Chapter 05 (34Q)

1. In an adult person, red blood cells are produced mainly by

A. Liver
B. Spleen
C. Bone marrow of all bones throughout the body
D. The bone marrow of membranous bones
E. The thymus

2. Lack of vitamin B12 leads to

A. Pernicious anemia
B. Microcytic anemia
C. Aplasia anemia
D. Sickle cell anemia
E. Hemolytic anemia

3. Which is the factor that accelerates erythrocyte sedimentation rate (ESR)?

A. Increased number of red blood cell in the blood
B. Increased number of white blood cell in the blood
C. Increased number of platelets in the blood
D. Increased amount of albumin in the blood
E. Increased amount of globulin in the blood

4. Which of the following measures can prevents blood from clotting?

A. Adding some wood-dust into the blood
B. Smoothing the inner surface of blood container
C. Putting tube containing blood in ice-bath
D. Removing free calcium ions from the blood
E. Making the inner surface of a container unwettable

5. The factor that initiates the intrinsic pathway of blood clotting is

A. F III
B. F IV
C. F XII
 D. F X
E. F VII

6. A person’s serum contains agglutinin B, that person’s blood group is

A. A
B. B
C. O
D. AB
E. A or O

7. Release of erythropoietin is mainly dependent on

A. Number of red blood cells
B. Blood volume
C. Number of white blood cells
D. Oxygenation of tissue
E. Number of platelets

8. Under which one of the following conditions, red blood cells maintain their volume?
A. When they are placed in isosmotic urea solution (1.9% urea solution)
B. When they are placed in 0.9% NaCl solution
C. When sodium pump is inactivated
D. When they are placed in isoosmotic but not isotonic solution
E. When they are placed in sea-water

9. Which of the following clotting factors initiates extrinsic pathway?

A. F XII
B. F III
C. F V
D. F X
E. F XIII

10. Adding homogenate of lung tissue to blood

A. Will accelerate blood clotting process
B. Will slow down blood clotting process
 C. Will prevent blood clotting from occurrence
D. Will not affect blood clotting process
E. Will cause hemolysis

11. All the clotting factors are present in the blood except
A. F II
B. F III
C. F VIII
D. F XII
E. F X

12．The normal pH value in the blood is

A. 6.9～7.5
B. 7.2 ～7.5
C. 7.35～7.45
D. 7.25～7.45
E. 7.1～7.2

13. The total blood volume of a normal person accounts for

A. 7-8% of body weight
B. 7-8 of extracellular fluid
C. 7-8% of total body fluid
D. 7-8% of intracellular fluid
E. 7.8% of connective tissue

14. The principal substance that forms plasma colloid osmotic pressure is
A. Na+
B.Cl-
C. Albumin
D. Globulin
E. Fibrinogen

15. Hemophilia A is due to lack of

A. F XI
 B. F IX
C.F VIII
D. F XII
E. F V

16. The principal substances that forms plasma crystal osmotic pressure are
A. K+
B. HCO3-
C. Cl- and Na+
D. Albumin
E. Globulin

17. In which of the following solutions, partial hemolysis of normal red cells takes place?
A. 0.85%
B. 1.9%
C. 0.4%
D. 0.3%
E. 5 % glucose

18. Lack of intrinsic factor leads to

A. Microcytic anemia
B. Macrocytic anemia
C. Hemolytic anemia
D. Aplastic anemia
E. Sickle anemia

19. Under which of the following conditions, ESR is increased?

A. An increase in albumin in the plasma
B. An increase in lecithin in the plasma
C. An increase in globulin in the plasma
D. A decrease in fibrinogen in the plasma
E. A decrease in cholesterol in the plasma

20. Which of the following solutions is both isoosmotic and isotonic?

 A. 0.7% NaCl
B. 0.9% of NaCl
C. 5% of glucose
D. 0.85 % of NaCl
E. 1.9 % of urea

21. Lack of vitamin B12 leads to

A. Microcytic anemia
B. Pernicious anemia
C. Hemolytic anemia
D. Aplastic anemia
E. Sickle anemia

22. Which of the following factors accelerates the blood coagulation?

A. A decrease in temperature
B. A decrease in blood calcium concentration
C. Adding some heparin into the blood
D. Adding some tissue homogenate
E. Providing smooth surface of container

23. The fluid expressed out from blood clot is

A. ICF
B. ECF
C. Plasma
D. Serum
E. Tissue factor

24. Which of the following factors has nothing to do with platelet aggregation?
A. ADP from injured tissue
B. ADP from platelet
C. F III (factor III, also known as tissue factor) from damaged tissue
D. TXA2 synthesized by platelet
E. Collagen
25. The factor that promotes the rouleaux formation of red blood cells is
A. The number of red cells
B. Hb concentration
C. Increased plasma albumin and globulin concentration
D. Increased plasma globulin and fibrinogen concentration
E. Increased crystal substances in the plasma

26. Prothrombin activator is composed of

A. F V, Xa, Ca2+ and PF3
B. F XIIa, XIa, IXa and VIII
C. F III, VII and Ca2+
D. F I, II, and Ca2+
E. XIIa, III, and II

27. The correct description about the action of heparin is

A. It increases the affinity of antithrombin III for thrombin
B. It inactivates the activity of thrombin directly
C. It blocks the formation of prothrombin activators
D. It prevents the activation of intrinsic pathway
E. It prevent the activation of extrinsic pathway

28. The principle hormone that regulates the production of red blood cells is
A. Androgen
B. Estrogen
C. EPO
D. GH
E. Thyroid hormone

29. When red blood cells from a person whose ESR is increased into the normal serum,
ESR will
A. Not change
B. Accelerate
C. Return to normal
D. First return to normal and then decrease
 E. First return to normal and then increase

30. The wrong description about the physical and chemical characteristics is
A. SP (density) of plasma is larger than whole blood
B. The higher the hematocrit, the highere is the blood viscosity
C. The crystal osmotic pressure of plasma is almost the same as that of interstitial fluid
D. The total osmolarity of plasma is slightly higher than that of the interstitial fluid
E. NaHCO3/H2CO3 is the most important buffer pair in the blood

31. Which of the following clotting factors is not protein in nature?

A. F IV
B. F XI
C. X
D. F VII
E. F XII

32. The principal site to destroy red cells outside of the blood vessel is
A. Spleen
B. Kidney
C. Lung
D. Lymph node
E. Bone marrow

33. The factor that influences the water distribution between plasma membrane is
A. Plasma colloid osmotic pressure
B. Plasma crystal osmotic pressure
C. Interstitial colloid osmotic pressure
E. Hydrostatic pressure in the interstitial fluid

34. The anticoagulant in the blood is

A. Antithrombin III
B. PF3
C. F III
D. Fibrin
 E. XIII

Chapter 04 (15Q)
1. The potential having “all or none” principle is
A. Resting membrane potential
B. Action potential
C. End-plate potential
D. Receptor potential
E. Generator potential

2. When a person with emmetropia views an object that is nearer than 6 meters
A. Refractory system of the eye does not require accommodation, the object will focus on
the retina, one can see it clearly
B. Refractory system of the eye does not require accommodation, the object will focus in
front of the retina, but one can see it clearly
C. Refractory system of the eye does not require accommodation, the object will focus
behind the retina, but one can see it clearly
D. Refractory system of the eye requires accommodation, and object will focus on the
retina, and one can see it clearly
E. Refractory system of the eye requires accommodation, and object will focus in front of
the retina, and one can see it clearly

3. Near point of vision is mainly dependent on

A. Contractility of circular fiber in ciliary muscle
B. Contractility of papillary sphincter
C. The radius of curvature of cornea
D. Diameter of eyeball
E. Elasticity of crystalline lens

4. The structure that can sense the sound wave in the ear is
A. External auditory canal
B. Eardrum
C. Ossicular system
D. Hair cells in the organ of Corti
E. Basilar membrane

