RATIONALE OF PRELIM & UNIT TESTS QUESTIONS

MEDICAL PHYSIOLOGY A
1ST SEM: 2017-2018
CELL PHYSIOLOGY
1. To maintain homeostasis, cellular functions are mainly directed towards maintaining the volume and
composition of:
a. Plasma & Interstitial fluids
b. Nuclear content
c. Cytoplasm
d. Ingested food & water

2. In homeostasis, the activity of the different cells is directed towards maintaining constancy of the
internal environment, which of the following is considered the internal part of the environment?
a. Interstitial fluid
b. Cytoplasm
c. Nuclear region
d. Cell membrane

RATIONALE: HOMEOSTASIS- maintaining the normal or constant amounts of agents outside and
inside the cell (more importantly outside the cell). OUTSIDE THE CELL= volume and composition of plasma
and interstitial fluid. The extracellular area is our body’s internal environment. If we maintain the constant
condition of the outside the cell, we maintain the normal activity of the different cells of the body.

3. A control mechanism wherein plasma level of a certain hormone is affected by amount of non-
hormonal agent in the blood called:
a. Endocrine axis driven negative feedback
b. Physiologic response driven negative feedback
c. Positive feedback
d. Feed forward
RATIONALE:
DESCRIPTION EXAMPLES
NEGATIVE FEEDBACK The condition is opposed or counteracted in Increasing/ decreasing
order to bring the condition back to normal blood pressure
Observed in nervous & endocrine system
AKA: endocrine axis driven feedback
MODIFIED NEGATIVE Commonly seen in the endocrine system glucose level is controlled
FEEDBACK NON-HORMONAL agent is controlled & by secreting insulin
regulated by the hormone secreted by the Level of calcium level in
endocrine cell the blood is regulated by
AKA: PHYSIOLOGIC RESPONSE DRIVEN calcitonin & parathyroid
FEEDBACK hormone
POSITIVE FEED BACK Allows an existing condition to continue or Progressive uterine
progress contraction
Continuous bleeding to
allow clot formation
FEED FORWARD Anticipates/prepares the body in response Hunger increased
to a certain activity that will affect the body salivation & activation of
gastric cells happens to
prepare the body for the
entry of food
EXERCISE before the
activity, cardiac rate &
respiratory rate is
INCREASED so that O2 is
enough
UP REGULATION DECREASE ligand INCREASE # of receptors Receptor-NTA
Or SUPERSENSITI-ZATION Receptor-hormone
 DOWN REGULATION or INCREASE ligand DECREASE # of receptors Receptor-NTA
DESENSITIZATION Receptor-hormone

4. Transport of agents using tight junctions happens

a. With energy expenditure
b. Going along energy gradient
c. Usually at the basal region of the cell
d. With the involvement of connexons
5. The major proteins present in tight junctions
a. Connexons
b. Occludins
c. Clathrin- for endocytosis
d. Kinesin-
RATIONALE:
COMPLEX PROTEINS FUNCTION
TIGHT Occludin Involve in PASSIVE TRANSPORT
Zonula Occludens Claudin (along the energy gradient)
GAP Connexons Involve in ACTIVE TRANSPORT
Nexus
Kinesin- responsible for transporting molecular cargo — including chromosomes (e.g. during cell division),
neurotransmitters and other important material — along microtubule tracks from one region of the cell to
another

6. The sodium potassium pump is considered:

a. An electrogenic pump
b. Transporting ions until they reach a balance in concentration of the ions inside & outside of the
cell
c. Transporting ions in the same direction
d. An electroneutral pump
RATIONALE
TYPES OF ANTIPORT (transport in opposite direction)
 Electrogenic- can cause changes in electrical activity, unequal transport
o Ex: Na-K pump
 Non-Electrogenic/Electroneutral -does not create any electrical change in the cell, equal
transport
o Ex: H-K pump
7. In this type of transport, the agents transported all moving against their energy gradient:
a. Antiport
b. Symport
c. Counter-transport
d. Co-transport
RATIONALE: In Symport/Co-transport & Counter-transport: one agent is moving along the gradient
and the other agent is moving against the gradient.
8. Which is not an exchange transport?
a. Sodium potassium pump
b. Hydrogen-potassium pump
c. Sodium-calcium pump
d. Sodium-glucose pump
9. Which of the following transport is using a symporter?
a. Na-K pump
b. Na-Ca transport
c. HCO3-Cl transport
d. Na-Glucose Transport
RATIONALE:
PRIMARY ACTIVE TRANSPORT
- Can immediately hydrolyze the ATP to activate the carrier to initiate the transport
UNIPORT Carrier transports only one specific agent at a time
Ex: Sodium pump
 ANTIPORT Form of exchange transport
Transport of specific solutes in opposite direction
Movement of 2 ions in OPPOSITE direction
Ex: Sodium Potassium Exchange pump, H-K pump, HCO3-Cl
transport
SECONDARY ACTIVE TRANSPORT
- CANNOT IMMEDIATELY hydrolyze ATP
- Have to wait for the activity of PRIMARY TRANSPORT to provide energy
SYMPORT Coupled transport/co-transport
Transfer of 2-3 agents simultaneously by a single carrier in ONE-
DIRECTION
Ex: Na-Glucose Co-transport
COUNTER TRANSPORT Form of exchange transport
Similar to antiport but immediate activity cannot be seen
Ex: Na-Calcium exchange

10. If the permeability of the cell membrane is changed due to presence of chemical agent, the gating
mechanism is described as:
a. Voltage gating
b. Ligand gating
c. Receptor gating
d. Mechanical gating
RATIONALE:
GATED CHANNELS
VOLTAGE GATED  Depends on ELECTRICAL ACTIVITY of the membrane
 CHANGES in POLARITY
 Normally closed when cell is resting
LIGAND GATED  Associated with G-protein
 Affected by a certain chemical changes caused by
hormones/NTAs
 Can be extracellular/intracellular
 Observed in muscles & kidneys
G-PROTEIN MEDIATED  Dependent on the ligand
 Usually in close contact with the ligand
 LIGAND-1st messenger
 Can be:
 INHIBITORY- inactivates the channel
 EXCITATORY- activates the channel
MECHANICALLY GATED  Stress activated
 When STRETCHED- proteins are near each other & channels
are closed
 UNSTRETCHED- proteins are separatedopening the
channel

11. In the active transport of certain agents by a cell:

a. Agent could be transported through the paracellular route
b. It could happen even without mitochondrial activity
c. It involves activity of adaptin & dynamin
d. Agent could be transported through the gap junctions
RATIONALE:
Endocytosis- a type of vesicular transport that involves activity of adaptin & dynamin
PASSIVE ACTIVE
ALONG the gradient ACROSS the gradient
DOWNHILL (from high to low) UPHILL (from low to high)
NO ATP needed ATP is required/there is mitochondrial activity
Uses CHANNELS except facilitated Uses CARRIERS
diffusion
 Bidirectional Unidirectional
Almost always NONspecific ALWAYS SPECIFIC
EQUILIBRIUM SATURATION
Transcellular Transcellular Transport
Paracellular Transport
NO inhibition WITH inhibition
Living/non-living cells Living cells
Uses lipophilic bilayer Uses hydrophilic CHON carrier

12. Which type of vesicular transport is highly ligand dependent?

a. Adsorptive endocytosis
b. Fluid-phase endocytosis
c. Constitutive exocytosis
d. None of these

13. Which cellular activity could be ligand independent?

a. Transport of ions using gated channels
b. Non-constitutive endocytosis
c. Adsorptive endocytosis
d. Transport of ions using passive channels
14. Which of the following proteins is NOT involved in endocytosis?
a. Clathrin
b. Dynamin
c. Kinesin
d. Adaptin
RATIONALE:
ENDOCYTOSIS
- Allows agents to go in
- Explains the ability of the cell to absorb
- PROTEINS INVOLVED
1. Clathrin-essential so that the membrane can form a vesicle
2. Dynamine
3. Adaptin
PATHWAYS OF ENDOCYTOSIS
FLUID PHASE RECEPTOR-MEDIATED
No control/not regulated Regulated & specific
Involves passive or leaky substance Involves presence of ligand to initiate transport
Ex: Adsorptive endocystosis

EXOCYTOSIS
- Aka EMEIOCYTOSIS/REVERSE PHAGO/REVERSE PINOCYTOSIS
- Transport of agents in the opposite side of endocytosis
- Explains the ability of the cell to secrete/excrete
PATHWAYS OF EXOCYTOSIS
CONSTITUTIVE NON-CONSTITUTIVE
- Minimal/no control at all  Fully regulated exocytic activity using a
- Secretion is almost continuous ligand that will initiate transport
Ex: mucus secretion Ex: hormone secretion

