Choice

1.

A 100 mmol/L solution of MgCl2 would be expected to have an osmolality of which of the following?

A. B. C. D. E.

50 mOsm/kg H2O 100 mOsm/kg H2O 200 mOsm/kg H2O 300 mOsm/kg H2O 350 mOsm/kg H2O

ANS: D

2.

Three individuals, each weighing 55 kg and each having a plasma [Na+] of 145 mEq/L, receive infusions of different solutions. Individual A receives 1 L of isotonic NaCl (290 CaOnMnitol solution (290 mOsm/kg H2O); mOsm/kg H2O); individual BNrU ecR eiS veIsN1GLToB f. am and individual C receives 1 L of a 5% dextrose in water (D5W) solution (290 mOsm/kg H2O). Assuming that there is no urine output, and after complete equilibration of the extracellular and intracellular fluid, which of these individuals will have a lower plasma [Na+]?

A. B. C. D.

Individual A (NaCl infusion).

Individual B (mannitol infusion).

Individual C (D5W infusion).

Individuals A, B, and C will have the same plasma [Na+].

ANS: B

3.

Intravenous infusion of 2 L of which of the following solutions will lead to the largest increase in intracellular fluid volume?

A. B. C. D.

D5W Isotonic NaCl Hypotonic NaCl Hypertonic NaCl

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank ANS: A

4.

Intracellular fluid volume is normally what percentage of body weight?

A. B. C. D. E.

60% 40% 20% 10% 5%

ANS: B

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

2-2

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce .

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 03: Signal Transduction, Membrane Receptors, Second Messengers, and Regulation of Gene Expression Test Bank Multiple Choices 1.

Molecules that are produced by cells and act locally on other cells are called:

A. B. C. D. E.

Steroid hormones.

Receptors.

Paracrine hormones.

Phosphatases.

Iodothyronines.

ANS: C

2.

A typical flow of information in a signal transduction pathway would be which of the following?

A. Receptor → G protein → secNonUdRmSeIssNenGgTerB→.CbiOolMogicalresponse B. Hormone → second messenger → G protein–coupled receptor (GPCR) → biological response C. Hormone → second messenger → GPCR D. Hormone → receptor → second messenger → GPCR → biological response E. GPCR → second messenger → biological response ANS: A

3.

The negative side effects of nonsteroidal antiinflammatory drugs (NSAIDs) on the cardiovascular system are mediated by inhibition of which enzyme?

A. B. C. D. E.

Cyclooxygenase-1 (COX1) -Secretase Presenilin 1 Cyclooxygenase-2 (COX2) Adenylate cyclase

ANS: D

4.

In the following list, which drug is correctly used to treat the disease listed?

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

A. B. C. D. E.

-Adrenergic receptor agonists with depression Fluoxetine (Prozac) with low blood pressure Trastuzumab (Herceptin) with metastatic colorectal cancer Sildenafil (Viagra) with pulmonary arterial hypertension Cetuximab (Erbitux) and bevacizumab (Avastin) with metastatic breast cancer

ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

3-2

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne and Levy Physiology, 7th Edition Chapter 04: The Nervous System: Introduction to Cells and Systems Test Bank Multiple Choice 1.

Which of the following statements does not apply to dendrites?

A. B. C. D. E.

They can be highly branched.

They can have spines.

They are the main output element of the neuron.

One neuron can have many dendrites.

They are the main target for inputs to the neuron

ANS: C

2.

Which of the following statements does not apply to axons?

A. B. C. D. E.

Typically there is one axon per neuron.

Axons lack rough endoplasmic reticulum, free ribosomes, and a Golgi apparatus.

RaSyIfrNoG They conduct action potentiaN lsU aw mTthBe.cC ellObM ody.

They are the main output element of the neuron.

They can transport material only from the cell body to the axon terminal.

ANS: E

3.

In a case of hydrocephalus due to blockage of the cerebral aqueduct, which ventricles are distended?

A. B. C. D. E.

Lateral ventricles only Third ventricle only Lateral and third ventricles Fourth ventricle only Third and fourth ventricles

ANS: C

4.

Astrocytes help maintain the central nervous system (CNS) extracellular milieu by:

A. Taking up and redistributing excess K+ and other ions.

B. Wrapping extensions of their cytoplasm around axons.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank C. Phagocytosing damaged CNS neurons.

D. Lining the ventricular surface of the CNS. E. Differentiating into neurons in response to injury.

ANS: A

5.

Which statement is incorrect?

A. B. C. D. E.

White matter appears white because myelin refracts light.

Gray matter consists of dense aggregations of neurons.

White matter consists of dense aggregations of axons.

Tracts and pathways consist of long columns of neuronal cell bodies.

Motor neurons have axons that leave the CNS.

ANS: D

6.

After damage to the axon of a cell, the following sequence (A to E) occurs in the peripheral nervous system (PNS). However, in the CNS, the last step is usually:

A. B. C. D. E.

Degeneration of the distal axon.

Chromatolysis in the cell body.

Sprouting of new branches. NURSINGTB.COM Axon regrowth along the original pathway.

Reinnervation of the target.

ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

4-2

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne and Levy Physiology, 7th Edition Chapter 05: Generation and Conduction of Action Potentials Test Bank Multiple Choice 1.

The axon membrane responds to an intracellular injection of a subthreshold positive current with:

A. B. C. D. E.

Transient depolarization only in the region where the current is injected.

Maintained depolarization until negative current is injected.

Maximal depolarization locally and attenuated depolarization along the axon.

Immediately opening K+ channels to maintain resting potential.

Firing an action potential.

ANS: C

2.

The length constant of an unmyelinated axon increases as the diameter of the axon increases. This is primarily a result of:

A. B. C. D. E.

Increasing membrane capacitN anUcR e.SINGTB.COM Decreasing membrane capacitance.

Increasing membrane resistance.

Decreasing membrane resistance.

Decreasing axoplasmic resistance.

ANS: E

3.

At the threshold for generating an action potential:

A. B. C. D. E.

The membrane is at the K+ equilibrium potential.

The conductances for Na+ and K+ are equal.

There is a rapid opening of voltage-gated Na+ channels.

K+ conductance is maximal.

The transmembrane voltage is zero.

ANS: C

4.

Which of the following is responsible for the repolarization of the membrane after the peak of the action potential?

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

A. B. C. D. E.

The membrane potential reaches the Na+ equilibrium potential.

The voltage-gated Na+ channels begin to inactivate.

The slowly opening voltage-gated K+ channels allow K+ to enter.

The influx of Na+ and the outflow of K+ are equal.

There is no longer a gradient to drive K+ out of the cell.

ANS: B

5.

The afterhyperpolarization that follows the action potential:

A. B. C. D. E.

Results primarily from to the inactivation of voltage-gated Na+ channels.

Makes it easier to trigger another action potential.

Is the main cause of the relative refractory period.

Makes it impossible to fire another action potential.

Is the consequence of continuing K+ influx.

ANS: C

6.

Which of the following is not a true statement about the conduction of action potentials (APs) in axons?

an.AC n the neighboring node of a A. The inward Na+ current of anNA PU Rg en SIeNr aGtTe s B OP iM myelinated axon.

B. All APs in a given axon typically are identical in magnitude and duration.

C. An action potential experimentally generated by a depolarization in the middle of an axon is conducted in only one direction from the site of initiation.

D. The velocity of AP conduction is positively correlated with axon diameter.

E. The frequency of APs is limited by the length of the refractory period.

ANS: C

7.

Myelination increases AP conduction velocity by:

A. B. C. D. E.

Increasing the axonal diameter.

Increasing membrane capacitance.

Limiting voltage-gated K+ channels to the nodes.

Decreasing the membrane resistance.

Increasing the length constant and decreasing the membrane capacitance between the nodes.

ANS: E

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

5-3

8.

Which of the following statements about a compound action potential recording is not true?

A. B. C. D. E.

Each peak represents a group of axons of similar conduction velocity.

Each peak represents a group of axons of similar diameter.

The magnitude of each peak reflects the number of axons in that category.

The magnitude of a peak is negatively correlated with axonal conduction velocity.

The profiles of peaks are characteristic of and different for different peripheral nerves.

ANS: D

9.

Which of the following events is common to all types of sensory receptors?

A. B. C. D. E.

The generation of a receptor potential.

The generation of an action potential.

The binding of a stimulus to a receptor.

The binding of a stimulus to a membrane channel.

Membrane depolarization.

ANS: A a mNeG t ers 10. Which of the following s timuNlusU RparSI T Bis.nCot eMncoded in the pattern of action potentials in a sensory axon?

A. B. C. D. E.

Threshold Frequency Modality Duration Intensity

ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne and Levy Physiology, 7th Edition Chapter 06: Synaptic Transmission Test Bank Multiple Choice

1.

At electrical synapses:

A. There is a synaptic delay as the signal travels from the presynaptic element to the postsynaptic element.

B. Release of neurotransmitter is required.

C. There is a low-resistance pathway for flow of current between cells.

D. Electrical potentials can be transmitted in only one direction.

ANS: C

2.

At gap junctions, the intercellular space:

A. B. C. D.

Widens and is filled by electron-lucent material.

Widens and is filled by el e ct rNonU-R deS nI seNmGaT teB ria.l.COM Narrows and is filled by electron-lucent material.

Narrows and is filled by electron-dense material.

ANS: D

3.

Chemical synapses are typically characterized by:

A. B. C. D.

Unidirectional and instantaneous transmission of electrical signals.

Unidirectional transmission of electrical signals after a short delay.

Bidirectional and instantaneous transmission of electrical signals.

Bidirectional transmission of electrical signals after a short delay.

ANS: B

4.

Calcium entry into the presynaptic terminal is greatest:

A. B. C. D.

During the rising phase of the action potential.

At the peak of the action potential.

During the falling phase of the action potential.

During the afterhyperpolarization that follows an action potential.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

E. When the action potential is in its resting phase.

ANS: C

5.

The quantal nature of chemical synaptic transmission is best supported by observation of:

A. B. C. D. E.

Spontaneous miniature end plate potentials (mEPPs).

Discrete jumps in end plate potential (EPP) amplitude when [Ca++] is normal.

EPPs that vary smoothly in amplitude.

A constant EPP amplitude.

Evoked EPPs that are smaller than mEPPs.

ANS: A

6.

The kiss-and-run method of vesicle recycling is most important for maintaining synaptic transmission at:

A. B. C. D.

An axon with a high firing rate and small presynaptic terminals.

The neuromuscular junction.

A large central nervous system (CNS) synapse.

A presynaptic terminal with aNlU ow prI obNaG biT litB y. oC f rOe lM e as e .

RS

ANS: A

7.

Temporal summation refers to the fact that:

A. Excitatory postsynaptic potentials (EPSPs) generated by synapses on different dendrites will add linearly.

B. EPSPs generated by synapses on the same dendrite will add linearly.

C. Two EPSPs generated at slightly different times will produce a larger overall response.

D. Two EPSPs generated at the same time will shunt each other.

ANS: C

8.

The neurotransmitter gamma-aminobutyric acid (GABA):

A. B. C. D.

Is stored in large electron-dense vesicles.

Is the major excitatory transmitter in the brain.

When released, acts mainly at the immediate postsynaptic membrane.

Binds to only ionotropic receptors.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

6-3

ANS: C

9.

Ionotropic receptors:

A. B. C. D.

Activate second messenger cascades.

Trigger EPSPs that are longer than those of metabotropic receptors.

Are a common receptor type for neuropeptides.

Underlie fast synaptic transmission.

ANS: D

10. Metabotropic receptors: A. Trigger EPSPs whose time course is mainly determined by the resistor-capacitor (RC) circuit (i.e., passive electrical) properties of the cell membrane.

B. Trigger EPSPs that last approximately 10 msec.

C. Are coupled to a G protein.

D. Have only one significant action, which is to cause voltage changes (postsynaptic potentials [PSPs]).

ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne and Levy Physiology, 7th Edition Chapter 07: The Somatosensory System Test Bank Multiple Choice

1.

Fast-adapting type 1 fibers respond to a tactile stimulus by a:

A. B. C. D.

Maintained increase in firing rate for the duration of the stimulus Maintained decrease in firing rate for the duration of the stimulus Transient increase in firing rate at the initiation and cessation of the stimulus Transient increase in firing rate at the initiation of the stimulus and a transient decrease in firing rate at its cessation E. Transient decrease in firing rate at the initiation of the stimulus and a transient increase in firing rate at its cessation ANS: C

2.

Pacinian corpuscles are located:

A. B. C. D.

Superficially in the dermis and thus have receptive fields with sharp borders Deep in the dermis and thus have receptive fields with sharp borders Superficially in the dermis and thus have receptive fields with poorly defined borders Deep in the dermis and thus have receptive fields with poorly defined borders

NURSINGTB.COM

ANS: D

3.

The main pathway for fine discriminative touch information from the hand to the cerebral cortex includes:

A. Group A-β axons → fasciculus cuneatus → medial lemniscus → ventroposterolateral (VPL) nucleus → postcentral gyrus B. Group C axons → fasciculus cuneatus → medial lemniscus → VPL nucleus → postcentral gyrus C. Group A-β axons → fasciculus cuneatus → medial lemniscus → VPL nucleus → precentral gyrus D. Group C axons → fasciculus cuneatus → medial lemniscus → VPL nucleus → precentral gyrus E. Group A- axons → fasciculus gracilis → medial lemniscus → VPL nucleus → postcentral gyrus

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

ANS: A

4.

Which of the following sequences represents a pathway for conscious proprioceptive information (kinesthesia) from the lower limb?

A. Dorsal root ganglion cells → nucleus dorsalis → dorsal spinocerebellar tract → superior cerebellar peduncle B. Clarke's column → ventral spinocerebellar tract → inferior cerebellar peduncle C. Dorsal root ganglion cells → dorsal spinocerebellar tract → nucleus z → medial lemniscus → VPL nucleus D. Fasciculus cuneatus → internal arcuate fibers → medial lemniscus → VPL nucleus ANS: C

5.

In the primary somatosensory cortex (SI):

A. B. C. D.

All body parts are represented by equal amounts of cortex.

Body parts are represented by an amount of cortex proportional to their surface area.

The sensory homunculus has an upright position.

Proprioceptive and tactile information are directed to different parts of SI cortex and are examples of the labeled-line principle.

ANS: D

NURSINGTB.COM

6.

Pain fibers:

A. B. C. D.

Are not activated by a mechanical stimulus unless it is painful End in encapsulated receptors Are large-caliber myelinated axons May be activated by multiple classes of stimuli

ANS: D

7.

A lesion of the dorsal columns would result in:

A. B. C. D.

Loss of pain sensation Impaired graphesthesia Loss of ability to localize a tactile stimulus Motor weakness

ANS: B

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

7-3

8.

Second pain is mediated by:

A. B. C. D.

C fibers and is a sharp, highly localized sensation C fibers and is a dull, poorly localized sensation A- fibers and is a sharp, highly localized sensation A- fibers and is a dull, poorly localized sensation

ANS: B

9.

The gate control theory of pain is best described by which of the following statements?

A. Transient receptor potential (TRP) channels are gated by temperature.

B. Activation of low-threshold mechanoreceptors can reduce or block the activity of ascending pain pathways.

C. Gamma aminobutyric acid (GABA) inhibits neurons in the spinal cord.

D. After sensitization, a pain fiber begins responding to nondamaging tactile stimuli.

ANS: B 10. Which nonopioid neurotransmitter is involved in control of pain pathways?

A. B. C. D.

Serotonin Enkephalin Dynorphin -Endorphin

NURSINGTB.COM

ANS: A

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne and Levy Physiology, 7th Edition Chapter 08: The Special Senses Test Bank Multiple Choice

1.

Rods differ from cones in that:

A. B. C. D. E.

Rods function better in photopic conditions.

Rods are not found in the fovea.

There are three types of rods, each with different spectral sensitivity.

Rods hyperpolarize in response to light.

Rods, because of their synaptic connections, are capable of high spatial resolution.

ANS: B

2.

A retinal off-center bipolar cell:

A. B. C. D. E.

Depolarizes in response to a light in the center of its receptive field. + Has metabotropic glutamate N reU ceR ptS orIs N thG atTcB lo. seCNOaM channels.

Depolarizes in response to a light in the periphery of its receptive field.

Is hyperpolarized by horizontal cell input.

Connects to ganglion cells but not horizontal cells.

ANS: C

3.

P ganglion cells differ from M ganglion cells in that P cells:

A. B. C. D. E.

Have center-surround receptive fields.

Respond to movement within their receptive fields.

Have large dendritic trees.

Have large receptive fields.

Have color-opponent receptive fields.

ANS: E

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

4.

The different absorbance spectra expressed by the three types of cone photoreceptors found in the human eye result from differences in:

A. B. C. D.

The number of disc membranes found in the cone outer segments.

The stereoisomers of vitamin A found in the cone outer segments.

The type of opsins found in the cone outer segments.

The number of cyclic guanosine monophosphate (cGMP)–gated channels found in the cone inner segments.

E. The types of bipolar cells with which they synapse.

ANS: C

5.

A lesion in the left inferotemporal cortex would probably lead to a reduction in:

A. B. C. D. E.

Face recognition in the right visual field.

Motion discrimination in the right visual field.

Color discrimination in the left visual field.

Motion discrimination in the left visual field.

Face discrimination in the left visual field.

ANS: A

NURSINGTB.COM

6.

Detection of the frequency of a sound above 5 kHz is based on:

A. B. C. D. E.

The number of fibers discharging in cranial nerve VIII. The phase difference between the sound waves at the two ears.

The direction of deflection of the hair cell cilia.

The location along the cochlea of the most intensely stimulated hair cells.

The frequency of action potentials in cranial nerve VIII.

ANS: D

7.

Conduction deafness results from:

A. B. C. D. E.

Loss of hair cells.

A tumor in the cochlear nucleus.

Demyelination of primary auditory afferent nerves.

Ossification in the middle ear.

Loss of the pathway from the medial geniculate to the auditory cortex.

ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

8-3

8.

The most effective stimulus for excitation of the right horizontal semicircular canal hair cells is:

A. B. C. D. E.

Constant-velocity rotation to the right.

Constant-velocity rotation to the left.

Rotatory acceleration of the head to the right.

Rotatory acceleration of the head to the left.

The same stimulus as that for the left horizontal canal hair cells.

ANS: C

9.

Which characteristic of a vestibular hair cell is not a characteristic of an auditory hair cell?

A. B. C. D. E.

Synaptic vesicles Energy transduction Directional sensitivity of the stereocilia Axon Kinocilium

ANS: E

NURSINGTB.COM

10. In a comparison of the chemoreceptors of the olfactory and gustatory systems, which of the following statements is not true?

A. B. C. D. E.

Only the olfactory receptor cells are neurons with axons.

Only the taste receptor cells have ionotropic receptor mechanisms.

Only the olfactory receptor cells connect directly to the cerebrum.

Only the taste receptor cells are clustered in buds.

Only the olfactory receptor cells are continuously regenerated throughout life.

ANS: E

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne and Levy Physiology, 7th Edition Chapter 09: Organization of Motor Function Test Bank Multiple Choice

1.