5. Which part of the auditory system can increases the pressure intensity when sound
wave reaches ear?
A. Auricle
B. Oval window
C. Ossicular system
D. Hair cells in the organ of Corti
E. Basilar membrane

6. When ossicular system in the middle ear has been damaged,

A. Patient losses high frequency hearing
B. Patient losses low frequency hearing
C. Patient losses intermediate frequency hearing
D. Higher intensity of sound is needed for the patient to hear
E. There is no change in patient’s hearing

7. Normally, sound wave is conducted into the inner ear through

A. External auditory canal→ eardrum→ossicular system→oval window
B. External auditory canal→ ossicular system→ eardrum→oval window
C. External auditory canal→ ossicular system→ eardrum→ round window
D. Cranial bone →external auditory canal→ ossicular system→ eardrum→oval window
E. External auditory canal →cranial bone → ossicular system→ eardrum→oval window

8. Lack of vitamin A leads to

A. night blindness
B. weakened photopic vision
C. increased photopic vision
D. Color blindness
E. Increased scotopic vision

9. The correct description about myopia is

A. Near point of vision is farer than normal
B. It is caused by shortened eyeball
C. It is caused by weakened refractory power of crystalline lens
D. It is caused by decreased radius of curvature of cornea
E. It can be corrected by wearing appropriate concave lens

10. The wrong description about hyperopia is

A. It is caused by weakened refractive power of crystalline lens
B. It is caused by shortened eyeball
C. It can be corrected by wearing appropriate convex lens
D. Both viewing near object and far object need accommodation of crystalline lens
E. It can be corrected by wearing appropriate biconcave lens

11. Human ear can sense the frequency of sound wave

A. Between 20～20.000 Hz
B. Between 20～20.000 kHz
C. Between 20～20.000 MHz
D. Between 10～20.000 MHz
E. Between 20～2000 Hz

12. Normally, when viewing a near object

A. Refractive power of cornea can increase
B. Refractive power of aqueous humor can increase
C. Refractive power of vitreous humor can increase
D. Refractive power of crystalline lens can increase
E. Refractive power of retina can increase

13. Human eye can sense

A. 370 to 740 nm of electromagnetic wave
B. 370 to 740 mm of electromagnetic wave
C. 370 to 740 pm of electromagnetic wave
D. 370 to 740 m of electromagnetic wave
E. 800 ～ 2800 nm of electromagnetic wave

14. Which type of receptors generates hyperpolarization when stimulated?

A. Hair cells in the inner ear
B. Rods in the retina
C. Free nerve terminals
D. Baroreceptors in the arterial wall
E. Chemorecetors in the carotid body

15. The wrong description about adequate stimulus is

A. Maximal stimulus that cause excitation is adequate stimulus
B. Minimal stimulus that can cause the excitation is adequate stimulus
C. The sound wave with a certain frequency is the adequate stimulus to the ear
D. The electromagnetic wave with a certain wave length is the adequate stimulus to the eye
E. Head rotation is the adequate stimulus to the semicircular canals

Chapter 06 (40Q)
1. The highest pressure in the left ventricle occurs during
A Atrial systole
B. Isovolumic contraction
C. Isovolumic relaxation
D. Rapid ejection
E. Reduced ejection

2. Both A-V valves and semilunar valves are closed during

A. Atrial systole
B. Isovolumic contraction
C. Rapid filling
D. Rapid ejection
E. Reduced ejection

3. The peak pressure in large arteries occurs during

A. Atrial systole
B. Isovolumic contraction
C. Rapid filling
D. Rapid ejection
E. Reduced ejection
4. Arterial pressure is the lowest during
A. Atrial systole
B. Isovolumic contraction
C. Rapid filling
D. Isovolumic relaxation
E. Reduced ejection

5. Frank-Starling law of heart states that

A. Afterload has no effect on heart pumping activity
B. Preload mainly affect heart rate
C. Within physiologic range, the more the blood returns to the heart, the less the heart pumps
D. Within physiologic range the heart can pump the blood that returns to it
E. The heart pumps all the blood no matter how much the blood returns to it

6. When A-V conduction is prolonged, ECG shows

A. Prolonged P-R interval
B. Prolonged ST segment
C. Reversed QRS complex
D. Reversed T wave
E. Prolonged P wave

7. The most important factor that influences peripheral resistance is

A. Blood viscosity
B. Number of red blood cell in the blood
C. Velocity of blood flow in the arteries
D. Diameter of small arteries and arterioles
E. diameter of aorta and large arteries

8. To maintain normal arterial pressure from moment to moment

A. baroreceptor system plays a major role
B. Chemoreceptor system plays a major role
C. Volumic receptor in the heart and lungs plays a major role
D. Catecholamine from adrenal medulla plays a major role
E. ADH plays a major role

9. The correct statement about buffer reflex in maintaining normal arterial pressure is
that
A. It monitors arterial pressure all the time
B. It always reduces arterial pressure
C. It always increases arterial pressure
D. It plays an important role when a person is suffering from hypertension
E. It is known as positive feedback when pressure falls since it increases pressure by reflex
10. Stimulating effect on heart of sympathetic nerve can be blocked by
A. Atropine
B. Phentolamine
C. Propranolol
D. Curarine
E. Strychnin

11. Inhibitory effect on heart of vagus nerve can be blocked by

A. Atropine
B. Phentolamine
C. Propranolol
D. Curarine
E. Strychnin

12. Which of the following factors that does not influence effective filtration pressure?
A. Capillary pressure
B. Blood colloid osmotic pressure
C. Blood crystal osmotic pressure
D. Colloid osmotic pressure in the interstitial fluid
E. Hydrostatic pressure in theinterstitial pressure

13. Increased production of interstitial fluid in the patient with right heart failure is
mainly due to
A. Reduced blood colloid osmotic pressure
B. Increased crystal osmotic pressure
C. Increased capillary pressure
D. Increased interstitial colloid osmotic pressure
E. Decreased interstitial hydrostatic pressure

14. It is believed that the most important factor that dilates the coronary vessels is
A. H+ concentration
B. Lactic acid
C. Adenosine
D. Vagus nerve to the heart
E. K+ concentration

15. Sustained elevation of cardiac output will occur with which of the following
conditions?
A. Hypertension
B. Aortic stenosis
C. Anemia
D. Third-degree heart block (A-V conduction is completely blocked)
E. Heart failure

16. Which one of the following will be observed in a patient with aortic regurgitation?
A. An increased stroke volume
B. An increased coronary blood flow
C. An increased diastolic pressure
D. A decreased pulse pressure
E. A decreased left atrial end-diastolic pressure

17. Net filtration from capillaries will increase following

A. Increased contraction of the precapillary sphincter
B. Decreased arterial pressure
C. Increased plasma protein concentration
D. Decreased capillary permeability
E. Increased postcapillary resistance

18. Sympathetic vasoconstrictor nerve terminals innervate all blood vessels except
A. Arteries
B. Small arteries
C. Arterioles
D. True capillaries
E. veins

19. Heart rate is decreased by

A. Activation of muscarinic cholinergic receptor (M-receptor)
B. Blockage of muscarinic cholinergic receptor (M-receptor)
C. Sectioning (cut off) vagus nerve to the heart
D. Increasing body temperature from 37 ℃ to 39 ℃
E. Sectioning both sympathetic nerve and vagus nerve to the heart

20. Calcium channel can be blocked by

A. Verapamil
B. Tetrodotoxin (TTX)
C. Atropine
D. Tetraethyulammomium
E. Propranolol

21. Ventricular pressure reaches the peak during

A. Atrial contraction
B. Period of whole heart relaxation
C. Isovolumic contraction of left ventricle
D. Rapid ejection of left ventricle
E. Rapid filling period of left ventricle