15. As presented by Van hoff’s law, to determine osmotic pressure of solution. Which parameter is
inversely related to osmotic pressure?
a. Number of osmotically active molecules in the solution
b. Gas constant
c. Temperature
d. None of these
e.
RATIONALE:
 The osmotic pressure Π of a solution containing n moles of solute particles in a solution of volume V is
given by the van't Hoff equation: Π=nRT/V in which 
 R is the gas constant (0.0821 L atm mol–1 K–1) and
 T is the absolute temperature.
16. When a human cell is placed in a solution of 0.5% glucose, it will:
a. Swell & Burst
b. Shrink
c. Undergo several changes in shape
d. Not Change
RATIONALE:
TYPES OF SOLUTION
ISOTONIC  Amount of solute in the plasma is equal with the
amount of solute in the cell
 0.9% NaCl (NSS), 5% glucose
 280-300 mOsm/L average=290 mOsm/L
HYPERTONIC HYPOTONIC
>300 mOsm/L <280 mOsm/L
Amount of solute is greater in Amount of solute is greater inside the cell than in plasma
plasma than inside the cell
SHRINKAGE/CRENATION CELL SWELLINGLYSIS
Water will go to the area w/ Irreversible because there is total damage of cell
higher solute
REGULATORY VOLUME REGULATORY VOLUME DECREASE- counteracts SWELLING
INCREASE-counteracts SOLUTE LOSS-cells will release some osmotically active agents
shrinkage
SOLUTE GAIN- cells will absorb
some osmotically active agents

17. If 2 compartments having solutions with identical solutes but of different concentrations are separated
by a semipermeable membrane, this could happen
a. Solutes will move towards the compartment with lesser solute concentration
b. Solvent will have no net movement
c. Solute will have no net movement
d. Solvent flows towards the area with lesser solutes
RATIONALE: Since both solutions contain identical solutes, there is no electrical gradient created
between the two, therefore, solute will have no net movement.

18. Osmotic pressure of the cytoplasm is highly dependent on the normal amounts of intracellular:
a. Proteins
b. Sodium
c. Glucose
d. Potassium
RATIONALE: Proteins maintain the osmotic pressure outside the cell (plasma). Glucose is co-
transported with sodium so it depends on the amount of sodium that enters the cell.
19. Estimation of plasma osmolarity is determined by measuring amounts of these agents in the blood.
a. Glucose, sodium & BUN
b. Glucose, proteins & fatty acids
c. Cholesterol, sodium & BUN
d. Sodium, potassium & chloride
RATIONALE: Check the equation
Plasma Glucose BUN
Plasma osmolarity= 2 x Plasma Na + +
18 2.8
20. An effective osmole is a solute that”
a. Can easily penetrate cell membrane & effectively attract water molecules
b. Cannot penetrate a cell membrane and effectively attract water molecules
c. Cannot penetrate a cell membrane and cannot attract water molecules
d. Can easily penetrate cell membrane but cannot attract water molecules
RATIONALE:
 OSMOTIC COEFFICIENT/REFLECTION COEEFICIENT
 Responsible for telling if a solute is capable of passing through the membrane
RC=1  Effective osmole/solute
 Solute is UNABLE to penetrate the
membrane
 Allow only solvent flow
 Example: Albumin, Dissacharides
RC=0  Ineffective solute
 Solute can penetrate the membrane
 Allows solute transport
 Example: Urea
RC is between 1 and 0  Some solutes are transported, some are not
 EX: Glucose, electrolytes

21. Correct about a diffusive process that involves the activity of carrier molecules:
a. Involves consumption of ATP
b. Moves agents against concentration gradient
c. Seen in non-living cells
d. A passive transport
RATIONALE: Facilitated diffusion requires carrier. It does not need ATP because it is a passive type of
transport. It moves agent along the gradient.

22. The diffusion coefficient for spherical molecules as stated by Stoke’s Einstein equation shows that
these factors have indirect effect on diffusion except for:
a. Temperature
b. Viscosity of the medium
c. Molecular radius
d. Pi
RATIONALE: Einstein's result for the diffusion coefficient D of a
spherical particle of radius a in a fluid of dynamic viscosity h at
absolute temperature T is:
where   is the gas constant and NA is Avogadro's Number. 

23. Ligands acting on enzyme-linked hormone receptors (catalytic receptors) involves activation of:
a. Phospholipase A2
b. Tyrosine Kinase
c. Phospholipase
d. Adenyl Cyclase
RATIONALE: TYPES OF CELLULAR RECEPTORS
1. Surface/Membrane Receptors
2. Intracellular receptors
SURFACE/MEMBRANE INTRACELLULAR
 Affect membrane’s permeability  Affect cytoplasm & nucleus
Types:  Affect membrane’s permeability and
1. Ion Channel linked cellular activity
2. Cytokine linked
3. Catalytic Linked/Enzyme- Tyrosine Kinase
4. G-protein linked: Types
 Adenyl Cyclase (cAMP)
 Phospholipase A2
 Transducin pathways
 Phospholipase A2
 Phospholipase C (IP3)
24. In the extracellular pathway of apoptosis, the death ligand is produced by:
a. Macrophages
b. Activated B-lymphocytes
 c. Activated T-Lymphocytes
d. Cells under stress
RATIONALE: Macrophages is produced from monocytes. Activated B-Lymphocytes are produced by thymus,
does not function in apoptosis. Cells under stress cannot produce death ligand.
2 DISTINCT PATHWAYS of Apoptosis
 RECEPTOR MEDIATED PATHWAY
o Initiated by extracellular agent
o TnF [TUMOR NECROSIS FACTOR]- aka death factor, common agent
o EXECUTION PHASE
 MITOCHONDRIA MEDIATED PATHWAY
o ACTIVATION PHASE
o Gradual dysfunction of mitochondria
o The cell loses energy which leads to activation of caspases
o Intracellular Macrophages
ELECTROPHYSIOLOGY
25. CORRECT regarding the sodium-potassium pump
a. Transports sodium ions into the cell and potassium ions out of the cell
b. Activity increases during the latter part of depolarization
c. An electroneutral pump
d. Active when the cell is polarized
26. The activity of sodium-potassium pump:
a. Is essential to maintain normal electrical activity of an excitable cell
b. Is needed when a cell is depolarizing
c. Never affects the resting membrane electrical activity
d. Is responsible for increasing the amount of sodium ions inside the cell
RATIONALE:
Sodium-Potassium pump- contributes -3mV to the RMP
 is an ELECTROGENIC pump
 transports Potassium Ions IN and Sodium ions OUT [PISO]
 activity increases during the latter part of HYPERPOLARIZATION
 Active when the cell is polarized/RMP in order to counter act the action of Na-K leak
channels
 responsible for DECREASING the amount of sodium ions inside the cell
27. When a cell is polarized, which agent or ion is prevented to move inward by electrical gradient but
push inward by concentration gradient?
a. Sodium
b. Potassium
c. Chloride
d. Intracellular proteins
28. When the cell is polarized, it has no conductance to:
a. Chloride ions
b. Na+
c. Intracellular proteins
d. K+

29. When a cell is inactive or polarized:

 a. The sodium potassium pump is inhibited
b. The sodium-potassium leak channels transport K+ ions in and Na+ ions out
c. The membrane has greater conductance to sodium ions
d. The membrane has greater conductance to chloride ions
RATIONALE: When cell is inactive/polarized/in RMP:
 Chloride- has greater membrane permeability/conductance
 Sodium- tends to move in (influx) following concentration gradient and electrical gradient [Na
is positively charged, inside the cell is negative BUT ONLY IN SMALL AMOUNTS due to lesser
membrane permeability/conductance
 Potassium- has greater membrane permeability/conductance , tends to move out (efflux) in
SMALL AMOUNT following concentration gradient because it is retain inside the cell by
electrical gradient [K is positively charged, inside the cell is negative]
 Intracellular Proteins- no conductance/not permeable to the cell membrane, they remain
inside the cell
 Na-K leak channels- transport K+ ions OUT and Na+ in [POSI]

30. A much better equation to determine the magnitude of the resting membrane potential is the :
a. Nernst equation
b. Goldmann-Hodgkin-Katz Equation
c. Van Hoff’s equation
d. Stoke-Einstein Equation
RATIONALE:
Goldmann Hodgkin-Kats equation is measures all ions that affect the negativity of the potential
while the Nernst equation measures the effect of single ion in the negativity of potential. Van
Hoff’s equation is related to osmotic pressure. Stoke Einstein equation deals with diffusion.

