NBDE I Physiology Review

I. – – – – – Structure and function of connective tissue (8) Structure and function of membranes (4) Nervous System (9) Muscle System (6) Circulatory System (9) _____________________________________

II. – Respiratory System (6) – Renal System (6) – Digestive System / Nutrition (10) – Endocrine System (8) – Genetics (5)

PHYSIOLOGY I

Embryology
• Mesoderm – Mesenchyme/Connective tissue: skeleton, muscle, neurovascular, spleen
• In-between (endoderm and ectoderm)

• Endoderm – Digestive tract, Liver, Pancreas (GI organs)
• Inside

• Ectoderm – Skin, Neural crest derivatives (brain/head and neck nerves)
• Outside

Embryology
1. Morula 2. Blastula

3. Gastrula
Archenteron: primitive gut Establishment of 3 germ layers

CONNECTIVE TISSUE
• Soft tissue • Hard tissue

The craniofacial bones differ from long bones embryologically because most craniofacial bones develop through
A. B. C. D. Endochondral ossification Membranous ossification Primary mineralization Secondary mineralization

Which of the following proteins is LEAST likely to be found in fully developed fibrous connective tissue?
A. B. C. D. E. Fibronectin Elastin Osteonectin Collagen Vimentin

Which of the following proteins is LEAST likely to be found in fully developed mineralized hard tissue?
A. B. C. D. E. Osteopontin Tuftelin Osteonectin Endothelin Bone morphogenic protein (BMP)

Which of the following represent(s) a matrix protein of enamel?
A. B. C. D. E. Carboxyglutamic acid-containing proteins Type I collagen Amelogenin Proteoglycan Elastin

Which of the following proteins is LEAST likely to be found in enamel formation?
A. B. C. D. E. Amelogenin Ameloblastin Enamelin Elastin Tuftelin

Which of the following noncollagenous protein components BEST characterizes dentin matrix?
A. B. C. D. E. Laminin Vimentin Phosphophoryn Osteonectin Fibronectin

Which of the following is the major protein component of cementum?
A. B. C. D. E. Elastin Keratin Collagen Amelogenin Fibrin

Which of the following proteins is LEAST likely to be found in mucosal epithelium? A. B. C. D. E. Filaggrin Cytokeratin Involucrin Vimentin Transglutaminase

Predominant tissue matrix proteins, hardest to softest…
• • • • • • • Enamel – Amelogenin, Ameloblastin, Enamelin, Tuftelin Bone – Osteonectin, Osteopontin, Osteogenin, BMP, Collagen Cementum – Collagen Dentin – Collagen (type I), DMP, Phosphophoryn Fibrous connective tissue – Collagen, Fibronectin, Elastin, Vimentin, Laminin Epithelium – Keratin, Involucrin, Filaggrin, Transglutaminase, Melanin Vessels – Endothelin, VWF, VEGF

MEMBRANES

The fluid mosaic model for membrane structure proposes that
A. The outer and inner faces of the membrane are identical B. Peripheral proteins are situated only on the outer face of the plasma membrane C. Integral proteins are associated with the hydrophobic phase of the bilayer D. Both polar and non-polar ends of membrane phospholipids are within the hydrophobic phase of the bilayer

The cell membrane
Integral protein Cholesterol

Phospholipid bilayer

The most abundant non-phospholipid component of the cell membrane is
A. B. C. D. E. Cholesterol Deoxycholate Prostaglandin Macroglobulin Triacylglyceride

Each of the following lipid classes is incorporated into membranes EXCEPT one. Which one is the EXCEPTION?
A. B. C. D. E. Cholesterol Ganglioside Triglyceride Sphingomyelin Phosphatidylcholine

Which of the following is LEAST descriptive of lipids?
A. B. C. D. Nonpolar Carbon-containing Hydrophobic Hydrophilic

The largest amount of body water can be found in which of the following?
A. B. C. D. E. Urine Blood plasma Intracellular fluid Interstitial fluid Stomach and intestines

Intracellular and interstitial body fluids have similar
A. B. C. D. E. Total osmotic pressure Colloid osmotic pressures Sodium ion concentrations Chloride ion concentrations Potassium ion concentrations