22. The lowest ventricular pressure occurs during

A. Atrial contraction
B. Period of whole heart relaxation
C. Isovolumic contraction of left ventricle
D. Rapid ejection of left ventricle
E. Rapid filling period of left ventricle
23. Ejection fraction of heart is defined as
A. Blood volume ejected by left ventricle per heart beat
B. Blood volume ejected by right ventricle per heart beat
C. Blood volume ejected by left ventricle each minute
D. The ratio of stroke volume/end diastolic volume
E. Cardiac output/m2 of body surface

24. The marked difference between ventricular muscle action potential and skeletal
muscle action potential is that
A. Ventricular muscle can automatically depolarize
B. Upstroke of ventricular muscle action potential is caused by influx of calcium
C. The duration of action potential is much longer
D. The repolarization of ventricular muscle action potential is due to efflux of chloride ion
E. The amplitude of ventricular muscle action potential is almost twice as high as that of
skeletal muscle action potential

25. Heart rhythm and rate are normally controlled by

A. Internodal pathways (preferential pathway)
B. Pacemaker cells in sinoatrial node
C. Pacemaker cells in A-V node
D. Purkinji fibers
E. Ventricular cells

26. Postganglion terminals of Sympathetic nervous system innervating heart muscle

release ( ) as transmitter.
A. Epinephrin
B. Norepinephrine
C. Acetylcholine
D. Glutamate
E. Gamma-aminobutyric acid (GABA)

27. To initiate muscle contraction, calcium ion must bind to

A. Myosin molecule
B. Actin molecule
C. Tropomyosin molecule
D. Subunit C of troponin molecule
E. Subunit T of troponin molecule

28. Long refractory period of ventricular muscle is due to

A. Slow upstroke of action potential
B. Opening of voltage-gated sodium channels is very slow
C. Opening of voltage-gated sodium channels is very fast
D. Long period of plateau
E. No phase 4 autodepolarization

29．Fastest conduction occurs in

A. Atrial muscle fibers
B. Preferential pathway
C. Ventricular muscle fibers
D. A-V node (atrioventricular node)
E. Purkinje fiber terminals

30. When conduction through A-V node is prolonged,

A. P-wave is inverted in ECG
B. P-R interval is prolonged
C. T-wave is inverted in ECG
D. Q-T interval is increased
E. QRS complex is increased

31. The highest blood flow per gram of left ventricular myocardium would occur
A. When aortic pressure is highest
B. When left ventricular pressure is highest
C. At the beginning of isovolumic contraction of left ventricle
D. When aortic blood flow is highest
E. At the beginning of diastole

32. Closure of AV valves and opening of aortic valves occur

A. During atrial contraction
B. During isovolumic contraction of ventricles
C. During rapid ventricular ejection
D. During rapid filling of ventricles
E. During isovolumic relaxation of ventricles

33. The upstroke of the SA nodal action potential is produced by opening a channel that
is
A. Primarily permeable to Na+
B. Primarily permeable to Ca 2+
C. Primarily permeable to K+
D. Primarily permeable to Cl-
E. Equally permeable to Na+ and K+

34. The constriction of a blood vessel to one-half of its resting diameter would increase
its resistance to blood flow by a factor of
A. 2
B. 4
C. 8
D. 12
E. 16

35. A reduction in carotid sinus pressure would cause a decrease in

A. Heart rate
B. Myocrdial contractility
C. Total peripheral resistance
D. Venous compliance (dilation of veins)
E. Cardiac output

36. The largest resistance to blood flow in blood circulation is provided by

A. Aorta
B. Large arteries
C. Capillaries
D. Small arteries and arterioles
E. Veins
37. Systemic arteriolar constriction may result from an increase in the local
concentration of
A. Nitric oxide (NO)
B. Angiotensin II
C. Atrial natriuretic peptide
D. Beta (β) agonists
E. Hydrogen ion

38. Which one of the following will increase if massaging the neck stretches the carotid
sinus baroreceptor?
A. Total peripheral resistance
B. Right atrial pressure
C. Venous tone
D. Ventricular contractility
E. Vagal nerve activity to the heart

40. Heart rate is decreased by

A. Activation of muscarinic cholinergic receptor (M-receptor)
B. Blockage of muscarinic cholinergic receptor (M-receptor)
C. Sectioning (cut off) vagus nerve to the heart
D. Increasing body temperature from 37 oC to 39 oC
E. Sectioning both sympathetic nerve and
vagus nerve to the heart

Chapter 07 (31Q + 5Q)

1. The enzymatic breakdown of large molecules into their basic building blocks is
termed
A. Absorption
B. Secretion
C. Mechanical digestion
D. Chemical digestion
E. Reabsorption
2. Intrinsic factor and hydrochloric acid are secreted by cells in stomach wall called
A. Parietal cells
B. Chief cells
C. Acinar cells
D. G cells
E. S cells

3. The digestive enzyme in saliva is

A. Pepsin
B. Amylase
C. Trypsin
D. Chemoprypsin
E. Carboxypeptidase

4. The peculiar type of movement of stomach is called

A. Tonic contraction
B. Receptive relaxation
C. Peristalsis
D. Segmentation contraction
E. Mass movement

5. The only digestive enzyme in gastric juice is

A. Amylase
B. Pepsin
C. Trypsin
D. Lipase
E. Ptyalin

6. The factor that stimulates gastrin secretion in stomach is

A. Hydrochloric acid
B. Breakdown products of protein
C. Stimulation of sympathetic nerve
D. Secretin
E. Breakdown products of carbohydrates
7. Most important digestive juice to digest protein, carbohydrate and fat is
A. Saliva
B. Gastric juice
C. Bile
D. Pancreatic juice
E. Secretion of large intestine

8. The peculiar type of movement of small intestine is

A. Tonic contraction
B. Peristalsis
C. Haustration
D. Segmentation contraction
E. Mass movement

9. Most of nutrients are absorbed in

A. Oral cavity
B. Stomach
C. Small intestine
D. Cecum
E. Colon

10. The duodenal hormone that mainly stimulates production and secretion of
pancreatic enzymes is
A. Enterokinase
B. Gastrin
C. Secretin
D. Cholecystokinin (CCK)
E. Somatostatin

11. The duodenal hormone that mainly stimulates production and secretion of
pancreatic bicarbonate is
A. Enterokinase
B. Gastric inhibitory peptide
C. Secretin
D. Cholecystokinin
E. Somatostatin

12. The major function (s) of large intestine is (are)

A. Absorption of water
B. absorption of vitamins liberated by bacterial action
C. Storage of fecal material prior to defecation
D Compaction of feces
E. a, b, c, and d are all correct

13. Absorption of glucose by brush border membrane is by

A. Simple diffusion
B. Carrier-mediated diffusion
C. Channel-mediated diffusion
D. Primary active transport
E. Secondary active transport

14. Absorption of glucose by small intestine requires the presence of

A. Sodium ion
B. Potassium ion
C. Calcium ion
D. Chloride ion
E. Bicarbonate ion

15. Inhibition of cholinesterase cause the following except

A. Increase in salivary secretion
B. Increase in pancreatic secretion
C. Increase in gastric secretion
D. Inhibition of GI movement
E. Enhancement of GI movement

16. The frequency of GI smooth muscle contraction depends principally on

A. Amplitude of action potential
B. The frequency of action potential
C. The amplitude of slow wave
D. Frequency of slow wave
E. The intrinsic rhythm of smooth muscle

17. The major mechanism by which, acidic chyme enters small intestine and stimulates
large amount of pancreatic secretion is
A. Mucosa of small intestine releases gastrin
B. Mucosa of small intestine releases secretin
C. Mucosa of small intestine releases CCK
D. Vugus nerve becomes stimulated
E. Sympathetic nerve becomes stimulated