31. When the cell is polarized, these conditions are observed in the voltage-gated channels
a. Voltage-gated Na channels are closed by their inactivation gate
b. Voltage-gated K channels have open inactivation gates
c. Activation & inactivation gates of the voltage Na channels are both closed
d. Both voltage-gated Na & K channels have closed activation gates
RATIONALE: When the cell is in RMP/polarized:
 Voltage gated Na channel has open inactivation gate (H gate) and close activation gate (M
gate)
 Voltage-gated channel has NO inactivation gate. Its activation gate (N gate) is open.
32. At the peak of depolarization, the excitable cell is able to:
a. reach the equilibrium potential for sodium ions
b. reach the equilibrium potential for potassium ions
c. almost reach the equilibrium potential for sodium ions
d. almost reach the equilibrium potential for potassium ions

RATIONALE: In depolarization, SODIUM IONS are moving into the cell. Potassium ions are not
involved during depolarization. K+ moves out of the cell during repolarization.
 Equilibrium potential for Sodium: +55 to +65 mV
 Equilibrium potential for Potassium: -80 to -90 mV

33. Which of this/these change/s in the cell membrane would lead to hypopolarization of the membrane
or local depolarizing change?
a. The membrane promoting greater sodium leakage
b. The membrane promoting chloride influx
c. The membrane increasing its conductance to Potassium
d. Opening of the voltage gated sodium channels
RATIONALE:
Greater sodium leakage massive Na+ influx Cells become less negative hypopolarization.
Chloride influx would make the cell more negative less excitable. More potassium leaving the cells
cell becomes more negativerepolarization. Opening of the voltage gated sodium channels would
only lead to hypopolarization/local depolarizing change when there is an effective stimulus.

34. When an excitable tissue is affected by an ineffective stimulus, it is capable of:

 a. Having an absolute refractory period
b. Generating a graded potential
c. An electrical change that is propagated or conducted
d. Undergoing adaptation
RATIONALE:
Local response/acute sub-threshold potential/Local potential/graded potential is produced
when an excitable cell is affected by ineffective stimulus. This type of potential cannot be propagated
or conducted. It has no absolute refractory period.

35. When an excitable cell is affected by sub-threshold stimuli applied successively, this could happen:
a. Electrical activity of the membrane could reach the threshold voltage
b. Cell could inactivate the voltage-gated sodium channels
c. Cell generates only a local depolarizing change
d. Cell immediately opens the voltage-gated potassium channels

RATIONALE: When an excitable cell is affected by sub-threshold stimuli applied successively, Critical
firing level/threshold level is reached. It could activate & open voltage-gate sodium channel. It
produces an action potential.

36. Immediate closure of the voltage gated-sodium channels at the end of depolarization is due to the
activity of the :
a. Activation gates of the voltage gated sodium channels
b. Inactivation gates of the voltage-gated sodium channels
c. Sodium-potassium pump
d. Sodium-potassium leak channels
RATIONALE: Activation gates of voltage-gated sodium channel closes when the membrane almost
reaches the equilibrium potential. Sodium potassium pump’s function is not yet increased in the end of
depolarization. Sodium-potassium leak channels DO NOT CLOSE in the entire period of action potential.

37. After depolarization, voltage gated Na channels regain their normal polarized condition during the:
a. Peak of depolarization
b. After-depolarization
c. Initial period of repolarization
d. After-hyperpolarization
Rationale: Normal polarized condition of voltage-gated Na channel= M/activation gate is close, H
gate/activation gate is open
 In the peak of depolarization: M gate remains open, H gate closes
 Initial period of depolarization: M gate still open, H gate is still close
 After depolarization/Latter half of repolarization: M gate closes, H gate opens
 After-hyperpolarization: M gate is already close, H gate is already open

38. What ion channels are continuously open during the whole duration of action potential?
a. Voltage gated Na channels
b. Voltage gated K channels
c. Sodium-Potassium leak channels
d. None of these
39. When an excitable cell is repolarizing, it is trying to reach the equilibrium potential for:
a. Sodium
b. Chloride
c. Potassium
d. Calcium
RATIONALE: In repolarization, the cell is regaining its normal negativity. K+ goes outside the cell to
make the cell negative. In depolarization, the cell is trying to reach the equilibrium potential for
sodium or calcium.
40. Which ions channels could be open during the absolute refractory period?
a. Voltage-gated Na channels
b. Na-K leak channels
c. Voltage fated K+ channels
 d. All of these
e. A & C only
RATIONALE: ABSOLUTE REFRACTORY PERIOD- is a period in which another action potential cannot
be generated because the cell is not polarized. It includes whole depolarization and initial part of
repolarization. In these two periods, all the channels above are open.

41. Which channels are opened during the end of repolarization?

a. Voltage-gated sodium channel
b. Sodium-potassium leak channels
c. Voltage-gated potassium channels
d. None of these
RATIONALE: Voltage gated sodium channel is open at the start of depolarization. Its inactivation gate
closes at the peak of depolarization while its activation gate closes at the latter half of repolarization.
Voltage-gated potassium channels are open at the start of repolarization. It closes when it is near the
equilibrium potential for K+. Sodium-potassium leak channels are open during the end of repolarization
because it is not gated it is continuously open in the whole duration of action potential.
42. The activation gates of the voltage-gated sodium channels are closed during:
a. Peak of depolarization
b. Initial part of the absolute refractory period
c. Initial period of repolarization
d. After-hyperpolarization
RATIONALE: In After-hyperpolarization, the voltage-gated sodium channels are in
polarized/inactive state [M gate close, H gate open].
43. The initial stage of the relative refractory period is the:
a. Opening of the voltage gated sodium channel
b. After-depolarization
c. After-hyperpolarization
d. Peak of depolarization
RATIONALE: After-depolarization: latter half of repolarization is the initial stage because it is in this
period where the membrane regains its polarized state [M gate close, H gate open]

44. During the relative period of the action potential:

a. The voltage gated Na-channels are still open
b. The cell is at the early period of repolarization
c. The cell is depolarizing
d. The cell is trying to reach the equilibrium for potential ions
RATIONALE: During the relative period of the action potential [after-depolarization: latter half of
repolarization], the cell is trying to reach the equilibrium for potential because K channels are still
open more K efflux.

45. During the middle period of the relative refractoriness of the cell, the cell can generate another
potential when affected by
a. A threshold intensity
b. A sub-threshold intensity
c. An intensity greater than threshold intensity
d. All of these
RATIONALE: During the middle period of the relative refractoriness of the cell, the cell is becoming
more negative than normal [due to hyperpolarization] therefore it can be less excitable. To ensure
that an action potential can be generated intensity greater than threshold is applied. Threshold
intensity may not be strong enough to generate an action potential while the cell is undergoing
hyperpolarization.

46. The cell is at its subnormal period when it:

a. Is near the equilibrium for sodium ions
b. Is near the equilibrium for potassium ions
c. Is generating local potential
d. Opens the activation gates of the voltage-gated sodium channels
 RATIONALE: the cell at its subnormal period is less excitable therefore it can generate only a local
potential. The cell is depolarized when it is near the equilibrium for sodium ions. When the cell is
near the equilibrium for potassium ions, it is depolarized. The cell is effectively stimulated when it
opens the activation gates of the voltage-gated sodium channels

47. When local potentials undergo summation, it leads to:

a. Generation only of a local potential
b. Generation of an electrical charge that can reach the threshold voltage
c. Inability of excitable cells to perform its function
d. Development of sensory potential in a sensory receptor
RATIONALE: Summation is an application of several sub-threshold intensity (simultaneously or
successively) to generate an electrical charge that can reach the threshold voltage. Once it reaches
the threshold, it can now produce an action potential.
48. Chronaxie is the period of time wherein a cell generates an action potential when affected by:
a. Threshold intensity
b. Sub-threshold intensity
c. Rheobasic
d. Intensity twice rheobasic
RATIONALE: Threshold intensity is the lowest effective stimulus intensity. Sub-threshold is intensity
lower than threshold. Rheobasic intensity is a sub-threshold intensity that can still generate an
action potential if applied for a long time.
49. This is NOT a characteristic of action potential
a. Changing the polarity of the cell
b. Ability to undergo summation
c. Presents refractory period
d. Follows “all or none” principle”
RATIONALE: Ability to undergo summation is distinctive to local potential.
ACTION POTENTIAL LOCAL POTENTIAL
Uses threshold/greater than threshold intensity Uses sub-threshold intensity
Reaches the CRITICAL FIRING LEVEL DOESN’T reach the CRITICAL FIRING LEVEL
Higher magnitude Lower magnitude
Greater electrical change Lesser electrical change
Can be transmitted CANNOT be transmitted
Hypopolarization to depolarization Hypopolarization
Repolarization, hyperpolarization, ARP & RRP NONE is observed
Leads to an activity No activity
Non incremental/non decremental Incremental/decremental
Follows all or none law Does not follow
No summation With summation
Can be propagated Not propagated

NERVE PHYSIOLOGY
50. When stimulated by sub-threshold intensity, a sensory anatomical receptor develops a/an:
a. Action potential
b. Generator potential
c. End-plate potential
d. Synaptic potential
RATIONALE: Action potential- stimulated by threshold/greater than threshold intensity. End-plate
potential- local potential produced in skeletal muscles. Synaptic potential-local potential produced
in neurons.
51. When resting or inactive, a neuron while maintaining its normal conditions is doing all these activities
EXCEPT:
a. Transporting potassium out of the cell
b. Transporting sodium into the cell
c. Consuming energy
d. Transporting chloride ions into the cell
 RATIONALE: There is transport of potassium out of the cell and sodium into the cell because the
sodium-potassium leak channels are open. The neuron is consuming energy because Na-K pump is
active the counter act the action of Na-K leaky channels. Chloride ions is transported into the cell
when the cell hypopolarizes.