According to the size principle:

A. B. C. D. E.

Large α motor neurons are recruited before small ones.

Large and small α motor neurons are recruited simultaneously. α and  motor neurons are activated simultaneously during a movement. α motor neurons are activated before  motor neurons during a movement.

Small motor neurons are more excitable than are large motor neurons.

ANS: E

2.

Intrafusal muscle fibers but not extrafusal fibers:

A. B. C. D.

Receive only sensory innervation.

Are innervated by only one mNoU toR rS n eIu N r oG n.TB.COM Contain an equatorial region with little to no contractile protein.

Run the length of the muscle.

ANS: C

3.

The phasic Ia stretch reflex:

A. B. C. D.

Has a polysynaptic reflex arc.

Acts to maintain a constant level of tension in the muscle.

Is initiated by a receptor that lies in series with the extrafusal fibers.

Has its sensitivity controlled by the gamma motor neuron system.

ANS: D

4.

Damage to which structure would produce an extensor rigidity that would not be significantly altered by section of the dorsal roots?

A. Lateral vestibular nucleus.

B. Anterior vermal region of the cerebellar cortex.

C. Medullary reticular formation (nucleus gigantocellularis).

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

D. Cortical afferent pathways to the pontine and medullary reticular formation.

E. Cortex of the cerebellar hemisphere.

ANS: B

5.

Upper motor neuron (or pyramidal tract) syndrome is:

A. B. C. D. E.

Characterized by the permanent loss of the stretch reflexes.

Fully expressed when only the corticospinal tract is interrupted.

Characterized by a lasting decrease in muscle tone.

Characterized by Babinski's sign and the appearance of other pathological reflexes.

Fully expressed after damage to the vestibular nuclei.

ANS: D

6.

In the motor map of the primary motor cortex:

A. Each muscle is represented by a single cortical column.

B. Each muscle is represented by multiple columns within a single continuous region.

C. The number of cortical columns representing a muscle is proportional to the mass of the muscle. senR tU ingS D. The amount of territory repreN Ia mNGuscTBle.isCcorMrelated with the degree of fine control over movements made using that muscle.

E. Columns controlling different muscles are randomly intermixed.

ANS: D

7.

A monkey makes arm movements while you record the activity of a cell in primary motor cortex in a cortical column related to arm muscles. What is probably true about the cell's activity?

A. It is linearly related to movement direction and thus can predict the direction of the upcoming movement.

B. It does not vary with movement direction.

C. It always increases during the movement.

D. It is nonlinearly related to movement direction and does not predict the specific direction of the upcoming movement.

ANS: D

8.

A stimulus applied to the surface of the cerebellar cortex activates a beam of parallel fibers. This produces:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

A. B. C. D. E.

9-3

A wave of inhibited Purkinje cells in line with the parallel fiber beam.

Waves of excited Purkinje cells that flank the parallel fiber beam.

A wave of excited basket and stellate cells in line with the parallel fiber beam.

Waves of excited basket and stellate cells that flank the parallel fiber beam.

Complex spikes in Purkinje cells in line with the parallel fiber beam.

ANS: C

9.

Dopamine's action in the caudate and putamen will internal (GPi) as a result of .

activity in the globus pallidus

A. B. C. D. E.

Decrease; activation of the direct pathway and inhibition of the indirect pathway Decrease; inhibition of the direct pathway and activation of the indirect pathway Increase; activation of the direct pathway and inhibition of the indirect pathway Increase; inhibition of the direct pathway and activation of the indirect pathway Decrease; inhibition of both direct and indirect pathways

ANS: A 10. With a person standing upright, head rotation to the right causes: A. B. C. D. E.

NURSINGTB.COM

Activation of hair cells in the left horizontal canal and right abducens nucleus.

Activation of hair cells in the right horizontal canal and right abducens nucleus.

Activation of hair cells in the left horizontal canal and left abducens nucleus.

Activation of hair cells in the right horizontal canal and left abducens nucleus.

A vertical nystagmus

ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 10: Higher Functions of the Nervous System Test Bank Multiple Choice 1.

Brodmann’s map of the cerebral cortex:

A. B. C. D.

Is based on recordings of cortical evoked potentials.

Is based on regional variation of the cytoarchitecture of the cortical layers.

Has no correlation with functional organization.

Shows the regions numbered sequentially from frontal pole (area 1) to occipital pole (area 47).

E. Shows the regions numbered sequentially from left (area 1) to right (area 47).

ANS: B

2.

Which of the following is not true about the electroencephalogram (EEG)?

A. B. C. D. E.

The EEG is a field potential generated by the activity of large numbers of neurons.

CaOl.M During epileptic seizures, theNEUER GSreImNaG inT sB no.rm An evoked potential is a change in the EEG in response to a stimulus.

Alpha and beta EEG patterns are seen in awake individuals.

Slow EEG rhythms become prominent during drowsiness and sleep.

ANS: B

3.

Which of the following is an incorrect assignment of a lobe of the cerebral cortex and function?

A. B. C. D. E.

Frontal lobe and motor control Parietal lobe and olfactory perception Occipital lobe and visual processing Temporal lobe and auditory processing Limbic lobe and memory

ANS: B

4.

Rapid eye movement (REM) sleep can be distinguished from the other levels of sleep because it:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

A. B. C. D. E.

Is most common early in the night’s sleep.

Occurs only once a night.

Is the deepest level of sleep.

Is associated with increased muscle tone in the limbs.

Produces an EEG pattern that resembles that of the alert awake state.

ANS: E

5.

Investigations of the differences between the left and right cerebral hemispheres have demonstrated all of the following except which of the following?

A. Speech is usually localized in the left hemisphere.

B. Each hemisphere receives sensory input from and has motor control of the opposite side of the body.

C. Lesions of Broca’s area in the left hemisphere lead to an inability to understand spoken or written language.

D. The corpus callosum is the major route for information transfer between the hemispheres.

E. The right parietal cortex is more capable of spatial tasks.

ANS: C

6.

A. B. C. D. E.

NURSINGTB.COM

A patient with an inability to write or to generate meaningful speech, but can understand requests and make sounds, probably has a lesion in: The left frontal lobe.

The right frontal lobe.

The left temporal lobe.

The right temporal lobe.

The left parietal lobe.

ANS: A

7.

In a patient who has undergone corpus callosotomy, the failure of interhemispheric transfer of information is best demonstrated by:

A. B. C. D.

A task in which the patient uses both hands.

A task that requires eye-hand coordination while one eye is covered.

A task in which the patient is asked to identify an object placed to his or her left.

A task in which the patient is asked to identify an object only by touch with the left hand.

E. A task in which the patient is asked to identify an object only by touch with the right hand

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

10-3

ANS: D

8.

The “critical period”:

A. B. C. D. E.

Is the transition between the awake and sleep states.

Is the transition between short-term and long-term memory.

Is a period of maximal developmental plasticity.

Is a period of changes in neural circuits that occur after the onset of blindness in adults.

Occurs only in mature individuals.

ANS: C

9.

Evidence for the existence of neural plasticity includes all of the following except:

A. The retention of procedural memory after lesions that result in loss of declarative memory (amnesia).

B. The appearance of distinct cortical regions for each digit after surgery for syndactyly.

C. The enlargement of adjacent cortical regions to encompass that of a removed digit.

D. The establishment of ocular dominance columns in the visual cortex during development. aiS nI afN teG r aTnBa. mC puOtaMtion.

E. The sensation of phantom limNbUpR ANS: A

10. Klüver-Bucy syndrome does not include: A. B. C. D. E.

Visual agnosia Hypersexuality Hemineglect Hyperorality Changes in emotional behavior

ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 11: The Autonomic Nervous System and Its Central Control Test Bank Multiple Choice

1.

Postganglionic neurons are found in which of the following?

A. B. C. D. E.

Intermediolateral cell column Thoracic ventral root White communicating ramus Paravertebral ganglion Gray communicating ramus

ANS: D

2.

Norepinephrine is a neurotransmitter:

A. B. C. D. E.

At all autonomic ganglia.

For all postganglionic parasyN mU paRthSeI ticNnGerTvB es. . COM For all preganglionic sympathetic nerves.

For most postganglionic sympathetic nerves.

For most postganglionic parasympathetic nerves.

ANS: D

3.

Damage to the intermediolateral cell column in the upper thoracic spinal cord causes:

A. B. C. D. E.

Ptosis Pupillary dilation Increased sweating on the face Paralysis of the thoracic musculature Increased sweating on the body

ANS: A

4.

In controlling micturation:

A. Sympathetic and somatic nerves act synergistically.

B. Sympathetic and parasympathetic nerves act synergistically.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

C. Parasympathetic and somatic nerves act synergistically.

D. Sympathetic, parasympathetic, and somatic nerves all act synergistically.

ANS: A

5.

A lesion in the preoptic region of the hypothalamus causes:

A. B. C. D. E.

Hypothermia Decreased sweating Increased food intake Decreased food intake Cutaneous vasodilation

ANS: B

6.

Maintenance of body temperature in a cold environment involves all of the following except:

A. B. C. D. E.

Shivering thermogenesis. brown adipose tissue (BAT) thermogenesis.

Cutaneous vasoconstriction.

Voluntary behaviors (e.g., cloNsU inR gS anIoN pG enTwBin.dC ow O)M. A decrease in thyroid activity.

ANS: E

7.

Leptin acts to control body fat levels (adiposity) by:

A. Inhibiting food intake.

B. Stimulating proopiomelanocortin (POMC)/ cocaine- and amphetamine-related transcript (CART) neurons in the hypothalamus.

C. Inhibiting neuropeptide Y (NPY)/ agouti-related peptide (AgRP) neurons in the hypothalamus.

D. Promoting the loss of fat tissue.

E. Decreasing in response to increased adiposity.

ANS: E

8.

Urinary continence is maintained by excitatory:

A. Somatic innervation of the internal sphincter.

B. Postganglionic parasympathetic innervation of the detrusor muscle.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank C. Postganglionic parasympathetic innervation of the internal sphincter.

D. Postganglionic sympathetic innervation of the detrusor muscle.

E. Postganglionic sympathetic innervation of the external sphincter.

ANS: B

9.

The parasympathetic system differs from the sympathetic system by:

A. B. C. D.

Exiting the central nervous system (CNS) at spinal cord levels.

Having a two-neuron motor pathway.

Having preganglionic cell bodies located in the CNS. Having short postganglionic axons.

ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

11-3

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 12: Skeletal Muscle Physiology Test Bank Multiple Choice 1.

In the absence of extracellular Ca++, an action potential in a motor neuron fails to initiate contraction of the innervated skeletal muscle because of:

A. B. C. D. E.

Inhibition of Ca++ influx into the innervated muscle.

Inhibition of acetylcholine (ACh) binding to receptors on the muscle end plate.

Stimulation of ACh degradation.

Inhibition of ACh release from the motor neuron.

Inhibition of Ca++ binding to troponin C in the innervated muscle.

ANS: D

2.

Contraction of skeletal muscle in response to an action potential requires:

A. B. C. D. E.

Ca++ influx through L-type Ca++ channels.

Ca++ binding to troponin C. Phosphorylation of a myosin light chain.

Phosphorylation of troponin I. Ca++ extrusion through the Na+-Ca++ antiporter.

ANS: B

3.

Relaxation of skeletal muscle after contraction requires:

A. Ca++ release by the ryanodine receptor.

B. Ca++ uptake by sarcoplasmic endoplasmic reticulum calcium–adenosine triphosphatase (SERCA).

C. Ca++ efflux by the plasmalemmal Ca++ pump.

D. Dephosphorylation of a myosin light chain.

E. Activation of Rho kinase.

ANS: B

4.

The force of contraction of skeletal muscle can be increased by:

A. Activation of additional skeletal muscle fibers within a motor unit.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank B. C. D. E.

12-2

Increase in the frequency of action potentials within a skeletal muscle fiber.

Increase in β-adrenergic stimulation of the skeletal muscle.

Increase in myosin light chain phosphorylation in the skeletal muscle.

Increase in Ca++ extrusion from the skeletal muscle fiber.

ANS: B

5.

The speed of contraction of skeletal muscle is related to:

A. B. C. D. E.

The oxidative capacity of the skeletal muscle fiber.

The myosin adenosine triphosphatase (ATPase) activity of the skeletal muscle fiber.

The level of β-adrenergic stimulation.

The rate of Ca++ extrusion from the skeletal muscle fiber.

The level of myosin light-chain phosphorylation within the muscle fiber.

ANS: B

6.

During intense exercise, fatigue of skeletal muscle occurs because of:

A. B. C. D. E.

Depletion of ATP within the skeletal muscle fiber.

Ca++ overload by mitochondria within the muscle fiber.

Inhibition of actin-myosin inN t eraR c tio I n.

Stimulation of Ca++ release in the sarcoplasmic reticulum (SR) Increase in pH within the muscle fiber.

ANS: C

7.

Stretching a skeletal muscle beyond rest length reduces the force of contraction because of:

A. B. C. D. E.

Increased Ca++ sensitivity of actin-myosin interaction.

Increased Ca++ influx through stretch-activated channels.

Decreased actin-myosin overlap.

Decreased Ca++ uptake by the SR. Decreased intracellular pH.

ANS: C

8.

Endurance training typically increases:

A. Ca++ influx into the muscle fiber.

B. The oxidative capacity of the muscle.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

12-3

C. The conversion of slow-twitch muscle fibers into fast-twitch muscle fibers.

D. The number of muscle fibers within a muscle.

E. Ca++ extrusion from the muscle fiber.

ANS: B

9.

A. B. C. D. E.

Malignant hyperthermia is a hereditary disorder that can increase surgical risk because temperature may be elevated during certain types of anesthesia. The cause of the increased temperature is an increase in cytosolic Ca++ level as a result of an anestheticinduced: Increase in Ca++ release from the SR, as a result of a mutation in the ryanodine receptor.

Decrease in Ca++ uptake by the SR, as a result of a mutation in SERCA. Increase in frequency of the rupturing of skeletal muscle fibers.

Decrease in Ca++ extrusion, as a result of hyperphosphorylation of the plasmalemmal Ca++ pump.

Increase in Ca++ influx, as a result of a mutation in N-type Ca++ channels.

ANS: A

10. The ability to develop increasing levels of force in an intact muscle composed of both fast- and slow-twitch muscle fibers typically involves: A. Recruitment of slow-twitch muscle fibers before fast-twitch muscle fibers.

B. Tetany of fast-twitch muscle fibers at lower stimulus frequencies than those for tetany of slow-twitch muscle fibers.

C. A progressive recruitment of more muscle fibers within a given motor unit.

D. A progressive increase in the amplitude of the intracellular Ca++ transient.

E. A progressive decrease in the threshold for an action potential in the skeletal muscle.

ANS: A

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 13: Cardiac Muscle Test Bank Multiple Choice 1.

Contraction of cardiac muscle typically requires:

A. Ca++ influx through voltage-gated Ca++ channels to trigger a rise in cytosolic [Ca++].

B. Ca++ influx through voltage-gated Ca++ channels, which is sufficient to support contraction.

C. Activation of myosin light-chain kinase (MLCK).

D. Phosphorylation of myosin heavy chain.

E. Ca++ influx through the Na+-Ca++ antiporter.

ANS: A

2.

Relaxation of cardiac muscle typically requires:

A. B. C. D. E.

Myosin light-chain dephosphorylation.

Activation of the ryanodine rN ecU epRtoSrI . ++ Ca uptake by the sarcoplasmic reticulum (SR).

Phosphorylation of phospholamban.

Activation of the dihydropyridine receptor.

ANS: C

3.

The force of contraction of cardiac muscle is typically increased by:

A. B. C. D. E.

An increase in Ca++ extrusion by the Na+-Ca++ antiporter in cardiac muscle.

An increase in myosin phosphorylation in cardiac muscle.

A decrease in cytosolic [Ca++] in the cardiac muscle. β-Adrenergic stimulation of the cardiac muscle.

Recruitment of more cardiac muscle cells.

ANS: D

4.

Epinephrine increases the force of contraction of cardiac muscle by:

A. Increasing the amount of Ca++ in the SR for release to the cytosol.

B. Increasing the level of myosin light-chain phosphorylation.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

13-2

C. Inhibiting the ryanodine receptor.

D. Increasing Ca++ extrusion through the sarcolemmal Ca++ pump.

E. Shortening the duration of the action potential.

ANS: A

5.

In cardiac muscle, phosphorylation of phospholamban by protein kinase A modulates:

A. Ca++ extrusion through the plasmalemmal Ca++ pump.

B. Ca++ transport by sarcoplasmic endoplasmic reticulum calcium–adenosine triphosphatase (SERCA).

C. Open probability of the ryanodine receptor.

D. Ca++ affinity for troponin C. E. Ca++ extrusion through the Na+-Ca++ antiporter.

ANS: B

6.

Stretching cardiac muscle results in an increase in the force of contraction as a result of:

A. B. C. D. E.

Activation of K+ channels.

An increase in the sensitivity of actin-myosin interactions to Ca++.

Phosphorylation of the ryanoN dineRrecIeptG o r.

Increased phosphorylation of troponin I. Increased Ca++ influx through the Na+-Ca++ antiporter.

ANS: B

7.

Calsequestrin in cardiac muscle:

A. B. C. D. E.

Acts as a high-affinity Ca++ buffer in the cytosol.

Acts as a low-affinity Ca++ buffer in the SR lumen, near the ryanodine receptor.

Promotes Ca++ accumulation by the mitochondria.

Increases the Ca++ affinity of the sarcolemmal Ca++ pump.

Facilitates myosin binding to the actin thin filament.

ANS: B

8.

Cardiac muscle cells in the atria are capable of contracting spontaneously because of a spontaneous depolarization that results from:

A. An inward current through a hyperpolarization-activated channel.

B. Cyclic changes in the activity of Na+,K+-ATPase.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

13-3

C. Slow leak of Ca++ through the dihydropyridine receptor.

D. Cyclic changes in the activity of the sarcolemmal Ca++ pump.

E. Cyclic changes in the activity of SERCA. ANS: A

9.

Mutations in the cardiac ryanodine receptor have been associated with cardiac arrhythmias. Specifically, a mutation in the cardiac ryanodine receptor that increases Ca++ efflux from the SR promotes the development of delayed afterdepolarizations by:

A. B. C. D. E.

Decreasing the activity of calcineurin.

Increasing Ca++ efflux through the Na+-Ca++ antiporter.

Increasing mitochondrial Ca++ uptake.

Decreasing actin-myosin interactions.

Increasing the activity of K+ channels.

ANS: B

10. The mechanisms underlying the development of cardiac hypertrophy are complex, although relaxation abnormalities that result in chronic elevation of cytosolic Ca++ level appear to promote the development of hypertrophy through: A. B. C. D. E.

Stimulation of the sarcolemmal Ca++ pump.

Ca++ binding to troponin I. Activation of calcineurin.

Inhibition of Ca++/calmodulin-dependent protein kinase.

Opening of Ca++-activated K+ channels.

ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 14: Smooth Muscle Test Bank Multiple Choice 1.

