ACID-BASE PHYSIOLOGY MCQS .........................................................................................................

2"
BASIC PHYSIOLOGY MCQ ................................................................................................................... 9"
BLOOD AND IMMUNOLOGY MCQS ................................................................................................... 12"
ENDOCRINE AND METABOLIC MCQS ............................................................................................... 21"
FLUID AND ELECTROLYTES MCQS ................................................................................................... 31"
RENAL MCQS .................................................................................................................................... 44"
GASTROINTESTINAL MCQS............................................................................................................... 62"
MATERNAL AND FOETAL MCQS ....................................................................................................... 69"
NEUROPHYSIOLOGY MCQS ............................................................................................................... 74"
MUSCLE PHYSIOLOGY MCQS ............................................................................................................ 78"
RESPIRATORY PHYSIOLOGY MCQS ................................................................................................... 85"
Cardiovascular MCQs ...................................................................................................................... 117"

1"
 ACID%BASE)PHYSIOLOGY)MCQS)
)

Disorder Prediction of Compensation pH HCO3- PaCO2

PaCO2)=)(1.5)x)HCO3%))+)8)±)2,)or)
Metabolic)
PaCO2)will)↓)1.25mmHg)/)mmol/l)↓)[HCO3%]) Low) Low) Low)
acidosis)
or)PaCO2)=)[HCO3%])+15)
PaCO2)will)↑)0.75mmHg)/)mmol/L)↑)[HCO3%])
Metabolic)
or)PaCO2)will)↑)6mmHg)/)10mmol/L)↑[HCO3%]) High) High) High)
alkalosis)
or)PaCO2)=)[HCO3%])+15)
Resp)alkalosis)%)
[HCO3%])will)↓)0.2mmol/L)per)mmHg)↓)PaCO2) High) Low) Low)
acute)
Resp)alkalosis)%)
[HCO3%])will)↓)0.4mmol/L)per)mmHg)↓)PaCO2) High) Low) Low)
chronic)
Resp)acidosis)%)
[HCO3%])will)↑)0.1mmol/L)per)mmHg)↑)in)PaCO2) Low) High) High)
acute)
Resp)alkalosis)%)
[HCO3%])will)↑)0.4mmol/L)per)mmHg)↑)in)PaCO2) Low) High) High)
chronic)
From)Harrison’s))
D.)Chronic)resp)acidosis)
% Resp)acidosis)acute:)10mmHg)CO2)increases)HCO3%)
0.08mmol/L)and)decrease)pH)by)0.07)
% Resp)acidosis)chronic:)10mmHg)CO2)increases)HCO3%)
4mmol/L)and)decrease)pH)by)0.03)
% Resp)alkalosis)acute:)10mmHg)CO2)decrease,)HCO3%)
decrease)2mmol/L)and)pH)increase)by)0.08)
% Resp)alkalosis)chronic:)10mmHg)CO2)decrease,)HCO3%)
decrease)6mmol/L)and)pH)increases)by)0.03)
% Metabolic)acidosis:)1mmol/L)bicarb)decrease)gives)
0.1mmHg)CO2)decrease)and)pH)decrease)by)0.02)
From)Power)&)Kam)
AD01)[Mar96])[Apr01])[Mar05])[Jul05]) D.)Chronic)resp)acidosis)
ABGs:)pH)7.35,)pCO2)60)mmHg,)pO2)40)mmHg.) pH)low(ish),)pCO2)high,)pO2)low)%)consistent)with)
These)blood)gas)results)are)consistent)with:) respiratory)acidosis)on)figures)given)
A.)Atelectasis) )
B.)Morphine)induced)respiratory)depression)(OR:) If)acidaemia)was)to)be)acute,)20mmHg)CO2)above)normal)
Acute)morphine)overdose)) should)give)pH)7.4)%)0.14)
C.)Diabetic)ketoacidosis) If)acidaemia)was)chronic,)should)give)pH)7.4)%)0.06)
D.)Patient)with)COAD) )
E.)Lobar)pneumonia)(OR:)bronchopneumonia)) Therefore)is)chronic)resp)acidosis)and)COAD)is)only)one)from)
F.)Metabolic)acidosis) options)given.)
(Alt)version)of)the)gas)results:)pH)7.35;)pO2)45mmHg;) )
pCO2)60mmHg;)HCO3%)34mmol/l)) A.)Atelectasis)–)No.)This)would)produce)a)“shunt”)which)
would)decrease)pO2)but)pCO2)should)be)normal)as)
ventilation)is)increased.)
B.)Morphine)induced)respiratory)depression)(OR:)Acute)
morphine)overdose))–)No.)There)would)be)an)
uncompensated)respiratory)acidosis.)
C.)Diabetic)ketoacidosis)–)No.)The)patient)will)develop)
respiratory)compensation)for)the)metabolic)acidosis)and)
pCO2)will)be)decreased.)
D.#Patient#with#COAD#–#MOST#CORRECT#and#consistent#
with#Type#II#respiratory#failure.#
E.)Lobar)pneumonia)(OR:)bronchopneumonia))–)No.)There)
would)be)an)uncompensated)respiratory)acidosis.)
F.)Metabolic)acidosis)–)No.)pCO2)should)be)normal)or)there)
should)be)evidence)of)some)respiratory)compensation.)
)

2"
 AD02)[Mar97])[Mar98]) ?A)
The)ABGs)of)a)60yr)old)man)who)has)overdosed)on)
morphine)would)be:)
A.)paO2)60,)paCO2)55,)pH)7.29,)HCO3)32,)BE)%1)
B.)paO2)40,)paCO2)60,)pH)7.37,)HCO3)26,)BE)+5)
C.)?)

AD03)[Jul97])[Mar99])
Buffering)of)a)bicarbonate)infusion:)
A.)60)to)70%)occurs)intracellularly)
%
B.)Exchanged)for)Cl )across)the)red)cell)membrane)
C.)Compensated)for)by)increased)respiratory)rate.)
D.)Intracellular)proteins)
AD04)[Jul97])[Mar98])[Mar99])[Feb00])Phosphate)
buffer)system)is)an)effective)buffer)intracellularly)and) pKa)of)phosphate)buffer)system)is)6.8)(close)to)the)pH)
in)renal)tubules)because:)
A. Its)pKa)is)close)to)the)operating)pH)
B. B.)High)concentration)in)distal)tubule)
C. High)concentration)intracellularly)
D. All)of)the)above)
AD05)[Jul97])[Apr01])
Arterial)gases)including)pH)7.46)bicarbonate)
31mmol/l)PCO2)46mmHg)indicate:)
A.)Metabolic)alkalosis)with)respiratory)compensation)
B.)Respiratory)alkalosis)
C.)Respiratory)acidosis)with)compensation)
D.)Metabolic)acidosis)with)respiratory)compensation) )
E.)Mixed)metabolic)and)respiratory)alkalosis)
(Apr)01:)AB05)changed)so)2)top)stems)read)partially)
compensated)then)bottom)stem)was)"none)of)the)
above"))
AD06)[Jul98])
Metabolic)acidosis)is)characterised)by:)
+
A.)Increased)H ])intracellularly)
B.)Decreased)production)of)bicarbonate)
C.)?)
D.)?)
E.)?)
)
B)(Hamburger)effect))
Bicarb)infusion)is)an)alkali)load)of)HCO3%)(metabolic)
alkalosis))
30%)intracellular,)70%)extracellular)
Yes,)is)HCO3%)exchange)with)Cl%)across)red)cell)membrane)
(but)not)direct)countertransport))
Compensation)will)be)a)decrease)in)respiratory)rate)to)retain)
volatile)acid.)
D)%)not)enough)info)but)possible)
D)
intracellularly)and)in)renal)tubules).)In)urine,)phosphate)
concentrations)are)much)higher.)Intracellularly,)protein)&)
phosphates)are)important.)
A)
% Is)an)alkalaemia)
% pCO2)&)HCO3)high)(so)metabolic)alkalosis)or)resp)acidosis))
% No)provided)clues)(AG,)glucose,)others()
% Assessing)for)compensation:)yes!))
A)
Metabolic)acidosis)prompts)exchange)of)H+/K+)across)cell)
membrane)%)increased)intracellular)H+)and)hyperkalaemia.)
Bicarb)production)(renal))is)increased.)

3"
AD07)[Jul99])[Feb00])[Jul00])[Jul03])[Feb04])
Bicarbonate)system)is)the)most)important)ECF)buffer)
system)because:)
A.)It)has)a)pKa)close)to)physiological)pH)
B.)CO2)can)be)exchanged)in)lungs)and)HCO3)excreted) %
in)the)kidneys)
%
C:)HCO3 )occurs)in)such)large)amounts)
D.)?)
E:)CO2)can)be)regulated)by)lung)&)HCO3)by)the)
kidneys)
AD08)[Jul00])[Jul10])
During)infusion)of)an)acidic)solution)(hydrochloric)
acid)solution),)which)contributes)most)to)
buffering?)
A.)Phosphate)buffer)
B.)Bicarbonate)buffer)
C.)Intracellular)buffers)
D.)Proteins)(?intracellular)proteins))
E.)None)of)the)above)
AD09)[Jul00])[Jul01])
In)a)patient)with)diabetic)ketoacidosis,)the)following)
are)true)except:)
A.)?)
B.)There)is)decreased)PaCO2)
+
C.)There)is)decreased)concentration)of)H )
intracellularly)
D.)Renal)excretion)of)titratable)acids)will)be)increased)
E.)There)is)increased)synthesis)of)bicarbonate)
AD09b)[Mar05])
In)a)patient)with)metabolic)acidosis)with)excess)
ketones,)which)of)the)following)is)true:)
A.)Decreased)urinary)NH4)excretion)
B.)Normal)CO2)concentration)
C.)Hyperventilation)can)excrete)non)volatile)acid)
D.)Increased)intracellular)H+)
E.)Increased)urinary)excretion)of)HCO3%)
AD10)[Apr01])[Jul04])[Jul10])
A)patient)is)draining)1)litre)of)fluid)per)day)from)a)
pancreatic)fistula)while)maintaining)normal)volume)
status.)The)most)likely)acid%base)disorder)is:)
A.)Hyperchloraemic)metabolic)acidosis)
B.)Hypochloraemic)metabolic)acidosis)
C.)Metabolic)acidosis)with)normal)chloride)
D.)Hyperchloraemic)metabolic)alkalosis)
E.)Hypochloraemic)metabolic)alkalosis)
AD11)[Apr01])
ABG's)in)healthy)young)man)with)pneumothorax:)
A.)pO2=50,)pCO2=25)
B.)pO2=50,)pCO2=46)
C.)pO2=90,)pCO2=25)
D.)pO2=90,)pCO2=46)
E)(B)is)similar)by)HCO3)is)regulated)more)than)excreted)
strictly)speaking))
Bicarbonate)system:)
% pKa)6.1)(far)from)physiological)pH))
Effectiveness)is)increased)because)system)is)‘open’)at)both)
ends:)CO2)and)[HCO3])can)be)altered)&)assists)in)minimising)
changes)in)the)([HCO3]/pCO2).)
% Bicarb)present)in)ample)concentration)in)blood)stream)
C)
)
In)acidic)environment,)buffers:)
ECF)43%)(bicarb)&)proteins))
ICF)57%)(proteins)&)bicarb))
)
In)metabolic)acidosis,)only)15%50%)of)acid)load)is)buffered)by)
H2CO3%HCO3%)system)in)ECF,)and)most)of)the)remainder)is)
buffered)in)cells.)(Ganong))
C)
Decreased)PaCO2)due)to)hyperventilation)(respiratory)
compensation)for)acidosis).)Renal)excretion)of)titratable)
acids)will)be)increased)and)so)will)the)synthesis)of)bicarb.))
D)
A)
)
Loss)of)alkali)(pancreatic)fluid))rich)in)bicarb,)causes)a)normal)
anion)gap)acidosis)(raised)Cl).)
Anion)gap)=)(Na)+)K))%)(Cl)+)bicarb))
A)best)answer)
C)would)be)correct)if)this)is)not)massive)
Healthy)%)so)assuming)normal)heart)&)lung)(other)than)Ptx))
PTx)→)dyspnoea)→)Hyperventilation)so)low)CO2)(25)as)per)
options)presented)
Alveolar)gas)equation:)
pAO2)=)0.21)x)(760%47))%))(25/0.8))=)118)
BUT)will)be)a)bit)lower)as)not)perfect)exchange)because)of)
PTx)%)may)be)even)lower)(ie)answer)A))if)was)massive)
collapse)
4"
Alt)version:)ABG)of)young)male)who)develops)total) C)
collapse)of)one)lung)postop:) )
A.)pO2)95mmHg)pCO2)50)mmHg) As)above)but)debatable))
B.)pO2)80mmHg)pCO2)50mmHg) C)if)on)oxygen,)D)if)coexisting)respiratory)depression)postop)
C.)pO2)90mmHg)pCO2)25mmHg) (hopefully)the)question)on)the)day)will)be)more)specific))
D.)pO2)60mmHg)pCO2)50mmHg)
AD12)[Mar03])[Jul03])[Jul10])For)the)following)blood) 2003)E,)F)
gas)results,)which)clinical)scenario)fits)best?) 2010)B,)possible)or)G)
2003)version:)ABGs)pH)7.48,)PCO2)24)(or)26),)HCO3) )
19)BE)15) ’03)
Jul10)version:)::ABGs:)pH)7.53,)PCO2)26,)HCO3)22) Alkalaemia,)pH)0.03%0.08)high)
A.)Mixed)metabolic)and)respiratory)acidosis) PCO2)low)so)is)resp)problem)~15)out)
B.)Acute)respiratory)alkalosis) HCO3)low)but)approx)6)
C.)Metabolic)acidosis)with)compensated)respiratory) so)fits)with)chronic)resp)alkalosis)
alkalosis) )
D.)Chronic)respiratory)disease) ‘10)
E.)Mountain)climber)after)several)weeks)at)altitude) Alkalemia,)pH)0.08)high)
F.)Hyperventilating)consistent)with)acclimatisation)to) pCO2)15mmHg)low)
altitude) HCO3)4)mmol/L)low)
G.)Hyperventilation)for)5)mins) Fits)with)acute)resp)alkalosis)
)
Expected)acute)[HCO3%])=)24)–)2(40%pCO2)/10)
Expected)chronic)[HCO3%])=)24)–)5(40%pCO2)/10)
)
AD13)[Mar03])[Jul03]) B)
A)26)year)old)female)with)the)following)ABG’s:)pH)
7.1,)pCO2)11,)pO2)110)
A.)?)
B.)Metabolic)acidosis)with)respiratory)compensation)
C.)?)
AD13b)[Feb04]) A)
A)19)year)old)is)admitted)unconscious.)She)has)the) )
with)the)following)arterial)blood)gases:) pH)=)6.1)+)log([HCO3]/(0.03)x)pCO2)))
PaO2)117)PaCO2)11)pH)7.1)Base)excess)%15) Therefore)1)=)log([HCO3]/(0.03)x)pCO2)))
This)is)most)consistent)with:) 10)=)[HCO3]/(0.03)x)pCO2))
A.)Metabolic)acidosis)with)respiratory)compensation) HCO3)=)3.3)
B.)Respiratory)alkalosis)with)metabolic)compensation) pH)7.1)%)acidaemia)with)deficit)0.30)
C.)Mixed)metabolic)and)respiratory)acidosis) PaCO2)low)ie)not)just)resp)problem)%)out)by)~30)%)so)for)
D.)?) metabolic)acidosis)bicarb)should)be)24)lower)(↓1.25)CO2)for)
↓1)HCO3))%)approx)fits!)
AD14)[Feb04]) A)
Diabetic)ketoacidosis:)
+
A.)Causes)increased)intracellular)H )
AD15)[Mar05])A)previously)healthy)man)with)this) D)
blood)gas:) pH)%)neutral)
pH)7.40) CO2)increased)by)10)
pCO2)50) )
pO2)88) Alveolar)gas)equation)%)possible)to)be)breathing)room)air.))
Must)indicate) No)acidosis)is)suggested)by)pH)
A.)Breathing)FIO2>)0.21) Compensation)for)metabolic)acidosis)≠)↑CO2)
B.)Acute)respirator)acidosis) Mixed)acidosis)≠)normal)pH)
C.)Fully)compensated)metabolic)acidosis)
D.)HCO3)levels)will)be)raised)
E.)?Mixed)respiratory)&)metabolic)acidosis)