52. When a pre-synaptic nerve interacts with a post-synaptic nerve, the initially affected channels present
at the post synaptic area are:
a. Leak channels
b. Ligand gated sodium channels
c. Voltage-gated channels
d. Mechanically gated sodium channels
RATIONALE: Ligand gated sodium channels are present here because they serve as receptor for
neurotransmitters [ligand]. Once a ligand-receptor is formed, these channels open allowing sodium
to enter causing depolarization of the cell.
53. When an action potential is generated at axon hillock, the impulses travel towards the:
a. Dendrites
b. Soma
c. Terminal Endings
d. None of these
54. Summation of EPSPs normally occurs at the:
a. Cell body
b. Dendrites
c. Axon hillock
d. Axon terminals
55. In a nerve, NTAs are produced and secreted by the:
a. Cell body
b. Dendrites
c. Axon hillock
d. Axon terminals
RATIONALE:
 Axon terminal - the pre-synaptic area. This is the site of production storage & secretion of
neurotransmitter agents.
 Cell body- for integration
 Axon Hillock- start of action potential, for spike initiation
 Whole Neck of Axon- for impulse conduction
 Dendrites- post synaptic terminal of the nerve
56. Saltatory conduction along the axon is possible because of:
a. Numerous sodium channels in the nodes of Ranvier
b. Numerous Potassium channels in the nodes of Ranvier
c. Greater area of myelin covering the nerve
d. The presence of synaptic vesicles in the terminal buttons
57. Action potentials are difficult to generate at the:
a. Surface of myelin
b. Nodes of Ranvier
c. Unmyelinated nerves
d. Axon terminals

RATIONALE: The surface myelin contains the least number of voltage-gated sodium channels.
NUMBER OF VOLTAGE-GATED SODIUM
CHANNELS per square micrometer of
membrane
Node of Ranvier 2000-12000
Axon Hillock 350-500
Axon of Unmyelinated Nerve 110
Cell Body 50-100
Axon terminal 20-75
Surface of Myelin <25
58. Type of neural conduction seen in patients suffering from Multiple Sclerosis (a form of demyelinating
disorder)
a. Saltatory conduction
b. Fast but interrupted transmission
c. Continuous conduction
d. Axon Terminals
RATIONALE:
In multiple sclerosis, myelin sheath is absent therefore salutatory conduction is not possible.
Saltatory conduction: myelin serves as insulator and current flowing through it is negligible so
depolarization in myelinated axons jumps from one node to the next Node of ranvier enhancing
neural conduction

59. When the action potential is generating an action potential, the membrane immediately increases its
conductance to:
a. Chloride ions
b. Potassium ions
c. Calcium ions
d. Magnesium ions
RATIONALE: Calcium has increase permeability to the membrane because calcium is needed inside
the cell to help in the release of NTAs stored in the vesicles.
60. Part of the vesicular soluble NSF receptor protein (v-SNARES)
a. SNAP 25
b. Syntaxin
c. Synaptobrevin
d. None of these
61. In the activity of the pre-synaptic region, these are CORRECT about the v-SNARES:
a. Involve in the movement of the synaptic vesicles
b. Interact with syntaxin at the post-synaptic cell membrane
c. Prevents release of NTA towards the cleft
d. Inhibits interaction
62. When voltage-gated Calcium channels open up at the pre-synaptic area & there is calcium influx, the
attachment protein immediately activated are the:
a. Synaptotagmin
b. Synaptobrevin
c. Syntaxin
d. SNAP-25

RATIONALE: SYNAPTOTAGMIN- is a Calcium sensor. Synaptobrevin- is a v-Snare while Syntaxin and

SNAP-25 are T-snares. Zipper-like interactions between synaptobrevin and syntaxin & SNAP 25
bring the vesicle membrane together before fusion.

63. When the SNARES are defective, the immediate effect on the synapse is decrease in:
a. The sensitivity of receptors
b. NTA release
c. The number of receptors
d. The magnitude of action potential
RATIONALE: The interaction between SNARES is needed for the vesicle to fuse with the terminal
pre-synaptic membrane. If this is defective, fusion cannot occur, thereby, immediately affecting
release of NTA

64. A patient affected with botulinum toxin will suffer from:

a. Destruction in the nicotinic receptors at the neuromuscular junction
b. Abnormality in the activity of ventral horns (spinal cord)
c. Decrease release of Ach from the motor nerve at the neuromuscular junction
d. Excessive destruction of Ach at the synaptic cleft
RATIONALE: Botulinum toxin targets SNARE proteins. When these proteins are destroyed, fusion of
the vesicle containing the NTA and the terminal pre-synaptic membrane is affected. Thus, there is a
decrease release of Ach from the motor nerve at the neuromuscular junction.
65. If there is a problem wherein the pre-synaptic region is NOT capable of producing synaptotagmin,
there will be:
a. Inability of the vesicle (NTA) to move forwards the pre-synaptic membrane
b. Inability of pre-synaptic area to produce NTA
c. Excessive release of NTA towards the synaptic cleft
d. Increased sensitivity of the pre-synaptic nerve
RATIONALE: Synaptotagmin functions as calcium sensor. If this protein is absent, fusion of the
vesicles containing the NTA is not possible. Synaptotagmin-Ca 2+ binding triggers the fusion of the
vesicle to the pre-synaptic membrane.

66. When IPSP is generated the post-synaptic area undergoes:

a. Hyperpolarization w/ chloride efflux
b. Hyperpolarization w/ chloride influx
c. Local depolarization w/ potassium efflux
d. Local depolarization w/ sodium efflux

RATIONALE:
EXCITATORY- EPSP INHIBITORY-IPSP
Local depolarization/hypopolarization Hyperpolarization pre or post synaptic inhibition
depolarization
Activation of Na+ Channels (ligand gated) Inactivation of Na+ channels
Na+ influx Chloride influx, potassium efflux
NTAs: Ach, Norepinephrine, Epinephrine NTA: Glutamate, Glycine, GABA
67. Which of the following is NOT myelinated?
a. Motor Neurons
b. Type A Sensory neurons
c. Pre-ganglionic autonomic nerves
d. Post-ganglionic autonomic nerves
68. Which nerve fibers conduct fast pain?
a. Type A alpha
b. Type A delta
c. Type C
d. Type B
RATIONALE
TYPE OF FUNCTION DIAMETER MYELINATION VELOCITY
NEURON (m/sec)
A Alpha Proprioception/Motor 12-20 70-120
A Beta Tactile Sensations 5-12 Myelinated 30-70
A Gamma Motor 3-6 15-30
A Delta Acute Pain, Sensation, 2-5 12-20
Thermal, Touch
B Pre-ganglionic <3 Myelinated 3-15
(Autonomic)
C sensory nerve Chronic Pain, Thermal, 0.4-1.2 0.5-2
Touch Unmyelinated
C Sympathetic Post Ganglionic 0.3-1.3 0.7-2.3
slowest
*fastest, slowest
69. Transmission of impulses in a post-synaptic neuron coming from several pre-synaptic neurons is:
a. Sub-liminal fridge
b. Divergence
c. Convergence
d. Post-tetanic potentiation
70. Simultaneous activation of two neurons could have a response not as strong compared to the sum of
the responses when the two neurons are stimulated separately. This phenomenon is called
a. Summation
b. Facilitation
 c. Occlusion
d. Subliminal fridge
71. There is a greater amount of NTA secreted and enhanced sensitivity of receptors to its specific NTA
observed in:
a. Paired-pulse facilitation
b. Post-tetanic potentiation
c. Long-term potentiation
d. Subliminal fridge
72. In long-term potentiation of synaptic activity there is an increase in the:
a. Number of NTAs released without a change in the number receptors
b. Number of NTAs released as well as increase in the number of receptors
c. Number of receptors without an increase in number of NTAs released
d. Threshold for stimulation of the synapse
RATIONALE:

CHARACTERISTICS OF SYNAPSES
TEMPORAL SUMMATION Successive stimulation, EPSP can change to
undergo action potential
SPATIAL SUMMATION Simultaneous stimulation, IPSP can undergo
temporal/spatial but cannot undergo action
potential
CONVERGENCE Observed if several pre-synapses are activated
and went to 1 post synapse
Localized effect
DIVERGENCE one presynapse w/ many post-synapse
diffused/widespread effect
PAIRED-PULSE FACILITATION You can enhance neuron activity if given 2
successive stimuli
Greater NTA activity on post-synapse on 2nd
stimulation
Causes release of additional NTA in post
synapse
POST TETANIC POTENTIATION Before & After Stimulation responses are
compared
- Tens to hundreds of stimuli @ high
frequency
LONG TERM POTENTIATION Continuous stimulation, repeating of activity
enhances performance
LONG TERM DEPRESSION Excessive activity causes fatigue to neuron
OCCLUSION Response of 2 neurons simultaneously
stimulated is LESSER when 2 neurons are
stimulated separately
DELAY Due to activity happening in the pre-synapse to
cause release of neurotransmitter
SUBLIMINAL FRIDGE Increase excitability neurons are not directly
activated

73. In neural degeneration, if the injury affects initially the perikaryon it is called:
a. Chromatolysis
b. Wallerian degeneration
c. Plasticity
d. Apoptosis
RATIONALE:
 Chromatolysis- proximal degeneration, cell body/perikaryon degeneration
o seen in the soma if axon is transected
 Wallerian Degeneration- distal degeneration: axon degeneration
o seen in the axon terminal if the axon is transected
 Plasticity- injury is observed in sensory receptors
  Apoptosis- programmed cell death

MUSCLE PHYSIOLOGY
74. Which of the following muscles has an electrical communication?
a. Unitary smooth muscle
b. Fast glycolytic muscle
c. Slow oxidative muscle
d. A & B only
75. Action potential spreads from one muscle to the other as an electrical impulse thru gap junctions in
which type of muscle
a. Cardiac muscle for contraction
b. Multiunit smooth muscle
c. Slow oxidative skeletal muscle
d. Fast glycolytic skeletal muscle

RATIONALE:
 Gap junctions/electrical communication are present in unitary smooth muscles and cardiac
muscles. They are absent in skeletal muscles (fast glycolytic, slow oxidative, fast oxidative)
because skeletal muscles are voluntary.
 Mutiunitary- one neuron is to one muscle
 Unitary- one neuron is to several muscles (contains functional connections)

76. Which of the following is/are involuntarily striated?

a. Skeletal muscle
b. Cardiac muscle
c. Skeletal & cardiac muscles
d. Cardiac & Smooth muscles
RATIONALE: Skeletal muscle is voluntarily striated. Cardiac muscle is involuntarily striated. Smooth
muscle is involuntarily non-striated.
77. Which is an example of phasic smooth muscle?
a. Vascular smooth muscle
b. Smooth muscle in GIT walls
c. Respiratory smooth muscles
d. Smooth muscle in sphincters
RATIONALE:
 Tonic smooth muscle- active continuously. Vascular smooth muscle & respiratory smooth
muscle are active continuously because blood circulation & respiration are continuous
processes.
 Phasic smooth muscle-active at a certain time. Smooth muscle in GIT walls are active only
during absorption of food
78. Connections of muscles present in the tunica muscularis of gastrointestinal tract (GIT) needed for
synchronous contractions
a. Zonula occludens
b. Zonula adherens
c. Macula adherens
d. Nexus
RATIONALE: Nexus also known as gap junctions are needed in tunica muscularis of GIT because
smooth muscle of GIT is of unitary type of smooth muscle (one neuron is to several muscles).
79. Triad in skeletal muscle is found along
a. Z disc
b. A-I junction
c. M line
d. A-H junction
RATIONALE: TRIAD= 2 terminal cisternae + 1 T-tubule
Z disc- where the ends of the actin filaments are attached,
bisects the I band
M line bisects the H-band & A band
I band Light band; contains thin filaments – actin
A band Overlaps of thick and thin filaments
H band Thick filament
T tubules Invagination of the sarcolemma
In contact with the extracellular space
Terminal cisternae Portion of the SR nearest the T tubules; site of Ca++
release
Contains a high density of Ca++ pump protein
(Ca++ ATPase) which is critical for reaccumulation of
Ca++ in the SR and hence relaxation of the muscle

80. The thin filament of skeletal & cardiac muscles is made up of which of the following?
a. F-actin
b. F-actin, Meromyosin
c. F-actin, Tropomyosin, Troponin
d. F-actin, Meromyosin, Tropomyosin
RATIONALE:
 THICK FILAMENT- is composed of meromyosin/myosin
 Thin Filament- Formed by the aggregation of actin molecules – globular actin of G actin
F-actin or filamentous actin two-stranded helical filament – aggregated form of
G-actin
Tropomyosin Extend over the entire actin filament and cover
myosin binding sites on the actin molecules
Troponin complex
Troponin T Binds tropomyosin
Troponin I Facilitates the inhibition of myosin binding to actin
by tropomyosin
Troponin C Binds Ca++  promotes the movement of
tropomyosin on the actin filament, thereby
exposing myosin binding sites and facilitating the
interaction of myosin and actin filaments and
sarcomere contraction

81. Which of the following will have conformational change upon change in membrane potential?
a. Nicotinic receptors
b. Dihydropyridine receptors
c. Ryanodine receptors
d. Muscarinic receptors
RATIONALE:
 Nicotinic receptors- located in skeletal muscles and autonomic ganglia
 DIHYDROPYRIDINE (DHP) – receptor or channel located at T Tubule
 RYANODINE (RYR) – receptor located at the cisternae
  Muscarinic receptors- located at smooth muscles of visceral organs (example: brain, heart,
stomach)
82. Events in muscle contraction
a. Shortening of thin filament
b. Formation of cross bridges
c. Disappearance of A Band
d. All of the above
RATIONALE:
During muscle contraction, there is:
 No shortening of thin filament.
 Overlap of thin and thick filaments  shortening of sarcomere
 Disappearance of H band
 Formation of cross-bridges the head of the cross bridges bend back and forth and step by
step walk along the actin filament, pulling the ends of two successive actin filaments toward
the center of myosin filament
 Large amount of ATP cleaved to form ADP
83. Increasing the levels of blood calcium will
a. Facilitate excitability of muscles due to disinhibition of sodium channels
b. Facilitate excitability of muscles due to inhibition of sodium channels
c. Decrease excitability of muscles due to inhibition of sodium channels
d. Decrease excitability of muscles due to inhibition of sodium channels
RATIONALE: When sodium channels are not inhibited, action potential can propagate into the
membrane surface and deep into the T-tubules. The action potential causes conformational change in
the DHP receptors in the tubules, which in turn stimulate RYR receptor to release calcium to the
cytosol.
84. Which of the following is a CORRECT statement?
a. The source of the calcium during muscle contraction is intracellular
b. During latent phase of muscle twitch, calcium exits the muscle cells
c. In muscle relaxation, calcium is returned to its source through Na +-Ca2+ exchanger
d. The resting state of the muscle is a state of equilibrium.
RATIONALE:
 For muscle contraction to happen, Calcium must bind to Troponin C. Source of calcium in
this process is the smooth endoplasmic reticulum (located intracellularly).
 During latent phase of muscle twitch, calcium from the terminal cisternae is released.
 In muscle relaxation, calcium is returned to its source through the Ca+ ATPase pump
(SERCA) with the aid of sarcalumenin.

85. Excitation- contraction coupling commences by generation of

a. Action potential in the somatic neuron
b. End plate potential in the sarcolemma
c. Action potential in the sarcolemma
d. Local potential in the axon hillock
RATIONALE: an end plate potential alone cannot generate an action potential. It must undergo
summation to produce action potential. The muscle cells are excited once the action potential
propagates across surface membrane and down to the T-tubule.
86. Contraction of skeletal muscles requires
a. Influx of calcium
b. Efflux of calcium
c. Cistern release of calcium
d. Tubular sarcolemmal release of calcium
RATIONALE: Once release from the cistern, calcium binds to Troponin C. This event causes the
Tropomyosin to uncover cross-bridge binding sites in actin. Influx & efflux of calcium are not
needed in muscle contraction. The t-tubule does not store Calcium.
87. In smooth muscles, calcium binds to which of the following?
a. Thin Filament  Troponin C
b. Cytoplasmic Calmodulin
c. Thick FilamentMeromyosin
d. Thick Filament  Calmodulin
 RATIONALE: In smooth muscle, troponin C is absent. Its counterpart is Calmodulin. Calmodulin is
located in the cytoplas.
88. Which of the following is CORRECT about smooth muscle contraction?
a. Increasing the number of spike potential will increase the number of contraction
b. A pacesetting potential will dictate the occurrence of mechanical response
c. Number of action potential has no effect in the frequency of mechanical response
d. Several slow waves will generate several mechanical responses
RATIONALE: The number of action potential has no effect in the frequency of mechanical response
because smooth
89. Anchors the protein that binds the calcium inside the cisterns
a. Titin
b. Triadin
c. Cap Z and Alpha Actinin
d. Calsequestrin
90. Protein responsible for assisting SERCA in sequestering calcium from the sarcoplasm ferrying the ion
to the cisterns?
a. Calsequestrin
b. Histidine-rich calcium binding protein
c. Triadin
d. Sarcalumenin
RATIONALE:
 Calsequestrin- receive the Ca++ from Sarcalumenin, allows Ca++ to be stored in high
concentration & thereby establishes a favorable concentration gradient that facilitates
efflux of Calcium from SR into the sarcoplasm when RYR receptor open.
 Histidine rich Ca++ binding protein- receive the Ca++ from Sarcalumenin
 Triadin-anchor Calsequetrin & HRC to cistern to keep them in place.
 Titin- = anchors the thick filaments to Z line
 - Cap Z & Alpha Actinin = anchors the thin filaments to Z line