Contraction of smooth muscle requires:

A. B. C. D. E.

Myosin light-chain phosphorylation.

Ca++-dependent activation of calcineurin.

Binding of Ca++ to troponin C. An action potential in the smooth muscle cell.

Inhibition of Rho kinase.

ANS: A

2.

Decreased cytosolic Ca++ in smooth muscle typically promotes relaxation by:

Closing Ca++-activated K+ channels in the smooth muscle.

Reducing myosin light-chain kinase activity in the smooth muscle.

Reducing nitric oxide releaseNfrUoR mSeI ndNoG thT elB ia. l cC elO lsM .

Reducing Ca++ influx through transient receptor potential vanilloid (TRPV) channels in the smooth muscle.

E. Reducing production of inositol 1,4,5-triphosphate (InsP3) in the smooth muscle.

A. B. C. D.

ANS: B

3.

An increase in smooth muscle tension can occur at a given intracellular [Ca++] in response to:

A. Opening of K+ channels in the smooth muscle membrane.

B. Inhibition of myosin phosphatase by Rho kinase in the smooth muscle.

C. Cyclic adenosine monophosphate (cAMP)–dependent phosphorylation of myosin lightchain kinase in the smooth muscle.

D. Release of nitric oxide from adjacent endothelial cells.

E. Hyperpolarization of the smooth muscle membrane.

ANS: B

4.

The latch property of smooth muscle concerns the ability of the smooth muscle to maintain:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

A. B. C. D. E.

A relaxed state independent of cytosolic Ca++ level.

Force while decreasing the rate of energy utilization.

The rate of InsP3 production after agonist removal.

Force in the absence of myosin light-chain phosphorylation.

Membrane potential independent of contractile state.

ANS: B

5.

Smooth muscle can contract without a change in membrane potential after:

A. B. C. D. E.

Stimulation of -adrenergic receptors in the smooth muscle.

Inhibition of Rho kinase in the smooth muscle.

Stimulation of InsP3 production in the smooth muscle.

Stimulation of nitric oxide release from endothelial cells.

Stimulation of K+ channels in the smooth muscle.

ANS: C

6.

During exercise, skeletal muscle can release local factors, such as adenosine, which can relax neighboring vascular smooth muscle and thus promote vasodilation in the exercising muscle. The mechN anUisR mSbIyNwG hiT chB. adC enOoM sine promotes relaxation of smooth muscle typically involves:

A. B. C. D. E.

Inhibition of K+ channels in the vascular smooth muscle.

Stimulation of InsP3 production in the vascular smooth muscle.

Stimulation of release of endothelin from adjacent endothelial cells.

Stimulation of cAMP production in the vascular smooth muscle.

Activation of voltage-gated Ca++ channels in the vascular smooth muscle.

ANS: D

7.

A variety of smooth muscle relaxants can promote the occurrence of Ca++ sparks beneath sarcolemma of smooth muscle. The Ca++ sparks are thought to originate from a local activation of the ryanodine receptor, just beneath the sarcolemma. These Ca++ sparks promote relaxation by:

A. B. C. D. E.

Activating the Na+-Ca++ antiporter in the smooth muscle.

Activating the Ca++-dependent phosphatase calcineurin in the smooth muscle.

Activating Ca++-dependent K+ channels in the smooth muscle.

Promoting myosin light-chain phosphorylation in the smooth muscle.

Activating Rho kinase in the smooth muscle.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

14-3

ANS: C

8.

A variety of stimuli can elevate cyclic guanosine monophosphate (cGMP) concentration in smooth muscle, which results in activation of cGMP-dependent signaling pathways in the smooth muscle. This activation typically:

A. B. C. D. E.

Promotes relaxation, partly because of inhibition of myosin phosphatase.

Promotes contraction, partly because of decreased endothelin production.

Promotes relaxation, partly because of activation of potassium channels .

Promotes contraction, partly because of inhibition of InsP3 production.

Promotes relaxation, partly because of activation of voltage-gated Ca channels.

ANS: C

9.

In smooth muscle, actin and myosin filaments:

A. B. C. D. E.

Are organized into sarcomeres and aligned in a striated pattern.

Overlap, with the actin filaments anchored at dense bodies.

Overlap and contain a tropomyosin-troponin complex on the actin filament.

Require phosphorylation of the myosin heavy chain to initiate muscle contraction.

Typically generate contractile force in the absence of cytosolic Ca++.

ANS: B

NURSINGTB.COM

10. Endogenous agonists such as adenosine and prostacyclin, as well as 2-adrenergic receptor agonists, can elevate cAMP concentration in smooth muscle. The elevation of cAMP in the smooth muscle results in activation of cAMP-dependent signaling pathways in the smooth muscle. This activation typically: A. B. C. D. E.

Promotes relaxation, partly because of activation of myosin phosphatase.

Promotes contraction, partly because of activation of potassium channels.

Promotes relaxation, partly because of activation of Rho kinase.

Promotes contraction, partly because of inhibition of InsP3 production.

Promotes relaxation, partly because of inhibition potassium channels.

ANS: A

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Chapter 15: Overview of Circulation Test Bank Multiple Choice

1.

After a knife wound to the groin, a man develops a large arteriovenous (AV) shunt between the iliac artery and iliac vein. Which of the following changes occur in his systemic circulation?

A. B. C. D. E.

Blood flow in the capillaries of the fingernail bed becomes pulsatile.

The circulation time (antecubital vein to tongue) is decreased.

The arterial pulse pressure (systolic minus diastolic pressure) is decreased.

The greatest velocity of blood flow prevails in the vena cava.

Pressure in the right atrium is greater than in the inferior vena cava.

ANS: B

NURSINGTB.COM

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Chapter 16: Elements of Cardiac Function Test Bank Multiple Choice

1.

A patient presents for her annual physical examination in seemingly good health.

However, she is concerned about her heart because of family history, and you proceed to work up an examination of cardiovascular function. She has a blood pressure of 128/83 mm Hg, and echocardiography indicates that end-diastolic volume is 140 mL and endsystolic volume is 80 mL. A routine electrocardiogram (ECG) is obtained and is shown as follows:

The ECG reveals the patient is in normal sinus rhythm with an R-R interval of 0.76 seconds. This corresponds to a heart rate of: A. B. C. D. E.

70 beats/minute 74 beats/minute 79 beats/minute 84 beats/minute 88 beats/minute

ANS: C

2.

A patient presents for her annual physical examination in seemingly good health.

However, she is concerned about her heart because of family history, and you proceed to work up an examination of cardiovascular function. She has a blood pressure of 128/83 mm Hg, and echocardiography indicates that end-diastolic volume is 140 mL and endsystolic volume is 80 mL. A routine ECG is obtained and is shown as follows:

Inspection of the ECG indicates a PR interval of: A. 0.08 seconds B. 0.10 seconds Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

C. 0.12 seconds D. 0.16 seconds E. 0.20 seconds ANS: D

3.

A patient presents for her annual physical examination in seemingly good health.

However, she is concerned about her heart because of family history, and you proceed to work up an examination of cardiovascular function. She has a blood pressure of 128/83 mm Hg, and echocardiography indicates that end-diastolic volume is 140 mL and endsystolic volume is 80 mL. A routine ECG is obtained and is shown as follows:

According to the echocardiographic data, the patient’s stroke volume amounts to: A. 80 mL B. 70 mL C. 60 mL D. 50 mL E. 45 mL

NURSINGTB.COM

ANS: C

4.

A patient presents for her annual physical examination in seemingly good health.

However, she is concerned about her heart because of family history, and you proceed to work up an examination of cardiovascular function. She has a blood pressure of 128/83 mm Hg, and echocardiography indicates that end-diastolic volume is 140 mL and endsystolic volume is 80 mL. A routine ECG is obtained and is shown as follows:

You estimate this patient’s cardiac output as: A. 4.4 L/minute B. 4.7 L/minute C. 5.2 L/minute D. 5.5 L/minute E. 6.3 L/minute

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

ANS: B

5. A 63-year-old man was admitted to the hospital 1 hour after experiencing substernal chest pain. He was weak and diaphoretic, and his heart was beating rapidly at 90 beats/minute as a consequence of a coronary artery occlusion that impaired blood flow to the left ventricle. From an ECG, it was determined that the tachycardia originated in the sinoatrial (SA) node. Before therapy could be started, the man became much weaker; his arterial pulse rate was about 45 beats/minute, and yet the ECG revealed an atrial rate of 90 beats/minute. A cardiac pacemaker was inserted because the atrioventricular (AV) node had been damaged by ischemia. With the implanted pacemaker set at 75 beats/minute, he felt somewhat better, and drug therapy was initiated.

Soon after coronary artery occlusion, the interstitial fluid [K+] rose substantially in the flow-deprived region. In this region, the high extracellular [K+]: A. B. C. D. E.

Increased the propagation velocity of the myocardial action potentials.

Decreased the postrepolarization refractoriness of the myocardial cells.

Depolarized the resting transmembrane potential to a less negative value.

Diminished the automaticity of the myocardial cells.

Decreased the likelihood of reentry dysrhythmias.

ANS: C 6.

A 63-year-old man was admitted to the hospital 1 hour after experiencing substernal chest pain. He was weak and diaphoretic, and his heart was beating rapidly at 90 beats/minute as a consequence of a coronary artery occlusion that impaired blood flow to the left ventricle. From an ECG, it was determined that the tachycardia originated in the SA node. Before therapy could be started, the man became much weaker; his arterial pulse rate was about 45 beats/minute, and yet the ECG revealed an atrial rate of 90 beats/minute. A cardiac pacemaker was inserted because the AV node had been damaged by ischemia. With the implanted pacemaker set at 75 beats/minute, he felt somewhat better, and drug therapy was initiated.

The mechanism by which the SA node generated impulses at a rapid rate during the early stages of the coronary artery occlusion involves an increase in:

A. B. C. D. E.

The slope of the action potential upstroke (phase 0) of the automatic cells.

The slope of the slow diastolic depolarization of the automatic cells.

Firing threshold (less negative potential) of the automatic cells.

Negativity (hyperpolarization) of the initial portion of the slow diastolic depolarization.

Action potential amplitude of the automatic cells.

ANS: B

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

7.

A 63-year-old man was admitted to the hospital 1 hour after experiencing substernal chest pain. He was weak and diaphoretic, and his heart was beating rapidly at 90 beats/minute as a consequence of a coronary artery occlusion that impaired blood flow to the left ventricle. From an ECG, it was determined that the tachycardia originated in the SA node. Before therapy could be started, the man became much weaker; his arterial pulse rate was about 45 beats/minute, and yet the ECG revealed an atrial rate of 90 beats/minute. A cardiac pacemaker was inserted because the AV node had been damaged by ischemia. With the implanted pacemaker set at 75 beats/minute, he felt somewhat better, and drug therapy was initiated.

The most likely mechanism responsible for the patient’s arterial pulse rate of about 45 beats/minute after impulse conduction through the AV junction was blocked is:

A. Excitation of the ventricles via an AV bypass tract.

B. Conversion of ventricular myocardial fibers to automatic cells.

C. Firing of ventricular ectopic cells that have the same electrophysiological characteristics as SA node cells.

D. Firing of automatic cells (Purkinje fibers) in the specialized conduction system of the ventricles.

E. Excitation of ventricular cells by the rhythmic activity in the autonomic neurons that innervate the heart.

ANS: D 8.

A 63-year-old man was admitted to the hospital 1 hour after experiencing substernal chest pain. He was weak and diaphoretic, and his heart was beating rapidly at 90 beats/minute as a consequence of a coronary artery occlusion that impaired blood flow to the left ventricle. From an ECG, it was determined that the tachycardia originated in the SA node. Before therapy could be started, the man became much weaker; his arterial pulse rate was about 45 beats/minute, and yet the ECG revealed an atrial rate of 90 beats/minute. A cardiac pacemaker was inserted because the AV node had been damaged by ischemia. With the implanted pacemaker set at 75 beats/minute, he felt somewhat better, and drug therapy was initiated.

While the heart was being paced, the cardiologist discontinued ventricular pacing periodically to test the patient’s cardiac status. The cardiologist found that the ventricles did not begin beating spontaneously until about 5 to 10 seconds after cessation of pacing because the preceding period of pacing led to:

A. B. C. D. E.

Overdrive suppression of the automatic cells in the ventricles.

Release of norepinephrine from the cardiac sympathetic nerves.

Release of neuropeptide Y from the cardiac sympathetic nerves.

Fatigue of the ventricular myocytes.

Release of acetylcholine from the cardiac parasympathetic nerves

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

ANS: A

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne and Levy Physiology, 7th Edition Chapter 17: Properties of the Vasculature Test Bank Multiple Choice 1.

A 22-year-old student has to have a physical examination to certify that he is able to participate in interscholastic athletics. During the cardiovascular examination, you report his heart rate as 60 beats/minute and his arterial blood pressure as 118/68 mm Hg. According to echocardiographic study, his end-diastolic volume is 150 mL and his endsystolic volume is 60 mL. From the data, you estimate his pulse pressure to be:

A. 50 mm Hg B. 60 mm Hg C. 68 mm Hg D. 80 mm Hg E. 90 mm Hg ANS: A 2. A 22-year-old student has to have a physical examination to certify that he is able to participate in interscholastic athletics. During the cardiovascular examination, you report his heart rate as 60 beats/minute and his arterial blood pressure as 118/68 mm Hg. According to echocardiographic study, his end-diastolic volume is 150 mL and his endsystolic volume is 60 mL. The patient’s mean arterial pressure is estimated as: A. 68 mm Hg B. 77 mm Hg C. 85 mm Hg D. 92 mm Hg E. 118 mm Hg ANS: C

3. A 22-year-old student has to have a physical examination to certify that he is able to participate in interscholastic athletics. During the cardiovascular examination, you report his heart rate as 60 beats/minute and his arterial blood pressure as 118/68 mm Hg.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

17-2

According to echocardiographic study, his end-diastolic volume is 150 mL and his endsystolic volume is 60 mL. His cardiac output is: A. 4.5 L/minute B. 5.0 L/minute C. 5.4 L/minute D. 5.9 L/minute E. 6.3 L/minute ANS: C

4.

A 22-year-old student has to have a physical examination to certify that he is able to participate in interscholastic athletics. During the cardiovascular examination, you report his heart rate as 60 beats/minute and his arterial blood pressure as 118/68 mm Hg. According to echocardiographic study, his end-diastolic volume is 150 mL and his endsystolic volume is 60 mL. Starling forces are measured across a systemic capillary wall, and the following values are obtained: Capillary hydrostatic pressuN reUR 3I0NmGm Bg.COM TH Capillary oncotic pressure 25 mm Hg Interstitial hydrostatic pressure 0 mm Hg Interstitial oncotic pressure 10 mm Hg If the reflection coefficient for protein () across this capillary wall is 0.8, what is the net pressure and direction of fluid flow across the capillary wall?

A. B. C. D. E.

Net Pressure 15 mm Hg 15 mm Hg 18 mm Hg 18 mm Hg 30 mm Hg

Direction of Fluid Flow Out of capillary Into capillary Out of capillary Into capillary Out of capillary

ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne and Levy Physiology, 7th Edition Chapter 18: Regulation of the Heart and Vasculature Test Bank Multiple Choice

1. A 24-year-old man is seen for a routine physical examination. At rest, his blood pressure is 120/80 mm Hg and his heart rate is 75 beats/minute. He is advised to begin an exercise program. When he returns 3 months later, his heart rate has decreased to 50 beats/minute (asymptomatic). Which of the set of values below would you expect to observe in this patient at rest in comparison with those 3 months ago?

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

Pulse Pressure Increased Increased Decreased Decreased Increased

Cardiac Output No change Increased Increased No change Decreased

NURSINGTB.COM

2. During a cardiovascular examination, a patient has a resting heart rate of 65 beats/minute and a blood pressure of 100/70 mm Hg in the supine position. In the upright position at steady state, the patient’s heart rate is 74 beats/minute, and the blood pressure is 105/70 mm Hg. One physiological change that occurred in the patient as a result of assuming an upright position is: A. Diminished arteriolar resistance.

B. Increased venous capacitance.

C. Increased capillary filtration.

D. Increased cardiac vagal tone.

E. Increased cardiac sympathetic tone.

ANS: E

3. During a cardiovascular examination, a patient has a resting heart rate of 65 beats/minute and a blood pressure of 100/70 mm Hg in the supine position. In the upright position at steady state, the patient’s heart rate is 74 beats/minute, and the blood pressure is 105/70 mm Hg.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

18-2

Agents that increase intracellular cyclic adenosine monophosphate (cAMP), such as βadrenergic agonists, have a potent vasodilator effect by: A. B. C. D. E.

Increasing nitric oxide production in smooth muscle.

Stimulating guanylate cyclase activity in endothelial cells.

Reducing myosin light-chain kinase (MLCK) activity.

Suppressing calcium entry into smooth muscle cells.

Reducing the synthesis of guanosine monophosphate (cGMP) in smooth muscle

ANS: C

4.

The myogenic mechanism for autoregulation of vascular smooth muscle tone:

A. B. C. D. E.

Requires the release of nitric oxide from endothelial cells.

Involves the release of norepinephrine from sympathetic nerve endings.

Responds to changes in vessel wall transmural pressure.

Depends on changes in flow through the vessel.

Arises from changes in shear stress in the vessel wall.

ANS: C

NURSINGTB.COM

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne and Levy Physiology, 7th Edition Chapter 19: Integrated Control of the Cardiovascular System Test Bank Multiple Choice

1.

A well-trained athlete has prepared to run in the Boston marathon. Your purpose is to study how this athlete’s cardiovascular system adapts to the strenuous demands of the race. Assume that just before the athlete runs, measurements of heart rate (60 beats/minute), blood pressure (110/80 mm Hg), and cardiac output (4.2 L/minute) are recorded.

What is this athlete’s pulse pressure?

A. 100 mm Hg B. 90 mm Hg C. 80 mm Hg D. 60 mm Hg E. 30 mm Hg ANS: E

NURSINGTB.COM

2. A well-trained athlete has prepared to run in the Boston marathon. Your purpose is to study how this athlete’s cardiovascular system adapts to the strenuous demands of the race. Assume that just before the athlete runs, measurements of heart rate (60 beats/minute), blood pressure (110/80 mm Hg), and cardiac output (4.2 L/minute) are recorded.

Estimate the athlete’s stroke volume.

A. 42 mL B. 55 mL C. 70 mL D. 82 mL E. 90 mL ANS: C

3. A well-trained athlete has prepared to run in the Boston marathon. Your purpose is to study how this athlete’s cardiovascular system adapts to the strenuous demands of the race. Assume that just before the athlete runs, measurements of heart rate (60 Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

beats/minute), blood pressure (110/80 mm Hg), and cardiac output (4.2 L/minute) are recorded.

Assume that central venous pressure is 0 mm Hg, and calculate the athlete’s peripheral resistance.