5"
AD16)[Mar05])
A)man)is)air)lifted)up)to)5000m)and)his)arterial)blood)
gas)is)taken)after)½)hr.)He)lives)there)and)his)blood)
gas)is)repeated)after)1)week.)Compared)to)the)first)
sample,)the)second)blood)gas)shows:)
A.)No)change)in)PaCO2)and)PaO2)
B.)PaCO2)increase,)PaO2)increase)
C.)PaCO2)increase,)PaO2)decrease)
D.)PaCO2)decrease,)PaO2)decrease)
E.)PaCO2)decrease,)PaO2)increase)
AD17)[Jul05])[Feb06])
ABG:)pH)7.48,)PaO2)70,)HCO3)raised)(~35mmHg),)
PaCO2)48)(OR)58).)
This)ABG)could)be)explained)by:)
A.)Acclimatisation)to)altitude)
B.)COAD)
C.)Metabolic)acidosis)
D.)?)
E.)Prolonged)vomiting)
AD18)[Feb06])[Feb08])Base)excess)calculation:)
A.)When)PaCO2)is)40)mm)Hg)
B.)Difference)of)measured)HCO3)from)standard)HCO3)
C.)Lower)with)higher)HCO3)
D.)Is)an)indicator)of)cellular)buffers)
E.)Is)negative)when)pH)is)greater)than)7.40)
AD19)Which)of)the)following)is)a)'strong)ion'?)
A.)PO4)
B.)SO4)
C.)Cl)
D.)?)
E.)?)
AD20)During)infusion)of)hydrochloric)acid)(HCl),)
which)contributes)most)to)buffering?)(repeated)
MCQ))
A.)Phosphate)buffer)
B.#Bicarbonate#buffer#B#POSSIBLE#
C.#Intracellular#buffers#B#POSSIBLE#
D.)Proteins)(?intracellular)proteins))
E.)None)of)the)above)
AD21)Which)of)the)following)sets)of)values)are)
measured)directly)by)ABG)machine)
A.)pCO2,)paO2,)pH)
B.)paCO2,)HCO3,)pH)
C.)paCO2,)base)excess,)paO2)
D.)Something)with)base)excess)
E.)Something)with)HCO3)
E)
Asking)about)compensation)for)a)respiratory)alkalosis.)
PaCO2)will)be)allowed)to)further)decrease)by)renal)
compensation)with)further)increase)in)PaO2)
ACUTE)EXPOSURE)TO)ALTITUDE)
Ventilatory)changes)
At)high)altitude,)the)decrease)in)FiO2)reduces)alveolar)and)
therefore)arterial)PO2)which)stimulates)the)hypoxic)drive,)↑)
minute)ventilation)and)↓PACO2))which)helps)mitigate)the)
decrease)in)PAO2)as)by)the)alveolar)gas)equation:)FiO2)x)
(Patm)–)PH2O))–)PACO2/R)
)
The)ventilatory)response)however)is)short)lived)and)after)
about)30)minutes,)returns)to)only)slightly)above)normoxic)
levels)owing)to)a)combination)of)hypocapnia)and)hypoxic)
ventilatory)decline.)
)
Nunn’s)p254%259)
E)
Alkalaemic)%)pH)increased)0.08)
CO2)raised)by)8mmHg)%)NOT)a)primary)respiratory)issue)
HCO3)raised)by)about)10)
Lower)PaO2)
)
Roughly)fits)with)compensated)metabolic)alkalosis.)
A)
)
Base)excess)or)deficit)is)the)amount)of)acid)or)base)required)
to)titrate)whole)blood)at)37)degrees)celcius)and)PaCO2)of)
40mmHg)to)a)pH)of)7.4)
C)(and)also)B)%)sulphate))
Plasma)strong)cations:)sodium,)potassium,)calcium,)
magnesium.)Strong)anions)chloride,)lactate,)sulfate)
ketoacidosis,)nonesterified)fatty)acids,)etc))
Atot)includes)the)plasma)concentration)of)nonvolatile)
buffers)(albumin,)globulins,)inorganic)phosphate))
Repeat)of)question)8)
A)
)
HCO3)is)determined)by)substitution)of)the)known)values)into)
the)henderson)hasselbach)equation.)
6"
AD22)[Feb08])Person)with)these)blood)gas)results:)pH) B)
7.33)CO2)58)HCO3)33) Acidaemia)%)low)by)0.07)
A.)Acclimitization)after)several)weeks)at)altitude) Raised)CO2)by)18mmHg)%)primary)respiratory)process)
B.)Person)with)chronic)pulmonary)disease) Bicarb)increased)by)7)(from)26))
C.)Diabetic)ketoacidosis) )
D.)Hyperventilation) Fits)with)chronic)respiratory)acidosis)
E.)Prolonged)vomiting)
AD23)[Feb08])Person)with)these)blood)gas)results:)pH) D)
7.53)pCO2)27)HCO3)22) Alkalaemia)%)pH)high)by)0.13)
A.)Acclimitization)after)several)weeks)at)altitude) CO2)is)low)by)~)13mmHg)%)therefore)primary)respiratory)
B.)Person)with)chronic)pulmonary)disease) component)
C.)Diabetic)ketoacidosis) Bicarb)lower)by)about)2)(from)24))%)fits)with)acute)
D.)Hyperventilation) compensation)
E.)Prolonged)vomiting) )
Sounds)like)acute)resp)alkalosis)
Hb)has)38)carboxyl)residues:)Incorrect)Hb)has)got)38)
Buffering)by)Hb)better)than)by)plasma)proteins) Histidine)(imidazole))residues)which)are)important)in)
because) buffering)(i.e.)not)carboxyl)residues))
A.)Hb)has)38)carboxyl)residues)) Great)amount:)Correct)"Hb)is)about)six)times)more)
B.)great)amount)) important)quantitatively)as)a)buffer)compared)to)the)plasma)
C.)plasma)protein)pKa)near)pH)of)Blood)) proteins)because):)
D.)) ! Its)concentration)is)about)twice)as)much[Hb])150)gr/L)versus)
E.)) [plasma)proteins])70)gr/L)
Haemoglobin)is)an)effective)buffer)because:) ! Each)haemoglobin)molecule)contains)about)three)times)
A.)present)in)large)concentrations) more)histidine)residues)than)the)average)plasma)protein.")
B.)Has)38)carboxyl)residues)per)globin)molecule) Ref:)from)p25)physiology)viva)Kerry)Brandis)
C.)pKa)close)to)physiological)pH) Plasma)protein)pKa)near)pH)of)Blood)%)The)relevant)group)
D.)deoxyHb)is)more)acidic)than)oxyHb?) for)buffering)by)proteins)is)the)imidazole)group)of)histidine)
E.)Proteins)have)pKa)6.8) residues.)This)has)a)pKa)about)6.8)so)as)a)'closed')buffer)
system)this)provides)effective)buffering)for)a)pH)of)7.4)(i.e.)
[Feb11]) by)the)pKa)+/%)1)rule).)However)this)applies)equally)to)both)
plasma)proteins)and)Hb.)
Haemoglobin)is)a)better)buffer)than)plasma)proteins) )
because) In#summary:)
A.)present)in)much)greater)quanitity) A.)Correct)%)present)in)large)concentrations)
B.)Hb)contains)38)carboxyl)residues) B.)Wrong)%)has)38)HISTIDINE)residues,)and)that)in)total)
C.)plasma)proteins)have)pKa)closer)to)physiological) rather)than)per)globin)molecule)
pH) C.)Correct)%)pKa)of)~6.8)is)close)to)physiological)pH)7.4)(note)
D.)?) that)Feb)2011)recalls)'closer',)which)would)make)this)option)
E.)?) more)tenuous)as)the)reason)for)a)difference)between)Hb)
and)plasma)proteins))
) D.)Wrong)%)deoxyHb)is)a)better)H+)acceptor)(base))than)
oxyHb)
E.)Not)entirely)correct)%)Proteins)are)zwitterions)with)
multiple)pKas.)As)physiological)pH,)only)those)proteins)with)
imidazole)groups)have)the)a)pKa)6.8)
With)two)correct)choices,)one)wonders)whether)the)Feb)
2011)option)C)is)in)fact)the)correctly)recalled)option)with)
'closer')pKa.)If)we)were)talking)about)the)relative)buffering)
power)of)Hb)compared)to)plasma)proteins,)'A')would)be)
correct.)
%7
AD25)[Aug11])If)pH)is)7,)then)H+)concentration)of) If)pH)is)7,)then)[H+])is)10 )=)100)nmol/L,)therefore)option)
pure)water)is:) "D".)
A.)O) Note:)(40)nmol/L)for)pH)7.4,)roughly)35)nmol/L)for)pH)7.45)
B.)40)nmol/L) and)45)nmol/L)for)pH)7.35))
C.)70)nmol/L) )
D.)100nmol/L)
E.)1000nmol/L)

7"
 AD26)[Aug11])Fluid)loss)from)pancreatic)fistula)with) A)
normovolaemia) )
A.)Hypercholremic)metabolic)acidosis) Loss)of)alkali)(pancreatic)fluid))rich)in)bicarb,)causes)a)normal)
B.)?) anion)gap)acidosis)(raised)Cl).)
C.)all#other#combos) Anion)gap)=)(Na)+)K))%)(Cl)+)bicarb))
)
AD27)[Mar10])[Aug11])[Feb12])With)pCO2)200mmHg,) This)is)1)MAC)of)CO2.)Henderson)hasselbach)equation)
what)else)would)you)find) suggests)the)increased)dissociation)of)carbonic)acid)will)raise)
A.)Hyperkalemia) H+)concentration)(ICF)where)carbonic)anhydrase)is))leading)
B.)Bradycardia) to)exchange)across)the)cellular)membrane)and)consequent)
C.)Hypercalcaemia) decrease)of)ICF)K+)and)therefor)increase)in)ECF)K+)to)
D.)Hypermagnesemia) maintain)electroneutrality.)
E.)Hypo)?K/?Ca) No)idea)regarding)the)other)answers.)
Yep)so)A)correct.)
AD28)[Mar10])In)plasma,)a)'strong)ion':) Answer)=)D)
A.)is)usually)a)cation) By)definition,)a)strong)ion)is)essentially)completely)
B.)is)usually)an)anion) dissociated)at)physiological)pH)
C.)has)its)pKa)close)to)7.40) )
D.)almost)completely)dissociates)
E.)?)
)
)

8"
BASIC)PHYSIOLOGY)MCQ)

BP01)[aqr])[Mar05])[Jul05]) C)
Gap)junctions:) Gap)junction:)intercellular)space)narrows)from)25nm)to)
A.)Maintain)cellular)polarity) 3nm)&)connexons)in)the)cell)membranes)are)lined)up.)
B.)Occur)at)the)apices)of)cells) Connexons)have)an)interconnecting)channel)to)permit)
C.)Have)corresponding)connections)between)cells) passage)of)ions,)sugars,)amino)acids,)etc.))
D.)Are)formed)by)ridges)on)adjacent)cells) Permit)propagation)of)electrical)activity)from)cell)to)cell.))
E.)Gives)cells)stability)and)strength) Polarity)is)due)to)enzymes)on)apical)cell)membrane)
differing)from)those)in)basolateral)membrane)
Tight)junctions)on)apices)of)cells)(B),)are)formed)by)ridges)
on)adjacent)cells)(D),)and)give)cells)strength)&)stability)(E).)
BP02)[d]) C)
Bulk)flow:) Bulk)flow)=)ultrafiltration.)
A.)Is)related)to)concentration)gradient) A)process)whereby)fluid)moves)from)capillary)to)
B.)Is)related)to)permeability)coefficient) interstitial)fluid)by)excess)of)hydrostatic)over)oncotic)
C.)Depends)on)hydrostatic)and)oncotic)pressure) pressure)
D.)?) Concentration)gradient)related)to)Fick’s)law)&)diffusion)
(not)bulk)flow))
I)think)permeability)coefficient)(or)reflection)coefficient))is)
related)to)Gibbs%Donnan)effect)(so)would)have)some)
influence)on)bulk)flow)but)isn’t)the)best)answer))
BP03)[gko]) B)
All)of)the)following)histamine)effects)are)mediated)by)H2%) H2)receptors)post)synaptic)Gs)type,)increase)cAMP.)
receptors)EXCEPT:) Increase)gastric)H+)secretion,)increase)myocardial)
A.)Vasodilatation) contractility)&)HR,)cause)bronchodilation)&)coronary)
B.)Bronchoconstriction) vasodilation,)are)also)involved)in)histamine)release)from)
C.)Gastric)acid)secretion) mast)cells.)
D.)Tachycardia) Bronchoconstriction)is)a)result)of)H1)receptors.))
E.)Increased)contractility)
BP04)[i]) C)
The)trace)element)that)is)an)integral)component)of) They)are)zinc)containing)metallo%enzymes))
carbonic)anhydrase,)lactic)dehydrogenase,)and)several) )
other)peptidases:)
A.)Magnesium)
B.)Manganese)
C.)Zinc)
D.)Cobalt)
E.)Copper)
BP05)[Jul04])[Mar05])[Jul05]) B)
An)example)of)autoregulation)is:) Autoregulation)=)capacity)of)tissues)to)regulate)their)own)
A.)Renin)angiotensin)aldosterone) blood)flow.)
B.)Tubuloglomerular)feedback) Tubuloglomerular)feedback:)macula)densa)senses)amount)
C.)Baroreceptors) of)Na)&)Cl)%)alters)adenosine)release)%)adenosine)
D.)?) vasoconstricts)afferent)arteriole)%)controls)renal)blood)
E.)Increased)tissue)vascularity) flow)&)GFR.)
BP06)[Jul04])[JUl05]) B)
Which)is)not)essential)for)pain?) IASP)definition)“pain)is)an)unpleasent)sensory)and)
A.)Conscious)awareness) emotional)experience)associated)with)actual)or)potential)
B.)Actual)tissue)damage) tissue)damage,)or)described)in)terms)of)such)damage”.))
C.)something)like)May)be)modulated)over)time) The)“experience”)of)pain)requires)conscious)awareness,)
but)may)have)autonomic)response)when)not)aware)

9"
BP06b)[Jul05])An)alternative)version:)
Which)is)not)true)of)pain)pathways?)
A.)Withdrawal)pathways)are)involved)
B.)Emotional)pathways)are)involved)
C.)Tissue)damage)must)occur)
D.)Requires)conscious)awareness)
E.)?)
BP07)[Feb06])
Tight)junctions)between)cells:)
A.)impermeable)to)water)and)solutes)
B.)involved)in)active)transport)
C.)permeable)to)water)and)solutes)
D.)permeability)is)NOT)under)hormonal)control)
E.)permeable)to)large)compounds)(or)something)else)
wrong))
BP08)[July%07])Giant)Squid)Axons)are)used)to)study)action)
potentials)because:)
A.)They)are)large)
B.)They)only)contain)sodium)channels)
C.)?)
D.)?)
E.)?)
Alt:)In)regards)to)voltage)gated)Na+)channels:)
A.)Giant)squid)axons)used)to)study)as)they)only)contain)
Na+)channels)
B.)Blocked)from)the)inside)by)tetrodotoxin)
BP09)Which)is)incorrect)regarding)the)Kreb’s)cycle:)
A.)Acetyl%coA)is)metabolized)to)CO2)&)H+)
B.)?)
C.)Oxaloacetate)is)recycled)
D.)12)ATP)is)generated)
E.)Cycle)is)continous)during)anaerobic)metabolism)but)at)
slower)rate)
BP10)Cytochrome)c)oxidase)catalyses)*new*)
A.)O2)+)2H+)%>)H2O)
B.)?)
C.)?)
D.)H+)+)HCO3%)%>)H2CO3)
E.)None)of)the)above)
(Think)this)may)have)actually)been)asking)about)
cytochrome)a3))
BP11)In)regards)to)the)Na+/K+)ATPase)*new*)
A.)Three)K+)out)for)every)two)Na+)pumped)in)
B.)Stimulated)by)Ouabain)
C.3ATP)broken)down)to)ADP)and)P)for)every)3Na+)
pumped)in)
D.is)inhibited)by)high)extracellular)concentrations)of)Na+)
E.)an)electrogenic)pump)
10"
C)
as)above)
D)
Tight)junctions)=)zona)occuldens.)Usually)apical)&)often)
found)in)epithelia.)Ridges)hold)cells)tightly)together,)
provide)strength)&)stability.))
Allow)passage)of)some)ions)&)solute)in)between)adjacent)
cells)&)degree)of)‘leakiness’)varies)depending)on)protein)
makeup)of)tight)junction,)eg)blood)brain)barrier)
impermeable,)small)intestine)some)permeability.)No)
active)transport)but)are)involved)in)maintaining)cellular)
polarity)&)contribute)to)structural)integrity)of)epithelial)
layers.)
Version)1)
A)
Axons)very)large)(up)to)1mm)diameter))%)allow)insertion)of)
voltage)clamp)electrodes)into)the)nerve)to)study)ionic)
mechanisms)of)the)action)potential.)
Fast)inward)Na+,)time%dependent)outward)K+)current,)and)
time%independent)leak)current)
)
Version)2)%)neither)
Tetrodotoxin)blocks)voltage)gated)Na)channel)but)from)
extracellular)pore)opening.)
E)%)wrong:)requires)aerobic)conditions)
)
A)%)true)
C)%)true)
D)%)12)per)turn)of)the)cycle)(usually)undergoes)2)cycle)
turns))
A)
The)flavoprotein%cytochrome)system)is)a)chain)of)enzymes)
that)transfers)hydrogen)to)oxygen,)forming)water.)Found)
in)mitochondria.))
The)final)enzyme)in)the)chain)is)cytochrome)c)oxidase,)
which)transfers)H+)to)H2O.)
It)consists)of)2)Fe,)3)Cu)&)has)13)subunits.)
E)
Extrudes)3)Na)from)cell,)takes)2)K+)into)cell)for)each)
molecule)of)ATP)hydrolysed)(coupling)ratio)3:2).)It)is)an)
electrogenic)pump.)
Activity)is)inhibited)by)ouabain)&)related)digitalis)
glycosides)used)in)tx)heart)failure.)
)
BP12)[Feb12])Which)of)the)following)is)not)true)regarding) A.)True)Rough)ER)is)involved)in)protein)synthesis)
intracellular)organelles:) D.)False)Anucleate)cells)include)RBCs,)platelets,)outer)
A.)The)Endoplasmic)reticulum)is)involved)in) layer)of)epidermis.)
protein)synthesis) )
B.)The)Golgi)apparatus)..?..) )
C.)..Maybe#an#option#about#gene#transcription..?..)
D.)All)cells)contain)a)nucleus)
E.)..something#true#about#peroxisome?)
)
)
)
More)on)histamine:)
H1)receptor:)
% postsynaptic)Gp,)increase)PLC)→)PIP2)→)IP3)&)DAG)→)activating)protein)kinase)&)calcium)dep)kinase)
% constriction)of)smooth)muscle)in)airway,)GIT,)coronary)artery)musculature)
% In)peripheral)arterioles)&)precapillary)sphincters)contraction)only)in)endothelium)→)increased)permeability,)releases)
NO)&)prostacyclin)(PGI2))→)vasodilation)&)↓SVR)
% oedema)&)urticaria)
% factor)in)pain,)pruritis,)sneezing)
% hypotension,)tachycardia,)flushing,)headache)
H2:)
E. as)per)above)question)
F. Cimetidine)&)ranitidine)are)competitive)blockers)of)H2)receptor)
H3)receptor:)
% presynaptic)Gi)coupled)
% inhibit)synthesis)&)release)of)histamine)
% predominantly)in)CNS)

11"
 BLOOD)AND)IMMUNOLOGY)MCQS)
)
BL01)[Mar96]) E)
Which)of)the)following)decrease)platelet) Lange)Basic)&)Clinical)Pharmacology)online:)
aggregation)&)cause)vasodilatation?) Prostacyclin)(PGI2,)epoprostenol))is)syntheized)mainly)by)the)vascular)
A.)PGE2) endothelium)and)is)a)powerful)vasodilator)and)inhibitor)of)platelet)
B.)PGF2alpha) aggregation.)It)is)used)clinically)to)treat)pulmonary)hypertension)and)
C.)TBXA2) portopulmonary)hypertension.)
D.)PGD2)
E.)PGI2)

BL01b)Which)is)associated)with)inhibition)of) A)
platelet)aggregation?) Thromboxane)A2)(from)PLA2)action)on)platelets))lowers)platelet)cAMP)%)
A.)Prostaglandin)I) initiates)release)reaction)&)promotes)vasoconstriction)&))platelet)
B.)Prostaglandin)E) aggregation.))
C.)Prostaglandin)F) Fibrinogen,)thrombospondin)&)vWF)promote)platelet)adhesion)&)
D.)?) aggregation)

BL02)[Mar96])[Jul99])[Apr01])[Jul02])[Feb08]) A)
Which)ONE)of)the)following)causes) Respiratory)smooth)muscles)is)relaxed)by)PGE2)and)PGI2)and)
bronchodilatation?) contracted)by)PGD2,)TXA2)and)PGF2alpha)
A.)PGE2) )
B.)PGF2)alpha) Leukotrienes)(LTC4,)LTD4)etc))are)potent)bronchoconstrictors)&)are)
C.)TBXA2) recognized)as)the)primary)components)of)the)slow%reacting)substance)
D.)LTB4) of)anaphylaxis,)asthma.)
E.)LTD4) )

BL03)[Jul97])[Apr01])In)a)patient)receiving)24) C)
units)of)blood)over)2)hours,)the)complication) Massive)transfusions)complications:))
most)likely)to)be)seen)would)be:) % citrate)toxicity)and)hypocalcaemia)
A.)Hypercalcaemia)
% hyperkalaemia)
B.)Increased)oxygen)uptake)in)the)lungs)
C.)Coagulopathy)
% acidosis)
D.)Hypokalaemia) % hypothermia)
% 2,3%DPG)deficiency)&)reduced)tissue)oxygenation)
% dilutional)coagulopathy)
% microaggregates)
% APO)
% Infection,)sepsis,)TRALI,)SIRS)
% Incompatibility)
% Vasoactive)reactions)

BL03b)[d])[Jul98])Problems)of)massive) B)
transfusion)most)commonly)include:) Hypocalcaemia)clinical)features)are)involuntary)muscle)tremors,)
A.)Metabolic)alkalosis) bradycardia)with)ST)segment)prolongation)and)prolonged)QT)interval.)
B.)Hyperkalaemia)
C.)Coagulopathy)due)to)hypocalcaemia)
D.)?)

12"
BL03c)[Jul99])[Apr01])The)effect)which)is) C)
LEAST)likely)to)occur)shortly)after)transfusion) As)stored)blood)pregressively)becomes)acidotic)with)a)pH)of)6.5%6.8)
of)25U)of)whole)blood:) after)2)weeks)of)storage,)massive)blood)transfusion)can)aggravate)any)
A.)Hypocalcaemia) acidosis)already)present)in)the)recipient.)The)citrate)is)metabolized)to)
B.)Dilutional)coagulopathy) bicarbonate)in)the)liver)a)few)minutes)after)transfusion.)
C.)Metabolic)alkalosis)
D.)Increased)affinity)of)Hb)for)O2)
E.)Hyperkalaemia)

BL04)[Jul97])Which)immunoglobulin)(?MW) A)
69,000))would)exist)as)a)monomer)in)tears,) )
saliva)&)mucus)(?secretions)?) IgA)has)a)MW)of)170,000,)half)life)5%6)days.)Heavy)chain)is)an)alpha.)
A.)IgA) It)is)present)as)a)secretory)IgA)(dimeric)form))in)saliva,)tears,)breast)
B.)IgG) milk,)bronchial)fluids)and)GI)secretions.))
C.)IgM)
D.)IgE)
E.)IgD)

BL05)[Jul97])[Jul01])[Feb04])Erythropoietin)is)a) D)
glycoprotein)which:) Enhances)erythropoiesis)by)increasing)rate)of)differentiation)of)the)
A.)Stimulates)red)and)white)cell)production) stem)cell.)
B.)Is)broken)down)in)the)kidney) Erythropoeitin)is)produced)in)the)peritubular)complex)of)the)kidney)
C.)Has)a)half)life)of)days) (90%))and)liver)(10%).)T1/2)~5hrs)
D.)Levels)inversely)proportional)to) EPO)is)a)single%chain)glycoprotein)containing)2)intrachain)disulfide)
haematocrit) bridges.)
E.)Polypeptide)B)glycoprotein)
BL05b)[Mar99])Erythropoietin:) C)–)possibly)D)(if)hours))
A.)Red)cell)maturation)24)to)72)hours) A)=)2%3)days)
B.)Inactivated)by)Kupffer)cells) B)=)no)
C.)Metabolised)in)liver) D)=)half)life)is)5)hours)
D.)Half%life)is)5)?mins/hours)

BL06)[Jul97])Phagocytic)cells:) A)
A.)Capture)bacteria)in)the)blood) Phagocytic)cells)include)monocytes,)macrophages)and)neutrophils.)
B.)?) Phagocytosis)is)engulfing)and)digesting)cellular)debris)and)pathogens)in)
innate)immunity.)