91. In smooth muscles, increasing cytoplasmic calcium will increase the activity of
a. Troponin C
b. Actin
c. Meromyosin
d. Calponin
RATIONALE:
 Increasing cytoplasmic Calciumincrease in number of calcium that can bind with
Calmodulin. Ca-Calmodulin complex activates Myosin-Light chain kinase. MLCK then
phosphorylates light chains in myosin/meromyosin heads & increases meromyosin ATP
activity.
 Troponin C is absent in smooth muscles.
 Calponin-inhibits actomyosin ATPase
 Actin does not bind with Calcium
92. Energy is not required during which of the following?
a. Resting membrane potential
b. Latent phase of muscle twitch
c. Phase of contraction
d. Phase of relaxation
93. Energy is not a requirement in which of the following phase of muscle twitch?
a. Latent phase
b. Phase of muscle contraction
c. Phase of Muscle Relaxation
d. A & C only
RATIONALE: The latent phase is the period before the contraction. It is also the absolute refractory
period. An action potential cannot be generated to produce another muscle twitch, that’s why
energy is not needed in this process.
94. At the peak of muscle contraction, another action potential can be generated by an application of at
least _________ stimulus intensity.
a. Subthreshold
b. Threshold
c. Maximal
d. Supramaximal intensity
Rationale: Subthreshold intensity cannot produce an action potential. Maximal intensity can be
applied only if the muscle is on resting state.
95. Strength and endurance are developed when performing which of the following type of skeletal muscle
contraction
a. Isometric contraction
b. Auxotonic contraction
c. Isotonic contraction
d. Isokinetic contraction
96. Characteristic of the type of contraction when one pushes against the wall
a. Shortened sarcomere and shortened whole muscle
b. Shortened sarcomere but no actual whole muscle shortening
c. Sarcomere and whole muscle are not shortened
d. No actual sarcomere shortening but whole muscle is shortened
RATIONALE: This type of contraction is isometric. (Refer to the table below for description)

97. Force increases in all of the following skeletal muscle contractions EXCEPT:
a. Isometric
b. Isotonic
c. Isokinetic
d. Auxotonic
98. Characteristics of contractions generated by arm wrestlers with the same strength
a. Increasing force with no muscle shortening and eccentric
b. Increasing force with no muscle shortening and concentric
c. Same force and with muscle shortening and eccentric
d. Same force and with muscle shortening and concentric

RATIONALE: Types of Skeletal Muscle Contraction

1. Static - persistent or no change in the Isometric - same length, increasing force, load &
length of the muscle. tone
Examples: arm wrestling, pushing against a wall
TYPES:
 Concentric - shortening of muscle,
flexing the muscle
 Eccentric - extension of muscle,
lengthening of muscle, no shortening
(i.e. pushing heavy truck
2. Dynamic - frequent changes in the length of a. Isotonic – uses the same force but has
the muscle increasing or decreasing length (i.e. biceps curl)
b. Auxotonic – change in the tone and length,
increasing the force, decrease frequency of
muscle contraction
(i.e. changing weight of dumbbell and reps,
strength development)
c. Isokinetic – increasing the force but constant
velocity of contraction, iso = same, develop
strength and endurance (i.e. training athletes)
d. Plyocentric – modified form of isotonic,
stretching the length before contracting, you
start with a semicontracted/ shortened then
you flex or shorten (i.e. leaping and jumping)
 99. The muscles mainly utilized by long distance runners has the fewest/lowest
a. Capillaries
b. Glycogen
c. Mitochondria
d. Myoglobin
RATIONALE: Long distance runners have slow oxidative muscles. This type of muscle contains fewer
glycogen compared to fast oxidative & slow glycolytic muscles.
100. This type of muscle fibers utilizes energy from a system that yields one ATP per minute and is
utilized by marathoners primarily
a. Small, slow, oxidative
b. Small, slow glycolytic
c. Large fast oxidative
d. Large, fast glycolytic
RATIONALE:
Type I (Slow Oxidative Muscles) - Type IIA (Fast Oxidative Muscles) Type IIB (Fast Glycolytic Muscles)
Endurance Endurance + Strength - Strength
 Manner of ATP degradation:  Manner of ATP  Manner of ATP
Oxidative system [1 degradation: Oxidative degradation: More on
ATP/MIN] system [1 ATP/MIN] glycogen-lactic acid system
Maraming output, matagal  Balanced endurance and [2 ATP/MIN]
ang efficiency strength (kaya  Power-lifter type athletes
 Thin, endurance type athletes intermediate)  Fatigue: Easily, therefore
(marathoners)  High flexibility used only occasionally and
 Fatigue: Slowly, therefore  Decathlon type athletes for brief periods
used for more sustained
activities

101. Heat generated by muscle during biceps curve

a. Maintenance heat
b. Resting Heat
c. Recovery Heat
d. Activation Heat
RATIONALE:
A. Resting Heat
 Basal metabolic activity of the
muscle
 e.g. Na-K ATPase Pump
 Heat given off at rest
 Fenn Effect - work performed
is directly proportional to the
velocity of the muscle
contraction
D. Activation Heat
 Heat generated just before
contraction (latent period)
 From Calcium release in
the cistern
B. Initial Heat
 Active phase of contraction
 Sum of Activation and
Shortening heat
(Contraction should be
Isotonic)
E. Recovery Heat/ Delayed Heat
o Approximately equal to
initial heat
o Heat generated by
metabolic processes the
C. Shortening Heat
 Proportional in amount to
the distance the muscle
shortens.
 From the formation of
cross-bridging of the thin
and thick filaments and
breakdown of glycogen
 From Myosin ATPase restore muscles to its
 Isometric kind of relaxed state
contraction

102. Force of muscle contraction is greatest if the initial length of the muscle is
a. Shorter than resting length
b. At its resting length
c. Longer than resting length
d. At its longest length
RATIONALE: if the initial length of the muscle is
 Shorter than resting length-force of muscle contraction is least
 At its longest length- there is no force of muscle contraction
 Longer than resting length- force of muscle contraction is less
103. Which of the following motor unit is activated in 1 hour exercise such as biking?
a. Type 1
b. Type 2
c. Both
d. Neither
RATIONALE:
104. The principle that explains the occurrence of temporal summation in skeletal muscle
a. Recruitment of motor units
b. Increasing the release of calcium
c. Decreasing the sequestration of calcium
d. Increasing the availability of glycogen
RATIONALE: When the release of calcium is increase, temporal summation occurs because there is
enough calcium which can sustain contractile state without allowing any relaxation between action
potentials. Recruitment occurs in multiple fiber type of summation.
105. Denervating a skeletal muscle will result in
a. Non-responsive reflexes
b. Hyposensitive sodium channels
c. Enlargement of muscles
d. Sustained muscle contractions
106. Denervating a skeletal muscle will result in which of the following?
a. Spastic paralysis causing muscle rigidity due to sustained muscle contractions
b. Atrophy that is very evident in a couple of weeks’ time due to non-release of acetylcholine
c. Fasciculations which are seen by the naked eye but recorded by electromyography
d. Involuntary flail-like movement of extremities due to increase availability of acetylcholine
RATIONALE: the immediate effect of removing the nerve supply of the muscle is paralysis
Rationale: When a muscle loses its nerve supply, (1)it no longer receives the contractile signals that
are required to maintain normal muscle size and (2) the reflexes are not working.