18. The component in bile that stimulates bile secretion is

A. Bile salt
B. Cholesterol
C. Lecithin
D. Bile pigment
E. Fatty acid

19. The basic electrical rhythm mostly originates from

A. Circular smooth muscle cell
B. Cajal Cell
C. Smooth muscle cell
D. Mucosa
E. Longitudinal smooth muscle cell

20. The production of basic electrical rhythm is mostly due to

A. Calcium diffusion across the plasma membrane
B. Sodium diffusion across the plasma membrane
C. Potassium diffusion across the plasma membrane
D. Periodic change in sodium pump activity
E. Chloride diffusion across the plasma membrane
21. The segment of active absorption of bile salt and vitamin B 12 is
A. Duodenum
B. The upper segment of colon
C. The upper segment of jejunum
D. The lower segment of colon
E. The distal end of ileum

22. Gastric mucosa is constantly exposed to an environment of high acidity, but

normally, it is not damaged by high acidity due to self protective mechanism. This
self-protective mechanism is
A. Mucus barrier
B. The protection of mucus cell
C. The protection of mucus gel layer
D. Mucus-bicarbonate barrier
E. Bicarbonate barrier

23. The patient with atrophic gastritis has greatly reduced number of parietal cells,
leading to the lack of hydrochloric acid. But his blood level of gastrin is elevated due
to
A. Excitation of sympathetic nerve
B. Excitation of vagus nerve
C. Weakened gastro-enteric reflexes
D. Reduced release of secretin
E. Reduced inhibition of hydrochloric acid on G cells by way of negative feedback

24. In cholecystography, subjects are asked to eat fried eggs in order to examine the
contraction function of gallbladder. This procedure is aimed at
A. Stimulating the synthesis of bile salt
B. Stimulating the synthesis of cholesterol
C. Stimulating vagus nerve
D. Stimulating the release of CCK
E. Stimulating the secretion of gastrin

25. Surgical excision of major part of stomach commonly leads to anemia, the principle
 cause is
A. Reduced gastric acid secretion
B. Reduced gastric mucus secretion
C. Reduced pepsin secretion
D. Reduced bicarbonate secretion
E. Reduced intrinsic factor secretion 

26. When vagus nerve that innervates gastrointestinal tract is stimulated, which of the
following will not occur?
A. Contraction of gastric smooth muscle
B. Contraction of intestinal tract smooth muscle
C. Increased pancreatic secretion
D. Increased gastric secretion
E. Contraction of sphincters of gastrointestinal tract

27. The factor that inhibits gastrin secretion is

A. Excitation of vagus nerve
B. pH in gastric juice that is higher than 6.0
C. pH in gastric juice that is lower than 1.5
D. Increased concentration of peptides and amino acids
E. Distension of gastric antrum

28. The component in bile that involves fat digestion is

A. Bile pigment
B. Cholesterol
C. Bile salt
D. Fatty acid
E. Inorganic salt

29. The rate of gastric emptying increases with an increase in

A. Intragastric volume
B. Intraduodenal volume
C. Fat content of duodenum
E. Osmolality of duodenum
E. Acidity of duodenum

30. Basal acid output is increased by

A. Acidification of antrum
B. Administration of an H2 receptor antagonist
C. Vagotomy
D. Alkalinization of antrum
E. Acidification of duodenum

31. After secretion of trypsinogen into duodenum, the enzyme is coverted into its active
form, trypsin, by
A. Enteropeptidase (enterokinase)
B. Procarboxypeptidase
C. Pancreatic lipase
D. Carboxypeptidase
E. An alkaline pH

II. Essay (5)

1. How is gastric secretion regulated?
(1) Control of cephalic phase: Cephalic gastric secretion indicates the gastric resecretion
before food enters stomach. This secretion is caused by conditioned reflex (seeing, smelling,
hearing or even thinking of food) or food that enters oral cavity that stimulates receptors in
oral cavity or esophagus.
(2) Secretion of gastric phase: When food enters stomach, both chemical or physical
stimulation to the corresponding receptors in stomach that induce gastric secretion
(3) Secretion of enteric phase: When food or chime enters small intestine that can also
stimulate slightly gastric secretion.

2. Why is small intestine regarded most important part of digestion and absorption?
(1) Chyme stays in small intestine for a longer time (it is long and segmentation contraction
has little propulsion)
(2) There are tremendous total surface areas (about 250 or more square meters) that favors
digestion and absorption
(3) Segmentation contraction and the movements of the will promote absorption
(4) There are two pathways for absorption; blood vessel and lymphatic vessel (water
insoluble fat)

3. Explain why pancreatic juice is considered the most important digestive juice?
(1) Pancreatic juice contains all forms of chemically digestive enzymes that could digest
protein, carbohydrate and fat.
(2) Bicarbonate ions secreted by pancreas provides optimal environment for the activity of
pancreatic enzymes
(3) Trypsin and chymotrypsin digest protein; pancreatic amylase digests carbohydrate and
lipase digests fat with the help of bile salt.

4. Demonstrate by experiment the existence of cephalic phase of gastric secretion.

1) A gastric fistula is performed to collect gastric juice secretion
2) An esophageal fistula is made which allows or not allows entry of food to stomach by
opening or closing the fistula.
3) When esophageal fistula is closed and food cannot enter stomach, gastric secretion
increases when animal eats, sees food, or smells odor of food or hears something about food
(including conditioned and non-conditioned reflex.

5. A patient is poisoned by toxin called diisopropyl fluorophosphate. This toxin is an

irreversible cholinesterase inhibitor. What will happen to the patient’s activity of
gastrointestinal tract? What symptoms will appear of the patient, and explain in
detail the mechanism by which these symptoms occur?
(1) Motility of gastrointestinal tract increases and spasm occurs that causes patient to have
severe abdominal pain due to accumulation of acetylcholine that bind M receptor.
(2) Salivary secretion, gastric secretion, pancreatic secretion etc. increase due to
accumulation of acetylcholine that activates M receptor and stimulates these secretions
(3) Due to bladder contraction, incontinence of urine could occur

Chapter 08 (40Q + 8Q)

1. The inspiratory muscles participating in quiet breathing are
A. External and internal intercostals
B. External intercostals and diaphragm
C. Internal intercostals and anterior serrati
D. External intercostals and abdominal recti
E. Sternocleidomastoid muscle and scaleni

2. A reduction of pulmonary surfactant leads to

A. Increased compliance of lungs
B. Increased elastic resistance of lungs
C. Increased inertial resistance
D. Increased viscosity resistance
E. Airway resistance of respiratory tract

3. Alveolar pressure is lowest

A. During inspiration of quiet breathing
B. During expiration of quiet breathing
C. During inspiration of forced breathing
D. During expiration of forced breathing
E. When lung capacity is about 68% of its total capacity

4. During forced inspiration with glottis closed, alveolar pressure would be

A. Equal to atmospheric pressure
B. As low as – 70 to – 90 mmHg
C. – 5 to – 7 cm H2O
D. + 5 to + 7 cm H2O
E. – 5 to – 7 mm Hg

5. The driving force for gas exchange across respiratory membrane is

A. Respiratory movement
B. Ambient pressure gradient between atmosphere and alveolar pressure
C. Partial pressure gradient across respiratory membrane
D. The gradient between plural pressure and alveolar pressure
E. Solubility of a given gas in the blood

6. Alveolar pressure is equal to atmospheric pressure

A. During inspiration of quiet breathing
B. During expiration of quiet breathing
C. During expiration of forced breathing
D. During expiration of forced breathing
E. When breathing is held with airway opened

7. Intrapleural pressure is lowest

A. During inspiration of quiet breathing
B. During expiration of quiet breathing
C. During expiration of forced breathing
D. During expiration of forced breathing
E. When one inspires forcefully with glottis closed