NERVOUS SYSTEM

The spinal cord is the only structure in the central nervous system necessary for which of the following body functions?
A. B. C. D. Respiration Simple reflex Temperature regulation Coordinated muscle movement

Decreased response of sense organs when exposed to a constant stimulus is called
A. B. C. D. E. Occlusion Summation Adaptation Facilitation Sensory deprivation

An action potential in a nerve fiber is considered to be related to
A. The changed orientation of molecules in the membrane giving rise to a static potential difference B. The entry of sodium ions followed by the exit of potassium ions C. A breakdown of metabolic products resulting in different concentrations of potassium across the membrane D. The flow of electrons across the membrane following change in membrane permeability

“All or nothing”

Na+ into cell

K+ out of cell

Absolute

Relative

If an axonal membrane transiently becomes very permeable to Na+ ions, then the membrane potential of the cell wall will approach
A. B. C. D. E. -70 mV -60 mV -50 mV 0 mV +60 mV

When are nerve fibers hypoexcitable?
A. B. C. D. E. During resting potential At the firing level During local depolarization During negative after-potential During positive after-potential

The maximal frequency of impulses that can be carried by a nerve fiber is limited by which of the following?
A. B. C. D. Intensity of the stimulus Diameter of the nerve fiber Duration of the absolute refractory period Duration of the relative refractory period

GABA increases the permeability of postsynaptic membranes to which of the following ions?
A. B. C. D. E. Sodium Calcium Chloride Magnesium Potassium

Glutamate decarboxylase, an enzyme that catalyzes the formation of gamma-amino butyric acid (GABA), is unique to
A. B. C. D. E. Bone Skin Heart muscle Nervous tissue Connective tissue

Key neurotransmitters: Catecholamine biosynthetic pathway
Tyrosine ! L-Dopa (dopamine) ! Norepinephrine ! Epinephrine Degraded by enzymes:
– MAO – COMT

MUSCLE SYSTEM
• Cardiac • Skeletal • Smooth

Which of the following represents a striated muscle that contains transverse tubules, a slow rate of calcium sequestration, and is inhibited by acetylcholine?
A. B. C. D. Cardiac Skeletal Multi-unit smooth Single-unit smooth

Calcium ions initiate contraction in skeletal muscle when they
A. B. C. D. E. Bind to T tubules Bind to troponin Interact with actin Interact with myosin Bind to sarcoplasmic reticulum

During exercise, muscle tissue accumulates lactic acid. As a result, erythrocytes passing through capillaries in the muscle A. B. C. D. E. Release more CO2 Absorb more CO2 Release more O2 Both 1 and 3 above Both 2 and 3 above
CO2 + H2O "! H2CO3+ "! HCO3- + H+

Le Chatelier’s (note it has nothing to do with Oxygen)

The absolute refractory period of skeletal muscle is an interval during which
A. B. C. D. The stimulus is more than normally effective The threshold is lowered The muscle is relaxed No stimulus is effective

CIRCULATORY SYSTEM
• Cardiovascular

Which of the following portions of the cardiovascular system contains the greatest volume of blood?
A. B. C. D. E. Arterioles Capillaries Systemic veins Chambers of the heart Pulmonary vasculature

Edema may be caused by
A. B. C. D. Constriction of arterioles Increased permeability of capillaries Reduced blood pressure in the capillaries A tissue oncotic pressure that is lower than that of plasma

Lymph
Interstitial space/fluid

Artery
Interstitial space/fluid

Which of the following changes promotes the formation of extracellular edema?
A. B. C. D. E. Increase in tissue fluid hydrostatic pressure Increase in plasma protein concentration Decrease in capillary hydrostatic pressure Capillary filtration exceeds capillary absorption Capillary absorption exceeds capillary filtration

Which of the following could be beneficial in reducing edema in the arms of women who have had radical mastectomy with removal of axial lymph nodes?
A. B. C. D. E. Hypertensive agents Avoidance of all diuretic agents Increase interstitial oncotic pressure Decrease interstitial hydrostatic pressure Administration of a plasma volume expander