107. Muscle fatigue may occur if there is too much acidification of sarcoplasm like a decrease in
a. ADP
b. Oxygen
c. Lactic Acid
d. All of the above
RATIONALE: There is increased level ADP and lactic acid due to continuous muscle contraction.
Interruption of blood flow through a contracting muscle leads to fatigue because of the loss of
nutrient supply, especially oxygen.
108. Muscles predominantly used by century dash runner contain what type of SERCA?
a. SERCA 1
b. SERCA 2
c. SERCA 3
d. A & B only
RATIONALE: A century dash runner utilizes fast twitch muscle.SERCA1 is present in fast-twitch
muscle. SERCA2 is present in slow-twitch and cardiac muscle.
109. An increase in which of the following will increase the force of contraction?
a. Calcium influx
b. Sodium-Potassium ATPase pump
c. Sodium-Calcium exchanger
d. Activity of SERCA
RATIONALE: Increase activity of SERCA would lead to muscle relaxation. When the muscle is in
relaxed/resting state, the force of contraction will increase.
110. Which of the following best characterizes the motor unit activated in powerlifting?
a. It has low excitability
b. Utilizes oxidative metabolism
c. Low force unit
d. Fast conductive velocity
RATIONALE: In powerlifting, the motor unit activated is Type II. Low force unit, utilizes oxidative
metabolism, and fast conductive velocity pertains to Type I motor unit.

111. The stimulus intensity wherein plateau commences in graded response is

a. Threshold
b. Submaximal
c. Maximal
d. Supramaximal
RATIONALE:
 Threshold intensity- minimum intensity required to recruit a motor unit
 Submaximal intensity- intensity between threshold & maximal
 Supramaximal intensity- intensity in which recruitment of motor unit is not needed.

112.Sarcoplasmic calcium level is high in which of the following?

a. Muscle tetanus
b. Treppe
c. Contracture
d. All of the above
RATIONALE: There is continuous muscle contraction in all the conditions mentioned above.
113. TRUE statement about fatigue
a. Muscle is in relaxed state but given an adequate time to resynthesize energy it will again
contract
b. Muscle is in relaxed state and will never contract because of the failure to resynthesize ATP
c. Muscle is in a contracted state and remains contracted because of the failure to sequester
calcium back in the cisterns
 d. Muscle is in a contracted state but will eventually relax given the proper time to sequester
calcium back in the cisterns
RATIONALE: Fatigue is a result of continuous muscle contraction. In this condition, the muscles
cannot contract anymore due to excessive muscle performance. This is reversible if ATP is
generated soon.
114. Tetanization can be elicited during
a. Early contraction
b. Middle of contraction
c. Early relaxation
d. All of the above
RATIONALE: Tetanization is a type of summation in which the frequency of stimulation increases
causing smooth & continuous muscle contraction. It can be elicited in the 3 events mentioned
above because there are still enough calcium ions in the sarcoplasm.
115.Muscle contraction is compromised in myasthenia gravis due to which of the following?
a. Antibodies bound to the vesicles in the presynaptic terminal
b. Overactivity of membrane organizing proteins
c. Flattening of the end plate
d. Decrease release of neurotransmitters
RATIONALE: Myasthenia gravis is an autoimmune disease wherein there is no folding in the end
plate of their sarcolemma; therefore, receptors are not evenly distributed. As a result,
acetylcholine cannot bind to the receptorno end plate potential is generatedno summation of
EPP to become APno AP can excite the musclemuscle contraction is compromised

AUTONOMICS
D 116. Divisions of the CNS A. SYMPATHETIC NERVOUS SYSTEM
A 117. Cell bodies of the pre-ganglionic nerves B. PARASYMPATHETIC NERVOUS
are located in the thoracic and lumbar SYSTEM
spinal cord
B 118. Long pre-ganglionic fiber & short post- C. BOTH A & B
ganglionic fiber
B 119. Ciliary ganglion D. Neither A nor B
D 120. With extensive branching of
postganglionic fibers

RATIONALE:
 SYMPATHETIC PARASYMPATHETIC
Origin of pre- Thoracolumbar [T1-L3] Craniosacral (CN 3,7, 9, 10; S2-S4)
ganglionic fibers
Location of Peripheral NEAR THE CENTER, far far from the center, NEAR THE EFFECTOR CELL
Ganglion from the effector cell  CN3: ciliary ganglion
Outside the CNS  CN7: sphenopalatine & submandibular
Paraverterbral/ ganglion
Sympathetic chain beside  CN9: parotid gland
the spinal cord IN THE EFFECTOR CELL
 Superior cervical  CN 10
ganglion  S2-S4
 Middle cervical
ganglion
 Stellate ganglion
Prevertebral/ Collateral
ganglia (front of vertebral
column)
 Celiac ganglion
 Superior
mesenteric
ganglion
 Inferior mesenteric
ganglion
Length of the Pre & SHORT-pre, Long-post LONG-pre, Short-post
Post Ganglion
Degree of branching  Extensively  Limited branching
of PREganglionic branching  More localized except for the vagus nerve
fiber:  More widespread or  Example: (1pre:1post)
diffuse/ mass
discharge
 Example: (1 pre:20
post)
 B 121. Somatic nerve to the skeletal muscle A. ADRINERGIC TRANSMISSION
B 122. Sympathetic preganglionic nerve to the heart B. CHOLINERGIC TRANSMISSION
A 123. Sympathetic postganglionic nerve to the GIT
B 124. Parasympathetic postganglionic nerve to the
GIT
B 125. Sympathetic postganglionic nerve to the
sweat glands

RATIONALE:

SYMPATHETIC PARASYMPATHETIC
Anatomically Thoracolumbar Craniosacral
Biochemically Adrinergic Cholinergic
LOCATION: ALL SYMPATHETIC ADRENERGIC NEJ 1. ALL SOMATIC NMJ
2. ALL AUTONOMIC GANGLIA
3. ALL PARASYMPATHETIC NEJ
4. Sympathetic Cholinergic NEJ- only if the
effectors are :
sweat glands, blood vessels in the
skeletal muscles

5 TYPES OF NERVE TERMINALS THAT WILL SYNTHESIZE, STORE & RELEASE Acetylcholine
1. Parasympathetic pre-ganglionic
2. Parasympathetic post-ganglionic
3. Somatic Efferent
4. Sympathetic Cholinergic Pre-ganglionic
5. Sympathetic Cholinergic Post-ganglionic
 A 126. MAO-inhibitor A. Potentiates adrenergic effects
C 127. Organophosphates B. Blocks adrenergic effect
B 128. Drug that increases reuptake of epinephrine C. Potentiates cholinergic effect
by prejunctional fiber
D 129. Atropine D. Blocks cholinergic effects
B 130. Alpha & beta blockers

RATIONALE:
CHOLINERGIC DRUGS
PARASYMPATHOMIMETIC PARASYMPATHOLYTIC
- Increase/potentiate parasympathetic effects -decrease/blocks cholinergic effects
- Example: - EXAMPLES:
Pyrocartine, nicotine, neostigmine (inhibits Atropine- blocks interaction bet Ach & muscarinic
acetylcholinesterase), pilocarpine- increase receptor
interaction bet Ach & receptors Botulinum toxin- blocks release of Ach
Organophosphates Nicotine- HIGH dose becomes a ganglionic
blocker
Curare-blocks interaction bet Ach & N1
ADRINERGIC DRUGS
SYMPATHOMIMETIC SYMPATHOLYTIC
- Increase/potentiate sympathetic effects decrease adrinergic effects
Example: Example:
 Adrenaline/Epinephrine  Alpha- blockers: Phenoxybenzamine,
 Ephedrine/Amphetamine-increase release of Phentolamine, Prazosin
Norepi  Beta-blockers: -“olol”
 Isoproterenol-stimulate B1 Atenolol, propanolol, Metoprolol
 Salbutamol-stimulate B2 receptors

MULTIPLE CHOICE.
131. Practically all organs and tissues of the body receive autonomic innervations, EXCEPT:
a. Skeletal muscles
b. Cardiac muscle
c. Smooth muscle
d. Exocrine glands
RATIONALE: Skeletal muscles receive somatic innervations.
132. Which of the following structures/organs is innervated by the sympathetic nervous system only?
a. Heart
b. Stomach
c. Sweat Glands
d. Salivary glands
RATIONALE: The heart, stomach, salivary glands are innervated by both sympathetic &
parasympathetic nerves.
133. One difference between the somatic nervous system and the autonomic nervous system is that in
the latter:
a. The receptors are located in the body wall
b. Inhibition is mainly central
c. Acetylcholine is the NTA released at NMJ
d. Responses are instantaneous
SOMATIC AUTONOMIC
DESCRIPTION Deliberate impulse Automatic, instantaneous
External environment impulses
FUNCTIONS Movement/locomotion Regulates visceral functions
SENSORY RECEPTORS Head, body wall, extremities Internal organs
CENTER Cerebral cortex (basal ganglia, Hypothalamus, brainstem,
cerebellum, spinal cord) spinal cord
EFFECTOR CELL Skeletal muscle Visceral smooth muscle,
 cardiac muscle, glands
EFFERENT NERVE ONE-neuron fiber Two-neuron fiber
NTA UTILIZED Acetylcholine Acetylcholine, Norepinephrine
SITE OF INHIBITION Center, NMJ Center, peripheral ganglion
(mainly), NEJ
INTERRUPTION Complete paralysisatrophy Automaticity does not
atrophy