BL07)[Jul97])[Jul99])[Feb00])[Apr01]) E)
Antithrombin)III)affects)(?inactivates))which) Antithrombin)III)inhibits)the)active)forms)of)II,)IX,)X,)XI)
coagulation)factor?)
A.)XIIa)(?XIa))
B.)Xa)
C.)IIa)
D.)IXa)
E.)All)of)the)above)

13"
BL08)[Mar98])Vitamin)K)(?neutralizes):) A)
A.)Factor)5) Proteins)C)and)S)are)vitamin)K%dependent)serine)proteases.)
B.)Heparin) Protein)C)destroys)factor)V)and)VIII,)whilst)protein)S)enhances)protein)C)
C.)Antithrombin)3) by)binding)it)to)the)platelet)surface.)
D.)Plasminogen) )
Vitamin)K)confers)biologic)activity)upon)prothrombin)and)factors)VII,)IX)
and)X)by)participating)in)postribosomal)modification)

BL09)[Mar98])[Jul98])[Mar99])[Jul01])[Mar03]) A))))[Stoelting])
[Jul04])Desmopressin:) Desmopressin)(DDAVP))is)a)synthetic)analogue)of)AVP)with)an)intense)
A.)Increases)factor)8)levels/activity) antidiuretic)(V2))effect)&)decreased)pressor)(V1))effect.))
B.)Anti%heparin)effect) Through)its)V2)effects,)it)also)causes)endothelial)cells)to)release)von)
C.)Has)pressor)activity) Willebrand)Factor,)tissue%type)plasminogen)activator,)and)
D.)?) prostaglandins.))
It)is)used)in)diabetes)insipidus)and)haemostasis)

BL10)[Mar98])[Mar02]) D)
Post%translational)modification)occurs)with:) Vitamin)K)is)responsible)for)post%translational)modification)of:)
A.)Factor)V) G. Some)clotting)factors)(factors)II,)VII,)IX,)X,)protein)C)and)protein)S))
B.)Von)Willebrand)factor) H. some)bone)proteins)(eg)osteocalcin))
C.)Factor)XII) Translation)is)the)formation)of)a)protein)after)decoding)the)mRNA)and)
D.)Protein)C) occurs)outside)the)nucleus.)Post%translational)modification)is)the)
E.)?) alteration)of)existing)amino)acid)residues)in)a)protein,)and)includes)
(Mar)2002)version)of)stem:)Vitamin)K) phosphorylation,)glycosylation,)acetylation.))
dependent)factors)are:))

BL11)[])[Mar98])[Jul98])[Jul99])[Jul00]) B)
Post%translational)modification:) This)modification)places)a)second)carboxyl)group)on)certain)glutamine)
A.)Removal)of)introns) residues)in)these)proteins)to)produce)gamma%carboxyglutamyl)
B.)Modification)of)amino)acid)residues)in) residues.)The)presence)of)2)carboxyl)groups)produces)2)negative)
proteins) charges)and)is)needed)for)chelation)with)the)divalent)Ca++.)Without)
C.)Self%splicing) this)change,)the)precursor)proteins)produced)in)the)liver)are)inactive)in)
D.)tRNA)involved) coagulation.)

14"
BL12)[Mar98])[Feb04])
Haemoglobin)breakdown:)
A.)Fe)is)excreted)by)the)kidney)
B.)Haem)is)broken)down)to)biliverdin)
C.)Haem)is)converted)to)bilirubin)and)
transported)to)liver)bound)to)albumin)
D.)?)
)
B)(+/%)C))
The)protoporphyrin)ring)is)opened)to)form)biliverdin.)A)small)fraction)of)
protoporphyrin)is)converted)to)CO.)Biliverdin)is)metabolised)to)
bilirubin,)which)is)bound)to)albumin)and)carried)to)the)liver.)In)the)liver,)
bilirubin)is)conjugated)with)glucuronic)acid)&)excreted)in)bile.))

)
BL13)[Jul98]) A)
Platelet)activation)will)NOT)occur)without:) There)is)a)LOT)of)debate)in)MCQ)website)about)this.)
A.)Ca+2) B)%)wrong)as)can)be)induced)by)collagen,)soluble)agonists)&)cell)contact)
B.)Vessel)wall)damage) C,)E)%)not)necessary)for)activation)
C.)Von)Willebrand)factor) D)%)I)think)this)comes)later)
D.)Fibrinogen)
E.))?Serotonin)?Factor)VIII)

BL14)[Mar99])[Feb00])[Jul01]) C)
Glycoprotein)CD4)is)expressed)on:)
A.)Cytotoxic)T)cells)
B.)Suppressor)T)cells)
C.)Helper)T)cells)
D.)Plasma)cells)

15"
BL15)[Mar99])[Jul99])[Jul02]) C)+/%)D)
Immunoglobulin)G)(IgG))has:) All)immunoglobulins)are)composed)of)2)identical)light)chains)and)2)
A.)4)heavy)chains) identical)heavy)chains.)Each)light)and)heavy)chain)has)a)constant)
B.)4)light)chains) portion)and)a)variable)portion.)
C.)2)heavy)&)2)light)chains)
D.)Variable)heavy)&)light)chains)
E.)None)of)the)above)

Jul99)version:)Immunoglobulin)(?antigen) A)
specificity)is)determined)by:))
A.)Variable)heavy)&)light)chain)
B.)Constant)heavy)&)variable)light)chain)
C.)Constant)light)&)variable)heavy)chains)
D.)Constant)both)chains)

BL16)[Jul99]) B)
Platelet)activation)requires:) )
A.)Vessel)wall)damage) (same)question)as)13))
B.)Ca++)
C.)Cyclooxygenase)
D.)vonWillebrand)factor)
E.)Prostaglandins)

BL17)[Jul99])[Apr01]) A)
Cytokines)are:) Cytokines)are)low)molecular)weight)proteins)(polypeptides))that)act)as)
A.)Low)molecular)weight)proteins) signaling)molecules.)They)can)be)produced)by)many)different)body)cells)
B.)Enzymes) and)not)just)by)cells)of)the)immune)system.)Examples)include)
C.)Autacoids) interleukins,)interferons,)chemokines,)haemopoietic)colony)stimulating)
D.)Immunoglobulins) factors,)tumour)necrosis)factor.)
E.)Interleukins)

BL18)[Jul99])[Mar02])[Mar03])[Jul03]) )
Which)of)the)following)statements)about)FFP) D,)E,)F,)G)
is)NOT)true?) FFP)is)prepared)from)fresh)blood)and)frozen)rapidly)to)be)stored)at)%
A.)Must)be)group)specific) 30C.)It)is)used)for)the)replacement)of)coagulation)factors)(not)platelets)
B.)Does)not)need)to)be)cross)matched) though).)Factors)V)and)VIII)deplete)most)rapidly)and)FFP)may)be)
C.)Contains)all)clotting)factors)except)for) relatively)deficient.)
platelets) Must)be)group)specific)or)antibodies)in)plasma)will)cross)react)with)
D.)Contains)clotting)factors)except)deficient)in) RBC,)but)cross)matching)is)not)required.))
factors)V)and)VIII)
E.)Is)not)useful)in)treating)?protein)C)
deficiency/)coagulopathy)
F.)Does)not)contain)albumin)
G.)Does)not)contain)anticoagulant)
H.)Contains)an)anti%thrombotic)protein)

16"
BL19)[Feb00])[Mar03])[Jul03])
Complement)activation)requires)
A.)Antigen)antibody)complex)
B.)Opsonisation)of)bacteria)
C.)Helper)T)cells)
D.)Previous)exposure)to)antigen)
E.)Plasma)proteins)
BL20)[Jul00])
Tissue)Bound)Macrophages:)
A:)Derived)from)megakaryocytes)
B:)Not)found)in)the)lung)&)liver)
C:)Stimulated)by)lymphokines)
D:)Digest)bacteria)using)lymphokines)
E:)?)
Also)recalled)as:)Fixed)macrophages)in)lungs)&)
liver:)
A.)Originate)in)the)bone)marrow)and)migrate)
to)their)site)of)action)as)megakaryocytes)
B.)Kill)bacteria)in)phagosomes)by)lymphokines)
C.)Are)activated)by)cytokines)secreted)by)
activated)T)cells)
D.)Part)of)humoral)immunity)
BL21)[Jul00])
HLA)antigens)are)found)on:)
A.)All)leucocytes)
B.)B)cells)
C.)T)cells)
D.)All)nucleated)cells)
BL21b)HLA)is)expressed)on:)
A.)Antigen)presenting)cells)
B.)T%cells)
C.)B%cells)
D.)Red)cells)
E.)All)nucleated)cells)
)
BL22)[Apr01])
For)a)T)cell)to)react)to)(?recognise))a)foreign)
antigen:)
A.)Opsonisation)
B.)The)antigen)presenting)cell)presents)
antigen)
C.)Needs)T)helper)cells)
D.)Prior)exposure)to)Antigen)required)
A)
The)whole)complement)cascade)is)controlled)by)several)other)proteins)
(eg)C1)esterase)inhibitor))which)minimise)the)risk)of)runaway)activation)
of)the)active)components.)
Classical)pathway)activated)by)antigen%antibody)complexes.)Alternative)
pathway)can)be)activated)by)lipopolysaccharides)&)doesn’t)require)
previous)exposure.))
[Brandis)p204%5])
C)
Platelets)are)derived)from)megakaryocytes.)
Macrophages)are)definately)found)in)lung)and)liver.)
Lymphokines)are)cytokines)that)are)produced)by)lymphocytes)&)are)
used)in)cell)signalling)and)activation.)[Brandis)p193])
C)
Form)part)of)innate)immunity)(not)humoral).)
Killing)of)bacteria)by)reactive)oxgyen)species,)NO)production)by)iNOS,)
lysozymes)etc,)hydrolytic)enzymes)
D)
MHC)molecules)are)proteins)required)for)antigen)recognition)by)T)
lymphocytes.)In)humans,)they)are)known)as)HLA.))
Class)I)HLA)molecules)are)present)on)all)nucleated)cells.)Class)II)HLA)
molecules)are)expressed)by)cells)stimulated)by)interferon%gamma)&)
present)processed)foreign)antigen)to)helper)T)cells)
)
E)
B)
Exogenous)antigen)is)taken)up)by)an)antigen%presenting)cell)by)
phagocytosis)and)hydrolysed)into)peptides)which)bind)to)class)II)HLA)
molecules.)After)exocytosis)the)peptides)are)expressed)on)the)cell)
surface)&)are)presented)to)helper)T)cells)
17"
Alt)version:) B)
Antigen)binding)to)T)lymphocytes)requires)
A.)Previous)exposure)
B.)Presentation)of)antigen)by)“Antigen)
presenting)cells”)
C.)Active)T)helper)cells)
D.)
E.)None)of)the)above)

BL23)[Apr01]) E)
Thrombin)inhibits) Thrombin)cleaves)fibrinogen)to)fibrin)to)form)a)clot)and)activates)many)
A.)factor)Xa) upstream)clotting)factors)leading)to)more)thrombin)generation,)and)
B.)tPA) activates)factor)XIII.)
C.)protein)C) It)is)a)potent)platelet)activator)&)mitogen.)
D.)platelets) Thrombin)(factor)IIa))exerts)ANTIcoagulant)effects)by)activating)the)
E.)none)of)the)above) protein)C)pathway)

BL24)[Apr01])
Lymphocytes)
A.)Don’t)remain)in)the)lymph)system)
B.)Are)formed)in)the)bone)marrow)in)adults)
C.)Formed)from)neonatal)precursor)cells)
D.)Produced)by)tissues)derived)from)foetal)
bone)marrow)
E.)?)
)
)
A)and)(?B)via)lymphoid)stem)cells)")thymus))
Lymphocytes)enter)the)bloodstream)but)only)2%)are)in)the)peripheral)
blood,)the)rest)are)in)the)lymphoid)organs.))
After)birth,)some)lymphocytes)are)formed)in)the)bone)marrow,)
however)most)are)formed)in)the)lymph)nodes,)thymus)and)spleen.)They)
are)formed)from)precursor)cells)that)originally)came)from)the)bone)
marrow.)
))

BL25)[Jul01])[Jul04]) D)
Rejection)of)an)allograft)is)due)to:) E)–)describes)both)CD4+)helper)T)cells)binding)to)HLA)class)II)and)CD8+)
A.)Non)specific)immunity) cytotoxic)T)cells)binding)to)HLA)I)
B.)Supressor)T)cells) The)T)lymphocyte)system)is)responsible)for)the)rejection)of)
C.)Helper)T)cells) transplanted)tissue.))
D.)Cytotoxic)T)cells) Cytotoxic)T)cells)destroy)transplanted)and)other)foreign)cells,)under)
E.)HLA)cytotoxic)reaction) direction)of)T)helper)cells.)
T)cells)recognise)self)&)non)self)via)HLA)

18"
BL26)[Jul01])[Feb04])[Jul04]) C)
Haemoglobin)contains:) Haemoglobin)is)a)globular)molecule)made)up)of)4)subunits.)Each)
A.)One)protoporphorin)ring)and)4)ferrous)ions) subunit)contains)a)heme)moiety)conjugated)to)a)polypeptide.)Heme)is)
B.)Four)protoporphorin)ring)and)one)ferrous) an)iron%containing)porphyrin)derivative.)
ion)
C.)Four)protoporphorin)rings)and)four)ferrous)
ions)
D.)One)protoporphorin)ring)and)one)ferrous)
ion)
E.)None)of)the)above)

BL27)[Jul03])
Blood)viscosity:)
A.)Is)independent)of)the)white)cell)count)
B.)Falls)as)haematocrit)rises)
C.)Is)independent)of)vessel)diameter)
D.)Falls)as)flow)rate)rises)
E.)Is)independent)of)fibrinogen)concentration)
D)
Factors)affecting)blood)viscosity:)
% Hct)(↑)=)disproportionate)viscosity)↑))
% Temp)(↓)temp)=)↑)viscosity))
% Rate)of)flow)(low)flow)=)higher)viscosity))
% Vessel)diameter)(↓)diameter)=)↓)viscosity))
Assumable)WCC)and)fibrinogen)have)same)effect)as)increased)Hct)

BL28)[Feb04])
Comparing)thrombosis)to)normal)coagulation,)
which)of)the)following)is)NOT)true?)
A.)Thrombosis)is)always)pathological)
B.)Thrombosis)requires)venous)stasis)
C.)Thrombosis)does)not)involve)platelet)
activation)
B)(as)this)is)false))and)C)(it)does)involve)platelet)activation))
Formation)of)clots)inside)blood)vessels)is)called)thrombosis)to)
distinguish)it)from)the)normal)extravascular)clotting)of)blood.)They)are)
particularly)prone)to)occur)where)blood)flow)is)sluggish)because)this)
permits)activated)clotting)factors)to)accumulate)instead)of)being)
washed)away.)
Virchow’s)triad!)

BL29)[Jul04]) B)
Platelets:)
A.)Binding)to)endothelial)glycoprotein)requires)
hydrolysis)of)ATP)
B.)ADP)from)platelet)granules)causes)
aggregation)
BL30)Cross%matching)involves)comparing) B)–)cross)match)=)demonstration)in)vitro)of)serological)compatibility)
donor's) between)recipient’s)serum)and)donors)red)cells.)It)provides)99.95%)
A.)red)cells)with)recipient's)red)cells) safety)
B.)red)cells)with)recipient's)serum)
C.)serum)with)recipient's)red)cells)
D.)serum)with)recipient's)serum)
E.)whole)blood)with)recipient's)whole)
blood)

19"
 BL31)Feb12)Regarding)plasma)proteins:) C)is)most)correct)of)remembered)options..)
A.)Difference)between)total)protein) Ref)pg)531)Ganong)23rd)ed.)
and)albumin)concentration)is) A:)wrong)%)the)diffrence)is)made)up)of)globulin)and)fibrinogen,)globulin)
accounted)by)immunoglobulins) can)be)divided)into)a1,)a2,)b1,)b2)and)gamma.)Gamma)are)the)
B.)Low)albumin)is)always)associated) immunoglobulins)
with)liver)disease) B:)wrong)never)trust)an)answer)with)always)in)it)%)but)there)are)
C.)Most)are)in)anionic)form) obviously)other)causes)like)nephrotic)syndrome)
D.)?) Addit:)Albumin)is)also)an)acute)phase)protein,)so)should)decrease)with)
E.)?) any)systemic)inflammation.
)
BL32)[Feb12])Which)of)the)following)is)not) C)=)most)correct)answer,)D)=)possibility)
true)with)regards)to)hypersensitivity) Type)I)Immediate)%)IgE)/)Mast)Cell)mediated)(e.g.)asthma,)anaphylaxis))
reactions:)
A.)Type)I)hypersensitivity)is)mediated) Type)II)Antibody)mediated)(1))Opsonisation)(transfusion)reactions,)
by)IgE) erythoblastosis)foetalis))(2))Fc%receptor)mediated)(types)of)
B.)Type)I)hypersensitivity)does)not) glomulonephritis))(3))Antibody%mediated)cellular)dysfunction)
involve)complements) (myasthenia)gravis,)Graves)disease))
C.)Type)II)hypersensitivity)does)not) Type)III)Immune%Complex)Mediated)(deposition)of)IgG%antigen)
involve)IgM/IgG) complexes,)e.g.)serum)sickness))
D.)Always)involve)T)Cells)
E.)?) Type)IV)Cell)mediated)(1))Delayed)type)(2))T%cell)mediated)cytotoxicity)
)
BL33)[Feb12])What)changes)can)be)found)in) A)
stored)blood)at)Day)28?) Changes)=)small)amount)haemolysis,)loss)of)granulocytes)and)
A.)pH)less)than)7.0) lymphocytes,)platelets)become)non%functoinal)at)24%36)hrs,)factors)V)&)
B.)K)level)rises)to)10mM) VIII)decrease)(V)50%)at)14)days,)VIII)50%)by)24)hours),)other)factors)
C.)2,3)DPG)stays)constant) affected)after)>21)days,)reduced)2,3DPG)by)50%)at)D14)with)left)shift)
D.)Decreased)free)Hb) ODHC)(P50)15mmHg),)raised)K,)low)Na,)pH)decrease)to)as)low)as)6.7)
E.)Increased)glucose)concentration)
)
BL34)[Jul06])[Feb07])Bilirubin)metabolism:) A)
A.)Bilirubin)transferred)to)liver)bound)
to)albumen)
B.)is)only)produced)from)the)
breakdown)of)haemoglobin)
C.)is)produced)in)the)
reticuloendothelial)system)
D.)Liver)conjugates)bilirubin)and)
secretes)into)bloodstream)
E.)Stercobilinogen)is)excreted)in)the)
urine)
)
BL35)[Feb08])Plasmin)cleaves)all)the)following) C)–)plasmin)digests)fibrin)fibres)and)some)other)protein)coagulants)such)
except) as)fibrinogen,)Factor)V,)Factor)VIII,)prothrombin)[II])and)Factor)XII))(not)
A.)II) factor)VII))
B.)V)
C.)VII)
D.)VIII)
E.)XII)
)