8. Under which of the following conditions, respiratory tract resistance is greatest

A. Stimulation of sympathetic nerve to respirtory tract
B. Use of βreceptor agonist
C. Use of adrenaline
D. Use of noradrenaline
E. Pneumothorax

9. The principal form of CO2 transport in the blood is by

A. Physically dissolving in blood plasma
B. Forming bicarbonate in red blood cell
C. Forming carbonic acid in blood plasma
D. Forming carbaminohemoglobin
E. Forming carbominoprotein

10. The vital respiratory center is located in

A. Spinal cord
B. Cerebellum
C. Medulla oblongata
D. Pons
E. Thalamus
11. Oxygen dissociation curve shifts to right when
A. pH is high
B. PO2 in tissue is high
C. PCO2 in tissue is low
D. DPG in red cell is high
E. CO poisoning occurs

12. Section of both vagi leads to

A. Both prolonged inspiration and expiration
B. Prolonged expiration and shortened inspiration
C. Deep breathing, but fast rate
D. Slow rate and shallow breathing
E. Deep inspiration and slow rate

13. An increase in P50 of an oxygen-dissociation curve would result from a decrease in

A. Metabolism
B. pH
C. Temperature
D. Oxygen
E. 2,3-DPG

14. Which of the following will increase as a result of stimulating parasympathetic

nerves to bronchial smooth muscle?
A. Lung compliance
B. Airway diameter
C. Elastic work of breathing
D. Resistive work of breathing
E. Vital capacity

15. A person ascends to the top of a mountain where the atmospheric pressure is below
normal. Which one of the following blood gases was drawn from the person at the top
of the mountain?
A. PO2 50 mmHg PCO2 30 mmHg
B. PO2 60 mmHg PCO2 44 mmHg
C. PO2 80 mmHg PCO2 50 mmHg
D. PO2 100 mmHg PCO2 40 mmHg
E. PO2 120 mmHg PCO2 20 mmHg

16．At the end of quiet inspiration, intra-alveolar pressure is normally

A. 240 cmH2O
B. 24 cmH2O
C. 0 cmH2O
D. 14 mmHg
E. 140 mmHg

17. Which of the following conditions causes a decrease in arterial O 2 saturation without
a decrease in O2 tension (PO2)?
A. Anemia
B. Carbon monoxide poisoning
C. A low V/Q ratio (less than 0.84)
D. Hypoventilation
E. Right-to-left shunt (blood flows directly from right heart to left heart)

18. Complete transection of brainstem above pons would

A. Result in cessation of all breathing movements
B. Prevent any voluntary holding of breath
C. Prevent the central chemoreceptors from exerting any control over ventilation
D. Prevent the peripheral chemoreceptors from exerting any control over ventilation
E. Abolish the Hering-Breuer reflex (lung inflation and deflation reflex)

19. Inhalation of pure nitrogen gas leads to increased respiratory rate and depth
because breath is stimulated by
A. Increased PCO2 in the arterial blood
B. Increased H+ concentration in the arterial blood
C. Increased nitrogen concentration in arterial blood that excites central chemoreceptors
D. Decreased oxygen concentration in arterial blood that excites peripheral chemoreceptors
E. Increased nitrogen concentration in arterial blood that excites peripheral chemoreceptors
20. Normally, the most important factor that affects lung compliance is
A. The elasticity of lung tissue
B. The surface tension
C. The inertial resistance
D. The viscosity of air
E. The velocity of air flow

21. Breathing is stimulated when PO2 is decreased in arterial blood because decreased
PO2
A. Directly stimulates carotid body and aortic body
B. Directly stimulates carotid sinus and aortic arch
C. Directly stimulates chemoreceptors in the medulla oblongata
D. Directly stimulates respiratory center in the medulla oblongata
E. Directly stimulates motor neurons that innervate respiratory muscles

22. The highest PCO2 in body is in

A. Interstitial fluid
B. Active cells
C. Capillary blood
D. Venous blood
E. Arterial blood

23. Airway resistance is lowest

A. During a forced expiration
B. At total lung capacity
C. At residual volume
D. During vagal stimulation
E. At tide volume

24. Which of the following factors contributes the most to airway resistance?
A. Airway diameter
B. Airway length
C. Inert resistance of the air
D. Viscose resistance of the respiratory organ
E. Compliance of the lungs

25. During quiet breathing, the main inspiratory muscles are

A. Diaphragm and internal intercostal muscles
B. Diaphragm and external intercostal muscle
C. Diaphragm and stenocleidomastoid muscle
D. Internal intercostal muscle and abdominal recti
E. Diaphragm and abdominal recti

26. Under which of the following conditions, pleural pressure is most negative?
A. At the end of quiet inspiration
B. At the end of quiet expiration
C. At the end of forced inspiration
D. At the end of forced expiration
E. During forced inspiration when glottis is closed

27. The direct driving force for air diffusion across respiratory membrane is
A. Partial pressure difference
B. Contraction of inspiratory muscles
C. Contraction of expiratory muscles
D. The negative pressure in pleural cavity
E. Solubility of gases

28. The essential respiratory center is located

A. In medullar oblongata
B. In spinal cord
C. In pons
D. In mesencephalon
E. In cerebral cortex

30. Lack of surfactant leads to

A. Decreased elastic resistance of lungs
B. Reduced compliance of lungs
C. Decreased inertial resistance
D. Decreased viscose resistance
E. Decreased air way resistance

31. Hypoxia stimulates breathing by

A. Directly stimulating respiratory center
B. Stimulating peripheral chemoreceptors
C. Stimulating carotid sinus
D. Stimulating aortic arch
E. Stimulating central chemoreceptor in medulla

32. When one ascends to a top of 3000 m mountains, one’ breathing is stimulated mainly
due to
A. Accumulation of CO2
B. Insufficient supply of oxygen
C. Accumulation of lactic acid
D. Increased metabolism
E. Decreased CO2 concentration

33. A patient with anemia may have

A. lower PO2 in his or her arterial blood
B. Lower systolic pressure and higher diastolic pressure
C. Lower percentage of oxygen saturation
D. Decreased oxygen capacity
E. Bradycardia

34. Destruction of pneumotaxic center in lower 1/3 of pone leads to

A. Increased respiratory rate
B. Slower respiratory rate and deeper expiration
C. Faster respiratory rate and shallow inspiration
D. Slower rate and deeper inspiration
E. Both deeper inspiration and expiration

35. A patient with CO poisoning has

A. Very low PO2 in his or her arterial blood
B. Lower affinity of Hb for oxygen
C. Severe cyanosis
D. Severe anoxia
E. Increased PCO2 in his or her arterial blood

36. The most important factor that influences the airway resistance is
A. The amount of surfactant
B. Elasticity of lung tissue
C. Elasticity of thoracic cage
D. Radius of respiratory tract
E. Inertia of air flow

37. When glottis is closed, forced inspiration leads to

A. More negative pleural pressure
B. Less negative pleural pressure
C. Positive pleural pressure
D. Positive alveolar pressure
E. More positive alveolar pressure

38. Inhalation of nitrogen gas stimulates breathing mainly due to

A. Directly stimulating by nitrogen of peripheral chemoreceptor
B. Directly stimulating by nitrogen of central chemoreceptor
C. Accumulation of CO2 in arterial blood
D. Decreased pH in arterial blood
E. Hypoxia

39. The correct description about stimulation of breathing by increased PCO2

in arterial blood is that
A. CO2 can directly stimulate respiratory center
B. CO2 can directly stimulate central chemoreceptor
C. CO2 can directly depolarize respiratory center
D. CO2 can directly depolarize central chemoreceptor
E. CO2 stimulates breathing by stimulating central chemoreceptor in the form of H+
40. The correct description about the blood in the pulmonary arteries is
A. Its PO2 is equal to that in the systemic arterial blood
B. Its PCO2 is equal to that in the systemic arterial blood
C. Its PO2 is higher than that in venous blood
D. Its PCO2 is higher than that in the venous blood
E. Its PCO2 and PO2 are equal to those in the venous blood