A. 42.8 mm Hg/L/minute B. 32.1 mm Hg/L/minute C. 21.4 mm Hg/L/minute D. 10.7 mm Hg/L/minute E. 4.3 mm Hg/L/minute ANS: C

4. In the cardiac and vascular function curves shown below, the solid curves represent the control state:

NURSINGTB.COM The shift in these curves, illustrated by the dashed lines, is best explained by: A. B. C. D. E.

Administration of positive inotropic agent.

Decrease in peripheral vascular resistance.

Infusion of isotonic saline.

Increase in peripheral vascular resistance.

Administration of a negative inotropic agent.

ANS: D

5.

In the cardiac and vascular function curves shown below, the solid curves represent the control state:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

The shift, illustrated by the dashed line, is explained by: A. B. C. D. E.

Administration of positive inotropic agent.

Hemorrhage.

Infusion of isotonic saline.

Increase in peripheral vascular resistance.

Administration of a negative inotropic agent.

ANS: B

6.

A 44-year-old woman experienced an acute episode of severe abdominal pain and suddenly vomited a large volume of bloody fluid. Her husband had her brought to the hospital by ambulance. The emergency room physician estimated the she had lost about 600 mL of blood. On physical examination, she had a blood pressure of 85/65 mm Hg and was tachycardic, with a heart rate of 110 beats/minute. The patient’s skin was cool, moist, and pale. The physician’s tentative diagnosis was of a bleeding ulcer.

What would the acute blood loss from her duodenal ulcer be expected to do?

A. B. C. D. E.

Decrease central venous pressure and increase cardiac output Increase central venous pressure and decrease mean arterial pressure Decrease central venous presN suU reRaS ndIdNeG crT eaBse.cCardM iac output Increase mean arterial pressure and decrease cardiac output Decrease central venous pressure and increase aortic pulse pressure

ANS: C

7.

A 44-year-old woman experienced an acute episode of severe abdominal pain and suddenly vomited a large volume of bloody fluid. Her husband had her brought to the hospital by ambulance. The emergency room physician estimated the she had lost about 600 mL of blood. On physical examination, she had a blood pressure of 85/65 mm Hg and was tachycardic, with a heart rate of 110 beats/minute. The patient’s skin was cool, moist, and pale. The physician’s tentative diagnosis was of a bleeding ulcer.

Administration of a drug that acts specifically to improve myocardial contractility would:

A. B. C. D. E.

Decrease central venous pressure and increase cardiac output.

Decrease central venous pressure and decrease mean arterial pressure.

Increase central venous pressure and increase aortic pulse pressure.

Decrease central venous pressure and decrease cardiac output.

Increase central venous pressure and increase arterial compliance.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

19-4

ANS: A

NURSINGTB.COM

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 20: Structure and Function of the Respiratory System Test Bank Multiple Choice

1.

A 65-year-old woman with a smoking history of 2 packs/day for 30 years has received a diagnosis of chronic obstructive lung disease. She is obviously using her accessory respiratory muscles for breathing; this behavior is caused by:

A. Decreased work of breathing as a result of airflow obstruction.

B. Increased work of breathing as a result of a dysfunction in the neuromuscular junction.

C. Increased work of breathing as a result of airflow obstruction that necessitates active contraction of the expiratory muscles.

D. Abnormal breathing pattern.

E. Increased work of breathing as a result of airflow obstruction that necessitates active contraction of the inspiratory muscles.

ANS: C

NURSINGTB.COM 2.

A 65-year-old woman with a smoking history of 2 packs/day for 30 years has received a diagnosis of chronic obstructive lung disease. She probably has increased mucus viscosity as a result of:

A. B. C. D. E.

Bronchoconstriction.

Stimulation of parasympathetic fibers in bronchial glands.

Stimulation of the sympathetic nerves.

Abnormal breathing pattern.

Stimulation of smooth muscles

ANS: B

3.

A 25-year-old woman with asthma is brought to the emergency department because of an acute asthmatic attack. She is using her sternocleidomastoid and internal/external intercostal muscles to breathe. This can be interpreted as:

A. B. C. D.

Improved status; no intervention needed Worsening status; intervention needed Normal breathing pattern; no intervention needed Bronchodilation of the airways

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

ANS: B

4.

A 4-year-old child accidentally aspirates a small marble with a diameter of 0.8 mm.

Where in the lung is the toy most likely to be found?

A. B. C. D.

Bronchus Trachea Bronchioles Alveolus

ANS: C

5.

Which of the following is the correct proximal-to-distal alignment of the human airway?

A. Trachea → bronchi → respiratory bronchioles → nonrespiratory bronchioles → terminal bronchioles → alveolar ducts → alveolar sacs B. Trachea → bronchi → alveolar ducts → alveolar sacs → bronchioles → terminal bronchioles C. Trachea → bronchi → nonrespiratory bronchioles → terminal bronchioles → alveolar sacs → alveolar ducts D. Trachea → bronchi → nonrespiratory bronchioles → respiratory bronchioles → terminal bronchioles → alveolar ductsN→URalSveIoNlaGrsTa B c s .C O M

ANS: D

6.

A baby born at 30 weeks of gestation who develops respiratory distress characterized by atelectasis (collapse of the lung) probably suffers from a physiological defect in:

A. B. C. D. E.

Production of surfactant component phosphatidylglycerol.

Lack of surfactant components cholesterol and cholesterol esters.

Diaphragmatic movement.

Surfactant proteins.

Clara cell dysfunction.

ANS: A

7.

Surfactant aids in stabilizing the inflation of alveoli through its ability to decrease surface tension. What best describes the mechanism of interdependence, created by the pores of Kohn and canals of Lambert, which is also important in alveolar inflation?

A. Connection of adjacent alveoli and terminal airways to adjacent alveoli B. Connection of nonrespiratory bronchioles to alveoli Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

C. Connection of nonrespiratory bronchioles to respiratory bronchioles D. Connection of adjacent respiratory bronchioles ANS: A

8.

Which statement best describes the unique features of the pulmonary circulatory system?

A. It is a dual system that accommodates large volumes of blood at low pressure. Bronchial circulation arises from the aorta to nourish lung tissue, whereas the pulmonary circulation brings deoxygenated blood to the gas-exchanging units.

B. It is a dual system that accommodates large volumes of blood at high pressure.

Bronchial circulation arises from the aorta to nourish lung tissue, whereas the pulmonary circulation brings deoxygenated blood to the gas-exchanging units.

C. It is a dual system that accommodates steady, small volumes of blood at low pressure.

Bronchial circulation arises from the aorta to nourish lung tissue, whereas the pulmonary circulation brings deoxygenated blood to the gas-exchanging units.

D. It is a dual system that accommodates large volumes of blood at low pressure. Bronchial circulation arises from the right ventricle to nourish lung tissue, whereas the pulmonary circulation brings deoxygenated blood to the gas-exchanging units.

ANS: A

NURSINGTB.COM

9.

Which respiratory epithelial cell (1) is at maturation essential for survival of premature infants, (2) produces surfactant, (3) differentiates to establish normal cellular architecture during development and repair, and (4) normally occupies <5% of the luminal surface area after birth?

A. B. C. D. E.

Clara cell Type I epithelial cell Type II epithelial cell Goblet cell Kultschitzky cell

ANS: C

10. Like the kidneys, the lungs demonstrate functional unity; that is, each unit is structurally and functionally identical. The basic physiological unit of the lung is the respiratory unit, which consists of: A. B. C. D.

Nonrespiratory and respiratory bronchioles, alveolar ducts, and alveolar sacs.

Respiratory bronchioles, alveolar ducts, and alveolar sacs.

Bronchi, nonrespiratory bronchioles, and respiratory bronchioles.

Conducting airways, alveolar ducts, and alveolar sacs.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

20-4

ANS: B

NURSINGTB.COM

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 21: Static Lung and Chest Wall Mechanics Test Bank Multiple Choice

1.

If pleural pressure changes from –3 cm H2O to –7 cm H2O as a subject breathes, and if the functional residual capacity (FRC) increases by 1 L, what is the compliance of the lung?

A. B. C. D.

0.1 L/cm H2O 4 cm H2O/L 0.25 L/cm H2O 10 cm H2O/L

ANS: C

2.

What is the pressure in the alveolus when the translung pressure is 3.5 cm H2O and the pleural pressure is –8.5 cm H2O?

A. B. C. D.

–5 cm H2O 0 cm H2O 5 cm H2O –12 cm H2O

NURSINGTB.COM

ANS: A

3.

When the pressure across the respiratory system (Prs) is 0, which of the following statements is true?

A. B. C. D.

The individual is at total lung capacity (TLC).

The individual is at FRC. The individual is at residual volume (RV).

The transpulmonary (translung) pressure is 0.

ANS: B

4.

If the compliance of the lung is 0.2 L/cm H2O and the compliance of the chest wall is 0.2 L/cm H2O, what is the compliance across the respiratory system (Crs)?

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

A. B. C. D.

0.1 L/cm H2O 0.4 L/cm H2O 1.0 L/cm H2O 4.0 L/cm H2O

ANS: A

5.

A patient’s lung compliance was measured with the use of an intraesophageal balloon (a measure of pleural pressure). When he has inspired 500 mL, his intraesophageal pressure decreases from –3 cm H2O at FRC to –7 cm H2O. What is his lung compliance?

A. B. C. D.

1.67 L/cm H2O 0.71 L/cm H2O 0.500 L/cm H2O 0.125 L/cm H2O

ANS: D

6.

A. B. C. D. E.

An individual with pulmonary fibrosis will demonstrate An increase in lung compliance.

A decrease in lung compliance.

No change in lung compliance.NURSINGTB.COM An increase in chest wall compliance.

A decrease in chest wall compliance.

ANS: B

7.

A. B. C. D. E.

An individual with an increase in lung compliance will demonstrate which of the following changes in TLC and the ratio of the total lung capacity to the RV? An increase in TLC and a decrease in RV/TLC A decrease in TLC and a decrease in RV/TLC An increase in TLC and an increase in RV/TLC A decrease in TLC and an increase in RV/TLC No change in TLC or in RV/TLC

ANS: C

8.

An individual with increased mucus production and airway inflammation will demonstrate what changes in the residual volume (RV) and FRC? A. An increase in RV and an increase in FRC B. An increase in RV and a decrease in FRC Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce Test Bank

21-3

C. A decrease in RV and an increase in FRC D. A decrease in RV and a decrease in FRC E. No change in RV or FRC ANS: A

9.

A. B. C. D. E.

Which of the following statements about the effect of surfactant on chest wall compliance is correct?

Increased surfactant production is associated with an increase in chest wall compliance.

Increased surfactant production is associated with a decrease in chest wall compliance.

Decreased surfactant production is associated with an increase in chest wall compliance.

Decreased surfactant production is associated with a decrease in chest wall compliance.

Surfactant has no effect on chest wall compliance.

ANS: E

10. An individual with respiratory symptoms undergoes pulmonary function testing. The RV measured by helium dilution is increased but is lower than the RV measured by body plethysmography. Which of the following is the most likely explanation for this difference?

A. There is a problem with one of the machines.

B. The individual has severe air trapping.

C. The individual did not keep hisNmoRuth Ipre G s sed h tl yMaround the mouthpiece, and air leaked Bti.gC U S N T out during the helium dilution testing.

D. The individual held his breath during body plethysmography.

E. The individual has a loss of lung compliance.

ANS: B

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 22: Dynamic Lung and Chest Wall Mechanics Test Bank Multiple Choice

1.

The flow resistance across a set of airways is lowest under which of the following conditions?

A. B. C. D.

Airway radius is large and airways are in series.

Airway radius is large and airways are in parallel.

Airway radius is small and airways are in series.

Airway radius is small and airways are in parallel.

ANS: B

2.

The airways most responsible for the resistance of the respiratory system (Raw) during mouth breathing are:

A. B. C. D.

The trachea, main stem, and loN baU rR brS onIcN hiG . TB.COM The terminal bronchioles.

The respiratory bronchioles.

The alveoli and alveolar ducts.

ANS: A

3.

Pulmonary fibrosis is associated with a decrease in lung compliance. Individuals with pulmonary fibrosis:

A. Have a higher airway resistance than do individuals with normal lungs.

B. Require a higher transpulmonary (translung) pressure for a change in lung volume than do individuals with normal lungs.

C. Have a shift in their oxyhemoglobin dissociation curve to the right.

D. Have an increase in dead space.

ANS: B

4.

Common pulmonary function abnormalities in individuals with moderate obstructive pulmonary disease include:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

A. Normal forced expiratory volume in 1 minute (FEV1), normal expiratory flow rates, normal ratio of residual volume (RV) to total lung capacity (TLC) B. Increased FEV1, increased expiratory flow rates, increased RV/TLC ratio C. Decreased FEV1, decreased expiratory flow rates, increased RV/TLC ratio D. Decreased FEV1, decreased expiratory flow rates, decreased RV/TLC ratio E. Decreased FEV1, normal expiratory flow rates, increased RV/TLC ratio ANS: C

5.

Common pulmonary function abnormalities in individuals with moderate restrictive lung disease include:

A. B. C. D. E.

Normal FEV1, normal expiratory flow rates, and normal RV/TLC ratio.

Increased FEV1, increased expiratory flow rates, and increased RV/TLC ratio.

Decreased FEV1, decreased expiratory flow rates, and increased RV/TLC ratio.

Decreased FEV1, decreased expiratory flow rates, and decreased RV/TLC ratio.

Decreased FEV1, normal expiratory flow rates, and increased RV/TLC ratio.

ANS: E

6.

Factors associated with higher N exU pR iraStoIryNfG loTwBr. atC esOinMclude:

A. B. C. D. E.

Low lung volume.

Increased lung elastic recoil.

Negative pleural pressure.

Increased pulmonary vascular resistance.

None of the above.

ANS: B

7.

Air trapping is a sign of premature airway closure and results in:

A. B. C. D. E.

Movement of the equal pressure point at low lung volumes into the intrathoracic airways.

Movement of the equal pressure point at low lung volumes toward the alveolus.

Movement of the equal pressure point at low lung volumes toward the mouth.

No effect on the location of the equal pressure at low lung volumes.

Movement of the equal pressure point from airways with cartilage to airways without cartilage.

ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce Test Bank

22-3

8.

Maximal expiratory flow rates decrease during exhalation (i.e., in going from higher to lower lung volumes) for the following reasons:

A. B. C. D. E.

Intra-airway pressures increase and elastic recoil pressure increases at lower lung volumes.

Intra-airway pressures decrease and elastic recoil pressure increases at lower lung volumes.

Intra-airway pressures increase and elastic recoil pressure decreases at lower lung volumes.

Intra-airway pressures decrease and elastic recoil pressure decreases at lower lung volumes.

There is no change in intra-airway pressures or elastic recoil pressures at lower lung volumes.

ANS: D

9.

Which of the following diseases is associated with concaveness of the expiratory flow volume curve?

A. B. C. D. E.

Cystic fibrosis Pulmonary fibrosis Duchenne’s muscular dystrophy Scoliosis Paralysis of the diaphragm

ANS: A

NURSINGTB.COM

10. Which of the following factors is not associated with an increase in work of breathing?

A. B. C. D. E.

An increase in tidal volume An increase in respiratory rate Diseases associated with airway obstruction Diseases associated with loss of lung compliance None of the above

ANS: E

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 23: Ventilation ( ), Perfusion ( ), and

Relationships

Test Bank Multiple Choice

1.

Which of the following does not directly affect the alveolar partial pressure of oxygen?

A. B. C. D. E.

Arterial partial pressure of carbon dioxide (PaCO2) Atmospheric pressure Tidal volume Fraction of inspired oxygen Oxygen consumption and carbon dioxide production (R)

ANS: C

2.

When alveolar ventilation (VA) is reduced from 5 L/minute to 2.5 L/minute, the PaCO2 changes from 40 mm Hg to:

A. B. C. D. E.

20 mm Hg. 60 mm Hg. 80 mm Hg .

100 mm Hg. 250 mm Hg.

NURSINGTB.COM

ANS: C

3.

A twofold increase in the blood flow through a pulmonary arteriole is associated with:

A. B. C. D.

No significant change in pulmonary vascular resistance.

A twofold increase in pulmonary vascular resistance.

A fourfold increase in pulmonary vascular resistance.

A 15-fold increase in pulmonary vascular resistance.

ANS: A

4.

In comparison with pulmonary blood flow at rest in the upright position, pulmonary blood flow when upright during exercise in normal individuals is:

A. Distributed more to the bottom of the lung than to the top.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

B. Distributed more to the top of the lung than to the bottom.

C. Distributed essentially evenly between the top and the bottom of the lung.

D. Is too highly variable to be determined.

ANS: C

5.

When the respiratory rate is 15 breaths per minute, tidal volume is 500 mL, and anatomical dead space volume is 150 mL, what is the minute ventilation?

A. B. C. D.

2.25 L/minute 5.25 L/minute 7.50 L/minute 9.75 L/minute

ANS: C

6.

The PaCO2 decreases when:

A. Alveolar ventilation and CO2 production are increased and dead space is increased.

B. Alveolar ventilation is decreased, CO2 production is unchanged, and dead space is increased.

C. Alveolar ventilation is increaN s ed R od.uC ctioM n and dead space are decreased.

2 prB U and S ICNOGT D. Both alveolar ventilation and CO2 production are decreased and dead space is increased.

ANS: C

7.

An individual with early lung disease has a tidal volume of 500 mL. What is the alveolar volume if the dead space doubles and the tidal volume remains the same? (Assume that the normal ratio of dead space ventilation per minute to tidal volume [VD/VT] = 0.25.)

A. B. C. D.

150 mL 250 mL 300 mL 400 mL

ANS: B

8.

If the oxygen consumption is 200 mL/minute and the carbon dioxide production is 140 mL/minute, what is the respiratory quotient?

A. 60 mL/minute B. 0.8 Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

23-3

C. 0.7 D. 143 mL/minute ANS: C

9.

A patient is admitted to the hospital because of hypoxemia. While the patient breathes ambient air, the arterial partial pressure of oxygen (PaO2) is 50 mm Hg with an oxygen saturation of 82%. When the patient breathes 100% oxygen through a non-rebreathing mask, the PaO2 is 83 mm Hg with an oxygen saturation of 92%. The cause of this patient’s hypoxemia is probably:

A. B. C. D.

A physiological shunt.

Low V̇ /Q̇ .

Hypoventilation.

Decreased inspired oxygen.

ANS: A

10. Which of the following is not a primary cause of hypoxemia (low oxygen level in the blood)?

A. B. C. D.

Anatomical shunt Physiological shunt Low V̇/Q̇ Increased dead space

NURSINGTB.COM

ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 24: Oxygen and Carbon Dioxide Transport Test Bank Multiple Choice

1.

Pulmonary vascular resistance increases during hypoxia; how should it behave during exercise?

A. B. C. D.

Decreases Initially stays the same and then increases with time Increases Stays the same; not influenced

ANS: A

2.

A 62-year-old woman is admitted to the hospital with fever and pneumonia. How is her O2 dissociation curve affected by her clinical status?

A. B. C. D. E.

A shift to the left A shift to the right No change A downward shift An upward shift

NURSINGTB.COM

ANS: B

3.

A 44-year-old man who has experienced trauma is given multiple blood transfusions because of severe blood loss. What influence would this treatment have on his O2 dissociation curve?