20"
ENDOCRINE)AND)METABOLIC)MCQS)
ED01)[Mar96])[Mar97])[Jul99])Effects)of)a)
24)hour)fast:)
A.)Glycogenolysis)(?gluconeogenesis))
B.)Protein)catabolism)
C.)Acidosis)
D.)Ketone)production)from)protein)
E.)All)of)the)above)
A)
Phases)of)starvation:)
% Glucogenolytic)
I. First)12%48hrs)
J.Utilisation)of)stores)
% Glucoenogenic)
% From)day)1,)increases)over)several)days)then)declines)
% Synthesis)of)glucose)from)amino)acids,)glycerol)&)lactate)
% Ketogenic)
% Adaptation)to)using)ketones)instead)of)glucose)
% Synthesized)from)fatty)acids)by)liver)
21"
Alt)version:)After)24)hours)without)food) A)
or)water)a)healthy)young)adult)will:) As)above)
A. Deplete)glycogen)rapidly) )
B. Develop)a)metabolic)acidosis)
C. Demonstrate)ketone)body)formation)
in)the)liver)
D.)Have)decreased)protein)content)of)
body)
1.)Gastrointestinal)Phase)
The)six%hour)period)following)a)meal,)during)which)glucose,)amino)acids,)and)fat)are)absorbed)into)the)blood,)is)the)
gastrointestinal)phase.)The)hormone,)insulin,)is)released)from)the)pancreas)into)the)blood)in)response)to)glucose)and)
amino)acids)absorbed)into)the)blood)from)the)intestines.)Insulin)plays)the)major)role)in)this)phase)and)causes)the)liver)
and)muscle)to)take)the)blood)glucose)into)the)cells)and)store)it)as)glycogen.)Insulin)also)allows)all)the)other)tissues)of)the)
body)to)take)up)glucose)to)be)used)as)energy.)
)
In)muscle)cells,)insulin)causes)amino)acids)to)be)taken)up)from)the)blood)to)replace)the)contractile)protein)broken)down)
and)used)as)fuel)since)the)previous)meal.)Proteins)in)the)form)of)enzymes)in)other)tissues)are)also)replaced)in)this)way.)
Excess)glucose)is)converted)into)fatty)acids)by)the)liver)and)adipose)tissue.)
)
Those)fatty)acids)formed)in)the)liver)are)transported)to)the)adipose)tissue)via)the)blood)stream)where)they)are)stored)as)
fat)along)with)the)fatty)acids)produced)in)the)adipose)tissue.)Fat)is)absorbed)from)the)intestines)into)the)surrounding)
lymphatics)which)run)together)to)form)a)common)lymphatic)duct)called)the)thoracic)duct)which)dumps)the)contents)into)
the)venous)blood)system)at)a)point)in)the)neck.)This)fat)is)then)taken)up)from)the)blood)and)stored)in)adipose)tissue.)The)
uptake)and)storage)of)all)these)nutrients)into)the)cells)is)due)to)the)influence)of)elevated)insulin)levels)in)the)blood.)
)
2.)Glycogenolysis)
The)period)following)the)gastrointesting)phase,)which)continues)for)the)next)two)days,)is)the)glycogenolysis)phase,)during)
which)time)the)liver)and)muscle,)under)the)influence)of)decreased)insulin)and)increased)glucogen)(a)second)hormone)
released)by)the)pancreas),)break)down)their)glycogen)to)glucose.)Glucose)from)the)liver)is)used)mainly)by)the)brain,)
which)can)use)only)glucose)for)energy)at)this)stage.)(Red)blood)cells)and)the)adrenal)glands)also)can)only)use)glucose,)but)
they)require)much)less)than)the)central)nervous)system.))The)liver)glycogen)supply)of)glucose)lasts)about)twelve)hours.)
Muscle)glycogen)produces)glucose)for)consumption)by)muscle.)This)supply)may)last)twelve)to)twenty%four)hours)
depending)on)activity.)With)decreased)insulin)levels,)fat)is)broken)down)by)the)adipose)tissue)into)fatty)acids)which)are)
released)into)the)blood)and)used)as)fuel)by)liver)and)muscle)cells.)After)eight)to)ten)hours)one%half)of)muscle)fuel)is)from)
fatty)acids.)
)
3.)Gluconeogenesis)
Although)it)begins)a)few)hours)after)the)last)meal,)in)two)days)gluconeogenesis,)the)process)of)converting)amino)acids)
into)glucose,)becomes)the)major)source)of)glucose)for)the)brain.)Non%essential)proteins)found)in)muscle)and)digestive)
enzymes)are)broken)down)into)their)individual)amino)acids)which)are)then)transported)to)the)liver.)The)liver)converts)
amino)acids)into)glucose)and)urea.)Urea)is)excreted)by)the)kidneys,)and)the)glucose)is)used)mainly)by)the)brain)for)
energy.)After)two)weeks)of)fasting,)the)kidney)gradually)takes)on)the)majority)of)gluconeogenesis.)
)
4.)Ketosis)
By)the)third)day,)ketosis)becomes)significant)and)increases)up)to)the)second)week)of)fasting.)Due)to)the)low)insulin)levels)
and)increase)release)of)fatty)acids)from)adipose)tissue,)the)liver,)under)the)influence)of)high)levels)of)fatty)acids,)begins)
converting)them)to)ketones)to)be)used)by)muscle)and)brain)for)energy.)As)the)concentration)of)ketones)increases)in)the)
blood)during)the)first)two)weeks)of)fasting,)more)is)able)to)cross)the)blood)brain)barrier)and)supply)fuel)to)the)brain.)In)
this)way,)the)brain)can)use)less)glucose,)and)therefore,)the)demand)for)gluconeogenesis)and)breakdown)of)protein)
becomes)less.)
)
Protein)consumption)
The)consumption)of)protein)decreases)from)75)grams)per)day)in)the)first)week)to)20)grams)per)day)by)the)end)of)the)
second)week.)Muscle)tends)to)use)mainly)fatty)acid)and)saves)the)ketones)for)use)by)the)brain.)It)should)be)noted)that)
protein)is)still)a)required)source)of)energy.)

22"
ED02)[Mar96])Which)hormone)causes)
increased)BSL,)increased)protein)
anabolism)&)increased)plasma)FFA?)
A.)Cortisol)
B.)Parathyroid)hormone)
C.)Growth)hormone)
D.)Insulin)
ED03)[Mar96])Which)hormone)causes)
increased)BSL,)increased)protein)
catabolism)&)increased)plasma)FFA?)
A.)Cortisol)
B.)Parathyroid)hormone)
C.)Growth)hormone)
D.)Insulin)
ED04)[Mar96])Which)of)the)following)are)
associated)with)adrenocortical)
hypofunction?)
A.)Aseptic)necrosis)of)bone)
B.)Osteoporosis)
C.)Redistribution)of)body)fat)
D.)Decreased)muscle)bulk)
E.)Delayed)closure)of)epiphyses)
ED05)[Mar96])[Jul97])[Mar98])[Jul01])
[Jul04])The)hypothalamus)inhibits)the)
release)of:)
A.)TSH)
B.)ACTH)
C.)FSH)
D.)GH)
E.)Oxytocin)
ED06)[Mar97])[Jul00])[Jul01])[Mar03])
[Jul03])Secretion)of)renin)is)stimulated)
by:)
A.)Increased)left)atrial)pressure)
B.)Increased)angiotensin)II)
C.)Decreased)right)atrial)pressure)
D.)??erythropoietin)
Alt)version:)Which)decreases)renin)
release:)
A.)PG)
B.)Angiotensin)II)
C.)Vasopressin)
D.)Baroceptor)stimulation)
E.)ANP)
F.)Increased)right)atrial)pressure)
C)
% Parathyroid)hormone)%)no)real)role)in)glucose)metabolism,)regulates)calcium)&)
phosphate)
% Growth)hormone:)inhibits)glucose)uptake)by)muscle,)increased)release)from)
liver,)protein)synthesis,)lipolysis)
% Insulin)is)anabolic:)decreased)BGL))
[Faunce/Brandis])
A)
% Cortisol:)catabolic,)increase)BGL,)inhibits)utilisation)of)glucose,)favours)fat)
utilisation)and)amino)acid)release)(ie)catabolism)of)proteins,)not)anabolism)of)
proteins))
D)
Adrenocortical)hormones:)aldosterone,)cortisol,)sex)hormones.)
% Osteonecrosis)from)ischaemia/fracture,)more)likely)following)corticosteriod)
adminsitration)
% Osteoporosis)from)adrenocorticoid)excess)or)oestrogen)deficiency)
% C)%)cushinoid)appearance)
% Delay)epiphyseal)closure)from)decreased)GH)and)IGF%1)
[Ganong])
D)–)via)somatostatin)
Releasing)factors/hormones)from)hypothalamus:)
% TRF)for)TSH)(releasing))
% Gonadotrophin%releasing)factor)for)LH)&)FSH)
% Somatotrophin%releasing)factor)from)GH)
% Somatostatin)for)INHIBITION)of)GH,)ACTH,)TSH)and)PRL,)insulin)&)glucagon)
% Corticotrophin%releasing)factor)for)ACTH)
[Power)&)Kam)p328])
C)
Renin)secretion)stimulated)by:)
% sympathetic)nerve,)direct)B1)effect)
% Fall)in)GFR)(less)NaCl)past)macula)densa))
% Baroreceptor)reflexes)(detect)low)systemic)cardiovascular)pressures))
% Directly)inhibited)by)angiotensin)II)
[Power)&)Kam)p239])
B)directly,)also)C/D/E/F)indirectly)
All)except)A)will)decrease)renin)release)(mostly)indirectly)via)actions)on)
baroreceptors))
)
Julie’s)comments:)Maybe)wording)was)“which)does)not)decrease)renin)
release”???)
I)wouldn’t)say)that)B)is)best…)all)except)A)are)correct.)
)
23"
ED07)[Mar97])[Apr01])Regarding)
hyperglycaemia:)Which)of)the)following)
is)untrue?)It)causes:)
+
A.)Increased)H )
B.)Increased)Na+)(?K+))
C.)Increased)urine)output)
D.)Increased)ECF)(or)blood)volume))
E.)Increased)glucagon)
ED08)[Jul97])[Mar99])[Feb00])[Apr01])
[Feb04])Mechanism)of)action)of)ADH:)
A.)Insertion)of)water)channels)(pores))
into)basolateral)membrane)
B.)Increase)in)GFR)
C.)Insertion)of)water)channels)into)
luminal)(apical))membrane)
C.)Increased)Na+)uptake)in)DCT)
D.)Removal)of)water)pores)from)apical)
membrane)
Alt)version:)ADH)and)the)cortical)
collecting)ducts)
A.)Inserts)water)channels)into)the)apical)
membrane)
B.)Inserts)water)channels)into)the)
basolateral)membrane)
C.)Increases)paracellular)flow)
ED09)[Jul97])How)many)hours)after)a)
meal)is)Basal)Metabolic)Rate)(BMR))
measured?)
A.)1)hour)
B.)2)hours)
C.)6)hours)
D.)12)hours)
E.)18)hours)
(Note:)Another)response)gave)4,)8,)12,)15)
&)20)hrs)as)the)options))
ED10)[Jul97])[Feb00])Which)ONE)of)the)
following)is)a)water)soluble)vitamin?)
A.)Vitamin)A)
B.)Vitamin)B)
C.)Vitamin)D)
D.)Vitamin)E)
E.)Vitamin)K)
ED11)[Jul97])[Jul99])[Apr01])Insulin)(?)OR:)
Insulin)receptor):)
A.)Receptor)site)intracellular)
B.)Inactivates)tyrosine)kinase)
C.)Activates)membrane)glucose)transport)
D.)Acts)via)activation)of)transport)protein)
to)increase)glucose)transport)into)cells)
E)
Hyperglycaemia)causes:)
% glucosuria)(osmotic)diuresis))
% ECF)volume)depletion)&)dehydration)
% deficiency)in)whole)body)K+,)PO4)&)Mg)
% Promotes)intracellular)acidosis)
% Glucagon)will)increase)if)is)diabetic)ketoacidosis,)but)decreased)generally)in)
response)to)hyperglycaemic)
% [Faunce)p161])
)
Julie’s)comments:)With)hyperglycaemia)you)get)cell)dehydration)because)
glucose)doesn’t)diffuse)easily)through)cell)membranes.)The)increased)osmotic)
pressure)in)the)ECF)causes)water)to)come)out)of)cells.)See)Guyton)page)973.)
C)
Effects#of#ADH#
V1A)%)vasoconstricter)effect)of)vasopressin)
V1B)%)unique)to)anterior)pituitary,)mediate)increased)ACTH)secretion)from)
corticotropes)
V2)receptors)activated)→)2nd)messenger)cascade)→)protein)water)channels)
(aquaporins))moved)out)of)endosomes)and)inserted)into)apical)(luminal))
membrane)of)principal)cells)of)collecting)ducts)→)↑)permeability)of)collecting)
ducts)of)the)kidney)to)water)→)water)enters)hypertonic)interstitium)of)renal)
pyramids)→)decreased)urine)volume,)decreased)osmotic)pressure)of)body)
fluids.)
[Ganong])
A)
D)
Basal)metabolic)rate)is)measured)at)rest,)in)the)horizontal)position,)at)ambient)
temp,)12%14)hours)after)last)meal)and)is)related)to)body)surface)area.))
[Faunce)p)146])
B)
Vitamins)B)complex,)folate,)and)C)are)water)soluble.)
Vit)ADEK)are)fat)soluble.)
)
[Faunce)p146%7])
D)
Insulin)combines)with)its)specific)membrane)bound)receptor)&)causes)different)
effects)in)different)cells:)
% Increased)activity)of)specific)glucose)transporter)in)the)membrane)
% Activation)of)tyrosine)kinase)on)B)subunit)of)receptor)
[Brandis)p)171])
24"
ED11b)[Mar02])[Jul02])How)does)insulin) B)
act?)
A.)Voltage)gated)ion)channels)
B.)Tyrosine)kinase)membrane)receptor)
C.)Nuclear)receptor)
D.)G)protein)
E.)?)
EM12]])[Jul97])[Jul01])Heat)production)at) A)
rest)is)mostly)due)to:) Heat)production)by:)
A.)Skeletal)muscle)activity) % basic)metabolic)processes)
B.)Na%K)ATPase)pump) % Food)intake)(specific)dynamic)action))
C.)Dynamic)action)of)food)
% muscular)activity)
D.)?)
Even)under)resting)conditions,)skeletal)muscle)accounts)for)20%30%)of)BMR)and)
heat)production.))
ED12b)[Feb00])[Mar02]) A)
Decreased)heat)production)under) The)only)thermoregulatory)responses)available)to)anaesthetized,)paralysed)and)
general)anaesthesia)is)due)to:) hypothermic)patients)are)vasoconstriction)and)non%shivering)thermogenesis.)
A.)Decreased)skeletal)muscle)tone) [Power)&)Kam)p376])
B.)Decreased)anterior)pituitary)function) )
C.)Vasodilatation)
D.)Starvation)
E.)Decreased)Na+/K+)ATPase)activity)
Mar)2002)version:) C))
Heat)loss)in)anaesthesia)due)to) Cutaneous)veins)provide)an)important)countercurrent)system)for)heat)
A.)Loss)Na/K)ATPase)(?)) conservation.)
B.)Loss)of)skeletal)muscle)tone) General)anaesthesia)increases)the)interthreshold)range)by)decreasing)the)
C.)Vasodilatation) thermoregulatory)threshold)to)cold)and)increasing)threshold)to)hot.))
D.)Respiratory)tract) The)core)temperature)at)which)thermoregulatory)threshold)triggers)peripheral)
E.)?) vasoconstriction)is)altered.))
EM13]])[Jul97])[Mar99])[Jul00]) A)
Angiotensinogen)secretion)is)increased) The)production)of)angiotensinogen)is)increased)by:)
by:) % corticosteroids)
A.)ACTH) % oestrogens)
B.)Beta%endorphin)
% thyroid)hormones)
C.)Growth)hormone)
D.)Antidiuretic)hormone) % angiotensin)II)
E.)Prolactin) % pregnancy)
% OCP)
[Ganong)online])
ED14)[Jul97])[Jul01])The)energy)value)of) B)
1g)of)carbohydrate)is:) )
A.)3)kcal) [Power)&)Kam)p)363])
B.)4)kcal)
C.)5)kcal)
D.)7)kcal)
E.)9)kcal)
ED15)[Mar98])[Jul01])Oxytocin)causes:) E)
A.)Decrease)in)systolic)blood)pressure) Oxytocin)causes:)
B.)Water)intoxication) % Milk)let)down)&)uterine)contraction)
C.)Increase)in)cardiac)output) % weak)antidiuretic)
D.)Increase)in)systolic)blood)pressure)
% weak)pressor)activity)(activation)of)vasopressin)receptors))
E.)All)of)the)above)
% Stimulates)release)of)prostaglandins)and)leukotrienes)
% Bolus)doses)can)cause)hypotension)
[Ganong)online])