II. Essay (8Q)

1. What is the function of pulmonary surfactant?
(1) Reduce surface tension of lung alveolus and therefore increase lung compliance
(2) Prevent lung alveolus from being expanded too much
(3) Keep size of different alveoli without larger one becoming larger and larger and small one
becoming smaller and smaller
(4) Prevent alveolus from edema

2. State the factors that affect gas exchange in the lung alveolus
(1) Partial pressure gradient of oxygen and carbon dioxide across pulmonary membrane
(2) Total surface area of pulmonary membrane
(3) Thickness of pulmonary membrane
(4) Body temperature
(5) Molecular size and solubility of gas
(6) Ventilation/perfusion (ratio of V/Q)

3. State the factors that shifts the oxygen-dissociation curve to right

(1) Low pH
(2) High DPG in red blood cell
(3) High temperature
(4) High partial pressure of CO2

4. State the factors that shifts the oxygen-dissociation curve to left

(1) High pH
(2) Low DPG in red blood cell
(3) Low temperature
(4) Low partial pressure of CO2
(5) CO

5. What does Boher effect state? What is significance?

1) It states that acidity of Hb can alter affinity of Hb to oxygen. When blood passes through
lung capillaries, where partial pressure CO 2 is high, affinity of Hb for oxygen increases and
therefore, oxygen easily binds to Hb; when blood passes through tissue capillaries, where
partial pressure of CO2 is high, oxygenated Hb easily releases oxygen to deliver to tissue
cells for metabolism.
2) Significance: From the meaning mentioned above, it is clear that Boher effect promotes
binding of oxygen to Hb when venous blood passes through lungs and promotes release of
oxygen from oxygenated Hb when arterial blood passes through tissue capillaries.

6. State the role of negative pleural pressure

1) Keeps alveolus expended all the time
2) Promotes blood return to heart
3) Promotes lymphatic fluid return to blood vessels
4) Keeps lung volume to change as thoracic volume increases and decreases

7. State how does air go in and out of alveolus during inspiration and expiration?
1) Inspiration: inspiratory muscle contracts, thoracic cage increases its volume in all
direction, intrapleural pressure becomes more negative and lung is expanded passively.
Expansion of lung increases alveolar volume and therefore, alveolar pressure becomes lower
than atmospheric pressure. Air goes into alveolus (inspiration)
2) Expiration: Either inspiratory muscle relaxation or expiratory muscle contraction,
thoracic cage returns to its original volume (becomes smaller than that in inspiration) and
intrapleural pressure becomes less negative. Lung recoils back and alveolar volume
becomes smaller and intra-alveolar pressure is higher than atmospheric pressure. Air goes
out (expiration)
8. Describe the factors that affect the airway resistance
1) Radius of respiratory passageway
2) Length of respiratory passageway
3) Inertial resistance (velocity of air flow, direction of air flow, acceleration and deceleration
of air flow,
4) Inspiration and expiration
5) Sympathetic nerve and parasympathetic nerve
6) Bioactive substances, such as histamine, bradykinin, slow-reactive substance anaphylaxis

Chapter 09 (30Q + 12Q)

1. The principle excretory organ of human body is
A. Digestive tract
B. Skin
C. Respiratory passageway
D. Kidney
E. Liver

2. The function of juxtaglomerular cell is to

A. release renin
B. Excrete sodium chloride
C. Release ADH
D. Concentrate urine
E. Sense sodium chloride concentration

3. The factor that does not affect GFR is

A. Glomerular capillary pressure
B. Plasma colloid osmotic pressure
C. Bowman’s capsular pressure
D. Plasma crystal osmotic pressure
E. Effective filtration pressure

4. The only renal tubular segment that is able to reabsorb glucose is

A. Collecting duct
B. Distal tubule
C. Proximal tubule
D. Descending limb of Henle
E. Ascending limb of Henle

5. Glucose is reabsorbed in luminal membrane of proximal tubule by

A. Primary active transport
B. Simple diffusion
C. Carrier-mediated diffusion
D. Secondary active transport
E. Endocytosis

6. The osmolarity and volume of terminal urine depends mostly on reabsorption by

A. Proximal tubule
B. Distal tubule and collecting duct
C. Thin segment of descending limb of Henle
D. Thin segment of ascending limb of Henle
E. Early segment of distal tubule

7. The factor that increases GFR is

A. Losing large amount of blood
B. Doing heavy exercise
C. Sweating copiously
D. Stimulating renal sympathetic fiber
E. Increasing renal blood flow

8. The most potent hormone that determines permeability of collecting duct is

A. Parathryoid hormone
B. Aldosterone
C. Atrial natriuretic peptide (ANP)
D. Antidiuretic hormone (ADH)
E. Angiotensin II

9. Which of the following hormones is not synthesized and released by kidney?

A. Renin
B. Erythropoitin (EPO)
C. 1, 25-(OH)2 vitamin D3
D. Angiotensin
E. PG

10. Kidney performs the following functions except

A. Regulation of extracellular volume
B. Regulation of extracellular osmolarity
C. Regulation of acid-base balance
D. Regulation of blood CO2 concentration
E. Excretion of some drugs, such as penicillin

11. Glucose is reabsorbed by proximal tubule in the presence of

A. Sodium ion
B. Potassium ion
C. Chloride ion
D. Magnesium ion
E. Calcium ions
12. Concentrated or diluted urine is mainly determined by water reabsorption in
A. Proximal tubule
B. Thin segment of descending limb of Henle
C. Thin segment of ascending limb of Henle
D. Thick segment of ascending limb of Henle
E. Collecting ducts

13. A substance that is freely filtrable through filtration membrane, but it is

neither reabsorbed nor secreted, its clearance must be
A. Equal to GFR
B. Greater than GFR
C. Less than GFR
D. Equal to RBF
E. Equal to RPF

14. The structure of kidney that releases renin is known as

A. Macula densa
B. Granular cells
C. Endothelial cells
D. Basement membrane
E. Mesangial cells

15. Under resting condition, renal blood flow is mainly regulated by

A. Sympathetic vasoconstrictor fiber
B. Parasympathetic vasodilator fiber
C. Autoregulation
D. Hormonal regulation
E. Sympathetic vasodilator fiber

16. At which segment of renal tubules, tubular fluid osmolarity is equal to that in blood
plasma?
A. The thin descending segment of loop of Henle
B. The thin ascending segment of loop of Henle
C. Proximal tubule
D. Collecting ducts in the inner medulla
E. The thick ascending segment of loop of Henle

17. NH3 or NH4+ produced by renal tubules is derived from

A. Glycine
B. Glutamine
C. Arginin
D. Aspartate
E. Gamm-aminobutyric acid

18. The most important hormone that regulates reabsorption of sodium and excretion of
potassium is
A. ADH
B. Aldosterone
C. ANP
D. Angiotensin II
E. Norepinephrine

19. The substances that form high osmolarity in inner medulla are
A. Urea and NaCl
B. Urea and potassium
C. NH3 and HCO3-
D. KCl and glucose
E. Creatine and urea

20. The most effective stimulus for aldosterone release is

A. ACTH
B. Potassium concentration in blood
C. Sodium concentratioin in blood
D. Chloride concentration in blood
E. Plasma pH

21. Under which of the following conditions, hyperkalemia may appear?

A. Administration of diuretics
B. Administration of insulin
C. Metabolic alkalosis
D. Anuria
E. Excess aldosterone secretion

22. Under which of the following conditions hyponatremia may appear?

A. Excess ADH secretion
B. Excess norepinephrine secretion
C. Excess insulin secretion
D. Excess aldosterone secretion
E. Excess renin secretion