A. B. C. D. E.

A shift to the left A shift to the right No change A downward shift An upward shift

ANS: A

4.

Tissue hypoxia is caused by all of the following except:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

A. B. C. D. E.

Anemia.

Carbon monoxide poisoning.

Cyanide poisoning.

Shock.

Pneumonia.

ANS: E

5.

The ability of CO2 to alter the affinity of hemoglobin for O2, which enhances O2 delivery to tissues and O2 uptake in the lungs, is referred to as:

A. B. C. D. E.

Chloride shift Haldane’s effect Bohr’s effect Hamburger’s phenomenon Graham’s effect

ANS: C 6.

The predominant transport mechanism of CO2 in blood is by:

A. B. C. D. E.

Dissolved CO2.

Carbamino protein complexes.

Hemoglobin binding.

HCO3- within red blood cells.

Deoxyhemoglobin

NURSINGTB.COM

ANS: D

7.

The dissociation curve of CO2 in blood is:

A. B. C. D. E.

Linear and directly related to partial pressure of carbon dioxide (PCO2).

Linear and not related to PCO2.

Not linear Linear and directly related to partial pressure of oxygen (PO2).

S-shaped and directly related to PCO2.

ANS: A

8.

A 10-year-old girl with primary pulmonary hypertension is receiving nitric oxide therapy for its vasodilatation properties. She presents with a deficiency in oxygen-

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

24-3

carrying capacity with the hemoglobin iron molecule in the ferric acid state and a methemoglobin level of 10%. She probably has a condition known as: A. B. C. D. E.

Sickle cell disease.

Anemia.

Methemoglobinemia.

Hypoxic shock.

Restrictive lung disease.

ANS: C

9.

A 48-year-old man presents with a low PaO2, low oxygen content in arterial blood (CaO2), low amount of O2 delivered, and a normal amount of O2 utilized. He is probably suffering from what type of hypoxia?

A. B. C. D.

Circulatory Hypoxic Anemic Histotoxic

ANS: B

NURSINGTB.COM

10. A 12-year-old girl of Hispanic descent enters the emergency department with severe pain on the left side of her abdomen. The family has recently immigrated to the United States. First attempts at pain relief with nonnarcotic drugs are unsuccessful. Opioids are needed to suppress the pain. Her laboratory results show that she is anemic and her parents reveal a history of chronic infections and a stroke. Genetic testing reveals that her hemoglobin gene has a single amino acid substitution of valine for glutamic acid.

Her primary diagnosis is: A. B. C. D.

Blunt traumatic injury to the spleen.

Aneurysm.

Sickle cell disease.

Cystic fibrosis

ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 25: Control of Respiration Test Bank Multiple Choice

1.

The respiratory control center is located in:

A. B. C. D.

The cerebral cortex.

The pons.

The medulla oblongata.

The cerebellum.

ANS: B

2.

Carotid sinus nerve activity is increased in the presence of:

A. B. C. D.

High O2 levels in the blood.

Normal CO2 levels in the blood.

Low O2 content.

NURSINGTB.COM Low pH.

ANS: D

3.

Increased activity in the neurons in the dorsal respiratory group is associated with:

A. B. C. D.

High lung volume.

High levels of CO2 in the blood.

High levels of O2 in the blood.

Breath holding.

ANS: B

4.

Changes in partial pressure of oxygen (PO2) are recognized/sensed by:

A. B. C. D.

Central chemoreceptors.

Peripheral chemoreceptors.

Pulmonary mechanoreceptors.

The blood-brain barrier.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

ANS: B

5.

The Hering-Breuer reflex is:

A. B. C. D.

An inspiratory inhibitory reflex.

Stimulated by lung deflation.

Mediated by the phrenic nerve.

Activated by low PO2.

ANS: A

6.

Mild-moderate exercise is associated with:

A. B. C. D. E.

Increases in arterial partial pressure of carbon dioxide (PCO2).

Decreases in arterial PO2.

Normal pH. Lactic acidosis.

Anaerobic metabolism.

ANS: C

NURSINGTB.COM

7.

Irritant receptors in the lower airway respond to all of the following except:

A. B. C. D.

Chemical vapors.

Physical factors.

Distortion of the alveolar walls.

Particles.

ANS: C

8.

Central apnea is characterized by:

A. B. C. D.

Vigorous chest wall and abdominal muscle activity.

Cessation of airflow at the nose.

Snoring.

Severe hypercarbia.

ANS: B

9.

The ventilatory response to CO2 is enhanced by:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank A. B. C. D.

25-3

Hypoxia.

Alkalosis.

Sleep.

Barbiturates.

ANS: A 10. The respiratory “pacemaker” is located in: A. B. C. D.

The dorsal respiratory group.

The ventral respiratory group.

The cerebral cortex.

Chest wall joints and muscles.

ANS: A

NURSINGTB.COM

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 26: Non-Physiologic Functions of the Lung: Host Defense and Metabolism Test Bank Multiple Choice

1.

A 56-year-old woman has worked in a photography shop developing film for the past 20 years. She has a long history of shortness of breath and chronic cough, which have progressively become worse. Her forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) values were reduced, but the FEV1/FVC ratio was within the normal range. Her diffusion capacity, as measured with diffusion of carbon monoxide in the lungs (DLCO), was low, at 15 mL/minute/mm Hg. Bronchoalveolar lavage and tissue biopsy were performed. The lavage sample revealed high numbers of abnormalappearing macrophages and high numbers of dead macrophages.

What type of lung disease do you suspect?

A. B. C. D. E.

Restrictive disease Obstructive disease Infectious disease NURSINGTB.COM Lung cancer Genetically inherited disease

ANS: A

2.

A 56-year-old woman has worked in a photography shop developing film for the past 20 years. She has a long history of shortness of breath and chronic cough, which have progressively become worse. Her FEV1 and FVC values were reduced, but the FEV1/FVC ratio was within the normal range. Her diffusion capacity, as measured with DLCO, was low, at 15 mL/minute/mm Hg. Bronchoalveolar lavage and tissue biopsy were performed. The lavage sample revealed high numbers of abnormal-appearing macrophages and high numbers of dead macrophages.

What type of pathologic process would you expect to find?

A. Peribronchial inflammation with eosinophils B. Granuloma-like lesion in the terminal bronchioles with interstitial fibrosis and large foamy macrophages C. Interstitial edema fluid accumulation with neutrophil infiltrate D. Emphysematous lesion with large alveoli and minimum interstitial fibrosis ANS: B Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

3.

A 56-year-old woman has worked in a photography shop developing film for the past 20 years. She has a long history of shortness of breath and chronic cough, which have progressively become worse. Her FEV1 and FVC values were reduced, but the FEV1/FVC ratio was within the normal range. Her diffusion capacity, as measured by DLCO, was low, at 15 mL/min/mm Hg. Bronchoalveolar lavage and tissue biopsy were performed. The lavage sample revealed high numbers of abnormal-appearing macrophages and high numbers of dead macrophages.

What is the specific diagnosis?

A. B. C. D. E.

Allergic airway disease Chronic bronchitis Silicosis Pneumoconiosis Tuberculosis

ANS: C

4.

A. B. C. D. E.

A 50-year-old male coal miner has a long history of lung disease. Where in the lung would you expect to find the greatest deposition of inhaled coal dust?

Terminal bronchioles Bronchi Nonrespiratory bronchioles Alveolus Trachea

NURSINGTB.COM

ANS: A

5.

The four cell types that contribute to the quantity and composition of mucus include:

A. Type II epithelial cells, mucous and serous cells within the submucosal tracheobronchial glands, and Clara cells B. Type II epithelial cells, mucous cells within the submucosal tracheobronchial glands, goblet cells, and Clara cells C. Type II epithelial cells, mucous and serous cells within the submucosal tracheobronchial glands, and goblet cells D. Goblet cells, mucous and serous cells within the submucosal tracheobronchial glands, and Clara cells ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

6.

26-3

A 16-year-old girl develops shortness of breath, runny nose, wheezing, and chest tightening with no fever. A spirometry test is performed and reveals that her FEV1 is reduced and the ratio of FEV1 to FVC is abnormal. Her FEV1 improves by 15% after bronchodilator use. A chest radiograph is also obtained. The family mentions that they purchased a cat several weeks ago. You suspect allergic asthma.

Increased levels of what type of serum antibody would you like to see to confirm your diagnosis?

A. B. C. D. E.

Immunoglobulin A (IgA) IgG IgM IgE IgD

ANS: D

NURSINGTB.COM

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 27: Functional Anatomy and General Principles of Regulation in the Gastrointestinal Tract Test Bank Multiple Choice

1.

A patient who has suffered a spinal injury in an automobile accident is determined to have an interruption of spinal transmission at the sixth cervical vertebra. Which of the following gastrointestinal functions would be expected to be abnormal in such a patient?

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

Gastric acid secretion Lipid digestion/absorption Defecation Peristalsis Swallowing None of the above

ANS: C

NURSINGTB.COM 2.

The craniosacral outflow from the central nervous system gives rise to which subdivision of the autonomic nervous system?

A. Sympathetic nervous system B. Parasympathetic nervous system C. Enteric nervous system ANS: B

3.

The postganglionic sympathetic neurons innervating the gastrointestinal tract lie in which ganglia?

A. B. C. D. E.

Dorsal root ganglia Nodose ganglia Ventral horn of the spinal cord Paravertebral ganglia Prevertebral ganglia

ANS: E

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank 4.

27-2

Gastrin stimulates release of histamine through an action defined as:

A. Neurocrine.

B. Endocrine.

C. Paracrine.

ANS: B

5.

The enteric nervous system contains which kinds of neurons?

A. B. C. D.

Interneurons Afferent (sensory) neurons Efferent (motor) neurons All of the above

ANS: D

6.

A scientist genetically engineers a mouse to lack the hormone secretin. In comparison with a normal animal, which of the following would be expected to be increased in the mutant mouse?

A. B. C. D. E.

The pH of pancreatic ductulaN r sUeR crS etI ioN n GTB.COM The volume of pancreatic secretion The pH of duodenal contents The susceptibility to duodenal erosions and ulcerations Gallbladder contractibility

ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne Levy Physiology, 7th Edition Chapter 28: The Cephalic, Oral, and Esophageal Phases of the Integrated Response to a Meal Test Bank Multiple Choice 1.

In an experimental study, a researcher transects cranial nerve IX in a dog. In comparison with an animal with an intact cranial nerve IX, which of the following responses to the sight and smell of a meal will be reduced?

A. B. C. D. E.

Pancreatic enzyme secretion Relaxation of the sphincter of Oddi Gastric acid secretion Gastric relaxation Salivation

ANS: E

2.

A patient is referred to a rheumatologist for treatment of an autoimmune disease. She complains of excessive d r y n eNs sUoRf S heIr N eyGeT s aBn. dC mO ouMth. After tests, Sjögren’s syndrome is diagnosed. The rheumatologist advises her that she is also at increased risk for which of the following?

A. B. C. D. E.

Foodborne diarrheal diseases Compression fractures Hypertension Tooth decay Asthma

ANS: D

3.

When a person is chewing food, the concentration of ions in saliva changes with:

A. B. C. D. E.

A decrease in Na+, Cl–, and HCO3–.

A decrease in Na+ and Cl– and an increase in HCO3–.

A decrease in K+ and Na+.

An increase in Na+, Cl–, and HCO3–.

A decrease in K+ and HCO3–.

ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

28-2

4.

Swallowing initiates which of the following events?

A. B. C. D. E.

Contraction of the lower esophageal sphincter Relaxation of the gastric antrum Secondary esophageal peristalsis Relaxation of the pyloric sphincter Relaxation of the gastric cardia

ANS: E

5.

A 50-year-old man complains to his primary care physician about a chronic burning sensation in his chest. The pain is worse when he lies down at night after a large meal, and it can be alleviated to some degree by the use of over-the-counter antacids. The pain experienced by the patient is probably caused by dysfunction of which of the following gastrointestinal structures?

A. B. C. D. E.

Lower esophageal sphincter Pylorus Salivary glands Pancreas Gallbladder

ANS: A

NURSINGTB.COM

6.

In a diagnostic test, a gastroenterologist uses an endoscope to deliver a bolus of dilute acid into the distal esophagus. The bolus is sufficient to cause esophageal dilatation. In a normal individual, the bolus is cleared from the esophagus predominantly by which of the following?

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

Primary peristalsis Swallowing Secondary peristalsis Relaxation of the upper esophageal sphincter Receptive relaxation Gravity

ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 29: The Gastric Phase of the Integrated Response to a Meal Test Bank Multiple Choice 1.

A patient with a history of gastroesophageal reflux disease has been treated continuously with a proton pump inhibitor that substantially reduces gastric acid secretion. In comparison with a normal individual, the patient is at increased risk for which of the following?

A. B. C. D. E.

Enteric infections Fat malabsorption Carbohydrate malabsorption Lactose intolerance Cystic fibrosis

ANS: A

2.

A patient with severe vertigo secondary to an inner ear infection suffers from a protracted bout of vomiting. N ShUeR isSmIoN stGaT t rB is. kC foO rM s ystemic symptoms related to reduced plasma concentration of which of the following electrolytes?

A. HCO3– B. Cl– C. Na+ D. H+ E. K+ ANS: E

3.

A 30-year-old man is referred to a gastroenterologist for evaluation of persistent dyspepsia (indigestion). He is noted to have other symptoms, including flushing and hypotension, and after a bone marrow biopsy, systemic mastocytosis (an excessive proliferation of histamine-containing mast cells) is diagnosed. An increased propensity for gastric and duodenal ulcers in this patient is probably ascribable to overproduction of which of the following second messengers in gastric parietal cells?

A. B. C. D.

Calcium Inositol trisphosphate Diacyglycerol Cyclic guanosine monophosphate (cGMP)

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

29-2

E. Cyclic adenosine monophosphate (cAMP) ANS: E

4.

A 60-year-old woman who is hospitalized during recovery from a hysterectomy does not have a bowel movement for several days, although she is eating solid foods. Because intestinal obstruction is suspected, she is returned to the operating room for an exploratory laparotomy. The pattern of motility most likely to be observed in her gastrointestinal tract during the surgery can best be described as:

A. B. C. D. E.

Peristalsis Segmentation Retroperistalsis Spasm Ileus

ANS: E

5.

Three medical students (X, Y, and Z) studying for their physiology final examination develop headaches. Student X takes a regular aspirin with a glass of water; Y takes an enteric-coated aspirin with a glass of water; and Z takes an enteric-coated aspirin with a glass of milk (an enteric coatN ing R olveM s only when the pH is above 6).

Ga t dBis.sC Uis So InNe t hT Assuming that headache relief is proportional to plasma aspirin concentrations and that Xt, Yt, and Zt are the times until relief is experienced by the respective students, which of the following best represents the relationship between Xt, Yt, and Zt?

A. B. C. D. E.

Xt = Yt = Zt Xt > Yt = Zt Xt < Yt < Zt Xt = Yt > Zt Xt > Yt > Zt

ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 30: The Small Intestinal Phase of the Integrated Response to a Meal Test Bank Multiple Choice 1.

A scientist develops a mouse that lacks the ability to express CCK1 receptors. In comparison with a normal mouse, which of the following would be expected to be increased?

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

Gastric acid secretion Gallbladder contraction after a meal Cytosolic Ca++ in pancreatic acinar cells Firing of duodenal vagal afferent neurons when food is in the lumen Gastric emptying Histamine release from enterochromaffin-like (ECL) cells

ANS: E

2.

A patient with severe Crohn’s disease undergoes resection of her terminal ileum. After recovering from the s u r ger y, N s hUe RdeSvIelN o pGs TchBr. o nCi cOdMi arrh ea that is treated effectively with cholestyramine (a resin that can bind bile acids). If her Crohn’s disease has not recurred, the diarrhea in the patient can probably be attributed to loss of which of the following membrane proteins?

A. B. C. D. E.

Sodium-glucose linked transporter 1 (SGLT1) Cystic fibrosis transmembrane conductance regulator (CFTR) Electrogenic Na+/HCO3– cotransporter 1 (NBC1) Na+,K+-ATPase Apical sodium-dependent bile acid transporter (ASBT)

ANS: E

3.

A 20-year-old African American woman complains to her physician about bloating, gas, diarrhea, and cramping pain that have occurred approximately two to three times per week for the previous 2 months. The physician asks her to keep a diary of her diet and symptoms, which reveals that the symptoms most often occur after she ingests dairy products. The patient probably has a relative deficiency of which of the following molecules in the brush border of her enterocytes?

A. Sucrase/isomaltase Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank B. C. D. E. F.

30-2

SGLT1 Glucose transporter 5 (GLUT-5) Enterokinase Glucose transporter 2 (GLUT-2) Lactase

ANS: F

4.

A 50-year-old man with alcoholism suffers recurrent bouts of pancreatitis that reduce output of pancreatic enzymes after ingestion of a mixed meal. He also presents with diarrhea, and his stools contain high levels of triglycerides but no intact starch. Duodenal aspirates obtained after a meal likewise reveal that starch is being digested appropriately.

If the output of all pancreatic enzymes is impaired during pancreatitis, what structure or structures supply an alternative source of enzymatic activity capable of starch digestion?

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

Brunner’s glands Brush border of enterocytes Gallbladder Parietal cells Chief cells Salivary glands

ANS: F

NURSINGTB.COM

5.

Routine neonatal testing suggests that a baby lacks a transport protein responsible for the uptake of cysteine in the intestines and kidneys. However, although cysteine accumulates in the urine, its concentration in the plasma is normal when the child receives a diet containing protein. Which intestinal transporter probably provides for uptake of cysteine in this child?

A. B. C. D. E.

CFTR Na+/K+/2Cl– cotransporter, isoform 1 (NKCC1) Epithelial sodium channel (ENaC) Peptide transporter 1 (PepT1) SLC6A19 gene

ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 31: The Colonic Phase of the Integrated Response to a Meal Test Bank Multiple Choice 1.

A college student notes that when sitting down to dinner, he is frequently struck by an intense impulse to use the restroom. The proximal signal that triggers the reflex arc promoting this response probably originates in which part of the system involved in the integrated response to a meal?

A. B. C. D. E.

The brain The pharynx The esophagus The stomach The duodenum

ANS: D

2.

A child is brought to a gastroenterologist because of persistent diarrhea, particularly after fatty meals. An extensivNeU wR orSkI upNeG veTnB tu. alC lyOrM eveals that the child lacks the ability to synthesize peptide YY. The increased stool volume seen in the child is probably ascribable primarily to abnormally high active secretion of which of the following?

A. B. C. D. E.

Short-chain fatty acids Na+ K+ Cl− Triglycerides

ANS: D

3.

A 45-year-old woman receiving chemotherapy for breast cancer complains of nausea, abdominal pain, bloody diarrhea, and malnutrition. Her symptoms probably reflect toxic effects of the chemotherapy on which of the following gastrointestinal cell types?

A. B. C. D. E.

Smooth muscle cells Parietal cells Pancreatic acinar cells Hepatocytes Epithelial cells

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

31-2

ANS: E

4.