25"
ED16)[Mar98])[Mar99])ADH)secretion:)
A.)Plasma)osmolality)at)osmoreceptors)in)
posterior)hypothalamus)
B.)Decreased)ECF)volume)
C.)?)
ED17)[Mar98])The)active)section)of)the)
G%Protein)is:)
(No)other)details))
ED18)[Jul98])[Jul99])[Apr01])[Jul02])G)
protein)coupled)receptors.)All)true)
EXCEPT:)
A.)Seven)transmembrane)components)
B.)Hydrophobic)links)
C.)Extracellular)portion)for)
phosphorylation)
D.)G)protein)has)intrinsic)GTPase)activity)
E.)The)receptor)is)a)heterotrimeric)
protein)
Jul)99)version:)G)proteins)include:)
A.)Multiple)external)phosphorylation)
sites)
B.)Alpha)subunit)has)GTPase)activity)
C.)
(Comment:)also)remembered)as)ATPase)
activity.)The)intrinsic)GTPase)activity)
resides)in)the)alpha)sub%unit.)The)G)
protein)is)the)heterotrimer)not)the)GPCR))
ED19)[Jul98])Regarding)the)
interthreshold)range)in)temperature)
control:)
A.)Is)constantly)altered)by)feedback)from)
temperature)sensors)in)the)periphery)
B.)Is)lowered)by)general)anaesthetic)
agents)
C.)?)
D.)
ED19b)[Jul98])The)set%point)of)
temperature)of)an)adult)is)normally)
37.1C.)This:)
A.)Is)fixed)in)individuals)
B.)?)
C.)Parallels)rectal)temperature)
D.)Decreases)with)exercise)
E.)Decreases)with)anaesthesia)
B)
% Strongest)stimulus)for)ADH)secretion)is)hyperosmolality)(osmoreceptor)cells)
closely)located)to)PVN)and)SON)promote)ADH)secretion,))ie)are)found)in)
anteroventral)third)ventricle,)in)ANTERIOR)hypothalamus))
% Release)of)ADH)is)from)posterior)pituitary)
% Hypovolaemia)can)override)this)(more)potent))
To)quote)Kam):)"G)Proteins)consist)of)α,)β,)and)γ)chains)and)bind)guanosine)
disphosphate.)Upon)receptor)stimulation,)the)α)unit)releases)GDP)in)favour)of)
GTP)and)dissociates)from)the)βγ.)The)active)α%GTP)complex)then)affects)ion)
channels)or)second)messengers.)G)proteins)are)inactivated)when)the)α)unit)
hydrolyses)GTP)to)GDP)and)rejoins)the)the)βγ)complex.")
C)and)E)
% G)proteins)are)nucleotide)regulatory)proteins)that)bind)guanosine)triphosphate)
(GTP))and)modulate)ion)channels)or)cellular)enzymes)
% large,)heterotrimeric)protein)(ie)consists)of)3)different)subunits,)alpha,)beta)and)
gamma))
% has)7)transmembrane)components)(this)is)the)serpentine)receptor)bit))
% each)segment)has)20%28)hydrophobic)AA)residues)
% intracellular)(cytoplasmic))phosphorylation)site)
[Ganong)online)and)Brandis)p181])
)
%)E)technically)isn’t)correct.)The)G)protein)is)heterotrimeric,)not)the)receptor!)
B)
A)–)the)threshold)temperatures)are)influenced)by)circadian)rhythms,)food)
intake,)thyroid)function,)drugs)and)thermal)adaption)to)warm)or)cold)ambient)
temperatures)
% over)a)wide)range)of)ambient)temperatures,)the)core)temperature)is)kept)
constant)within)0.4C)
% Expanded)interthreshold)range)
[Power)&)Kam)p373,)376])
)
C)
)
Circadian)fluctuations)in)temperature)
% Rectal)temp)different)to)core)temp)(but)may)“parallel”)it))
% Increases)with)exercise)due)to)muscle)heat)production)
)
The core temperature response is a triphasic relationship with an initial
rapid drop due to vasodilation and redistribution of heat from the core to
the peripheries (first 30 minutes), followed by a phase of temperature
loss at a slower rate (as the pt become poikilothermic and will assume
the temperature of his environment), and a final plateau phase at which
the thermoregulatory response to cold has been triggered and the
associated vasoconstriction and non-shivering thermogenesis (the only
responses available under GA) conserve/generate enough heat to equal
the ongoing heat loss (via conduction, radiation). This equilibrium occurs
after 3-4 hours.
26"
ED20)[Jul98])[Feb00])Decrease)in)set)
temperature)in)anaesthesia)due)to:)
A.)Decreased)Na+%K+)ATPase)activity)
B.)Decreased)skeletal)muscle)activity)
C.)Vasodilatation)
D.)Starvation)
ED21)[Jul98])[Mar99])[Apr01])
Endothelins:)
A.)Produced)by)damaged)vascular)
endothelium)
B.)Vasoactive)
C.)Found)in)brain)&)intestine)
D.)?)
ED22)[Jul98])[Feb04])Growth)hormone:)
A.)Increases)fatty)acid)production)
B.)Increases)glucose)output)form)the)liver)
C.)Causes)ketosis)
D.)Provides)a)source)of)energy)during)
hypoglycaemia)
E.)Increases)free)fatty)acids)
F.)all)of)the)above)
G.)Increase)glucose)output)from)liver)
H.)Increase)plasma)FFA)
I.)Can)act)as)an)energy)source)during)
starvation)
ED23)[Mar99])[Jul00])[Feb04])A)low)
respiratory)quotient)in)a)septic)patient)is)
due)to:)
A.)Increased)lactic)acid)
B.)Fat)metabolism)
C.)Increased)ventilation)
D.)Fever)
E.)Hypoxaemia)
Jul)2000)version:)Respiratory)exchange)
ratio)increased)in)septic)patient)because)
A.)Increased)C02)output)
B.)Increased)02)uptake)
C.)Increased)fat)utilisation)
D.)?)
(?)respiratory)quotient))
B)?)
General)anaesthesia)increases)the)interthreshold)range)by)decreasing)the)
thermoregulatory)threshold)to)cold)by)~2.5C...within)this)expanded)
interthreshold)range,)the)patients)are)poikilothermic)as)active)
thermoregulatory)responses)are)absent)so)that)body)temperature)changes)
passively)in)proportion)to)the)difference)between)metabolic)heat)production)
and)heat)lost)to)the)environment.)[Power)&)Kam)p376])
But)quite)a)lot)of)website)debate!)
)
Julie’s)comments:)None)correct)the)way)the)question)is)worded…)but)B)correct)
if)referring)to)increased)heat)loss)
B)(best),)C)and)A)also)correct)
% Endothelin)family:)potent)vasoconstrictor)peptides)(ET%1,)ET%2,)ET%3))
% Widely)distributed)in)the)body)
% ET%1))secreted)by)vascular)endothelium,)also)produced)by)neurons,)astrocytes,)
endometrial,)renal)mesangial,)breast,)others.))
% ET%2)found)in)kidneys)&)intestines)
% ET%2)highest)in)brain,)also)in)GIT,)lungs)
% Expression)is)increased)by)growth)factors)&)cytokines,)vasoactive)substances)
and)mechanical)stress)
% Inhibited)by)NO,)prostacyclin)&)ANP)
% Cause)dose%dependent)vasoconstriction)in)most)vascular)beds)
% Also)exert)direct)positive)inotropy)&)chronotropy)
)
Julie’s)comments:)A)is)correct)too…)
Guyton:)Plasma)endothelin)levels)are)increased)in)certain)disease)states)
associated)with)vascular)injury,)such)as)toxaemia)of)pregnancy,)acute)renal)
failure,)and)chronic)uraemia,)and)may)contribute)to)renal)vasoconstriction)and)
decreased)GFR)in)some)of)these)pathophysiologic)conditions)
All)
% Reduced)insulin)sensitivity)at)muscle,)mild)hyperglycaemia)
% increase)hepatic)glucose)output)
% Stimulates)longitudinal)bone)growth)until)epiphyses)close,)then)acromegaly)
% Anabolic)hormone)
% positive)nitrogen)and)phosphrus)balance))
% increase)in)lean)body)mass)
% decrease)in)body)fat)
% also)ketogenic)and)increases)circulating)free)fatty)acid)(for)energy)source))
% increased)metabolic)rate)
% fall)in)plasma)cholesterol)
B)
% In)metabolic)acidosis,)the)RER)increases)because)the)respiratory)compensation)
for)acidosis)causes)the)amount)of)CO2)expired)to)increase)(same)for)increased)
ventilation))
% Fat)metabolism)has)a))lower)RQ)(as)fat)utilised)in)trauma,)burns,)sepsis,)etc))
% Fever)increases)metabolic)rate,)CO2)production)and)RQ)
[Power)&)Kam)p365])
A)
See)above)
Respiratory)quotient)reflects)cellular)activity)and)in)practice)cannot)be)
measured.)Measurements)of)the)volume)of)CO2)expired)and)volume)of)O2)
consumed)via)the)respiratory)tract)is)termed)the)respiratory)exchange)ratio.)
Any)factor)that)alters)CO2)production)such)as)ventilation,)temperature)or)acid%
base)disturbances)will)affect)RER)measurement.)
[Power)&)Kam)p365])
27"
ED23b)[Mar03])[Jul03])Respiratory) B)
exchange)ratio:) % Usually)RER=RQ)but)if)subject)is)hyperventilating,)has)an)acid%base)disturbance)
A.)Always)equals)respiratory)quotient) or)is)performing)intense)exercise,)RER)include)CO2)produced)as)a)result)of)
B.)Increases)in)strenuous)exercise) buffering,)RQ)includes)only)CO2)produced)as)a)result)of)metabolism.)
C.)Decreases)after)payment)of)oxygen) % Increases)after)payment)of)O2)debt)
debt)
D.)Is)measured)at)steady)state)
E.)?)
ED24)[Feb00])Lactate) Both)wrong)
A.)The)way)products)of)glucose)enter)the) )
citric)acid)cycle) - AcetylCoa generated via pyruvate is the product of glucose that
B.)Formation)used)to)regenerate)NADP) enters the citric acid cycle.
C.)?) )
- Pyruvate + NADH = Lactate + NAD+ and H+ Ganong p275
Alt)verson:)Normal)blood)lactate)level)is)2) A)
mmol/l.)Where)does)this)come)from) Some)anaerobic)metabolism)(RBC,)embden%meyerhof)pathway))
A.)Even)in)resting)individuals)there)is) Acetyl%CoA)enters)the)citric)acid)cycle)
some)anaerobic)metabolism) The)Cori)cycle)converts)lactate)back)to)glucose)
B.)Lactate)is)the)substrate)that)is) [Power)&)Kam)p359])
produced)to)enter)the)citric)acid)cycle)
ED25)[Jul00])[Mar02])[Jul02])[Mar03]) B,)C)(A)true)if)means)all)phosphorylase),)E)
[Jul03])Phosphorylase:) % Many)different)sorts)of)phosphorylase)%)assume)talking)about)glycogen)
A.)Is)found)in)all)human)cells) formation)&)breakdown)
B.)Present)in)liver)&)muscle) % Phosphorylase)kinase)is)a)Calmodulin%dependent)kinasee)
C.)Increased)activity)by)adrenaline)
% Activation)of)phosphorylase)in)liver)by)catecholamines)
D.)In)liver)increases)glycogen)production)
and)reduce)breakdown)of)glycogen) % In)muscle,)the)phosphorylase)is)also)activated)via)cAMP)and)presumably)Ca2+)
E.)“Something)about)cAMP/adrenergic) (but)no)G6P)so)can’t)release)glucose)into)blood))
transmission”)
[[The)following)MCQ)fragment)has)also) B)
been)submitted)which)looks)like)this) )
question:) %)Glucagon)more)in)liver)phosphorylase)(MCQ)website))
During)starvation:)
A.)Glucagon)causes)increased)
phosphorylase)activity)in)liver/muscle)
B.)Adrenaline)causes)increased)
phosphorylase)activity)in)liver/muscle)
C.)?)
ED26)[Jul99])[Feb00])[Apr01])[Jul01]) C)
[Jul02])[Jul04])Creatine)phosphate:) % Creatine)phosphate)=)phosphorylcreatine)
A.)Is)a)source)of)creatinine)for)protein) % Phosphorylcreatine)is)hydrolyzed)to)creatine)and)phosphate)groups)with)the)
synthesis.) release)of)considerable)energy)(short)term)energy)store))
B.)Is)a)source)of)cyclic)AMP)for)second)
% ATP)replenished)
messenger)systems.)
C.)Is)a)high)energy)phosphate)source)for) % Stores)built)up)at)rest)
muscle)contraction.) % creatine)syntheized)in)the)liver)from)methionine,)glycine)&)arginine)%)
D.)Is)a)source)of)urea)for)loop)of)Henle) transported)to)cells)for)storage)
gradient) [MCQ)website])
E.)Energy)source)for)ADP)production.)
(This)was)Q)No.)54)on)the)Jul)01)paper))
Previous)versions)which)are)considered) C)
to)be)the)above)question)remembered)
differently):)
Creatine)phosphate)is)important)in:)
A.)Readily)usable)phosphate)for)muscle)
upon)intensive)exercise)
B.)Synthesis)of)urea)
C.)Supply)of)ATP)
D.)?)

28"
?Creatinine)?Creatine) C)
A.)?Phosphorylcreatine)is)synthesised)in)
the)liver)
B.)?Phosphorylcreatine)is)excreted)in)the)
urine)
C.)?During)exercise)phosphorylcreatine)
reacts)with)ADP)
D.)?)
E.)Rate)of)creatinine)
(?excretion/production))remains)
constant)throughout)life)
ED27)[Apr01])Metabolic)rate)is)increased) E)
least)with:) % Exercise)can)dramatically)increase)BMR)
A.)Exercise) % SDA)increases)metabolic)rate)up)to)30%)
B.)Specific)dynamic)action)of)food)
% Cold)climate)increase)BMR)10%)
C.)Hot)climate)
D.)Cold)climate) % Hot)climate)(depends)on)how)hot!))may)decrease)BMR)but)may)increase)overall)
E.)Increased)CNS)activity) metabolic)rate)if)sweating,)etc)
ED28)[Apr01])Glucocorticoids) A)
A.)Increases)RBC) % Variety)of)effects)on)haematological)system)
B.)Increases)lymphocytes) % mild)increase)in)number)of)RBC)
C.)?)
% Increased)number)of)platelets)and)neutrophils)
% Decrease)lymphocytes)&)eosinophils)
[Power)&)Kam)p344])
ED29)[Jul01])ADH)secretion)is)decreased) E)%)alcohol!)
by:) All)others)are)causes)of)increased)ADH)
A.)Morphine) )
B.)Nicotine) [Ganong])
C.)Nausea)(?and)vomiting)) )
D.)Hypoxia)(or:)ACTH)) Increased vasopressin:
E.)Alcohol)
- Increased effective plasma oncotic pressure
- Decreased extracellular fluid volume
- Pain, emotion, exercise
- Nausea and vomiting
- Standing
- Clofibrate, carbamazepine
- Angiotensin II

Decreased vasopressin:

- Decreased effective plasma osmotic pressure

ED30)[Mar03])[Jul03])Calcitriol:)Main)
actions)on)calcium)by)
A.)Increased)absorption)of)Ca++)and)PO4)
from)gut)
B.)Negative)feedback)on)PTH)
C.)Increased)absorption)of)vit)D)from)gut)
D.)Increased)parathormone)levels)
- Increased extracellular fluid volume
- Alcohol
A)
% Calcitriol)appears)to)act)on)the)intestine)both)by)induction)of)new)protein)
synthesis)(Ca++)binding)protein))&)modulation)of)Ca++)flux)across)brush)border)
% Actions:)regulation)of)PTH)secretion,)insulin)secretion,)cytokine)production)&)
others)
% Vit)is)transformed)from)cholesterole)
[Ganong)online])
)
Power)&)Kam)p341)%)acts)on)gut)to)increase)absorption)of)calcium)and)
phosphate)

29"
 ED31 Brown fat MCQ - recoded Both B and C appear to be correct.
as MF05 as its an old MCQ which has Metabolism of brown fat in the neonate is one form of non-shivering
re-surfaced thermogenesis. It is important as the neonate can sustain large heat
losses as a consequence of a high surface area:volume ratio (2-2.5 times
that of adults).
Brown fat: Brown fat is found in the axillae, near major blood vessels in the neck
A. Produces ATP and heat (not the "great vessels"; they are in the chest), in the mediastinum,
B. Insulates the great between the scapulae and in the perinephric tissue. It comprises about
vessels of the neck 11% of total body fat.
C. Is autonomically mediated
D. Extramitochondrial Cold ambient temperatures increase sympathetic activity and release of
uncoupling of oxidative noradrenaline in brown fat. Lipase activity is increased due to increase in
phosphorylation adenyl cyclase and protein kinase activity via β3receptor stimulation by
Brown fat: noradrenaline.
A. Metabolism leads to lots ! Triglycerides are hydrolysed to free fatty acids and glycerol which
of heat and ATP provides the substrate for mitochondrial oxidative phosphorylation. Some
production(?? ATP uncoupling of OxPhos occurs so that more heat is produced compared to
utilisation) other body cells, and presumably ATP is not produced (but I can't find a
B. Insulates great veins of specific ref for this). Oxygen is required. Thus option A is incorrect (ATP
neck against temperature is not produced). (P&K 363 Guyton 861)
(OR ?Insulates the ! D is also incorrect as the reaction requires mitochondia (brown fat has
thermoreceptors around great high mitochondria content).
vessels of the neck ) ! B is (partially) correct in describing the distribution of brown fat but is not
C. Metabolism is the best answer
autonomically mediated ! C correctly attributes the autonomic nervous system (in this case, the
D. Uncoupling oxidative sympathetic nervous system, β3-NorAdR) as being essential to the
phosphorylation outside process of heat production by brown fat metabolism.
mitochondria Regarding Option A: Hydrolysis of triglycerides to FFA and glycerol
doesn't involve ATP (either generation or consumption). The generation
) of heat in brown fat is by the usual Krebs cycle and generation of a
proton gradient across the mitochondrial membrane, but the big
difference is the presence of an "uncoupling protein" which uncouples the
Kreb's cycle and other intermediary metabolism from ATP generation by
providing an alternative pathway for the protons to re-enter the
mitochondrial matrix, other than via ATP synthase. Normally ATP has to
be consumed (eg shivering) in order for the Krebs cycle etc to progress,
but this is not the case in brown fat. However brown fat does still produce
ATP (mentioned in Ganong), but just less than you would expect given its
consumption of nutrients. So i guess option A is technically correct, but i
wouldn't consider it the single best answer
Regarding option B: Brown fat may be around the great vessels of the
neck, but i don't necessarily think there role is to insulate them as such,
but rather to transfer heat to them (as compared with white fat; given
their different morphology, they may actually not be very good
insulators?). I guess it's like comparing a heater to a blanket. So again,
probably not the single best answer
Regarding Option C: CORRECT. Brown fat has a dense sympathetic
innervation, so i think this IS the single best answer
Regarding Option D: INCORRECT. The uncoupling of oxidative
phosphorylation occurs in the wall of the mitochondria
ED32 [Jul06] Basal insulin secretion E)
in an otherwise healthy person
(70kg) :
A. 10 U/hr
B. 7 U/hr ?8
C. 5 U/hr ?6
D. 2 U/hr
E. 1 U/hr
I'm pretty sure the choices were 1 / 2 /
4 / 8 Units/Hr
I'm pretty sure they were 1/2/6/10
units/hr!
)

30"
FLUID)AND)ELECTROLYTES)MCQS)
FE01"[Mar96]"[Mar98]"[Jul98]"[Apr01]"
[Jul01]"[Mar03]"[Jul03]"[Mar05]"[Jul05]""
Effects"of"hypokalaemia:""
A."Short"PR"interval""
B."Ventricular"extrasystoles""
C."Elevated"ST"segments""
D."Long"QRS"interval""
E."Long"QT"interval""
F."Q"waves""
" • Prominent"U"waves"
FE01b"Jul98"version:"Hypokalaemia:""
A."Hyperpolarises"membrane""
B."Peaked"T"waves""
C."Prolonged"QT""
D."VEBs""
E."ST"elevation""
"
Alt"version:"Hypokalaemia:""
A."Hyperpolarizes"the"membrane""
B."Shortens"the"QRS""
C."Shortens"the"PR"interval""
D."Depresses"the"ST"segment""
E."Prolongs"the"QT"interval""
" potential energy at RMP (depolarized).
Alt"version:"Hypokalemia""
A."ST"segment"changes"(it"did"read"
“changes”)""
B."P"wave"flattening""
C."Shortened"QT""
D."No"Q"wave""
"
ANSWER:(
Feb01:(B((
Feb01b:(D(and(A(
Alt1:(A(and(D(
Alt2:(A(
"
Hypokalaemia"ECG"changes:""
• Prolonged"PR"
• ST"depression"
• Late"T"wave"inversion"
• If"T/U"waves"merge"apparent"QT"interval"prolonged"(normal"QT"
if"they"are"separate)"
Hypokalaemia"causes:"
• Hyperpolarisation"of"membrane"
• Ventricular"extrasystoles"
If the extracellular [K+] increases, the K concentration gradient between
the ICF and ECFdecreases. Specifically, there is a reduced gradient and
less force influencing K+ movement out of the cell. Intuitively, more
K+ in the ECF is also going to change the electrical forces at work,
specifically resisting K+ movement out of the cell. In this setting, less
K+ leaks out of the cell and a new equilibrium is reached with less
If the extracellular [K+] decreases, the opposite occurs. The K+ gradient
between the ICF and ECF increases. This increased gradient (both
concentration and electrical) results in a high driving force influencing
K+ movement out of the cell. The result is passive leakage of K+ out of
the cell where a new equilibrium is reached with more potential energy
at RMP (hyperpolarized)
31"
Thus, hyperkalemia results in depolarization from RMP, and hypokalemia results in hyperpolarization from RMP.

Hyperkalaemia Cardiac manifestations are primarily due to delayed depolarization and consistently present when
plasma [K+] is greater than 7 mEq/L. ECG changes characteristically progress (in order) from:
1. Symmetrically peaked T waves (often with a shortened QT interval)
2. Widening of the QRS complex
3. Prolongation of the P–R interval
4. Loss of the P wave
5. Loss of R-wave amplitude
6. ST-segment depression (occasionally elevation)
7. An ECG that resembles a sine wave
8. Before progression to ventricular fibrillation and asystole.
Contractility appears to be relatively well preserved. Hypocalcemia, hyponatremia, and acidosis accentuate the cardiac
effects of hyperkalemia.