Which of the following is MOST often associated with free fatty acid transport in human blood?
A. B. C. D. E. Albumin Globulin Cholesterol Sphingolipid Mucopolysaccharide

The main function of plasma globulins is to
A. Maintain colloid osmotic pressure B. Provide the body with both natural and acquired immunity C. Act as a framework on which clot formation may occur D. None of the above

Distended veins in the neck result from which of the following?
A. B. C. D. Pulmonary edema Hemolytic anemia Systemic hypotension Congestive heart failure

Cardiac output is expressed as a product of
A. B. C. D. E. Stroke volume and heart rate Venous pressure and heart rate Stroke volume and respiratory rate Stroke volume and diastolic filling Venous pressure and coronary blood flow

CO=HR x SV

(Starling’s Law: CO=CR)

In the absence of compensatory changes, a drop in blood pressure results from
A. B. C. D. E. Vasoconstriction Increased hematocrit Increased stroke volume Increased cardiac output Decreased venous return

A marked fall in the oxygen tension in arterial blood would stimulate the receptors in the
A. B. C. D. Aortic arch and carotid sinus Walls of the great veins Aortic and carotid bodies Respiratory center

Sounds heard during systole in the antecubital space are produced by
A. B. C. D. Closure of AV valves Closure of the aortic valve Turbulent blood flow through the artery Laminar blood flow through the occluded artery

The first heart sound is produced by
A. B. C. D. E. Ejection of blood from the ventricles Filling of the ventricles Closure of the AV valves Closure of the semilunar valves Turbulent blood flow through the artery

Heart Sounds
• Systole – ejection of blood from ventricles • Diastole – filling of ventricles • S1 – 1st heart sound
– Closing of the atrioventricular valves: mitral and tricuspid

• S2 – 2nd heart sound
– Closing of the seminular valves: aortic and pulmonary

In which of the following conditions might the systolic blood pressure be abnormally high?
A. B. C. D. E. Cardiac shock Heart failure Anaphylactic shock Decreased arterial blood compliance Ventricular fibrillation

Decreased arterial blood pressure upon standing is compensated by
A. B. C. D. Decreased heart rate Dilation of mesenteric vessels Constriction of systemic arterioles Dilation of venules

Administration of a local anesthetic with epinephrine will MOST likely produce which of the following cardiovascular effects?
A. B. C. D. Increased heart rate Decreased heart rate Increased diastolic blood pressure Decreased systolic blood pressure

NBDE I Physiology Review
I. – – – – – Structure and function of connective tissue (8) Structure and function of membranes (4) Nervous System (9) Muscle System (6) Circulatory System (9) _____________________________________

II. – Respiratory System (6) – Renal System (6) – Digestive System / Nutrition (10) – Endocrine System (8) – Genetics

PHYSIOLOGY II

RESPIRATORY SYSTEM

In respiratory acidosis, arterial CO2 content and pH become abnormal. Which of the following BEST describes their respective changes?
CO2 A. B. C. D. Increases Increases Decreases Decreases pH Increases Decreases Increases Decreases

CO2 + H2O "! H2CO3+ "! HCO3- + H+

Le Chatelier’s (note it has nothing to do with Oxygen)

Most of the CO2 in blood is combined as
A. B. C. D. Acetic acid Bicarbonate Carbonic acid Carbaminohemoglobin

Hyperventilation alters acid-base balance of arterial blood by
A. B. C. D. Increasing CO2 and increasing pH Increasing CO2 and decreasing pH Decreasing CO2 and decreasing pH Decreasing CO2 and increasing pH

CO2 + H2O "! H2CO3+ "! HCO3- + H+

Le Chatelier’s

Which of the following stimulates vagal nerve endings in the lung parenchyma and inhibits respiration?
A. B. C. D. Decreased arterial pH Expansion of the lungs Decreased alveolar oxygen tension Increased alveolar carbon dioxide tension

RENAL SYSTEM

MOST fluid reabsorption by the kidneys occurs in which of the following?
A. B. C. D. E. Distal tubule Proximal tubule Collecting duct Ascending loop of Henle Descending loop of Henle