In an experiment, a researcher raises mice under completely germfree conditions so that colonization of their intestine with commensal bacteria cannot occur. In comparison with a conventionally raised animal, the concentration of which of the following would be expected to be increased in the colonic contents of such mice?

A. B. C. D. E.

Butyrate Taurochenodeoxycholic acid Unconjugated bilirubin Immunoglobulin A (IgA) Lithocholic acid

ANS: B

5.

A college student decides to enter the Peace Corps after graduation and is assigned to teach English in sub-Saharan Africa, where the ambient temperature averages 100F. During the first few weeks of his stay, he notes copious sweating and mild constipation.

His gastrointestinal symptoms are probably due in part to upregulated expression of which of the following transport proteins?

A. B. C. D. E.

Cystic fibrosis transmembranN eU coRnS duIcN taG ncT eB re. guClato OMr (CFTR) Electrogenic Na+/HCO3–cotransporter 1 (NBC1) Apical sodium-dependent bile acid transporter (ABST) Na+/K+/2Cl– cotransporter, isoform 1 (NKCC1) Epithelial sodium channel (ENaC)

ANS: E

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 32: Transport and Metabolic Functions of the Liver Test Bank Multiple Choice 1.

In a study of liver function, a researcher determines the relationship of portal pressures to hepatic blood flow in a normal, anesthetized rat. Which of the following graphs most closely resembles the relationship she is most likely to discover between flow (F) and pressure (P)?

ANS: Graph A 2.

A 45-year-old woman complains to her physician about a 2-month history of recurrent, severe abdominal pain that occurs mainly after she eats large, fatty meals. However, she is well-nourished, and an aspirate of her duodenal contents shows normal micellar concentrations of bile acids. A diagnostic procedure reveals a biliary obstruction; where is the gallstone most likely to be lodged?

A. B. C. D. E.

Right hepatic duct Cystic duct Common hepatic duct Vommon bile duct Sphincter of Oddi

ANS: A

3.

A 60-year-old man is seen in the emergency room. He is disoriented and complains of fatigue and weakness. A physical examination reveals signs of alcohol abuse and a hardened liver. Blood tests reveal hypoglycemia. Loss of the function of which hepatic cell type probably accounts for his inability to maintain normal plasma levels of glucose?

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank A. B. C. D. E.

32-2

Endothelial cells Kupffer's cells Stellate cells Hepatocytes Cholangiocytes

ANS: D

4.

In an experiment, a researcher infuses a solution of conjugated bile acids into the portal vein of a rat so that their normal concentrations are approximately doubled. He collects samples of hepatic bile from the rat before and after the infusion. Before the infusion, the concentrations of bile acids, phosphatidylcholine (PC), and cholesterol (chol) are 30, 9, and 3 units per milliliter. What would be the predicted concentrations of PC and chol in the bile after the infusion of bile acids?

A. B. C. D. E.

PC: 9 U/mL; chol: 3 U/mL PC: 18 U/mL; chol: 3 U/mL PC: 9 U/mL; chol: 6 U/mL PC: 18 U/mL; chol: 6 U/mL PC: 3 U/mL; chol: 9 U/mL

ANS: D 5.

A newborn is observed to be mildly jaundiced. Bilirubin is not found in the urine. A relative absence of which of the following liver proteins probably accounts for the symptoms?

A. B. C. D. E.

Bile salt export pump (BSEP) Organic anion-transporting polypeptide (OATP) Uridine diphosphate–glucuronosyltransferase (UGT) Multidrug resistance protein 2 (MRP2) Adenosine triphosphate–binding cassette proteins 5 and 8 (ABC5/ABC8

ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 33: Elements of Renal Function Test Bank Multiple Choice

1.

According to the tubuloglomerular feedback theory, an increase in tubular fluid NaCl delivery to the macula densa results in which of the following?

A. B. C. D. E.

A decrease in the glomerular filtration rate of the same nephron An increase in renal blood flow to the glomerulus of the same nephron Activation of the renal sympathetic nerves An increase in proximal tubule solute and water reabsorption An increase in renin secretion

ANS: A 2.

Which of the following structures is a barrier to the filtration of proteins across the glomerulus?

A. B. C. D. E.

Capillary endothelial cells Basement membrane Lacis cells Parietal epithelial cells Mesangial cells

ANS: B

3.

A 56-year-old man was admitted to the hospital with a myocardial infarction. At admission, his serum creatinine level was 1.2 mg/dL, and his creatinine clearance rate was 100 mL/minute. Over the next 3 days, he had several periods of hypotension, and his serum creatinine level increased to 3.6 mg/dL. Assuming that he is in steady-state balance for creatinine level (i.e., amount excreted = amounted produced), what is his predicted creatinine clearance rate?

A. B. C. D. E.

10 mL/minute 33 mL/minute 50 mL/minute 66 mL/minute 100 mL/minute

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

ANS: B

4.

The macula densa is part of which of the following structures in the kidney?

A. B. C. D. E.

Extraglomerular matrix Vasa recta Afferent arteriole Juxtamedullary nephron Juxtaglomerular apparatus

ANS: E

5.

The efferent arteriole of some juxtamedullary nephrons enters the renal medulla and becomes which of the following vessels?

A. B. C. D. E.

Interlobular artery Arcuate artery Vasa recta Glomerular capillary Interlobar artery

ANS: C

6.

Which of the following responses to a fall in arterial pressure accounts for the ability of the kidneys to autoregulate glomerular filtration rate (GFR)?

A. B. C. D. E.

Decreased resistance of the efferent arteriole Increased delivery of fluid to the end of the proximal tubule Increase resistance of the afferent arteriole Increased [NaCl] in tubular fluid at the macula densa Decreased resistance of the afferent arteriole

ANS: E

7.

GFR decreases in which of the following conditions?

A. B. C. D. E.

Dilation of the afferent arteriole Decrease in renal nerve activity Decrease in plasma oncotic pressure Increase in hydrostatic pressure in Bowman’s space Increase in renal blood flow

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

ANS: D

8.

A healthy 25-year-old woman donates a kidney to her identical twin, who has chronic renal failure. Her serum creatinine concentration before removal of the kidney is 1.0 mg/dL. After removal of her kidney, her serum creatinine concentration increases to 2.0 mg/dL. One month later her serum creatinine concentration has decreased to 1.5 mg/dL. Which of the following accounts for the fact that her serum creatinine concentration fell from 2.0 to 1.5 mg/dL?

A. B. C. D.

Decreased production of creatinine by skeletal muscle Enhanced secretion of creatinine by the proximal tubule Increase in the GFR of each of the remaining nephrons Expansion of the extracellular fluid (ECF) volume

ANS: C

9.

A substance (Y) is found in the plasma at a concentration of 2 mg/dL. A 24-hour urine collection is performed to determine the renal clearance of Y. The following data are obtained: Urine volume: 1.44 L Urine [Y]: 500 mg/L What is the renal clearance rate of Y?

A. B. C. D. E.

5 mL/minute 36 mL/minute 50 mL/minute 100 mL/minute 250 mL/minute

ANS: B

10. Starling forces are measured across a capillary wall, and the following values are obtained: Capillary hydrostatic pressure: 30 mm Hg Capillary oncotic pressure: 25 mm Hg Interstitial hydrostatic pressure: 0 mm Hg Interstitial oncotic pressure: 15 mm Hg If the reflection coefficient for protein across this capillary wall is 0.5, what is the pressure and direction of fluid flow across the capillary wall?

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

A. B. C. D. E.

33-4 Net pressure 5 mm Hg 10 mm Hg 15 mm Hg 20 mm Hg 25 mm Hg

Direction of fluid flow Into capillary Out of capillary Out of capillary Out of capillary Out of capillary

ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 34: Solute and Water Transport along the Nephron: Tubular Function Test Bank Multiple Choice

1.

Proximal tubule HCO3- reabsorption is inhibited by which of the following?

A. B. C. D. E.

Increased partial pressure of carbon dioxide (PCO2) Expansion of the extracellular fluid (ECF) volume Systemic acidosis Endothelin Hypokalemia

ANS: B 2.

A. B. C. D.

In the late portion of the proximal tubule, part of Na+ reabsorption is passive, through the paracellular pathway. What is the primary driving force for this passive reabsorption of Na+?

The fact that lower luminal hydrostatic pressure is lower than peritubular hydrostatic pressure The fact that luminal [Na+] is higher than peritubular [Na+] The fact that transepithelial voltage is lumen-positive The fact that the oncotic pressure of interstitial fluid is lower than that of luminal fluid

ANS: C

3.

The following graph depicts the changes in tubular fluid concentrations of various substances along the length of the proximal tubule, plotted as the tubular fluid-to-plasma concentration ratio (TF/P). Thus the TF/P = 1 for a substance that is at the same concentration in the tubular fluid and plasma (for all substances that are freely filtered, TF/P = 1 at the glomerulus).

Match the following substances to the appropriate TF/P curve.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

34-2

Na+ ANS: C

4.

The following graph depicts the changes in tubular fluid concentrations of various substances along the length of the proximal tubule, plotted as the tubular fluid-to-plasma concentration ratio (TF/P). T N h u s Rt h e I TF/G P =B 1. foCr a M s ubstance that is at the same U S N T concentration in the tubular fluid and plasma (for all substances that are freely filtered, TF/P = 1 at the glomerulus).

Match the following substances to the appropriate TF/P curve.

creatinine Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

34-3

ANS: A

5.

The following graph depicts the changes in tubular fluid concentrations of various substances along the length of the proximal tubule, plotted as the tubular fluid-to-plasma concentration ratio (TF/P). Thus the TF/P = 1 for a substance that is at the same concentration in the tubular fluid and plasma (for all substances that are freely filtered, TF/P = 1 at the glomerulus).

Match the following substances to the appropriate TF/P curve.

NURSINGT glucose ANS: E

6.

Na+ reabsorption by the thick ascending limb of Henle’s loop is:

A. B. C. D. E.

Inhibited by a decrease in peritubular capillary hydrostatic pressure.

Inhibited by angiotensin II. Increased with increased delivered load of Na+.

Inhibited by potassium-sparing diuretics.

Increased by natriuretic peptides.

ANS: C

7.

Starling forces regulate sodium and water reabsorption by the proximal tubule. Which of the following changes in Starling forces would increase reabsorption?

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

A. Increase in capillary hydrostatic pressure

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

34-4

B. Increase in capillary oncotic pressure C. Decrease in capillary oncotic pressure D. Decrease in the permeability of the peritubular capillary to sodium and water ANS: B

8.

Which of the following increases the reabsorption of sodium and chloride in the distal tubule and collecting duct?

A. B. C. D. E.

Uroguanylin Peritubular Starling forces Natriuretic peptides Aldosterone Urodilatin

ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 35: Control of Body Fluid Osmolality and Volume Test Bank Multiple Choice

1.

An individual is stricken with an illness characterized by nausea, vomiting, and diarrhea.

Over a 2-day period, this individual experiences a 3-kg loss in weight without a change in the plasma [Na+]. What can be concluded about body fluid volumes and composition in this individual?

A. B. C. D.

The volume of intracellular fluid (ICF) is increased.

The volume of extracellular fluid (ECF) is reduced.

The total body osmolar volume is increased.

The plasma osmolality is reduced.

ANS: B 2.

Which of the following maneuvers would be expected to stimulate antidiuretic hormone (ADH) secretion?

A. B. C. D. E.

Infusion of 1 L hypertonic NaCl Infusion of 1 L of an isoosmotic urea solution Expansion of the extracellular volume fraction (ECV) Infusion of 1 L of 5% dextrose in water (D5W) An acute increase in blood pressure

ANS: A

3.

Which of the following will occur with a decrease in the ECF volume?

A. B. C. D. E.

Increase in glomerular filtration rate (GFR) Increase in angiotensin II levels Increase in natriuretic peptide levels Increase in free H2O clearance Increase in fractional excretion of Na+

ANS: B

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

4.

A 56-year-old woman has congestive heart failure with generalized edema. Which of the following plays an important role in the formation of edema in this woman?

A. B. C. D. E.

Increased interstitial hydrostatic pressure Decreased interstitial oncotic pressure Increased plasma oncotic pressure Decreased renal excretion of Na+ Decreased venous pressure

ANS: D

5.

Vasopressin has which of the following actions?

A. B. C. D. E.

It increases the water permeability of the thick ascending limb of Henle’s loop.

It increases the urea permeability in the cortical portion of the collecting duct.

It increases the water permeability in the collecting duct.

It decreases the GFR. It increases the water permeability in the proximal tubule.

ANS: C

6.

A patient has polyuria and poN lyU dR ipS siI a, N anGdTt hBe.uC ri nOeMos m ol al i t y is 100 mOsm/kg H2O. After an intravenous injection of ADH, urine volume decreases and urine osmolality increases. What is the probable disorder in this patient?

A. B. C. D. E.

Syndrome of inappropriate ADH secretion (SIADH) Osmotic diuresis Central diabetes insipidus Nephrogenic diabetes insipidus Nephrolithiasis (renal stone)

ANS: C

7.

The kidneys maintain a constant plasma osmolality by regulating the excretion of which of the following?

A. B. C. D. E.

Glucose Na+ Creatinine H2O K+

ANS: D Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

8.

A 78-year-old woman with congestive heart failure develops pitting edema in her legs.

In comparison with a healthy (i.e., euvolemic) individual, what set of parameters would be expected in this woman?

A. B. C. D. E.

Plasma volume     

ECF volume     

ECV     

ANS: C

9.

Hyponatremia can sometimes be seen in individuals whose ECF volume is decreased by more than 10%. Which of the following factors contributes to the development of hyponatremia in this situation?

A. B. C. D. E.

Decreased levels of ADH Elevated levels of natriuretic peptides Increased excretion of Na+ byNtheRkidIneyGs Reduced excretion of solute-freUe wSaterNb yTthe kidO n eys + Development of positive Na balance

ANS: D

10. A 45-year-old woman has a blood pressure of 140/90 mm Hg. Her doctor recommends a low-salt diet. When she has reached a new steady state on her new diet, what would her serum [Na+] and ECF volume become in comparison with their values on her previous diet?

A. B. C. D. E.

Serum [Na+] No change No change No change  

ECF volume  No change  No change 

ANS: A

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

35-4

11. A patient has polyuria and polydipsia, and the urine osmolality is 100 mOsm/kg H2O. The polyuria and polydipsia are not corrected by intravenous injection of ADH, and the exogenous ADH does not alter urine osmolality. What is the probable disorder in this patient?

A. B. C. D. E.

SIADH Osmotic diuresis Central diabetes insipidus Nephrogenic diabetes insipidus Nephrolithiasis (renal stone)

ANS: D

12. Which of the following situations would be expected to cause an increase in ADH secretion by the posterior pituitary gland?

A. B. C. D.

A 5% decrease in arterial blood pressure A 5% increase in arterial blood pressure A 1% decrease in plasma osmolality A 1% increase in plasma osmolality

ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 36: Potassium, Calcium, and Phosphate Homeostasis Test Bank Multiple Choice

1.

Which of the following enhances urinary K+ excretion?

A. B. C. D. E.

Osmotic diuresis Acute metabolic acidosis Hypoaldosteronism Decreased tubular flow rate Water diuresis

ANS: A

2.

Which of the following hormones plays an important role in keeping the plasma concentration of K+ within normal limits?

A. B. C. D. E.

Calcitriol Vasopressin Parathyroid hormone (PTH) Insulin Glucagon

ANS: D

3.

A healthy individual, weighing 60 kg, receives an infusion of 1 L of isotonic saline to which 20 mEq of K+ has been added. After the infusion, the plasma [K+] of this individual has increased from 3.5 mEq/L to 7.8 mEq/L. What is the most plausible explanation for the development of hyperkalemia in this individual?

A. K+ shifts from the intracellular fluid (ICF) into the extracellular fluid (ECF).

B. Renal excretion of K+ is impaired.

C. The increase in plasma [K+] of 4.3 mEq/L is what is expected from the addition of 20 mEq/L of K+ to the ECF. D. The ECF volume contracts.

E. Hyperosmolality develops.

ANS: A

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

4.

Urinary K+ excretion is increased by which of the following?

A. B. C. D. E.

Hypokalemia Hyperaldosteronism Antidiuretic hormone (ADH) A decrease in glomerular filtration rate (GFR) Administration of amiloride

ANS: B

5.

A 21-year-old man with insulin-dependent (type 1) diabetes mellitus who forgot to inject his insulin is seen in the emergency department. The following laboratory data are obtained: Serum [Na+] = 140 mEq/L (normal: 135 to 147 mEq/L) Serum [K+] = 6.5 mEq/L (normal: 3.5 to 5.0 mEq/L) Serum [HCO3-] = 10 mEq/L (normal: 22 to 28 mEq/L) Blood pH = 7.0 (normal: 7.35 to 7.45) Arterial partial pressure of carbon dioxide (PCO2) = 25 mm Hg (normal: 33 to 44 mm Hg) Serum glucose concentration = 1000 mg/dL (normal: 70 to 110 mg/dL) Which of the following plays the most important role in the generation of hyperkalemia in this man?

A. B. C. D. E.

Low plasma osmolality Low arterial PCO2 Hyponatremia Metabolic acidosis Low plasma insulin concentration

ANS: E

6.

A 45-year-old man is prescribed an angiotensin-converting enzyme inhibitor as part of his therapy for hypertension. If he does not change his diet, what changes in his serum [Na+] and serum [K+] would you expect?

A. B. C. D. E.

Serum [Na+] No change No change   

Serum [K+]   No change  

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

36-3

ANS: B

7.

A. B. C. D. E.

A 65-year-old man has chronic renal failure. What are the expected changes in his serum Ca++, inorganic phosphate (Pi), and calcitriol levels? (Note: Changes are those expected in comparison with the values in an individual with normal renal function.)

Serum [Ca++]     

Serum [Pi]     

Calcitriol level     

ANS: A

8.

Hyperkalemia is most likely to occur in which of the following conditions?

A. B. C. D. E.

Metabolic alkalosis Exercise Insulin injection Decreased plasma osmolality Administration of a -adrenergic agonist

ANS: B

9.

Which of the following conditions would be expected to reduce the free (i.e., ionized) [Ca++] in the plasma?

A. B. C. D. E.

Metabolic acidosis Reduced dietary intake of phosphate A tumor secreting parathyroid hormone–like peptide Ingestion of calcitriol Acute respiratory alkalosis

ANS: E

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 37: Role of the Kidneys in the Regulation of Acid-Base Balance Test Bank Multiple Choice

1.

An individual with an asthma attack; has the following data: pH = 7.32; [HCO3−] = 25 mEq/L; partial pressure of carbon dioxide (PCO2) = 50 mm Hg. Which acid-base disturbance is consistent with this clinical scenario and these arterial blood gas measurements?

A. B. C. D. E.

Metabolic acidosis with respiratory compensation Metabolic alkalosis with respiratory compensation Respiratory acidosis with renal compensation (chronic respiratory acidosis) Respiratory acidosis without renal compensation (acute respiratory acidosis) Metabolic acidosis and respiratory acidosis

ANS: D 2.