32"
FE02"[Mar97]"[Jul04]"For"two"solutions"
separated"by"a"semiapermeable"
membrane"(Solution"A:"saline"solution"
AND"solution"B:"H2O):"Which"of"the"
following"statements"is"true?""
A."A"hydrostatic"pressure"applied"to"A"
will"stop"osmotic"pressure"(?)""
B."There"will"be"bulk"flow"from"A"to"B""
C."The"fluid"level"in"B"will"go"up""
D."The"NaCl"concentration"at"A"will"
remain"the"same""
E."Water"will"move"from"A"to"B"by"
diffusion""
" undissociated"NaCl"in"solution)."Thus"as"all"NaCl"exists"as"Na+"and"
FE03"[Mar97]"[Jul97]"[Jul99]"Rapid"
(?ingestion/?infusion)"of"2"litres"of"
normal"saline"causes:""
A."Increased"ECF,"increased"ICF,"
decreased"[Na+]""
B."Increased"ECF,"unchanged"ICF,"
increased"[Na+]""
C."Unchanged"ECF,"increased"ICF,"
increased"[Na+]""
D."Increased"ECF,"unchanged"ICF,"
unchanged"[Na+]""
FE04"[d]"[Jul98]"[Jul00]"Hyperkalaemia:""
A."Causes"a"prolonged"QT"interval""
B."Prolongs"the"QRS"duration""
C."Causes"ST"segment"elevation""
D."Potentiates"digoxin"toxicity""
E."Causes"loss"of"P"wave""
" 1."Tall"peaked"Tawaves"
FE04b"[Mar02]"[Feb07]"ECG"changes"in"
hyperkalaemia"include:""
A."ST"depression""
B."T"wave"inversion""
C."P"wave"flattening""
D."Sinus"tachycardia""
E."?""
"
Feb07&options:"
A."Long"PR""
B."Wide"QRS""
C."Long"QT""
D."ST"elevation""
E."ST"depression"
ANSWER:(?A(the(best(
Most"of"argument"surrounds"wording"and"whether"semiapermeable"
membrane"refers"to"solvent"water"can"cross"the"membrane"but"
solutes"cannot"(as"opposed"to"ions"being"able"to"move"across)."
(
A"?Yes"–"‘if"suitable"hydrostatic"pressure"applied"to"A"it"will"stop"the"
osmotic"movement"of"water"from"B"into"A’"(ie"if"wording"different"
B(No"–"net"H2O"movement"due"to"diffusion"from"B"to"A"due"to"
osmotic"gradient"(NOT"bulk"flow"which"is"the"movement"of"water"
and"solutes"together"down"a"pressure"gradient)."
C(No"–"H20"moves"B"to"A"down"its"osmotic"gradient"so"fluid"level"in"
B"drops."
D(No"but"technically"Yes"–"NaCl"is"totally"ionised"in"water"(no"
Cla"the"[NaCl]"at"both"beginning"and"end"of"water"movement"is"0"(no"
change)"
E(No"but"technically"Yesa"water"moves"both"ways"across"semia
permeable"membrane"where"there"is"an"osmotic"gradient"but"there"
will"be"net"movement"of"water"in"one"direction"(From"B"to"A)."
Assuming"this"refers"to"NET"movement."
ANSWER:(B(=(most(correct(
NaCl"is"distributed"throughout"ECF"([Na+]"restricts"its"distribution),"
so"increased"ECF,"unchanged"ICF.""
ANSWER:((
04:(B(the(best((E(occurs(later)(
04b:(C(
Feb(07:(B"
"
Order"of"ECG"Changes"in"Hyperkalaemia:"
2."Loss"of"pawave"
3."QRS"prolongation"
4."Ventricular"arrhythmias"
5."Asystole"
33"
FE05"[Mar98]"[Apr01]"[Jul04]"Thoracic" ANSWER:(A(
lymph"contains:"" "
A."Clotting"factors"" Contents"of"thoracic"lymph:"
B."Higher"protein"content"than"plasma"" 1."All"the"clotting"factors"(but"low"in"fibrinogen)"
C."Similar"composition"to"ISF"" 2."Lower"protein"concentration"than"plasma"
D."Rarely"contains"fat"" 3."More"protein"than"ISF"(because"contribution"of"hepatic"lymph"
E."?"" which"is"high"in"protein"c/w"lymph"from"rest"of"body)"
" 4."Small"bowel"lympatics"contains"chylomicrons"(fat)"after"meals"–"
accounts"for"90%"of"fat"absorption)"
"
Plasma:"70g/L"protein."
Albumin"40g/L"
Globulins"25g/L"
Fibrinogen"5g/L"
FE06"[Mar98]"[Jul98]"[Mar99]"[Feb04]" ANSWER:(
GibbsaDonnan"effect"leads"to:"" AE(incorrect(
A."Nonadiffusible"ions"between"2"sides" B(E(incorrect(
will"be"equal"" C(E(incorrect(
B."Diffusible"ions"between"2"sides"will" D(E(incorrect(
be"equal"" E(–(correct((by"altering"concentrations"of"diffusible"ions"results"in"
C."Equal"concentrations"of"ions"on"both" small"net"increase"in"ions"present"in"the"plasma"and"maintenance"of"
sides"" the"plasma"oncotic"pressure"of"blood.(
D."Equal"passive"diffusion"" F(E(?(correct(
E."Osmotic"gradient"" "
F."Important"in"the"measurement"of" GibbsaDonnan"Effect:"Charged"molecules"on"one"side"of"a"semia
plasma"oncotic"pressure"" permeable"membrane"sometimes"will"not"evenly"distribute"
" themselves"on"both"sides"of"the"membrane."This"is"due"to"other"
charge"substances"already"present"which"are"unable"to"move"
through"the"membrane"and"are"creating"an"electrical"field"that"
influences"the"movement"of"incoming"charged"molecules."
"
Guyton:"About"19mmHg"of"the"colloid"osmotic"pressure"is"due"to"the"
dissolved"protein,"but"an"additional"9mmHg"is"due"to"the"positively"
charged"cations,"mainly"sodium,"that"bind"to"the"negatively"charged"
proteins."This"is"called"the"Donnan"equilibrium"effect,"which"causes"
the"colloid"osmotic"pressure"in"the"plasma"to"be"about"50%"greater"
than"that"produced"by"the"protein"alone"
FE07"[Jul98]"[Mar05]"[Jul05]"" ANSWER:(D(
With"decreased"osmolality"and" "
hypovolaemia,"you"would"see:"" A:"NO:"Correct"if"it"says"DECREASED"
A."(?Decreased/increased)"urine"output"" B:"NO:"Osmoreceptors"are"very"sensitive"to"a"decrease"in"osmolality"
B."Decreased"ADH"secretion"" which"will"result"in"a"decreased"ADH"secretion."However,"the"low"
C."Decreased"aldosterone"" pressure"baroreceptors"("R"atrium"and"great"veins)"though"being"
D."Increased"permeability"of"collecting" less"sensitive"than"the"osmoreceptors"respond"far"more"powerfully."
ducts"to"water"" The"peak"[ADH]"resulting"from"hypovolaemia"is"much"higher"than"
E."Decreased"renin"" that"produced"by"maximal"response"to"osmoreceptor"input."This"
" means"that"hypovolaemia(overErides(the(inhibition(from(the(
hypoEosmolality.(Volume(is(maintained(at(the(expense(of(a(
decreased(osmolality."

34"
FE08"[Mar99]"[Jul00]"[Apr01]"[Jul04]" ANSWER:((
Hartmann’s"solution"contains:"" 08:(Nil(correct(
A."Potassium"2"mmol/l"" 08b:(C"
B."Calcium"3"mmol/l"" "
C."Magnesium"2"mmol/l"" Hartmanns"(mmol/L):"
D."Sodium"154"mmol/l"" Na"131"
E."Chloride"?131"?154"mmol/l"" K"5"
" Ca"2"
FE08b"[Apr01]"[Mar05]"" Cl"111"
Hartmann’s"solution"contains"no:"" Lactate"29"(converted"to"HCO3a"via"oxidation"and"GNG"in"liver)"
A."Na+"" pH"6.5"
B."Ca++"" Osmolarity"279"
C."Mg++""
D."Lactate""
E."Cla""
FE09"[Mar99]"[Feb00]"[Jul00]"The"total" ANSWER:(?E(–(C(possible(if(number(closer(to(5500mmHg(
osmotic"pressure"of"plasma"is:"" Plasma"osmotic"pressure"is"a"component"(0.5%)"of"total"osmotic"
A."25"mmHg"" pressure."
B."285"mOsm/l"(or"?308mOsm/l)"" "
C."5900"mmHg"" A"="Normal"plasma"oncotic"pressure"="25mmHg."
D."300"kPa"" B"="Normal"plasma"osmolality"
E."None"of"the"above"" C"="Faunce:"Total"osmotic"pressure"="5562mmHg"or"7.31"
atmospheres"(733kPa).""
D"="Incorrect"
FE10"[Mar99]"[Jul05]"Normal"saline:"" ANSWER:(A(
A."Osmolality"of"300a308"mOsm/l"" Normal"saline:""
B."Has"pH"7.35"to"7.45"" pH"4.0a7.0"
C."?"" Osmolality"300"mOsm/L"
" Na"150mmol/L;"Cl"150mmol/L"
FE11"[Mar99]"[Mar03]"[Jul03]" ANSWER:(
Obligatory"water"loss"from"body:"" July03:((E((question(states(obligatory),(?B((if(question(=(
A."400"mls"in"faeces"" insensible,(50mL(off)(
B."300"mls"from"lung"" Alt:(B(best"
C."Loss"from"skin"&"respiratory"tract" "
700ml"" Daily"Water"Loss"(Power&&&Kam)"
D."??Insensible"water"loss"" • 900ml"insensible"loss"from"skin"and"lungs"
E."500"mls"in"urine"" • 50ml"as"sweat"in"normal"climates"
" • 100ml"in"faeces"
Alt"version:"Normal"amount"of"daily" • 430ml"urine"a"minimum"volume"to"excrete"the"daily"solute"load"
water"loss"in"a"70kg"man:"" (600mOsmol"/"1400mosmol/kg)"
A."300mls"faeces"" "
B."500mls"from"urine"" Fluid"Output:"(Guyton&&&Hall)"
C."700mls"from"lungs"and"skin" • insensibleaskin"350ml"
(?insensible)"" • insensiblealung"350ml"
D."?"" • sweat"100ml"
E."None"of"the"above"" • faeces"100ml"
"All"figures"seemed"slightly"off"from"
• urine"1400ml"
standard"text"""
"
" Wording"of"the"1st"question"as""obligatory""water"loss"would"
suggest:"?"re:"urine,"rather"than"insensible"losses"from"skin/lung."

35"
FE12"[Jul99]"[Mar03]"[Jul03]"[Jul05]"" ANSWER:(D(
Which"ONE"of"the"following"statements" "
about"intravenous"crystalloid"solutions" A:"No"
is"TRUE?"" B":"No"(Osmolality"279"mOsm)"
A."Rapid"infusion"of"(?one"litre)" C":"No"(pH"4.0a7.0)"
Hartmann's"may"cause"lactic"acidosis"" D:"Yes"300"mOsm/L"
B."Hartmann's"300a308"mosm/kg"" E:"No"(pH"4.0a7.0)"
C."0.9%"saline"pH"7.35a7.45"" F:"No"(Harmanns"Na"131"mmol/L)"
D."N/saline"osmol"300a308"mosm/kg""
E."0.9%"sodium"chloride"has"a"pH"6.5a
7.5""
F."One"litre"of"Hartmann’s"solution"
contains"150"mmol"of"Na+""
FE13"[Mar99]"[Jul99]"[Feb00]"Water" ANSWER:(D((Ganong)(
handling"by"the"kidney"(%" "
reabsorption):"" GFR"180L/day"
A."93%"" Urine"1.0"L/day""
B."94%"" Reabsorption"99.4%"
C."99%"" "
D."99.4%"" (99.7%"a"500mL"obligate"urine"output"to"excrete"600a700"
E."99.9%"" mosmoles/day)"
" (99.2%"a"1500mL"urine"output)"
FE14"[Jul00]"[Jul04]"[Mar05]"[Jul05]" ANSWER:(C(
[Feb06]"" "
The"ion"with"lowest"intracellular" Guyton"Intracellular"Ion"Concentrations:"
concentration"is:"" Na"="10mmol/L"
A:"Na+"" HCO3a"="10mmol/L"
B:"HCO3a"" Mg2+"="10mmol/L"
C:"Ca++"" K"="150"mmol/L"
D:"Mg++"" Ca"="100"nmol/L"
E:"K+""
"
FE15"[Apr01]"Total"plasma"osmolality" ANSWER:(E(
can"be"calculated"via:"" "
A."Van"Halen’s"equation"" Total"Plasma"osmolarity"="(2"x"Na+K)"+"urea"+"glucose."
B."Starling"equation"" "
C."P"="nRT"" Osmolarity"measure"(freezing"point"depression)"or"calculated"(as"
D."(multiplying"19.2mmHg/mOsm/L"by" above)."Osmotic"pressure"can"be"measure"(oncometer)"or"calculated"
body"Osm)"" (Vant"Hoff"equation)."
E."None"of"the"above""
FE16"[Apr01]"Which"of"the"following" ANSWER:(
will"increase"plasma"potassium" Apr01:(E(
concentration"" Jul05:(C(
A."Beta"adrenergic"receptor"AGONIST"" "
B."Insulin"" Things"that"cause"fall"in"plasma"[K+]:"
C."Aldosterone"" Beta"adrenergic"agonists"
D."?"" Insulin""
E."None"of"the"above"" Aldosterone"
" Hyperglycaemia"
FE16b"[Ju05]:"Which"will"increase" Carbonic"anhydrase"inhibitors"
plasma"[K+]?"" "
A."Hyperglycaemia"" Things"that"increase"[K+]:""
B."Aldosterone"" Metabolic"acidaemia"
C."Metabolic"acidosis"" Haemolysis"
D."?"" "
E."Carbonic"anhydrase"inhibitors"" Adrenaline"and"noradrenaline"cause"initialrise"via"liver"release"and"
" then"a"fall"in"plasma"[K+]"due"to"skeletal"muscle"(via"B2"adrenergic"
receptors)."

36"
FE17"[Apr01]"Osmotic"pressure"in"
plasma"is"usually"1.6"mosmol/L"more"
than"ISF."This"is"because"of""
A"Plasma"Proteins""
B"Plasma"Oxygen"Tension""
C"Plasma"creatinine""
"
FE18"[Apr01]"[Mar03]"[Jul03]"[Feb04]"
[Jul04]"(Responses"to"?increased"
osmolarity)""
A."?Thirst"and"ADH"from"stimulation"of"
osmoreceptors"in"posterior"
hypothalamus""
B."?Thirst"via"stimulation"of"SFO"and"
OVLT"via"Angiotensin"II"in"
hypovolaemia""
C."Baroreceptors"afferents"to"the"
Posterior"Pituitary""
D."Increased"ADH"levels""
E."Aldosterone""
" Feb(04:(A(
Alt"version(Mar"03):"Increases"in"
plasma"osmolarity"in"a"healthy"young"
person"produce:""
A."Production"of"ADH"from"posterior"
pituitary""
B."Thirst"via"ADH"effect"on"
paraventricular"nuclei""
C."….."angiotensin?""
D."?""
" changes"in"ECF"tonicity"(sodium"accounts"for"92%"of"ECF"tonicity).""
Alt"version:"In"hypovolaemic"shock,"
thirst"is"triggered"via:""
A."Angiotensin"II"acting"on"the"
circumventricular"organs""
B."?""
" "
Feb"04"version""
Thirst"is"stimulated"by:""
A."Release"of"angiotensin"II""
B."Supraoptic"nuclei""
" thirst"centre,"ADH"synthesis)"
July"04""
Thirst"in"hypovolaemia"from""
A."Stimulation"of"baroreceptors"which"
stimulate"posterior"pituitary""
B."Angiotensin"II"stimulating"SFO"and"
OVLT""
C."increased"ADH"levels""
D."Aldosterone""
(?),"osmoreceptor"stimulation"not"an"
option).""
"
ANSWER:(A(
"
Difference"between"plasma"and"ISF"osmotic"pressure"is"1mOsmol/L"
due"to"plasma"proteins."
ANSWER:(
Apr01:(B(+(D(
A"–"wrong"(anterior"not"posterior"hypothalamus)"
B"–"True"
C"–"False"(baroreceptor"afferents"go"to"medullary"vasomotor"centre)"
D"and"E:"increased"osmolarity"
Mar(03:((?C(
A"No"–"ADH"produced"in"hypothalamus"
B"No"–"thirst"via"osmoreceptors,"ADH"acts"in"parallel"
C""a"?Yes"if"AT2:"ADH"stimulated"by"increase"plasma"tonicity,"
hypovolaemia,"hypotension,"AT2,"stress,"drugs"
Alt:(A"
A"–"subfornical"organ"and"OVLT"are"circumventricular"organs"
July(04:(B(
"
Control"of"Water"Balance:"
Sensors:"osmoreceptors,"volume"receptors,"highapressure"
baroreceptors"
Central"controller:"hypothalamus"
Effectors:"thirst"and"ADH"
"
Osmoreceptors:"specialised"cells"in"hypothalamus"which"respond"to"
Volume"receptors:"lowapressure"baroreceptors"are"stretch"receptors"
located"in"walls"of"large"veins"and"right"atrium."They"monitor"
effective"vascular"volume"by"assessing"CVP."
High"pressure"baroreceptors:"carotid"sinus"and"aortic"arch"monitor"
arterial"BP."
Hypothalamus"includes:"
1."Osmoreceptors"for"monitoring"H20"balance"
2."Other"receptors"input"into"hypothalamus"via"nervous"pathways"
3."Effector"mechanisms"controlled"by"parts"of"hypothalamus"(eg"
"
Factors"stimulating"thirst"(Brandis)"
1."Hypertonicity"
2."Hypovolaemia"
3."Hypotension"
4."Angiotensin"II"
37"
FE19"[Apr01]"[Feb04]"Sweat"in"patients" ANSWER:(B(
acclimatised"to"hot"weather"(as" "Can’t"find"reference"to"this"a"google"
compared"to"patients"in"a"temperate" "
climate)"contains"less"Na+"because:""
A."Takes"longer"for"Na+"to"be"
transported"through"sweat"ducts""
B."Aldosterone"effect"causing"a"
reduction"in"Na+"in"sweat""
C."Increased"intake"of"water"causing"a"
reduction"in"Na"concentration""
D."?""
FE20"[Jul01]"Magnesium"is"required"for:"" ANSWER:(B(
A."To"Depolarise"excitable"cell" Brandis:"
membranes"" Mg2+"ICF"functions:"
B."Na+aK+"ATPase"" Catalysing"Mg2+adependent"enzymes:"
C."Coagulation"" 1."All"enzymes"for"phosphate"transfer"
D."?"" 2."All"enzymes"requiring"thiamine"phosphorylase"as"a"coafactor)"ie"
E."?"" Na/K"pump,"oxidative"phosphorylation,"all"reactions"involving"ATP"
" 3."Acts"as"‘plug’"in"NMDA"receptors"
"
Mg2+"ECF"functions:"
1."Reduces"nerve"and"membrane"excitability"
2."Inhibits"transmitter"release"(cholinergic"and"adrenergic"junctions)"
3."Inhibits"excitationacontraction"coupling"in"skeletal"and"cardiac"
muscle."
FE21"[Jul01]"Intracellular"?osmolality"is" ANSWER:(B(
greater"than"interstitial"?osmolality" Ganong(
because:"" Gibbs"Donnan"effect:"because"of"proteins"in"cells,"there"are"more"
A."Proteins"in"plasma"" osmotically"active"particles"in"cells"than"in"interstitial"fluid,"osmosis"
B."Cells"producing"intracellular"proteins"" would"make"them"swell"and"rupture"if"not"for"Na/K/ATPase"
C."?"" pumping"ions"back"out'"
D."?""
E."?""
FE22"[Mar02]"[Jul02]"[Mar03]"[Jul03]" ANSWER:(A(
Sweating"in"strenuous"exercise."Sweat" Again"no"references"just"what"is"on"MCQ"site.""
contains"Na+:"" At"rest"Na+"loss"is"11mmol/L"via"sweat."However"this"can"vary"from"
A."Less"than"plasma"" 30a65"mmol/L"depending"on"level"of"acclimitisation."Aldosterone"
B."Equal"to"plasma"" decreases"the"[Na+]"of"sweat."
C."More"than"plasma""
D."?""
E."?""
"