Each of the following appears in the glomerular filtrate in concentrations approximately equal to those in plasma EXCEPT one. Which one is the exception?
A. B. C. D. E. Urea Glucose Amino acids Steroid hormones Plasma electrolytes

ADH receptors in the nephron are located on the tubular membrane of which of the following?
A. B. C. D. Distal tubule Proximal tubule Ascending loop of Henle Descending loop of Henle

Which of the following represents the major force that causes glomerular filtration?
A. B. C. D. Tubular hydrostatic pressure Tubular colloid osmotic pressure Glomerular capillary hydrostatic pressure Glomerular capillary colloid osmotic pressure

Which of the following structures of the kidney most actively regulates blood pressure?
A. B. C. D. Proximal tubule Distal tubule Loop of Henle Juxtaglomerular apparatus

The clearance rate for a substance that is completely removed from the blood in the urine during one pass through the kidney is equal to which of the following?
A. B. C. D. Renal plasma clearance Filtration fraction Glomerular filtration rate Tubular transport maximum

Filtration

*Inulin is filtered, but not reabsorbed or secreted, so the RPC=GFR

Tubule Reabsorbed into blood

Secreted into tubule

If the renal plasma clearance of a substance which is freely filtered is less than that of inulin, then
A. The substance becomes bound to protein in the tubules B. There is a net secretion of the substance in the tubules C. There is a net reabsorption of the substance in the tubules D. The substance is neither secreted nor reabsorbed in the tubules

DIGESTIVE SYSTEM / NUTRITION

Which of the following is NOT a primary electrolyte of saliva?
A. B. C. D. E. Sodium Calcium Fluoride Potassium Bicarbonate

Tooth erosion in bulimic patients is due to
A. B. C. D. E. Hyposalivation Hypersalivation Action of pepsin Excessive fluoride intake Solubility of hydroxyapatite in acid

Bulimia

Hyposalivation

Digestive System
Physiology / Biochemistry
– What happens to a bolus of food during digestion? What do the components become? – Use your knowledge of anatomy.

Gross metabolism: • Proteins (-amino acids) • Carbohydrates (-saccharides) • Lipids (-fatty acids) • Vitamins, Minerals

Each of the following segments of the GI tract consists of smooth muscle under autonomic nervous control EXCEPT one. Which one is the exception? A. B. C. D. Rectum Internal anal sphincter Antrum of the stomach Upper esophagus

Pellagra, or niacin deficiency, can manifest as all of the following EXCEPT?
A. B. C. D. E. Dermatitis Diarrhea Dementia Death Anemia

Vitamins
Fat-soluble: D- made in skin, pathology=rickets/osteomalacia A- made from β-carotene, pathology=night blindness K- made in intestine by bacteria, pathology=bleeding E- from tocopherols=antioxidant, pathology=rare

Water-soluble:
C- made from glucose=antioxidant, connective tissue formation pathology=scurvy B1-thiamine, coenzyme for acetyl-CoA production from pyruvic acid pathology=Beriberi B2-riboflavin, coenzyme FAD and FMN pathology=vision problems, cheilosis, glossitis B3-niacin, NAD+ constituent pathology=pellagra B5-pantothenic acid, coenzyme A function pathology=loss of appetite, depression B6-pyridoxine, functions in cellular metabolism pathology=convulsions, pain, anemia B12-DNA synthesis (requires Intrinsic Factor from stomach for absorption) pathology=pernicious anemia Folic acid-DNA synthesis with Vit. B12, RBC production pathology=megaloblastic anemia Biotin-urea derivative, coenzyme function in cellular metabolism pathology=pallor, anorexia, fatigue, alopecia

Ingestion of which of the following MOST markedly decreases gastric emptying?
A. B. C. D. E. Lipids Water Minerals Proteins Carbohydrates

Cellular Metabolism
Fats/Lipids…Function? • Membranes, myelin, cholesterol, bile, steroid hormones, prostaglandins, transport other fats, energy storage, energy 2°.
– Lipogenesis
• Anabolism of fats when ATP levels are adequate or high, or when glucose is high. Catabolism of fats for fuel. When glucose is low, ketogenesis occurs so the brain can use ketone bodies for fuel, but this results in metabolic ketoacidosis…