A. B. C. D. E.

NeUllR An individual with diabetes m ituSsIwN hG oT foB rg. etC sO t o Mt a k e insulin has the following data: pH = 7.29; [HCO3−] = 12 mEq/L; PCO2 = 26 mm Hg. Which acid-base disturbance is consistent with this clinical scenario and these arterial blood gas measurements?

Metabolic acidosis with respiratory compensation Metabolic alkalosis with respiratory compensation Respiratory acidosis with renal compensation (chronic respiratory acidosis) Respiratory acidosis without renal compensation (acute respiratory acidosis) Metabolic acidosis and respiratory acidosis

ANS: A

3.

An individual with cardiopulmonary arrest has the following data: pH = 6.85; [HCO 3−] = 10 mEq/L; PCO2 = 60 mm Hg. Which acid-base disturbance is consistent with this clinical scenario and these arterial blood gas measurements?

A. B. C. D. E.

Metabolic acidosis with respiratory compensation Metabolic alkalosis with respiratory compensation Respiratory acidosis with renal compensation (chronic respiratory acidosis) Respiratory acidosis without renal compensation (acute respiratory acidosis) Metabolic acidosis and respiratory acidosis

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

ANS: E

4.

An individual with a gastric ulcer who ingests large quantities of antacids has the following data: pH = 7.45; [HCO 3−] = 30 mEq/L; PCO 2= 45 mm Hg. Which acid-base disturbance is consistent with this clinical scenario and these arterial blood gas measurements?

A. B. C. D. E.

Metabolic acidosis with respiratory compensation Metabolic alkalosis with respiratory compensation Tespiratory acidosis with renal compensation (chronic respiratory acidosis) Respiratory acidosis without renal compensation (acute respiratory acidosis) Metabolic acidosis and respiratory acidosis

ANS: B

5.

An individual with a 20-year history of smoking three packs/day who has emphysema has the following data: pH = 7.37; [HCO3−] = 28 mEq/L; PCO2 = 50 mm Hg. Which acid-base disturbance is consistent with this clinical scenario and these arterial blood gas measurements?

A. Metabolic acidosis with respiratory compensation irU atR orS yI coNmGpT enBsa.tiC onO B. Metabolic alkalosis with respN C. Respiratory acidosis with renal compensation (chronic respiratory acidosis) D. Respiratory acidosis without renal compensation (acute respiratory acidosis) E. Metabolic acidosis and respiratory acidosis ANS: C

6.

During a 24-hour period, an individual excretes in the urine 60 mmol of NH4+, 40 mmol of titratable acid, and 10 mmol of HCO3−. If this individual is in acid-base balance, how much nonvolatile acid was produced from metabolism?

A. B. C. D. E.

80 mmol/day 90 mmol/day 100 mmol/day 110 mmol/day 120 mmol/day

ANS: B

7.

A 6-year-old boy presents to the emergency department with fever, abdominal cramps, and diarrhea. Arterial blood gas measurements are as follows:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

37-3

pH: 7.28 (normal: 7.35 to 7.45) PCO2: 24 mm Hg (normal: 33 to 44 mm Hg) [HCO3−]: 11 mEq/L (normal: 22 to 28 mEq/L) What is the acid-base disorder?

A. B. C. D.

Metabolic acidosis with respiratory compensation Metabolic acidosis with respiratory acidosis Acute respiratory acidosis Chronic respiratory acidosis

ANS: A

8.

A 60-year-old woman comes to the emergency department with shortness of breath. An arterial blood sample is obtained, and the following data are noted: Partial pressure of oxygen (PO2): 75 mm Hg (normal: 75 to 100 mm Hg) PCO2: 58 mm Hg (normal: 33 to 44 mm Hg) [HCO3−]: 24 mEq/L (normal: 22 to 28 mEq/L) pH: 7.24 (normal: 7.35 to 7.45) What is the acid-base disordeNr?

A. B. C. D. E.

Metabolic acidosis Metabolic alkalosis Acute respiratory acidosis Acute respiratory alkalosis Chronic respiratory acidosis

ANS: C

9.

In response to metabolic acidosis, the kidneys increase the excretion of net acid. Which of the following is the most important component of this compensatory response?

A. Increased filtered load of HCO3− B. Enhanced reabsorption of HCO3− by the proximal tubule C. Increased synthesis and excretion of NH4+ D. Reduced H+ secretion by the distal tubule and collecting duct E. Reduced secretion of HCO3− by the collecting duct ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 38: Introduction to the Endocrine System Test Bank Multiple Choice 1.

An elderly person becomes confused and takes an overdose of a medication designed to block both cholesterol uptake from the gastrointestinal (GI) tract and cholesterol synthesis by all cells. After 24 hours, the individual is severely hypocholesterolemic (i.e., has very low levels of circulating cholesterol). This individual would exhibit a transient lower level of which type of hormone?

A. B. C. D. E.

Catecholamines Protein hormones Steroid hormones Iodothyronines Peptide hormones

ANS: C

2.

A. B. C. D. E.

An elderly person becomes cN onUfuRsS edIaN ndGtT akBe. sC a nOoMv e r d o s e of a medication designed to block both cholesterol uptake from the GI tract and cholesterol synthesis by all cells.

After 24 hours, the individual is severely hypocholesterolemic (i.e., has very low levels of circulating cholesterol). This effect is transient: as the effects of the drug wear off, hormone levels rebound. Which of the following is most responsible for stability of hormone levels in this situation?

Hepatic turnover Negative feedback loop Peripheral conversion Renal excretion Melatonin

ANS: B

3.

Endocrine diseases are often due to loss of hormone (i.e., a hormone deficiency). Which of the following would cause an endocrine disease that mimicked a protein hormone deficiency without a deficiency in the levels of a circulating protein hormone?

A. Inactive prohormone convertase B. Defective exocytotic machinery C. Loss of blood transport proteins Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

D. Defective receptor E. Null mutation in corresponding hormone gene ANS: D

4.

Hormones act through binding to their receptors. Which of following hormones binds only to a receptor located on the cell membrane?

A. B. C. D. E.

Thyroid hormone Catecholamine Estrogen Progesterone Vitamin D

ANS: B

5.

Many hormones are synthesized as preprohormones. A mutation in a preprohormoneencoding gene that changed the amino acid sequence of the signal peptide could result in:

A. Inability of the hormone to be secreted. ofRthSeIhN orG mT oB ne. . O B. Decreased circulating half-l i fNe U C. Secretion of a smaller hormone.

D. Inability of the hormone gene to be transcribed.

E. Reduced affinity of the hormone for its receptor.

ANS: A

6.

Endocrine glands are organs dedicated to making hormones. Some organs make hormones but have other important functions. An example of such a hormone-producing organ that is not considered a dedicated endocrine gland is:

A. B. C. D. E.

The adrenal gland.

The thyroid gland.

The liver.

The pituitary gland.

The parathyroid gland.

ANS: C

7.

The hypothalamus has an important role in the hypothalamic–pituitary–endocrine gland axes. As part of these axes, hypothalamic neuroendocrine neurons secrete:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

A. B. C. D.

38-3

Tropic hormones.

Steroid hormones.

Releasing hormones.

Thyroid hormones.

ANS: C

8.

Many pituitary hormones are secreted in a circadian rhythm. A structure important in the regulation of circadian hormonal rhythms is:

A. B. C. D. E.

The paraventricular nucleus.

The supraoptic nucleus.

The superior fornix.

The suprachiasmatic nucleus.

The arcuate nucleus.

ANS: D 9.

Protein hormones are secreted in a regulated manner, through a mechanism referred to as:

A. B. C. D. E.

Stimulus-secretion coupling.

Constitutive secretion.

Endocytosis recycling.

Signal peptidase-induced cleavage.

Membrane shedding.

ANS: A

10. An important process that can activate a steroid hormone or even change a steroid hormone into a different type of hormone (e.g., changing an androgen molecule into an estrogen molecule) is called: A. B. C. D. E.

Renal excretion.

Peripheral conversion.

Steroid hormone–receptor binding.

Hepatic conjugation.

Dimerization.

ANS: B

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 39: Hormonal Regulation of Energy Metabolism Test Bank Multiple Choice 1.

During his annual physical examination, a 55-year-old man is noted to have a body mass index of 33 (>30 indicates obesity) and high blood pressure. His blood chemistry profile indicates hyperlipidemia, hypertriglyceridemia, and hypercholesterolemia. Furthermore, his fasting blood glucose level is 120 mg/dL (elevated). His physician suspects type 2 diabetes and orders a glucose tolerance test. The patient drinks 75 g of glucose and then has his blood glucose measured 2 hours later. The 2-hour glucose level is 190 mg/dL (high end of glucose intolerance range; for the diagnosis of diabetes, the level is 200 mg/dL or higher). The most likely reason for this patient’s glucose intolerance is:

A. B. C. D. E.

Autoimmune destruction of the β cells.

Impairment of adenosine triphosphate (ATP)–sensitive potassium channel.

Insulin resistance.

Low leptin levels.

Impairment of glucose transporter 2 (GLUT-2) function.

ANS: C 2.

High circulating lipid levels are typical of the prediabetic and diabetic states. When the liver is saturated with glucose from the blood, it converts the glucose into free fatty acids (FFAs) and triglycerides. One of the enzymes involved in hepatic lipogenesis is:

A. B. C. D. E.

Glucose-6-phosphatase.

Phosphorylase.

Pyruvate carboxylase.

Fatty acyl oxidase.

Acetyl coenzyme A (CoA) carboxylase.

ANS: E

3.

Levels of circulating FFAs (associated primarily with albumin) are often elevated in the prediabetic and diabetic states. This is due to:

A. B. C. D.

Elevated levels of hormone-sensitive lipase.

Elevated levels of lipoprotein lipase.

Elevated levels of hepatic lipase.

Elevated rate of very-low-density lipoprotein (VLDL) formation.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

E. Reduced expression of low-density lipoprotein (LDL) receptor.

ANS: A

4.

During fasting, blood glucose level is maintained through several sources. The first source of stored energy to be mobilized for blood glucose is:

A. B. C. D. E.

Adipose triglyceride.

Hepatic ketone bodies.

Skeletal muscle glycogen.

Skeletal muscle protein.

Hepatic glycogen.

ANS: E

5.

A major source of stored energy for skeletal muscle during exercise is:

A. B. C. D. E.

Lactate.

Triglyceride.

Glycogen.

Ketone bodies.

Fatty acids.

NURSINGTB.COM

ANS: C

6.

The hormone released by adipose tissue that decreases appetite is called:

 Type  melanocyte–stimulating hormone (-MSH).

B. Adiponectin.

C. Neuropeptide Y. D. Leptin.

E. Insulin.

ANS: D

7.

The most important stimulus of insulin release is:

A. B. C. D. E.

Glucose.

Glucagon.

Adrenergic stimulation.

Cholinergic stimulation.

Amino acids.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

ANS: A

8.

Insulin stimulates triglyceride storage in adipose tissue. Which of the following enzymes plays an important role in this?

A. B. C. D. E.

Phosphoenolpyruvate carboxykinase (PEPCK).

Glucokinase.

Hormone-sensitive lipase.

Lipoprotein lipase.

Thiolase.

ANS: D

9.

Triglycerides are extremely hydrophobic and need to be transported in lipoprotein particles. The particle involved in the transfer of triglycerides from the liver to adipose tissue is called:

A. B. C. D. E.

VLDL. LDL. Chylomicron.

Intermediate-density lip op rotN eiU nR ( IS DI L)N . GTB.COM High-density lipoprotein (HDL).

ANS: A

10. A key metabolite that controls the movement of fatty acyl CoA into the mitochondria (where they are oxidized) is: A. B. C. D. E.

Acetyl CoA. Malonyl CoA. Palmitate.

Citrate.

ATP

ANS: B

11. The insulin receptor belongs to which family of receptors?

A. Tyrosine kinase receptors B. Steroid receptors C. Cytokine receptors Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

D. G protein–coupled receptors E. LDL receptors ANS: A

12. A primary target of insulin in skeletal muscle is: A. B. C. D. E.

Glucokinase.

Acetyl CoA carboxylase.

Uncoupling proteins.

Fatty acid synthase.

Glucose transporter 4 (GLUT-4).

ANS: E

13. The first action of secreted insulin is: A. B. C. D. E.

Activation of lipoprotein lipase.

Inhibition of glucagon secretion.

Stimulation of hepatic glycolysis.

Mobilization of GLUT-4 into myocellular membranes.

Inhibition of appetite.

NURSINGTB.COM

ANS: B

14. Juvenile-onset type 1 diabetes is often suspected by parents because of which change in the child’s appearance or behavior?

A. B. C. D. E.

Sudden increase in muscle mass Darkening of the skin Increased thirst and frequency of urination Puffiness around the face Early (precocious) pubertal growth spurt

ANS: C

15. Glucagon has an important counterregulatory role that prevents hypoglycemia. Which glucagon-stimulated enzyme increases hepatic glucose production and thus blood glucose levels?

A. Hormone-sensitive lipase B. Lipoprotein lipase Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

39-5

C. Fructose-1,6-bisphosphatase D. Glycogen synthase E. Fatty acyl oxidase ANS: C

NURSINGTB.COM

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 40: Hormonal Regulation of Calcium and Phosphate Metabolism Test Bank Multiple Choice

1.

A 65-year-old woman presents with acute, severe flank pain radiating toward the pelvis.

She also complains of some chronic musculoskeletal pain and indigestion. Radiological studies reveals a kidney stone in her ureter. Blood chemistry testing reveals hypercalcemia, and urine chemistry testing reveals hypercalciuria and hyperphosphaturia. An endocrine pathological process most consistent with these findings is:

A. Infection of the gastrointestinal (GI) tract that inhibits calcium and phosphate absorption.

B. An adenoma of the parathyroid glands, secreting excessive parathyroid hormone (PTH).

C. Hepatocellular carcinoma of the liver, resulting in overproduction of 25-hydroxyvitamin D. D. A medullary carcinoma of the thyroid, secreting large amounts of calcitonin.

E. Autoimmune destruction of the parathyroid glands.

ANS: B

NURSINGTB.COM

2.

Endogenous vitamin D synthesis begins in:

A. B. C. D. E.

The intestines.

The kidneys.

The liver.

The skin.

Bone tissue.

ANS: D

3.

Estrogen can oppose some of the effects of PTH. This occurs because of the effects of estrogen on:

A. B. C. D. E.

Intestinal enterocytes.

Osteoclasts.

Osteoblasts.

Chief cells of the parathyroid gland.

Proximal renal tubule cells.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

ANS: B

4.

Osteoporosis can result from excessive production of receptor activator of nuclear factor  light-chain enhancer of activated B cells (RANK) ligand (RANKL) by osteoblasts. A molecule that directly inhibits RANKL and protects bones from osteoclast overactivity is:

A. B. C. D. E.

PTH. Osteoprotegerin.

Alkaline phosphatase.

Osteoid.

RANK.

ANS: B

5.

The parathyroid glands respond rapidly to hypocalcemia. The protein responsible for the rapid response of the principal cells to a falling calcium level is:

A. B. C. D. E.

The PTH receptor.

Membrane Ca++–adenosine triphosphatase (ATPase).

NURSINGTB.COM Ca++-sensing receptor. + ++ The Na -Ca exchange antiporter.

The transient receptor potential cation channel subfamily V, member 5 (TRPV5) calcium channel.

ANS: C

6.

Lack of vitamin D can cause rickets in children. Of the following, which is the most important lifestyle activity that promotes normal endogenous vitamin D production?

A. B. C. D. E.

Playing outside.

Exercising at a gym.

Eating green vegetables.

Consuming highly unsaturated oils (e.g., olive oil).

Drinking fruit juices.

ANS: A

7.

The vitamin D receptor belongs to which class of receptors?

A. G protein–coupled receptors Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank B. C. D. E.

40-3

Tyrosine kinase receptors Nuclear hormone receptors Calcium-sensing receptors Janus kinase/signal transducer and activator of transcription (JAK/STAT) receptors

ANS: C

8.

PTH is secreted in a regulated manner. Which of the following directly increases PTH synthesis, secretion, or both?

A. B. C. D. E.

Elevated 1,25-dihydroxyvitamin D Decreased blood phosphate levels (hypophosphatemia) Decreased blood Ca++ levels (hypocalcemia) Elevated blood K+ levels (hyperkalemia) Elevated Mg++ levels (hypermagnesemia)

ANS: C

9.

1,25-Dihydroxyvitamin D stimulates the synthesis of the TrpV proteins in the small intestine. The TrpV proteins act as:

A. B. C. D. E.

Voltage-sensitive calcium chN anU nR elsS. INGTB.COM Calcium-sensing receptors.

Serum Ca++ transport proteins.

Intracellular Ca++-binding proteins.

Apical membrane calcium channels.

ANS: E 10. A drop in blood Ca++ level indirectly increases renal 1α-hydroxylase activity. This occurs in response to: A. B. C. D. E.

Elevated levels of 25-hydroxyvitamin D. Elevated levels of PTH. Elevated levels of inorganic phosphate (Pi).

Elevated levels of calcitonin.

Increased 24-hydroxylase activity.

ANS: B

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 41: The Hypothalamus and Pituitary Gland Test Bank Multiple Choice

1.

A 17-year-old girl has not had her first menstrual period (menarche) and has no signs of puberty-associated growth spurt, breast development, or pubic hair growth. Her pediatrician suspects hypogonadism/delayed puberty of some form. One form of hypogonadism is associated with loss of gonadotropin-releasing hormone (GnRH) neurons in the hypothalamus (Kallmann’s syndrome). This form of tertiary hypogonadism results in which of the following?

A. B. C. D. E.

Increased levels of prolactin Decreased levels of thyroid-stimulating hormone (TSH) Increased levels of adrenocorticotropic hormone (ACTH) Increased levels of luteinizing hormone (LH) Decreased levels of follicle-stimulating hormone (FSH)

ANS: E

NURSINGTB.COM

2.

A 17-year-old girl has not had her first menstrual period (menarche) and has no signs of puberty-associated growth spurt, breast development, or pubic hair growth. Her pediatrician suspects hypogonadism/delayed puberty of some form. If this patient had a form of primary hypogonadism, she would probably exhibit increased:

A. B. C. D. E.

Estrogen levels.

FSH levels.

Androgen levels.

TSH levels.

Growth hormone (GH) levels.

ANS: B

3.

The cell type that expresses prohormone convertases capable of cleaving proopiomelanocortin (POMC) into an active tropic hormone is:

A. B. C. D.

The thyrotrope.

The lactotrope.

The corticotrope.

The gonadotrope.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Copyright© 2018 by Elsevier, Inc. All rights reserved.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

E. The somatotrope.

ANS: C

4.

The preprohormone preprovasophysin is synthesized in:

A. B. C. D. E.

The pars nervosa.

The median eminence.

The hypothalamic nuclei.

The pars distalis.

The infundibular stalk.

ANS: C

5.