38"
FE23"[Mar03]"[Jul03]"[Feb04]"[Jul05]""
Acute"onset"(4"hours)"diabetes"insipidus"
in"an"otherwise"healthy"person"
produces"these"biochemical"changes"
("these"numbers"may"not"be"exact"):""
A."Na+"130,"K+"3.0,"Osm"260""
B."Na+"130,"K+"4.0,"Osm"300""
C."Na+"150,"K+"3.0,"Osm"260""
D."Na+"150,"K+"3.5,"Osm"320""
E."Na+"160,"K+"3.0,"Osm"320""
" Comment received July 03: "For the DI question there were a set of
FE24"[Mar03]"[Jul03]"Colligative"
properties:""
A."Increase"BP,"decrease"freezing"point,"
decrease"SVP""
B."Other"combinations:"increase/"
decrease…boiling"point/FP/SVP""
C."?"
FE25"[Mar03]"[Jul03]"Organic"ion"
necessary"in"NaaK"ATPase""
A."?""
B."?""
C."Mg+2""
D."PO4""
E."SO4a2""
"
FE26"[Jul04]"A"patient"is"given"an"
infusion"of"100"mL"of"8.4%"sodium"
bicarbonate"solution."This"represents"an"
osmotic"load"of:""
A."42"mosmol""
B"84"mosmol""
C"100"mosmol""
D"168"mosmol""
E"200"mosmol""
" This"is"an"osmolality"of"2"Osm/L"or"2,000"mOsm/L."100mL"of"this"
ANSWER:((D(
"
Argument"on"MCQ"is"that"‘otherwise"healthy"person’"would"able"to"
have"normal"physiological"response"to"DI"ie:"thirst"and"therefore"
correct"their"own"electrolytes.""
However,"would"they"be"able"to"do"this"within"4hrs?"Also"I"think"
they"are"trying"to"get"us"to"figure"our"preatreated"values."So"I"went"
with"D"as"this"is"what"I"have"found"on"night"duty"lately!"(although"
note"discussion"below!!)"
"
normal electrolytes as an option too - which is missing from the bank
thus far (the problem with the discussion previously on the Bulletin
Board ie the most 'normal' set of electrolytes were
hyponatraemic/hypoosmotic - if your thirst mechanism is intact and you
have access to water you have normal electrolytes but tend towards
hypernatraemia/hyperosmolality. The actual numbers in the MCQ were
Na 140 K 3.5 Osm 300. (One of the options also had a K of 6.0!)"
"I must admit I still answered normal electrolytes in spite of the
'untreated' bit in the Q since drinking is part of the normal physiology of
DI (most DI's are not the head injured ventilated pt's we tend to see in
ICU but rather the compensating DI's in renal clinics)... ie I regarded
drinking lots as normal physiology for DI, not a treatment for it."
"
ANSWER:(A(
"
Colligative"Properties:"properties"that"depend"ONLY"on"the"particle"
concentration"of"a"solution"and"NOT"the"chemical"properties"of"the"
substance"or"size"of"the"molecules."This"includes:"
1."Freezing"point"depression"
2."Vapour"point"depression"(reduction"of"the"solvent"molecules"
ability"to"leave"solution)"
3."Boiling"point"elevation"
4."Osmotic"pressure"
ANSWER:(C(
"Mg2+"is"an"essential"coafactor"for"NaaKaATPase"pump."
Argument"on"MCQ"site:"Mg2+"is"inorganic"rather"than"organic"ion."
Thought"to"be"incorrectly"remembered"stem."
ANSWER:(E(
"
MW"of"NaHCO3"is"84"so"a"one"molar"solution"whould"contain"84"
grams"in"a"litre"(8.4"g"in"100mL"which"is"8.4%"solution)."NaHCO3"
then"splits"into"Na+"and"HCO3a"ions.""
"
So"8.4%"solution"of"NaHCO3"contains:"
1,000"mmol"Na"
1,000"mmol"HCO3"
solution"would"have"osmotic"load"of"200"mOsmoles"
39"
FE27"[Mar05]""
Regarding"the"ECF"concentrations"of"K+"
and"H+:""
A."K+"rise"causes"pH"rise""
B."They"move"in"the"same"direction""
C."?""
D."Hypokalaemia"inhibits"renal"H+"
excretion""
E."?""
" Therefore decreased K+, decrease aldosterone, which decreases H+
FE28"[Jul05]"Hyperkalemia"caused"by:""
A."Metabolic"acidosis""
B."Aldosterone"excess""
C."?""
D."?""
" which"is"balanced"by"efflux"of"K+"from"the"cell."
FE29"[Feb06]"Diffusion"across"
semipermeable"membrane:""
A."is"inversely"proportional"to"thickness"" Diffusion"is"inversely"proportional"to"MW."
B."is"proportional"to"molecular"weight""
C."?""
D."?""
ANSWER:(D((
A:"No"–"should"be"that"acidaemia"causes"rise"in"plasma"K+"(but"also"
see"below"–"depends"on"cause"of"acidaemia.""
B"–"no,"they"move"in"opposite"directions"to"maintain"neutrality"(both"
increase"in"acidaemia,"due"to"renal"mechanisms)"
D - The increased potassium level works to regulate aldosterone
synthesis by depolarizing the cells in the zona glomerulosa, which opens
the voltage-dependent calcium channels.
excretion.
"
"
This(is(a(much(debated(question.(
Brandis:(Acidosis"is"commonly"said"to"cause"hyperkalaemia"by"a"
shift"of"potassium"out"of"cells."The"effect"on"potassium"levels"is"
extremely"variable"and"indirect"effects"due"to"the"type"of"acidosis"
present"are"much"more"important."For"example"hyperkalaemia"is"
due"to"renal"failure"in"uraemic"acidosis"rather"than"the"acidosis."
Significant"potassium"loss"due"to"osmotic"diuresis"occurs"during"
diabetic"ketoacidosis"and"the"potassium"level"at"presentation"is"
variable"(though"total"body"potassium"stores"are"invariably"
depleted)."Treatment"with"fluid"and"insulin"can"cause"a"prompt"and"
marked"fall"in"plasma"potassium."Hypokalaemia"may"then"be"a"
problem."
ANSWER:(A((aldosterone(" (K(excretion)(
Vander:"
Low(plasma(pH(is(usually(associated(with(hyperkalaemia:(
1."Changes"in"extracellular"[H+]"cause"exchange"of"H+"with"cellular"
cations"(mainly"K+)."Acidosis"results"in"H+"being"taken"up"by"cells"
2."Intracellular"pH"inhibits"NaaKaATPase"contributing"to"K+"loss"from"
cells"and"an"inability"of"cells"to"uptake"extracellular"K+."Principal"
cells"have"their"NaaKaATPase"pumps"and"luminal"membrane"K+"
channels"inhibited"which"results"in"paradoxical"K+"retention"
"
Vander:"
Aldosterone(stimulates(K+(secretion(by(the(principal(cells(by(3(
mechanisms:(
1."Activation"of"apical"K+"channels"(ROMK)."
2."Stimulation"of"basolateral"membrane"NaaKaATPase"pumps"which"
increases"intracellular"K+"and"the"gradient"driving"K+"secretion"into"
the"lumen."
3."Increases"activity"or"number"of"luminal"membrane"Na"channels"
which"allows"more"Na"to"enter"the"principal"cell"to"then"be"pumped"
out"by"the"NaaKaATPase"basolaterally"(K+"secretion"is"dependent"on"
Na+"being"pumped"out"so"more"Na+"entering"the"cell"allows"more"K+"
to"leave)"
ANSWER:(A(
Good"ol’"Fick"again."
40"
FE30A"[Jul07]"[Feb08]"Infusion"of" ANSWER:((
40ml/kg"of"0.9%"saline"solution"will" 30A:(Either(C(or(E((depends(on(volume(and(rate(of(
cause:"" administration)(
A."Hypochloraemic"metabolic"acidosis."" 30B:(A(
B."Hypochloraemic"metabolic"alkalosis."" "
C."Hyperchloraemic"metabolic"acidosis."" Large"volume"of"normal"saline"causes"hypercholoraemia"metabolic"
D."Hyperchloraemic"metabolic"alkalosis."" acidaemia.""
E."No"acid"base"disturbance."" "
" Hyperchloremic"acidosis:"The"Classic"Example"of"Strong"Ion"
FE30b"Apr"08:"The"use"of"large"amounts" Acidosis:"
of"normal"saline"for"patient" http://www.anesthesiaaanalgesia.org/content/96/4/919.long"
resuscitation"is"associated"with:" "
A."hyperchloraemic"acidosis"
B."hyperchloraemic"alkalosis"
C."hypernatraemic"acidosis"
D."hypernataemic"alkalosis"
E."serum"hyperosmolarity"
FE31"[Jul07]"Lymph"flow:"" ANSWER:(A(
A."greatest"when"skeletal"muscle" Lymph"flow"""
contracting"" a"assisted"when"muscles"contract"
B."when"interstitial"pressure"1a2mmHg" a"120mL/hr"total"lymph"flow"(100mL/hr"via"thoracic"duct)"
above"atmospheric""
C."approx."1000ml"per"hour"via"thoracic"
duct""
D."?""
FE32"[Jul07]"Postathoracotomy"the" ANSWER:(B(
drain"is"leaking"fluid"with"protein,"fat,"
lymphocytes"etc."What"could"be"the"
cause?""
A."Bleeding""
B."Thoracic"duct"injury""
C."sympathectomy""
D."Pleural"fluid""
E."??""something"like"CHF"or"pulmonary"
oedema"""
"
Alt"stem:""Postathoracotomy"the"drain"is"
leaking"fluid"that"contains"protein,"
coagulation"factors,"with"a"high"fat"&"
lymphocyte"count"""
FE33"[Feb08]"Hyponatraemia"is"usually" ANSWER:(E(
due"to:"" Both"excess"lipids"and"excess"glucose"can"cause"
A."Excess"lipids"" pseudohyponatraemia."Most"common"cause"is"likely"free"water"
B."Excess"glucose"" excess."
C."Free"water"deficit""
D."Excess"protein""
E."Free"water"excess""
FE34"Hypertonic"fluid"is"used"in" E"
resuscitation"for:"

A. increase in total body sodium

B. reduction in viscosity
C. improve coagulation
D. reduce intracellular oedema
E. rapid expansion of
intravascular volume

41"
FE35"Feb12"Chronic"hypokalaemia"(3.0"
mM)"will"cause"which"ECG"changes?"
A. Flat p waves
B. Flat T waves
C. Cardiac arrest in diastole
D. More prone to arrhythmia than
acute hypokalaemia
E. Resting membrane potential
will be higher?
FE36"Feb12"With"regards"to"chloride:"
A. Hyperchloraemia leads to
decreased plasma HCO3
B. Intracellular concentration is
less than 20mM
C. ?
D. ?
E. ?
" This is true, but higher in erythrocytes (~77 mM). Assuming this
With regards to chloride:
A. ? changes in direct proportion to
bicarboate
B. it is the major cation extracellularly
C. is a weak base
D. ?
E. Intracellular concentration < 20
mMol/L
"
FE37"Feb12"A"person"with"undiagnosed"
adrenocortical"insufficiency"will"have"
the"following"electrolyte"profile:"
A. Na 122 K 6.2 Cl 72 HCO3
40 ??
B. Low Na, High K, Low Cl,
Low HCO3
C. Low Na, High K, Low Cl,
Normal HCO3
D. Low Na, High K, Low Cl,
Raised HCO3
E. High Na, Low K ... ??
Not clear whether this MCQ had example
values, or was just high, low &
normal options
FE38"Feb12"Long"PR"interval,"ST"
depression,"T"wave"inversion"and"U"
wave"is"caused"by"which"electrolyte"
abnormality?"
A. Hypokalaemia
B. Ca++
C. Na+
D. ?
! A - wrong
! B - seems most correct of these options
! C - wrong - this happens in hyperkalemia - Ganong pp566 Ed 21
! D - probably wrong as chronic electrolyte changes are usually better
tolerated than acute
! E - wrong - "RMP in hyperkalemia decreases" Ganong
"
! A: not sure.. hyperchloremia usually ends up with a decreased
serum bicarb - normal anion gap metabolic acidosis, but is it causal?
Under the Stewart acid-base system, hyperchloraemia ought to decrease
the Strong Ion Difference of plasma (usually about 40 mEq/L), reducing
bicarbonate concentrations (a weak ion), and so cause a metabolic
acidosis. The problem is that this assumes an isolated hyperchloraemia,
which is a rare event, and we don't have complete blood chemistry to
really comment. Hard call.
! B: is true, value is 9 mM from Ganong Ed 21 pp 8
question was correctly recalled,
B seems the "most correct" answer.
FE36b
! A. Partly correct - per A above
! B. Wrong - Cl- is an anion (but is the major anion extracellularly)
! C. Wrong - subject to the acid-base definition being employed, it is
a strong base (taken to be "H+ acceptor" under the Brønsted-Lowry
definition)
! D. ?
! E. Partly correct - per B above
"Most correct" answer: E
Not clear whether this MCQ had example values, or was just high,low,
normal options
This is a table straight from Ganong: In adrenal insufficiency
! Na low
! Cl low (goes with Na presumably)
! K high (hypoaldosteronism so Na wasted, K retained)
! HCO3 unchanged
"
A"
42"
FE39"[Mar10]"Which"is"true"regarding" "
colloids?"

A. dextrans stay in the circulation

for 6-8hrs
B. gelatins have a higher rate of
anaphylaxis than starches
C. ?? has greater effect on
coagulation than ??
D. do not depend on renal
clearance for excretion
E. ?

FE39b"[Feb13]"Probably&a&different&MCQ&
on&the&same&topic&as&one&above"

Colloids:
A. ?
B. ?
C. HES is completely excreted by
the kidney
D. Dextran 40 is used to improve
micro-circulatory flow
E. ?
"
"

43"
RENAL)MCQS)

KD01a"(Mar96)(Apr01)" PART(A:(D(
Renal"blood"flow"is"dependent"on:" RBF"is"determined"mainly"by"MAP"and"contractile"state"
A."Juxtaglomerular"apparatus"" of"smooth"muscle"in"renal"arterioles."(Vander)"
B."[Na+]"at"macula"densa"" "
C."Afferent"vasodilatation"" PART(B:(D((most(correct)(
D."Arterial"pressure"" A."INCORRECT"
E."Efferent"vasoconstriction"" B.INCORRECT"
" C.INCORRECT"
KD01b" D."Correct"(due"to"autoregulation)"
Factors"(not)"affecting"?renal"blood"flow/GFR:"" E.?"Correct"(tubuloglomerular"feedback)"
A."Sympathetic"nervous"system"" (
B."Sodium"flow"past"macula"densa"" PART(C:(A(
C."Afferent"arteriolar"vasodilatation"" A:"CORRECT"(per"KIDNEY)"
D."Arterial"pressure"" RBF"is"420mL/100g/min"(25%"CO"at"rest"or"
E."Efferent"arteriolar"vasoconstriction"" 1250ml/min)."Kidneys"weigh"300g."Per"kidney,"flow"is"
(Similar"Q:"see"KD18)"" half"1250ml/min"or"around"600ml/min"
" B:"INCORRECT:"PAH"="paamino"hippuric"acid,"used"to"
KDO1c"[Jul97]"Renal"blood"flow:"" indirectly"measure"renal"blood"flow"as"it"is"filtered"by"
A."Is"600a650ml/min"per"kidney"" glomeruli"and"secreted"by"tubular"cells.""
B."Is"directly"measured"by"infusing"PAH"" C:"INCORRECT:"Increased"SNS"""afferent"arteriolar"
C."Is"increased"by"sympathetic"tone"" constriction"""reduced"RBF."
" "
KD01D"[Jul98]"[Feb04]"Renal"blood"flow:"" PART(D:(A(
A."Greater"per"unit"mass"than"cerebral"blood" A."CORRECT"(RBF>CBF"per"unit"mass"in"Ganong)"
flow"" B."INCORRECT:"renal"cortical"blood"flow"5mL/g/min,"
B."Is"greater"in"the"medulla"compared"to"the" outer"+"inner"medulla"both"0.6mL/g/min."Cerebral"blood"
cortex"" flow"0.5mL/g/min."
C."Is"closely"related"to"tubular"sodium" C."Incorrect"
reabsorption"" D."Incorrect"
D."Only"sympathetically"mediated"" E."Ganong"says"yes"there"are"some"noradrenergic"nerve"
E."Some"noradrenergic"endings"on"JG"complex" endings"on"JG"complex"and"tubules"
and"tubules"" F."Ganong:"cholinergic"innervation"via"vagus"(function"is"
F."Parasympathetic"via"hypogastric"plexus"" uncertain.""
KD02"[Mar96]"Which"has"the"greatest"renal" ANSWER:(A(
clearance?"" PAH"is"both"filtered"and"secreted."
A."PAH"" "
B."Glucose"" Clearance:"renal"clearance"means"that"a"substance"is"
C."Urea"" removed"from"the"blood"and"excreted"in"the"urine."
D."Water""
E."Inulin""
"
KD03"[Mar97]"[Jul99]"[Apr01]"The"ascending" ANSWER:(C(and(E"
limb"of"the"Loop"of"Henle"is:"" "
A."Impermeable"to"Na+"" A"Incorrect"
B."Involved"in"active"transport"of"K+"into"the" B"Incorrect"
lumen"" C"CORRECT"
C."Involved"in"active"transport"of"Cla"out"of" D"Incorrect"
lumen"" E"CORRECT"
D."Involved"in"active"transport"of"Na+"into" F"Incorrect"
lumen"" "
E."Hypotonic"at"the"top"" Ascending"LOH"impermeable"to"H20"but"has"many"
F."?None"of"the"above"?Actively"transports" luminal"transporters:"
water"" Na/K/2Cl:"Na,"K,"Cl"uptake"
" Na/H"exchanger:"Na"uptake,"H"extrusion"
K"channels"(ROMK)"–"K"extrusion"(recycling)""
"
NaaKaATPase"is"the"only"primary"active"transport,"but"
NaaKa2CL"is"involved"in"secondary"active"transport"of"Cl"
and"K."

44"
KD04"[d]"[Jul98]"[Feb00]"Regarding"glucose" ANSWER:(C(
handling"in"the"kidney"" "
A."Reuptake"is"passive"" Glucose"undergoes"secondary"active"reauptake"
B."Tm"is"the"same"for"all"nephrons"" predominately"in"early"proximal"tubule."Both"glucose"
C."Daglucose"more"rapidly"absorbed"than"La and"Na+"bind"to"SGLTa2"receptors"and"are"transport"
glucose"" from"lumen"into"cell."The"transport"maximum"(TmG)"for"
D."Reabsorption"is"inversely"proportional"to" glucose"varies"between"nephrons"""‘splay.’"SGLT2"
lipid"solubility"" trasnporter"has"increased"avidity"to"Daglucose"(more"
" than"Laglucose)."
"
(SGLT:"sodium"dependent"glucose"transporter)"
KD05"[Jul97]"Water"filtration"by"the"kidney:"" ANSWER:(B((
A."Is"180"l/hr"" (
B."Is"125"ml/min"" A"Incorrect"–"180L"per"DAY"(not"hour)"
C."Up"to"90%"is"reabsorbed"" B"CORRECT"
D."Most"drugs"have"MW"less"than"600"and"are" C"Incorrect"a"Usually"99%"of"water"filtered"by"kidneys"is"
freely"filtered"" reabsorbed."
E."?"" D"?"wording"of"<600MW"–"most"drugs"have"MW"between"
" 100a1000."Substances"up"to"MW"68,000"are"freely"
filtered."As"such"most"drugs"(as"they"are"MW<1000)"are"
freely"filtered.""
"

45"
KD06"[]"[Mar98]"[Jul98]"[Mar99]"[Jul99]" Relation between the plasma level (P) and excretion (UV) of
[Jul00]"A"substance"is"freely"filtered"and" glucose and inulin:
actively"secreted."Which"of"the"following"
represent"the"changes"in"concentration"of"the"
substance"along"the"nephron?""
{A"graph"of"clearance"vs"plasma"concentration"
with"various"labelled"curves"labelled"A,"B,"C,"D}""
"
Alt"version:"Substance"that"is"freely"filtered"
and"then"reabsorbed"by"a"saturable"transport"
mechanism:""
(Graph"of"Excretion"rate"(y"axis)"vs"Plasma"
concentration"(x"axis)"with"4"curves"labelled"A"
to"D"and"with"E:"None"of"the"above.)"(See"
Ganong"19th"ed"Fig"38.10)""
"
Also"remembered"as:"" Clearance of inulin, glucose, and PAH at various plasma
A"substance"is"freely"filtered"then"resorbed"up" levels:
to"its"transport"maximum"in"the"kidney."Which" "
curve"represents"the"?excretion/resorption"
curve?""
"
A."Curve"AaB""
B."Curve"AaC""
C."Curve"AaD""
D."Curve"AaE""
E."None"of"the"above""
"
Several"comments"received"re"July"2000"
paper:""
"KD06"Reworded:"The"excretion"of"a"
substance"that"is"freely"filtered"and"secreted"
up"to"its"maximum"threshold"is"represented"
by:"" "
Note:"Please"draw"new"curve"(AaF)"consisting"
of"a"line"of"high"gradient"which"then"sharply"
changes"into"a"line"of"lesser"gradient"(but"not"
zero)."""
AND""
"Which"one"is"filtered"and"actively"secreted"at"
kidney""
4"graphs"aab,aac,"aad,"aae"and"none"of"above""
correct"answer"corresponds"to"Ganong"graph"
of"PAH"clearance"aad"I"think"""
AND""
"For"a"substance"filtered"and"secreted"by"a"
saturable"transport"mechanism"the"correct"
curve"is:"four"curves"including"a"straight"line,"
logarithmic"washin"curve,"straight"line"then"
flat,"straight"line"then"abrupt"change"to"less"
steep"straight"line."""