23. A lesion to the supraoptic nuclei leads to

A. Increased and diluted urine
B. Increased and concentrated urine
C. No significant change in urine volume and osmolality
D. Decreased and diluted urine
E. Decreased and concentrated urine

24. Which of the following is caused by renal failure to release hormone?

A. Edema
B. Hypertension
C. Anemia
D. Acidosis
E. Uremia

25. The primary center for micturition reflex is located in

A. Pone
B. Medulla oblongata
C. Cerebral cortex
D. Lumbar cord
E. Sacral cord

26. The maintenance of water balance by kidneys depends on

A. GFR
B. Secretion of renal tubules and collecting ducts
C. Reabsorption of sodium, potassium and chloride by thick ascending segment
D. Reabsorption of distal tubule and collecting duct
E. Reabsorption percentage of proximal tubule

27. The syndrome of inappropriate ADH secretion (SIADH) is caused by the excess
release of ADH. SIADH will cause an increase in
A. Concentration of plasma sodium
B. Intracellualr volume
C. Urinary flow
D. Plasma oncotic pressure
E. Plasma osmolarity

28. A decrease in concentration of NaCl in intraluminal fluid causes the juxtaglomerular

apparatus to release
A. ADH
B. Aldosteone
C. Adenosine
D. Renin
E. Angiotensinogen

29. Phenol red binds to plasma protein to form complex which is not filtrable through
glomerular capillary wall. When phenol red is intravenously injected and it appears
in the urine which can be used to
A. Evaluate GFR
B. Evaluate permeability of glomerular membrane
C. Evaluate excretion ability of renal tubules
D. Evaluate reabsoption ability of renal tubules
E. Evaluate charges in the filtration membrane

30. A patient with hyperadrenocorticism with elevated level of blood aldosterone, it can
be anticipated that the patient may have
A. Hypernatremia and increased extracellular fluid
B. Hyperkalem ia and increased extrcellualr fluid
C. Hypernatremia and decreased extracellular fluid
D. Hypokalemia and decreasd extrcellular fluid
E. Hyponatremia and decreased extracellular fluid

II. Essay (12Q)

1. What are characteristics of juxtaglomerular and cortical nephrons?
1) Cortical nephron is characterized by ① corpuscle is located in outer adrenal cortex;② The
number of nephron is much more than juxtagomerular enphron; ③ Loop is relatively short
and only penetrate into outer medulla or within cortex;④ Diameter of afferent arteriole is
larger than that of efferent arteriole
2) Juxtaglomerular nephron is characterized by ① Corpuscle is located in inner cortex near
outer medulla; ② The number are fewer than that of cortical nephron,③ Loop is relatively
long and dips into deep medulla;④ Diameter of afferent arteriole is almost equal to that
efferent arteriole.

2. What are characteristics of renal blood flow and renal blood flow regulation?
1) Renal blood flow is large compared to its weight, about 1200 ml/min; It distribution in
kidney is uneven, with more than90% flowing into cortex and small percentage of blood
flowing into medulla.
2) Renal blood flow is regulated under different conditions. At resting condition, within an
arterial blood pressure between 80 t0 180 mmHg, blood pressure change will not lead to
 renal blood flow change, remaining relatively constant. This constant renal blood flow is
regulated by autoregulation.
3) During emergency, renal blood flow reduces greatly through nervous regulation and
hormonal regulation. In this case, renal sympathetic nerve is strongly stimulated and renal
vessels contract.

3. Summarize the factors that affect GFR

(1) Net filtration pressure or effective filtration presure
1) Capillary pressure of glomerulus
2) Plasma colloid osmotic pressure
3) Bowmann;s capsular pressure
4) Colloid osmotic pressure in Bowmann’s fuid
(2) Renal blood flow
(3) Kf (total surrace area of filtration membrane and conductivity of filtration membrane)

4. The factors that stimulate renin release include

1) Excitation of sympathetic nervous system
2) Elevated level of catecholamine
3) Reduced blood flow to kidney
4) Reduced sodium ion passing through macula densa

5. What role do the kidneys play in maintaining acid-base balance?

1) Kidney regulates acid-base balance by conserving base: renal tubules can reabsorb filtered
bicarnate ions secondarily in the form of CO2
2) Kidney can excrete H+: renal tubules can use proton pump that actively pumps H + into
tubular fluid; tubules can also use H+-Na+ exchange to secrete H+ into urine.
3) Kidney can generate bicarbonate ion through breadown of glutamine in renal epithelial cell
4) Kidney can generate ammonia or ammonium which binds H+, thus increasing pH in urine
that will promote H+ secretion

6. How do the kidneys regulate extracellular crystal osmotic pressure?

Kidney regulates extracellular crystal osmotic pressure together with ADH. When blood
cystal osmotic pressure is higher than normal for any reason, this immeidatly stimulates
osmotic receptor in hypothalamus and that leads to the increased release of ADH. ADH
increases number of AQP2 in the distal tubule and collecting duct and this increases
permeability tubular wall to water. Reabsorption of water increases. If crystal osmotic
pressure is very high and large amount of ADH release can also stimulates thirsty center in
hypothalamus. This will induce the desire to drink wate, restoring crystal osmolarity in ECF.
Conversely, if crystal osmotic pressure is lower than normal, this will cause the opposite
effect (ADH release decreases, permeability to water decreases and causes water diuresis)
In this way, whether crystal osmotic pressure is higher or lower than normal, after ADH-
kidney regulation, crystal osmotic pressure in ECF is kept relatively constant.

7. A normal person drinks about 1 liter of tap water, what will be the change in his or
her urine volume and urine osmolarity? What is the mechanism?
(1) Urine volume increases and osmolarity of urine also decreases
(2) Mechanism: after absorption of water in GI tract, blood volume increases and crystal
osmolarity decreases, which will inhibit ADH release from posterior pituitary gland,
Reduced ADH concentration in blood, permeability of distal tubule and collecting duct to
water decreases and more tubular fluid becomes terminal urine and therefore, urine output
increases.
Due to decreased water reabsorption by distal tubule and collecting duct, plus continuously
reabsorption of salts from tubular fluid by distal tubule and collecting duct, urine is diluted
and osmolarity is lower than that of blood plasma

8. A healthy person has acutely lost about 15 % of his or her total blood volume, what
will be his or her urine volume and urine osmotic pressure? What is the mechanism?
(1) Urine volume decreases and osmolarity of urine increases (hyperosmolarity)
(2) Mechanisms: Loss of 15% of total amount of blood will reduce arterial blood pressure.
This will immediately cause baroreceptor reflex, leading to excitation of sympathetic
nervous system and release of catecholamine, ADH and formation of angiotensin II.
1) Reduced blood pressure due to loss of blood will reduce renal blood flow, and therefore
reduce GFR
2) Excitation of sympathetic nervous system causes renal blood vessel constriction that again
reduces renal blood flow and GFR
3) Release of vasoconstrictor substances causes renal vessel constriction, which in turn
reduces GFR
4) ADH increase permeability of distal tubule and collecting duct to water will increase water
reabsorption
All these factors together, namely reducing GRF and increasing water reabsorption final
reduces urine output and increases osmolarity of urine.