Pituitary glycoprotein hormones are heterodimers containing a common  subunit and a hormone-specific  subunit. The glycoprotein hormones from the pituitary gland include:

A. B. C. D. E.

TSH, GH, and LH. Human chorionic gonadotropin (hCG), TSH, and FSH. Prolactin, GH, and ACTH. NURSINGTB.COM FSH, LH, and TSH. FSH, LH, and prolactin.

ANS: D

6.

Hypothalamic releasing hormones are secreted from neuroendocrine neurons at:

A. B. C. D. E.

The median eminence.

The pars distalis.

The paraventricular nucleus.

The pars nervosa.

The infundibular stalk.

ANS: A

7.

An example of a “short-loop” feedback loop is:

A. B. C. D.

GH inhibition of growth hormone–releasing hormone (GHRH) Cortisol inhibition of ACTH. FSH inhibition of LH. Estrogen inhibition of GnRH.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

41-3

E. Somatostatin inhibition of GH. ANS: A

8.

The major target of growth hormone, which determines the circulating levels of insulinlike growth factor type 1 (IGF-1), is:

A. B. C. D. E.

The pituitary gland Muscles.

The liver.

The kidneys.

Adipose tissue.

ANS: C

9.

Elevated levels of ACTH can cause skin darkening, as a result of the ability of ACTH to:

A. B. C. D. E.

Bind to the melanocortin 1 receptor (MC1R).

Stimulate cortisol production.

Bind to the corticotropin-releasing hormone (CRH) receptor Stimulate adrenal androgen production.

Stimulate –melanocyte-stimNuUalRnitSgIhNorGmToBne.(C-O MMSH) production

ANS: A

10. The one pituitary tropic hormone that is under predominantly inhibitory control by the hypothalamus is: A. B. C. D. E.

GH. TSH. Somatostatin.

Prolactin.

ACTH.

ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 42: The Thyroid Gland Test Bank Multiple Choice

1.

A 50-year-old woman complains that in the past few months she has had little energy, has frequently felt chilled, and has noticed excessive hair loss when she washes her hair.

During the physical examination, her blood pressure registers at 105/85 mm Hg, her pulse is slow, and her physician notes dry, cool skin with puffiness of the face and arms.

A preliminary diagnosis of primary hypothyroidism is made. If the diagnosis is correct, which of the following blood values would be expected?

A. B. C. D. E.

Total Thyroxine (T4)

Free T4

Low Normal Low Low Low

Low Low Low Low Low NURSINGTB.CO Normal Low Low Normal Low

Triiodothyronine (T3)

ThyroidStimulating Hormone (TSH) Low High Normal High High

ANS: D

2.

A 50-year-old woman complains that in the past few months she has had little energy, has frequently felt chilled, and has noticed excessive hair loss when she washes her hair.

During the physical examination, her blood pressure registers at 105/85 mm Hg, her pulse is slow, and her physician notes dry, cool skin with puffiness of the face and arms.

A preliminary diagnosis of primary hypothyroidism is made. The primary reason for the elevated diastolic pressure is:

A. B. C. D. E.

Pulmonary congestion.

Increased peripheral resistance.

Decreased cardiac output.

Low catecholamine levels.

Increased blood volume.

ANS: B

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

3.

Secondary hyperthyroidism due to a pituitary tumor would be associated with the following histophysiological characteristics of the thyroid gland (in relation to normal):

A. B. C. D. E.

Increased iodine uptake at 24 hours Increased colloid Tall columnar thyroid epithelium Decreased thyroglobulin endocytosis Lowered organification of iodide

ANS: C

4.

Which of the following proteins is found only at the basolateral side of thyroid epithelium?

A. B. C. D. E.

Na+-I– symporter Pendrin Megalin Iodotyrosine deiodinase Thyroid peroxidase

ANS: A

NURSINGTB.COM

5.

The thyroid hormone receptor is most like which of the following?

A. B. C. D. E.

Adrenergic receptor Insulin receptor Growth hormone receptor Estrogen receptor Follicle-stimulating hormone (FSH) receptor

ANS: D

6.

Organification defect specifically concerns the inability of the thyroid to covalently bind iodide to tyrosine residues in the colloid. This reaction is performed by:

A. B. C. D. E.

Thyroid peroxidase.

The sodium-iodide transporter.

The TSH receptor.

Iodotyrosine deiodinases.

Thyroglobulin.

ANS: A

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

7.

Graves’ disease is due to an autoantibody that binds to and activates the TSH receptor.

This interaction would primarily increase which second messenger in the thyroid epithelial cells?

A. B. C. D. E.

Ca++ Activated signal transducer and activator of transcription (STAT) Phosphatidylinositol 3-kinase (PI3K) Cyclic guanosine monophosphate (cGMP) Cyclic adenosine monophosphate (cAMP)

ANS: E

8.

Although pregnant women do not typically exhibit hyperthyroidism, maternal total T4 levels increase during pregnancy. This benign increase in total T4 is due to:

A. B. C. D. E.

Increased synthesis of thyroid hormone–binding globulin (TBG).

Increased pituitary deiodinase activity.

Decreased placental deiodinase activity.

Resistance to thyroid hormone receptor signaling.

Decreased excretion of thyroid hormone by the kidneys.

ANS: A

NURSINGTB.COM

9.

Peripheral deiodinases can have which effect on T4?

A. B. C. D.

Activation Deactivation No effect; theyuse only T3 as substrate Activation and deactivation

ANS: D

10. A primary way by which T3 increases oxygen consumption and causes heat to be generated (metabolic thermogenesis) in most cells in the body is through increasing the levels of: A. B. C. D. E.

Myosin heavy chain  Glucose transporter 4 (GLUT-4).

Uncoupling proteins.

Nicotinamide adenine dinucleotide phosphate (NADP) oxidase.

Epithelial sodium channel (ENaC).

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank

42-4

ANS: C

NURSINGTB.COM

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 43: The Adrenal Glands Test Bank Multiple Choice

1.

A 25-year-old woman sees her physician because of hirsutism (inappropriate hair growth) and excessive acne. During examination, her blood pressure is 150/90 mm Hg (elevated). Blood work reveals normal Na+ levels but low/normal K+ levels.

Testosterone and dihydrotestosterone (DHT) levels are in the high end of the normal range, and the levels of dehydroepiandrosterone sulfate (DHEAS) and adrenocorticotropic hormone (ACTH) are moderately elevated. Her physician suspects late-onset congenital adrenal hyperplasia resulting from subnormal activity of an adrenal enzyme. The subnormal activity of which enzyme explains both the elevated adrenal androgens (e.g., DHEAS) and hypertension (elevated blood pressure)?

A. B. C. D. E.

CYP11B1 CYP17 CYP21A2 CYP11B2 CYP11A1

NURSINGTB.COM

ANS: A

2.

A 25-year-old woman sees her physician because of hirsutism (inappropriate hair growth) and excessive acne. During examination, her blood pressure is 150/90 mm Hg (elevated). Blood work reveals normal Na+ but low/normal K+ levels. Testosterone and dihydrotestosterone (DHT) levels are in the high end of the normal range, and levelso f DHEAS and ACTH are moderately elevated. Her physician suspects late-onset congenital adrenal hyperplasia resulting from subnormal activity of an adrenal enzyme.

The “hyperplasia” associated with congenital adrenal hyperplasia is caused by elevated levels of:

A. B. C. D. E.

DHEAS. Cortisol.

ACTH. Aldosterone.

Deoxycorticosterone (DOC).

ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Copyright© 2018 by Elsevier, Inc. All rights reserved.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

3.

The adrenal medulla synthesizes catecholamines. The first enzyme in the catecholamine synthesis pathway, tyrosine hydroxylase, is stimulated by:

A. B. C. D. E.

Cortisol.

Epinephrine.

Norepinephrine.

Acetylcholine.

Nitric oxide.

ANS: D

4.

Exercise increases catecholamine release. Stimulation of -adrenergic receptors specifically leads to:

A. B. C. D. E.

An increase in insulin secretion.

Vasodilation of skeletal muscle arterioles.

Vasoconstriction of splanchnic arterioles.

Vasodilation of veins and lymphatic vessels.

A positive inotropic effect on cardiac function.

ANS: C

NURSINGTB.COM

5.

ACTH has rapid, intermediate, and longer term effects on the function of the zona fasciculata. Which of the following is a target of rapid effects?

A. B. C. D. E.

Adrenal hypertrophy.

Cortisol secretion.

Steroidogenic acute regulatory (StAR) protein activation.

CYP21A2 expression.

Low-density lipoprotein (LDL) receptor expression.

ANS: C

6.

The zona glomerulosa is notable for its absence of the following enzyme:

A. B. C. D. E.

CYP17 CYP11B2 CYP21A2 CYP11A1 3β-Hydroxysteroid dehydrogenase (3 HSD)

ANS: A

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

7.

Cortisol is considered a “stress hormone.” One of its direct actions that help an individual survive a physiological stress (e.g., surgery) is:

A. B. C. D. E.

To increase hepatic gluconeogenesis.

To increase skeletal muscle protein synthesis.

To increase hepatic lipogenesis.

To decrease adipose tissue lipolysis.

To increase hepatic glycolysis.

ANS: A

8.

Cortisol can bind to both the glucocorticoid receptor and the mineralocorticoid receptor.

In the cells of the distal nephron, cortisol is prevented from binding to the mineralocorticoid receptor by:

A. B. C. D. E.

Competitive inhibition by aldosterone.

Glucuronide conjugation.

Conversion to cortisone.

Rapid excretion.

Binding to heat shock chaperone proteins.

ANS: C

NURSINGTB.COM

9.

A patient has been receiving immunosuppressive doses of glucocorticoids for 6 months.

At the end of this therapy, the dosage of the hormone must be slowly tapered down over a period of weeks. This is because of the development of:

A. B. C. D. E.

Adrenal atrophy.

Pituitary hypertrophy.

Upregulation of glucocorticoid receptors.

Elevated ACTH levels.

Increased levels of circulating cortisol-binding globulin (CBG).

ANS: A 10. Cushing’s disease is caused by an ACTH-oversecreting pituitary tumor. One of the effects of this is: A. B. C. D.

Increased skeletal muscle mass.

Decreased catecholamine responsiveness in the heart.

Anorexia.

Insulin resistance.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank E. Decreased glucagon responsiveness in adipose tissue.

ANS: D

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

43-4

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Koeppen: Berne & Levy Physiology, 7th Edition Chapter 44: The Male and Female Reproductive Systems Test Bank Multiple Choice

1.

A young couple has had regular, unprotected sexual intercourse for 4 years, without a pregnancy. They are seeking help at an assisted reproduction/in vitro fertilization clinic for infertility. The husband is very serious about weight training and physical fitness.

Semen analysis reveals a sperm count of 7 million/mL (i.e., very low). His blood analysis reveals an elevated testosterone level. The psychiatrist at the clinic suspects that the husband injects (i.e., abuses) testosterone, which turns out to be true. The husband has read online that testosterone stimulates spermatogenesis, and so he is confused as to why he has a low sperm count. How is this explained?

A. Injected testosterone must first be converted to dihydrotestosterone (DHT) in the testes.

B. High levels of injected testosterone are toxic to sperm.

C. Injected testosterone increases levels of sex hormone–binding globulin (SHBG), thereby reducing the level of “free” testosterone.

D. Injected testosterone inhibits intratesticular production of testosterone through negative I)N. feedback on luteinizing hormN onUeR(S LH E. Injected testosterone increases levels of circulating estrogen, which inhibits spermatogenesis.

ANS: D

2.

A young couple has had regular, unprotected sexual intercourse for 4 years, without a pregnancy. They are seeking help at an assisted reproduction/in vitro fertilization clinic for infertility. The husband is very serious about weight training and physical fitness.

Semen analysis reveals a sperm count of 7 million/mL (i.e., very low). His blood analysis reveals an elevated testosterone level. The psychiatrist at the clinic suspects that the husband injects (i.e., abuses) testosterone, which turns out to be true. Further blood work will reveal which of the following?

A. Increased level of estrogen and decreased levels of LH and follicle-stimulating hormone (FSH) B. Increased levels of DHT, estrogen, and FSH C. Increased levels of DHT, LH, and FSH D. Increased level of estrogen and decreased levels of LH and DHT E. Decreased levels of DHT, FSH, and LH ANS: A Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

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Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

3.

A young couple has had regular, unprotected sexual intercourse for 4 years, without a pregnancy. They are seeking help at an assisted reproduction/in vitro fertilization clinic for infertility. The husband is very serious about weight training and physical fitness.

Semen analysis reveals a sperm count of 10 million/mL (i.e., very low). His blood analysis reveals an elevated testosterone level. The psychiatrist at the clinic suspects that the husband injects (i.e., abuses) testosterone, which turns out to be true. Another effect of the injected T could be:

A. B. C. D. E.

Erectile dysfunction.

Polycythemia (increased numbers of erythrocytes).

Gynecomastia (inappropriate breast development).

Prostatic atrophy.

Lower levels of adrenal androgens.

ANS: B

4.

Spermiogenesis results in the metamorphosis of which cell type?

A. B. C. D. E.

Secondary spermatocyte Spermatogonia Primary spermatocyte Spermatozoan Spermatid

ANS: E

5.

Ejaculation is controlled by a reflex arc that involves several nerves and neurotransmitters. The final neurotransmitter in this arc that directly stimulates the contraction of the muscularis of the male reproductive tract is:

A. B. C. D. E.

Acetylcholine.

Nitric oxide.

Oxytocin.

Norepinephrine.

Somatostatin.

ANS: D

6.

In the prostate, testosterone is converted primarily to DHT through the activity of:

A. Type 3 17β-dehydrogenase.

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

B. C. D. E.

CYP 19 (aromatase).

5α-Reductase.

1α-Hydroxylase.

11β-Dehydrogenase.

ANS: C

7.

In addition to their role in reproduction, androgens have effects on nonreproductive organs. In the liver, androgens stimulate:

A. B. C. D. E.

Gluconeogenesis.

Production of very-low-density lipoprotein (VLDL).

Glycolysis.

Ketone production.

Glycogenolysis.

ANS: B

8.

In the male hypothalamic-pituitary-gonadal axis, negative feedback on LH secretion is limited to:

A. B. C. D. E.

Testosterone and estradiol.

Testosterone and DHT. DHT and estradiol.

Testosterone, DHT, and inhibin.

Testosterone.

ANS: A

9.

The Sertoli cell expresses:

A. B. C. D. E.

The FSH receptor and the inhibin receptor.

The FSH receptor and the androgen receptor.

The LH receptor and the androgen receptor.

The LH receptor.

The FSH receptor.

ANS: B

10. A disorder of sexual development (e.g., having an XY genotype and a female phenotype) is caused by loss of type 3 17β-hydroxysteroid dehydrogenase (17β-HSD).

In affected individuals, which of the following hormone levels would be expected?

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

A. B. C. D. E.

Androstenedione Normal Low Low High High

Testosterone Low Low High Low Low

Estradiol-17β Low High Low Low High

ANS: E

11. A young couple has had regular, unprotected sexual intercourse for 4 years, without a pregnancy. They are seeking help at an assisted reproduction/in vitro fertilization (IVF) clinic for infertility. The husband’s sperm count and sperm structure are normal. The wife undergoes a round of IVF. She must inject herself with FSH, which produces large antral follicles visible on ultrasonography. She is then given an LH injection, and her eggs are collected in a long needle by transvaginal approach 16 hours later. The FSH injections have the following effect on the ovary: A. B. C. D. E.

Increase LH receptor expression in the theca Increase androstenedione production Stimulate oocyte maturation Increase CYP19 (aromatase) expression in the granulosa cells Induce luteinization

ANS: D

12. A young couple has had regular, unprotected sexual intercourse for 4 years, without a pregnancy. They are seeking help at an assisted reproduction/IVF clinic for infertility.

The husband’s sperm count and sperm structure are normal. The wife undergoes a round of IVF. She must inject herself with FSH, which produces large antral follicles visible on ultrasonography. She is then given an LH injection, and her eggs are collected in a long needle by transvaginal approach 16 hours later. One of the main effects of LH is the induction of ovulation. During IVF, the eggs are retrieved before ovulation. The LH is given in order to: A. B. C. D. E.

Increase the size and number of the antral follicles.

Induce luteinization of the cumulus cells.

Induce oocyte meiotic maturation.

Promote breakdown of the tunica albuginea.

Increase androstenedione synthesis.

ANS: C

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

13. A young couple has had regular, unprotected sexual intercourse for 4 years, without a pregnancy. They are seeking help at an assisted reproduction/IVF clinic for infertility.

The husband’s sperm count and sperm structure are normal. The wife undergoes a round of IVF. She must inject herself with FSH, which produces large antral follicles visible on ultrasonography. She is then given an LH injection, and her eggs are collected in a long needle by transvaginal approach 16 hours later. After egg retrieval, the eggs are examined. Unfortunately, the team decides not to go forward with fertilization. A reason for this decision could be the following observation in all of the eggs: A. B. C. D. E.

Expansion of the cumulus cells Persistence of a zona pellucida Presence of a germinal vesicle (nucleus) Presence of the first polar body Presence of a metaphase plate

ANS: C

14. During the early follicular phase, the granulosa cells of a recruitable antral follicle respond primarily to which hormone?

A. B. C. D. E.

FSH LH Estradiol Progesterone Inhibin

ANS: A

15. The primordial follicles collectively make up: A. B. C. D. E.

The ovarian stroma.

The total number of oogonia.

The total number of preantral follicles.

The ovarian reserve.

The ovulatory quotient.

ANS: D

16. During the late follicular phase, estradiol-17 has the following effect on the uterine endometrium: A. Stimulates secretion from endometrial glands B. Causes contraction of spiral arteries and ischemia Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

C. Induces expression of the progesterone receptor D. Stimulates proliferation of epithelial cells, with no effect on stromal cells E. Induces a phase of “receptivity” ANS: C

17. Estrogen has which of the following cardiovascular effects in women?

A. B. C. D. E.

Increases levels of low-density lipoprotein (LDL) Increases the number of adrenergic receptors in the heart Stimulates red blood cell production Increases nitric oxide production in blood vessels Increases peripheral vascular resistance

ANS: D 18. “Lactational amenorrhea” is a physiological phenomenon that parallels a common cause of infertility caused by elevated levels of: A. B. C. D. E.

Prolactin.

Oxytocin.

Progesterone.

Inhibin.

Dopamine.

ANS: A

19. Normal placental progesterone synthesis can occur in pregnancies in which the fetal steroidogenic organs (adrenal cortex, testis, ovary) cannot efficiently make progesterone.

This is because placental progesterone synthesis is not dependent on: A. B. C. D. E.

The LDL receptor.

3-Hydroxysteroid dehydrogenase.

CYP11A1 (side-chain cleavage).

Steroidogenic acute regulatory (StAR) protein.

Cholesterol ester hydrolase.

ANS: D

20. The zona pellucida represents a formidable barrier to sperm and can be penetrated only after the process called:

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce

A. B. C. D. E.

Egg activation.

Acrosome reaction.

Sperm-egg fusion.

Block to polyspermy.

Modification of zona pellucida sperm-binding protein 2 (ZP2).

ANS: B

Test Bank for Berne and Levy Physiology E-Book 7th Edition Koeppen Bruce