– Lipolysis

Excessive use of fats by the body as a source of energy during starvation or disturbances in carbohydrate metabolism may lead to any of the following conditions EXCEPT A. B. C. D. Ketosis Acidosis Ketonurea Alkalosis

Cellular Metabolism
Proteins/Polypeptides…Function? • Structural, enzymatic, hormonal.
– Proteogenesis
• • DNA! RNA!Protein 10 essential amino acids, can’t be synthesized
– Without them you get PEM (kwashiorkor or marasmus), edema (osmotics/oncotics and albumin) and wasting (muscle breakdown)

– Proteolysis
• Catabolism of proteins as a final energy source in cases of malnutrition (wasting, muscle loss and herniation)

Kwashiorkor ⇓serum albumin ! edema signs Marasmus

Cellular Metabolism
Carb’s/Sugars…Function? • Energy/ATP from Glycolysis, Kreb’s, and ETC!
– Gluconeogenesis or Glycogenesis
• Anabolism of glucose (when ATP low) or glycogen (when ATP high) by liver from non-carbohydrate sources, such as lactic acid from muscle waste – such as Cori Cycle in Liver.

– Glycogenolysis
• Catabolism of glycogen to glucose for glycolysis by glucose-6-phosphatase, an enzyme which is found only in liver, kidney and intestinal cells. Occurs when energy/ATP is needed.

A sustained, severe carbohydrate deficiency will result in which of the following?
A. B. C. D. Ketoacidosis Severe metabolic alkalosis A deficiency in prostaglandin formation An inability to synthesize ascorbic acid

The catabolism of which of the following results in no energy production in the form of ATP? A. B. C. D. Lipid Protein Nucleotide Carbohydrate

ENDOCRINE SYSTEM

Prolonged medication with cortisol produces atrophy of the adrenal cortex through
A. B. C. D. Inhibition of ACTH production Inhibition of aldosterone secretion Direct action on the synthesis of corticoids None of the above
Hypothalamus ! + Pituitary: FLAT PIG(s)! + Adrenals or other target organs - negative feedback

Androgens are produced in the testis and
A. B. C. D. E. Adrenal cortex Thyroid Adrenal medulla Pituitary Hypothalamus

Adrenal Gland
MEDULLA: Catecholamines epinephrine/norepinephrine CORTEX: (outermost to innermost layers) Zona Glomerulosa: Mineralcorticoids (Aldosterone) Zona Fasciculata: Glucocorticoids (Cortisol) Zona Reticularis: Androgens (Testosterone) “Three S’s”: Salt, Sugar, Sex

Acromegaly is due to an excessive production of which of the following?
A. B. C. D. Thyrotropin Gonadotropin Somatotropin Adrenocorticotropin

Glucosuria with hyperglycemia usually occurs in which of the following?
A. B. C. D. Addison’s disease Diabetes mellitus Cushing’s disease Parkinson’s disease

In a parathyroid deficiency state, there is
A. An increase in serum calcium and a decrease in serum phosphate B. A decrease in serum calcium and an increase in serum phosphate C. An increase in serum calcium and a normal serum phosphate D. A normal serum calcium and an increase in serum phosphate
PTH=“Break bone” vs. CALCITONIN (from thyroid)=“Build bone”

GENETICS

Central dogma: DNA ! RNA ! Proteins

Known enzymes and players at each step!

Which of the following types of blotting can be used to identify DNA restriction fragments? A. B. C. D. Eastern Southern Northern Western ↑RNA ←Protein ↓DNA SNOW DROP

Which of the following is a pyrimidine base that is present in RNA but is NOT present in DNA?
A. B. C. D. E. Uracil Guanine Thymine Adenine Cytosine CUT the Pie (Pyrimidines) GA=Purines

If the molar percentage of A (adenine) in a native DNA specimen is 22%, then what is the molar content of G (guanine)?
A. B. C. D. E. 22% 28% 44% 56% 78%

In the DNA molecule, guanine on one strand is joined to cytosine on the complementary strand by which of the following bonds?
A. B. C. D. Amide 1 hydrogen 2 hydrogen 3 hydrogen

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