9. A person is doing heavy exercise and sweating copiously about 1 liter of sweat without
drinking. What will be his or her urine volume and urine osmotic pressure? What is
the mechanism?
(1) Urine volume decreases and osmolarity of urine increases (hyperosmolarity)
(2) Mechanisms: Secretion of sweat by sweating glands is an active process. Ductal
epithelial cells can reabsorb salt when sweat passes through ductal tube. Therefore, sweat is
hyposmotic. After large amount of sweating, body has lost more water than salt, leading to
hyposmotic dehydration (crystal osmotic pressure in blood is higher than normal). This will
stimulate osmotic receptor in thalamus and release of ADH. ADH increases the number of
AQP2 in peritubular wall of distal tubule land collecting duct. As a result, permeability to
water increases. So, more water is reabsorbed, resulting in reduced urine output and
increased urine osmolality.
10. 50 ml of 50% glucose solution is injected into a rabbit weighing about 2 kg. What
will be its urine volume and osmolarity? What is the mechanism?
(1) Urine output increases and urine osmolarity increases due to osmotic diuresis.
(2) Mechanisms: When large amount of glucose is rapidly injected intravenously into rabbit,
blood glucose concentration will increase sharply which is excess to renal threshold for
glucose. Since proximal tubule is the only segment able to reabsorb glucose, glucose will
not be completely reabsorbed when blood glucose concentration is higher than threshold.
Glucose in the tubular fluid will reduce reabsorption of other substances, such as sodium
and chloride ions. Therefore, glucose, sodium and chloride and other substances in tubular
fluid increases osmotic pressure which oppose water reabsorption, leading to increased urine
output and increased osmotic pressure of urine.

11. Describe why glucose appears in the urine (glucosuria) and urine volume increases
in patient with diabetes mellitus. What is the mechanism?
1) Proximal tubule is the only segment of renal tubule that is able to reabsorb glucose. The
reabsorptio is mediated through secondary active transport which requires special glucose
transpoter protein. As the number of carrier protein there is limited, therefore, when glucose
concentration in blood is higher enough that proximal tubule fails to reabsorb all glucose
filtered into tubular fluid. The glucose that is not reabsorbed in proximal tubule will pass
through all renal tubules and collecting duct and appear in terminal urine.
2) In patient with diabetes mellitus, blood glucose concentration rises high and is higher than
renal threshold for glucose either due to insufficient release of insulin or insensitivity of
insulin receptor to insulin.
3) Since more glucose is present in tubular fluid, it not only handles reabsorption of sodium
chloride, thus increasing osmotic pressure in the tubular fluid, but also itself increases
osmotic pressure. Increased osmotic pressure in tubular fluid would oppose water
reabsorption, resulting in increased urine volume.

12. How is medullary hyperosmolality established and maintained? If a drug inhibits

co-transporter of Na+, K+, and Cl- in the thick ascending segment, what is the urine
volume? State the mechanism.
1) Outer medulla: due to secondary active transport of sodium- potassium chloride transport
by thick segment of loop of Henle, but membrane is not permeable to water, leading to high
osmolarity in outer medulla.
2) Inner medulla: Sodium and chloride ions in thin ascending limb tubular fluid diffuse out,
but again membrane is not permeable to water; urea recycling also contributes to the
formation of high osmolarity of inner medulla.

Chapter 10 (15Q + 2Q)

1. The compound that not only directly liberates energy, but also stores high-energy
phosphate bound is
A. ATP
B. AMP
C. Glucose
D. Protein
E. Fat

2. In a normal adult person, the main source of energy is derived from

A. Carbohydrate
B. Protein
C. Fatty acid
D. Vitamins
E. Brown fat

3. The largest amount of energy that is stored in body as

A. Carbohydrate
B. Fat
C. ATP
D. CP
E. Protein

4. Respiratory quotient defines

A. Calorie produced per gram of protein oxidation
B. Ration of CO2 production to oxygen consumption at the same time
C. Calorie produced per gram of glucose oxidation
D. Calorie produced per gram of galactose oxidation
E. Calorie produced per liter of oxygen used for oxidizing foodstuff

5. Which of the substances has largest specific dynamic action?

A. Protein
B. Fat
C. Carbohydrate
D. Vitamin
E. Inorganic substance

6. At resting condition with ambient temperature of 23 ℃, heat is lost mainly through

A. Thermal radiation
B. Thermal conduction
C. Thermal convection
D. Insensible evaporation
E. Sweating

7. When set point is reset at 39 ℃ from normal 37℃, the incorrect description is
A. Shivering occurs
B. Heat production increases
C. Skin vasoconstriction occurs
D. Sweat gland stops sweating
E. Blood flow to skin vessels increases
8. The hormone that is most effective in stimulating heat production is
A. Growth hormone
B. Insulin
C. Thyroid hormone
D. Adrenaline
E. Glucocorticoids

9. When ambient temperature is higher than shell temperature, the principle way of
heat loss is
A. Thermal radiation
B. Thermal conduction
C. Thermal convection
D. Mental sweating
E. Evaporation

10. Which of the following diseases is accompanied with highest BMR?

A. Leukemia
B. Diabetes mellitus
C. Hyperthyroidism
D. Hypothyroidism
E. Erythrocytosis

11. The most of eccrine glands are innervated by

A. Adrenergic fibers of sympathetic nerve
B. Preganglionic fibers of sympathetic nerve
C. Cholinergic fibers of sympathetic nerve
D. Preganglionic fibers of parasympathetic nerve
E. Preganglionic fibers of parasysmpathetic nerve

12. The essential thermoregulation center is located in

A. Spinal cord
B. Medulla oblongata
C. Mesencephalone
D. Hypothalamus
E. Cerebral cortex

13. The principle organ that produces heat during heavy exercise is
A. Brain
B. Heart
C. Liver
D. Skin
E. Skeletal muscle

14. BMR is dependent mainly on

A. Function of thyroid gland
B. Function of adrenal cortex
C. Function of adrenal medulla
D. Posterior lobe of pituitary gland
E. Growth hormone level in the blood

15. Under which of the following conditions, BMR decreases?

A. 1 hour after meal
B. Emotional stress
C. at 10 ℃ of ambient temperature
D. Hyperthryoidism
E. Hypothyroidism

II. Essay (2Q)

1. State how heat is lost of a person when one is at resting state with ambient
temperature of 25 ℃
1) At resting condition, small amount of heat is lost through respiration and insensible
evaporation
2) Major part of heat is lost through skin by thermal radiation, thermal convection and
thermal conduction.

2. When set point is suddenly up-regulated to 39 ℃ from normal body temperature,

state the response of body.
1) Body will regard normal temperature to be lower than normal. So heat production will
 increase and heat loss will decrease through regulation.
2) Increase in heat production: Shivering takes please, basal metabolism also increases
3) Reduction of heat loss: Sympathetic vasoconstrictor nerve to blood vessels in the skin
causes small arteries and arterioles to contract, blood flow to skin reduce. In this way, less
heat is lost through thermal radiation, thermal convection and thermal conduction.
4) Erectile muscle contraction: This causes hairs in the skin to erect which reduces air flow so
that thermal convection decreases
Chapter03(15Q)
Chapter04(15Q)
Chapter02(36Q)
Chapter 01 (6Q)
1. Homeostasis is kept by
A. Nervous regulation
B. Hormonal regulation
C. Autoregulation
D. Negative feedback mechanism
E. Positive feedback mechanism

2. Which of the following fluid does not belong to the internal environment?
A. Blood plasma
B. Interstitial fluid
C. Cerebrospinal fluid
D. Fluid in the plural cavity
E. Urine

3. Which of the following reflex is caused by conditioned reflex?

A. Normal micturition
B. Normal defecation
C. Withdraw reflex
D. Cross extensor reflex
E. One’s mouth waters when one hears something one likes to eat.

4. All of the regulations are positive feedback mechanisms except

A. Child birth
B. Micturition reflex
C. Blood coagulation
D. Opening of voltage-gated sodium channel
E. Regulation of arterial blood pressure

5. The correct description about nervous regulation is

A. The reflex is slow
B. It requires the presence of receptor, but not afferent fiber
C. The reflex center must be located in brain
D. It requires intact reflex arc
E. Newborn has no nervous regulation

6. Which of the following reflexes is called conditioned reflex?

A. Micturition reflex
B. Withdraw reflex of flexor muscle
C. Corneal reflex
D. Pupil light reflex
E. Reflex salivary secretion when seeing delicious food