134. Post ganglionic nerves from the stellate ganglion innervate the:
a. Radial muscle of the iris
b. Parotid gland
c. Heart
d. Liver
RATIONALE: Post ganglionic nerves from superior cervical ganglion innervate the radial muscle of
iris. The parotid gland is innervated by post-ganglionic fibers from otic ganglion. Post-ganglionic
fibers from celiac ganglion innervate the liver.
135. Which of the following are correctly paired?
a. Adrenal medulla: Nicotinic I receptors
b. Pilomotor muscle: Alpha I receptor
c. Sweat glands: Beta 2-receptors
d. Heart: Muscarinic-3 receptors
NICOTINIC
- Ligand gated ion channels
SUBTYPES:
1. N1/NM- in membrane of skeletal muscles
2. N2/NN-on the membrane of autonomic
ganglion
ALPHA RECEPTORS
- Generally associated with EXCITATORY
response except in digestive system,
bronchial glands & pancreatic
islets(inhibitory)
- ALPHA 1: visceral smooth muscles (ex
pilomotor/arrector pili muscle), glands
- ALPHA 2: sympathetic post-ganglionic
terminals
MUSCARINIC
- G-PROTEIN coupled
- Found in All parasympathetic NEJ &
sympathetic cholinergic NEJ
M2- stimulated by Ach decrease cAMP
INCREASE K conductance  hypepopolarization ,
inhibitory
M3/M4: stimulated by IP3 excitatory
INCREASE calcium
SUBTYPES:
1. M1-brain & stomach
2. M2-heart
3. M3-smooth muscle & glands
4. M4- smooth muscle & glands
5. M5-sphincter muscle of IRIS, esophagus,
parotid gland, cerebral blood vessels
BETA RECEPTORS
- Generally associated with INHIBITORY
response except in heart, bronchial glands
& pancreatic islets (excitatory)
- Beta 1: heart
there is increase cAMP, increase Ca++ &
Na+ conductance
- Beta 2: visceral smooth muscle, glands
there is decrease cAMP, increase K
conductance
- Beta 3: adipose cells

136. Stimulation of which of the following receptors will inhibit adenylyl cyclase and decrease cAMP
a. M2
b. M3
c. α1
d. β1
137. Which of the following statements regarding Beta-I receptors is TRUE? They…
a. Increase K+ conductance
b. Cause mostly excitatory effects
c. Decrease Na+ conductance
 d. Are located mainly in the visceral smooth muscle
RATIONALE: please refer to the table above

138. Which of the following statements regarding the acetylcholine is FALSE?

a. ACH esterase causes degradation of ACH
b. Synthesis of Ach takes place when choline reacts with acetyl Co-A
c. The primary mechanism that deactivates ACH at the autonomic ganglia is enzymatic
d. Release of ACH from nerve terminals is Ca++ dependent
RATIONALE: The primary mechanism that deactivates ACH at the autonomic ganglia is REUPTAKE.
139. Stimulation of beta receptors by norepinephrine___________ stimulation of beta receptors by
epinephrine.
a. Is stronger than
b. Is the same as
c. Is weaker than
RATIONALE:
NOREPINEPHRINE EPINEPHRINE
-STRONGLY STIMULATE: A1, B1 -STRONGLY STIMULATE: A1, B1, B2
-WEAKLY STIMULATE: B2

140. Which of the following occurs in flight or fight response?

a. Decreased Blood Pressure
b. Increased lipogenesis
c. Bronchoconstriction
d. Coronary dilatation
RATIONALE:
SYMPATHETIC EFFECTS IN FLIGHT & FIGHT RESPONSE
NOREPHINEPRINE EPINEPRINE
 Increase Heart Rate- B2  Increase Heart Rate- B2
 Increase Blood Pressure-  Increase Blood Pressure
 Peripheral vasoconstriction-A1  Lipolysis- B2, B3
 Coronary dilation &
Bronchodilation- B2
 Glycogenolysis- B2
PARASYMPATHETIC EFFECTS IN FLIGHT & FIGHT RESPONSE
Acetylcholine
 Decrease Heart Rate
 Peripheral vasodilation
 Decrease lipid breakdown
 Coronary & Bronchial
vasoconstriction
 Glycogenesis

141. A 35 year old female was diagnosed with multiple system atrophy and had symptoms indicative of
failure of sympathetic nerve activity. Which of the following is expected to be present in the
patient?
a. Failure of the pupils to constrict when exposed to light
b. Decreased sweating
c. Her heart will stop beating
d. Persistent diarrhea
RATIONALE: the patient exhibits decrease sweating because due to failure of sympathetic nerve activity
his sweat gland cannot work properly. Sweat is innervated only by sympathetic nerves.
142. A 20 year old man, who became ill after eating mushrooms, is brought to the emergency
department, where he is treated for muscarinic poisoning. Which of the signs is consistent with
muscarinic poisoning?
a. Tachycardia
b. Mydriasis
c. Increased salivation
d. Constipation
RATIONALE: Due to muscarinic poisoining, the patient exhibited parasympathetic overstimulation. The
effect of sympathetic and parasympathetic nerves in salivary glands is the same. They will both
caused increase salivation. This condition may decrease heart rate (bradycardia), miosis (pupillary
constriction) & increase GIT movement.

143. What type of receptors does epinephrine stimulate to cause bronchodilation?

a. Alpha-1
b. Beta-2
c. M2
d. M3
RATIONALE: Epinephrine is a neurotransmitter agent that binds to adrinergic receptors. M3 & M4
are cholinergic receptors. Between Alpha 1 and Beta-2, epinephrine stimulates Beta-2 because it
will produce an excitatory effect (bronchodilation). When epinephrine stimulates alpha-2, an
inhibitory effect (bronchoconstriction) is produced.
144. Sympathetic postganglionic nerves release which of the following NTAs?
a. Norepinephrine
b. Acetylcholine
c. Epinephrine
d. All of these
e. A & B only
Rationale: epinephrine is produced by adrenal medulla.
145. A drug that potentiates the effects of Acetylcholinesterase will have which of the following effects?
a. Vasoconstriction
b. Increased heart rate
c. Bronchoconstriction
d. Increased intestinal motility
RATIONALE: A drug that potentiates the effects of Acetylcholinesterase decreases parasympathetic
activity. When this happens, there would be increased heart rate, bronchodilatation, decreased
intestinal motility, and vasodilatation.
146. Epinephrine stimulates which of the following receptors to cause arteriolar constriction
a. Alpha -1
b. Beta-2
c. M2
d. M3
RATIONALE: Epinephrine is a neurotransmitter agent that binds to adrinergic receptors. M3 & M4 are
cholinergic receptors. Between Alpha 1 and Beta-2, epinephrine stimulates alpha 1 because this
stimulation of this receptor will produce an excitatory response (contraction-arteriolar
constriction). If Beta-2 is stimulated, an inhibitory response (relaxation-arteriolar dilatation)- is
yield.
147. Sympathetic overstimulation decreases
a. Heart rate
b. Intestinal motility
c. Pupillary size
d. Bronchial diameter
RATIONALE: Sympathetic effect to the intestine is decrease motility. Sympathetic effect to the heart is
increase heart rate
 Sympathetic effect to the radial muscle of the iris is contraction (mydriasis=increase
pupillary size)
 Sympathetic effect to the bronchial lungs is relaxation=increase bronchial diameter.
148. A MAO-inhibitor drug will have which of the following effects?
a. Vasodilation
b. Increased heart rate
c. Decreased sweating
d. Decrease salivary secretion
RATIONALE: Monoamine oxidase is the enzyme that deactivates norepinephrine. If this is inhibited,
therefore sympathetic activity will increase.
Sympathetic effect to the: Blood vessel is vasoconstriction, Salivary gland is increase salivation and
to the sweat gland is increased sweating
149. Atropine decreases intestinal motility by blocking which receptor?
a. Nicotinic
b. Muscarinic
c. Alpha-1
d. Beta I and II
RATIONALE: Atopine is a parasympatholytic drug. It decreases parasympathetic activity by inhibiting
cholinergic receptors. Atropine acts on muscarinic receptors. Alpha 1 and Beta 1 & 2 receptors are
adrenergic receptors, that’s why they cannot be acted upon by atropine.
150. Parasympathetic dysfunction increases:
a. Heart rate
b. Salivary secretion
c. Sweating
d. Intestinal motility
RATIONALE: Normal parasympathetic effect to the heart is decrease heart rate. When
parasympathetic innervation is impaired, it will decrease the heart. There is no parasympathetic
effect to the sweat glands. In salivary secretion, parasympathetic stimulation causes increase
salivation. Normally, parasympathetic innervation causes increase intestinal motility. When it is
impaired, therefore intestinal motility decreases.