46"
KD07"[Mar98]"?Secretion/?absorption"of"urea"
takes"place"in:""
A."Proximal"convoluted"tubule""
B."Distal"convoluted"tubule""
C."?""
D."?""
" descending"limb"to"inner"medullary"collecting"duct,"very"
KD08"[Jul98]"Glomerular"capillary"
permeability"is:""
A."Less"than"in"ordinary"capillaries""
B."50"times"more"than"skeletal"muscle"
capillaries""
C."?""
D."?""
KD09"[Mar99]"Which"ONE"of"the"following"is"
not"involved"in"the"regulation"of"glomerular"
filtration"rate"(GFR)?""
A."Juxtaglomerular"apparatus""
B."Arterial"pressure""
C."Efferent"arteriolar"tone""
D."Na"content"in"distal"tubule""
E."Afferent"arteriolar"tone""
(Similar"Q:"KD14)""
" There"are"4"pressures"(“Starling"Forces”)"ie"2"x"oncotic"
ANSWER:(A((reabsorption)(
"
Urea"is"small"(MW"60d)"freely"filtered."About"½"is"
reabsorbed"in"proximal"tubule."About"½"is"then"secreted"
into"lumen"in"the"descending"LOH"(urea"transporter"
family)"–"essentially"restores"filtered"load."From"end"of"
little"urea"transport"occurs."Due"to"H20"being"
reabsorbed,"the"luminal"[urea]"increases."It"is"the"inner"
medullary"collecting"duct"that"further"urea"is"reabsorbed"
(specialised"urea"uniporters)."Urea"accumulates"in"
interstitium"here"and"incombination"with"Na/Cl"it"
contributes"½"of"the"medullary"concentration"gradient.""
ANSWER:(B(
"
Directly"from"Ganong"–"‘permeability"of"glomerular"
capillaries"is"about"50x"that"of"capillaries"in"skeletal"
muscle.’"
ANSWER:(D(
Arguments"re:"meaning"of"‘involved’"and"location"of"JGA.""
GFR"a"3"factors"to"consider:"
1."Hydraulic"permeability"of"the"capillaries"
2."Capillary"SA"
3."NFP"(net"filtration"pressure)"acting"across"caps"–"
algebraic"sum"of"the"hydrostatic"pressures"and"osmotic"
pressures"resulting"from"protein"(oncotic"or"colloid"
osmotic"pressures)"on"the"2"sides"of"the"capillary"wall."
and"2"x"hydrostatic"pressures.""
"
Rate&of&Filtration&=&Hydraulic&Permeability&x&SA&x&NFP&
NFP&=&(PGC&–∏&GC)&–&(PBC&–&∏BC)&
&
(
47"
KD10"[Jul98]"[Jul01]"With"regard"to"
glomerular"filtration:""
A."Autoregulation"maintains"flow""
B."?Afferent"arteriole"driving"force""
C."Is"equal"for"cationic"&"anionic"molecules""
D."All"cross"if"?>/?<"8"nm"in"diameter""
" "
Jul"2001"version:""
The"permeability"of"glomerular"capillaries:""
A."Equals"that"of"other"capillaries""
B."Is"much"less"than"that"of"other"capillaries""
C."Is"equal"for"cationic"and"anionic"molecules"
of"equal"size""
D."Approaches"100%"for"neutral"molecules"of"
8mm"diameter""
E."Is"about"50"times"as"great"as"that"of"a"
skeletal"muscle"capillary""
(This"was"MCQ"No."18"on"the"Jul"01"paper)"
KD11"[Mar99]"[Feb06]"Kidney:""
A."Maximum"urine"osmolality"of"1200"mOsm/l""
B."Min"urine"osmolality"100mosmol/Kg""
C."Minimum"osmolality"="20mOsmol/kg""
D."?""
E."?""
KD12"[Jul99]"[Feb00]"[Mar03]"Significant"
tubular"reabsorption"occurs"with:""
A."Phosphate""
B."Creatinine""
C."Urea""
D."Sulphate""
E."All"of"the"above""
KD14"[Feb00]"[Apr01]"Increased"GFR"is"
caused"by""
A."Increased"cardiac"output""
B."Afferent"arteriolar"vasoconstriction""
C."Efferent"arteriolar"vasodilatation""
D."Increased"chloride"delivery"to"the"macula"
densa""
" thought"to"be"incorrect."
[[Apr"2001"version:"Which"of"the"following"is"
involved"in"the"regulation"of"glomerular"
filtration"rate"(GFR)?""
A."Juxtaglomerular"apparatus""
B."Afferent"arteriolar"tone""
C."Efferent"arteriolar"tone""
D."Chloride"transport"at"the"macula"densa""
E."All"of"the"above""
ANSWER:((
PART(A:((A(
PART(B:((E(
"
Substances"that"are"<"4nm"are"freely"filtered,">8nm"are"
not"filtered"and"in"between"variable.""
Proteins"in"glomerular"wall"are"negatively"charged"and"
hence"filtration"of"anionic"substances"is"less"c/w"cationic"
substances.""
"
The"permeability"of"the"glomerular"capillaries"is"about"
50"times"that"of"the"capillaries"in"skeletal"muscle."
"
ANSWER:(A(
"
OsmolaRity"(mOsm/L):"number"of"osmoles"per"litre"of"
SOLUTION"(affected"by"temperature)"
OsmolaLity"(mOsm/Kg):"number"of"osmoles"per"KG"of"
SOLVENT((not"affected"by"temperature).""
Maximum"urine"osmolality"in"health"young"person"is"
1,200a1,400"mOsm/kg."Minimal"urine"osmolality"
(absence"ADH):"30a60"mOsm/kg.""
ANSWER:(A(&(D(
"
A."85a90%"of"PO4"is"reabsorbed"
B."Almost"nil"Cr"is"reabsorbed"
C."50%"is"reabsorbed"
D."Sulfate"is"significantly"reabsorbed"(between"80a95%)"
E."incorrect"
ANSWER:((
PART(1:(A(
PART(2:(E((
"
Arguments"regarding"CO"in"that"renal"autoregulation"
controls"GFR"within"certain"MAP"range"(so"?increased"CO"
doesn’t"cause"increased"GFR)."But"this"was"mainly"
"
Vander"states"that:"AUTOREGULATION"BLUNTS"or"
lowers"RBF"and"BFR"in"response"to"changes"in"arterial"
BP"but"DOES"NOT"PREVENT"those"changes."
"
"
"
"

48"

KD15"[Jul00]"The"formula"for"GFR"is:""
A."GFR"="Kf"(HPG"a"HPB"+"OPG"a"OPB)""
B."GFR"="Kf"(HPG"a"HPB"a"OPG"+"OPB)""
C."GFR"="Kf"(HPG"+"HPB"a"OPG"+"OPB)""
D."GFR"="Kf"(HPG"+"HPB"a"OPG"a"OPB)""
E."GFR"="Kf"(HPG"a"HPB"a"OPG"a"OPB)""
(Comment:"HP"is"hydrostatic"pressure,"OP"is"
oncotic"pressure,"G"is"glomerulus,"B"is"
Bowman’s"capsule)""
" wall."There"are"4"pressures"(“Starling"Forces”)"ie"2"x"
(
ANSWER:(B(
"
GFR"="Hydraulic"Permeability"x"SA"x"Net"filtration"
pressure"
HENCE:"GFR"="Kf"x"NFP"
"
NFP"=""algebraic"sum"of"the"hydrostatic"pressures"and"
osmotic"pressures"resulting"from"protein"(oncotic"or"
colloid"osmotic"pressures)"on"the"2"sides"of"the"capillary"
oncotic"and"2"x"hydrostatic"pressures.""
NFP"="(PGC"–∏"GC)"–"(PBC"–"∏BC)"
"
PGC"="hydraulic"pressure"glomerular"cap"
∏GC"="oncotic"pressure"in"glomerular"cap"
PBC"="hydraulic"pressure"in"Bowmans"capsule"
∏BC"="oncotic"pressure"in"Bowmans"capsule"
"
GFR"="Kf"((PGC"–∏"GC)"–"(PBC"–"∏BC))"
GFR"="Kf((HPGaOPG)"a"(HPBaOPB))"
GFR"="Kf"(HPGaOPGaHPB"+"OPB)"
GFR"="Kf"(HPG"–HPBa"OPG"+"OPB)"ie"answer"B"
"
"
"
49"
 (
(
KD16"[Jul00]"[Jul01]"The"effect"of"PTH"on"the" ANSWER:(C"
kidney"is"to:"" "
A."Increase"Ca"excretion"and"increase" PTH"increases"renalatubular"calcium"reabsorption,"
phosphate"excretion"" mainly"via"action"on"distal"convoluted"tubule."At"this"
B."Increase"Ca"excretion"and"decrease" location,"it"increases"apical"calcium"entry"through"
phosphate"excretion"" caliucm"channels."The"increased"uptake"of"Ca"from"the"
C."Decrease"Ca"excretion"and"increase" lumen"stimulates"basolateral"extrusion"(combination"of"
phosphate"excretion"" CaaATPase"and"activity"of"NaaCa"antiporter)."Hence"PTH"
D."Decrease"Ca"excretion"and"decrease" decreases"urinary"Ca"excretion.(
phosphate"excretion"" "
E."None"of"the"above"" In"primary"hyperparathyroidsm,"urinary"calcium"
" excretion"is"increased"despite"the"fact"that"tubular"
calcium"reabsorption"in"enhanced"by"PTH."The"reason"is"
that"elevated"plasma"[Ca]"induced"by"the"PTH"effects"on"
bone"causes"the"filtered"load"of"calcium"to"increase"more"
than"the"reabsorptive"rate.""
"
In"both"states"(normal"PTH"and"hyperPTH)"phosphate"
excretion"is"increased"via"PTH"causing"a"reduction"in"
proximal"reabsorption"of"PO4."
KD17"[Jul00]"Water"handling"by"kidney"(%" ANSWER:(C(or(D(–(D(most(correct(
reabsorption)"" "
A."93%"" Ganong"says:"99.4%"
B."94%"" Vander"says:"99%"
C."99%"" "
D."99.4%""
E."99.9%""

50"
KD18"[Jul00]"[Feb04]"Resistance"to"renal"
blood"flow"is"chiefly"determined"by:""
A."Renal"artery""
B."Afferent"&"efferent"arterioles""
C."Interlobular"&"arcuate"arteries""
D."Peritubular"capillaries""
E."?""
(see"also"KD01)""
" Resistance"is"determined"by"blood"viscosity,"
KD19"[Jul00]"Tubuloglomerular"feedback:""
A."Increased"solute"delivery"to"macula"densa"
causes"decreased"GFR.""
B."?""
C."?""
(see"also"the"more"complete"KD23"which"may"
be"the"same"Q"as"this"one)""
" tubule"or"loop"of"Henle"either"increases"or"decreases."
ANSWER:(B(
Renal"blood"flow"is"determined"
mainly"by"MAP"of"renal"artery"and"
contractile"of"smooth"muscle"in"renal"
arterioles"of"cortex."
"
Basic"equation"for"blood"flow"through"any"organ"is"Q"="
∆P/R"(∆P"="MAP,"R"="total"resistance"of"that"organ)."
length/radius"of"organ."Of"particular"importance"is"the"
radius"of"the"vessel"(r4)."Radius"of"vessels"determined"by"
arteriolar"smooth"muscle.""
"
In"addition"to"this"the"cortex"has"2"sets"of"arterioles"
(afferent"+"efferent)"and"2"sets"of"capillaries"(glomerular"
and"peritubular)"which"makes"it"quite"complex!"
Normally"the"resistances"of"the"afferent"and"efferent"
arterioles"are"approximately"equal"and"account"for"most"
of"total"renal"vascular"resistance."Resistance"in"arteries"
preceding"afferent"arteriole"(ie"cortical"radial"arteries)"
plays"some"limited"role"also.""
"
Vascular"pressures"in"the"2"cap"beds"are"quite"different."
Peritubular"caps"are"downstream"from"efferent"arteriole"
and"have"a"lower"hydraulic"pressure"(20mmHg)"c/w"
typical"glomerular"pressures"of"near"60mmHg"in"normal"
unstressed"individual."Higher"glomerular"pressure"is"
crucial"for"filtration"c/w"low"peritubular"pressure"is"
crucial"for"tubular"reabsorption"of"fluid.""
"
A"change"in"either"afferent"or"efferent"arteriolar"
resistance"produces"same"effect"on"RBF,"due"to"these"
vessels"being"in"series."When"their"resistances"both"
change"in"the"same"direction,"their"effects"on"RBF"are"
additive."When"they"change"in"different"directions"they"
exert"opposing"effects."
ANSWER:(A(
"
Intraarenal"processes"of"autoregulation:"
‘TUBULOGLOMERULAR"FEEDBACK.’"TGF"is"feedback"
from"the"tubules"back"to"the"glomerulus."As"the"filtration"
rate"of"an"individual"nephron"increases"or"decreases,"the"
amount"of"Na+"that"escapes"reabsorption"in"the"proximal"
More"sodium"filtered"""more"Na+"remaining"in"the"
lumen"of"the"nephron"and"more"Na+"flowing"from"thick"
ascending"limb"into"distal"tubule."This"is"sensed"by"
macula"densa"cells"(‘salt"detectors’)."The"changing"level"
of"intraluminal"Na"can"increase"or"decrease"the"secretion"
of"transmitter"agents"into"the"interstitial"space"that"affect"
filtration"in"the"nearby"glomerulus."High"levels"of"Na"
flowing"past"macula"densa""""decrease"in"filtration"and"
vice"versa.""
Transmitter"agents"released"by"macula"densa"""
vasoconstriction"of"afferent"arteriole"""reducing"
hydrostatic"pressure"in"glomerular"capillaries."The"same"
agents"also"cause"contraction"of"glomerular"mesangial"
cells"""decreasing"effective"filtration"coefficient."Both"of"
these"processes"reduce"the"single"nephron"filtration"rate"
and"keep"it"at"a"level"appropriate"for"the"rest"of"the"
nephron.""
51"
KD20"[Apr01]"[Feb04]"For"renal"clearance"of"a" ANSWER:(Secreted(substance(
substance"to"exceed"Inulin,"" PART(1(B(
A."Increase"in"GFR"" PART(2(B(
B."Must"be"secreted"by"either"the"proximal"or" PART(3(B(
distal"tubules"" "
C."Must"have"a"lower"molecular"weight"than" Inulin"is"freely"filtered"and"is"not"reabsorbed"nor"actively"
Inulin"" secreted,"making"it"useful"for"calculation"of"GFR"(renal"
" clearance"of"inulin"="GFR).""
Alt"version:"If"a"substance"is"cleared"by"the" "
kidney"at"a"rate"greater"than"inulin,"it"must"be:"" Clearance"="([Inulin]"in"urine/[Inulin]"in"blood)"x"volume"
A."Freely"filtered"" of"urine/hr"
B."Actively"secreted"" "
C."?"" To"possess"a"higher"renal"clearance"the"substance"must"
D."Actively"reabsorbed"" be"both"freely"filtered,"not"be"reabsorbed"AND"be"
E."?"" actively"secreted."PAH"(paraaamino"hippurate)"satisfies"
" these"criteria,"and"hence"is"useful"in"the"calculation"of"
Alt"version:"If"a"substance"is"found"in"the"urine" renal"plasma"flow"(RPF)"from"which"renal"blood"flow"
at"a"HIGHER"concentration"than"inulin,"then"" (RBF)"can"be"estimated.""
A."It"must"be"filtered"more"" "
B."It"is"secreted"into"the"lumen"" Effective"RPF"(ml/min)"="([PAH]"urine/[PAH]"plasma])"x"
C."?"" volume"urine/hr"
D."There"is"less"reabsorption"in"the"?DCT"" "
RBF"(ml/min)"="RPF/(1aHCT)"
KD21"[Apr01]"Water"excretion"by"the"kidney" ANSWER:((?E(
is"due"to:"" A"–"relates"to"water"reabsorption"
A"Osmosis"" B"–"water"reabsorption"is"passive"
B."Active"transport"into"the"lumen"" C"a"incorrect"
C."Passive"secretion"in"the"collecting"tubules"" D"–"N/A"
D."Solvent"drag"" E"–"relates"to"water"reabsorption"(eg"ADH"induced"
E."Facilitated"diffusion"" aquaportins"in"DCT"+"CCD)"
F."Paracellular"movement"" Fa"water"does"travel"paracellularly,"although"not"a"main"
(Comment:"“bulk"flow”"or"“filtration”"were"not" factor"
choices)"" "
" Water"movement"from"glomerular"caps"in"BC"is"due"to"
filtration"(bulk"flow)."Similarly"water"flow"along"tubules"
is"due"to"bulk"flow"in"response"to"pressure"gradient."""
"
Water"reabsorption"is"due"to"water"moving"passively"
down"its"osmotic"gradient"(ie"diffusion).""
"
Solvent"drag"–"entrainment"of"solute"with"rapidly"
reabsorbed"water."

52"
KD22"[Apr01]"[Jul01]"Angiotensin"II"causes:""
A."Increases"proximal"tubular"reabsorption"of"
Na"&"H2O"&"increases"secretion"of"K+""
B."Increases"distal"tubular"reabsorption"of"Na"
&"H2O"&"decreases"secretion"of"K+""
C."Decreases"distal"tubular"reabsorption"of"Na"
&"H2O""
D."Increases"excretion"of"Na"&"H2O""
" reabsorption"in"renal"tubules"in"3"ways:"
KD23"[Jul01]"[Feb04]"Glomerulotubular"
balance:""
A"Involves"afferent"arteriole"feedback"loop""
B"Involves"efferent"arteriole"feedback"loop""
C"Juxtaglomerular"complex""
D"Ability"to"increase"tubular"absorption"in"
response"to"an"increase"in"filtered"load""
E"None"of"the"above""
F."Tubular"resorption"is"matched"to"GFR""
(Q41"on"Jul"01"paper)""
KD24"[Jul01]"Kidneys"produce:""
A."Erythropoietin""
B."ADH""
C."Angiotensin"II""
D."ANP""
E."Cholecalciferol""
" from"the"posterior"pituitary."
ANSWER:(A(
AT2(increases(reabsorption(of(Na+(and(HCO3E(by(
action(on(the(proximal(tubule.(
"
AT2"is"bodys"most"powerful"Naaretaining"hormone."AT2"
increases"in"circumstances"associated"with"low"BP"
and/or"low"ECF"volume."AT2"helps"to"return"BP"and"ECF"
volume"back"to"normal"by"increasing"Na"and"H20"
"
1."AT2"stimulates"aldosterone"secretion"""increases"Na"
reabsorption."
"
2."AT2"constricts"afferent"arterioles"""raise"Na"and"H20"
reabsorption"in"2"ways:"
a)"efferent"arterioles"constriction"reduces"peritubular"
capillary"hydrostatic"pressure"""increases"net"tubular"
reabsorption"
b)efferent"arteriolar"constriction"""reduces"RBF"""
raises"filtration"fraction"in"glomerulus"""increases"
[proteins]"and"colloid"osmotic"pressure"in"peritubular"
caps"""increases"reabsorptive"force"at"peritubular"caps"
and"raises"tubular"reabsorption"of"Na/H20"
"
3."AT2"directly"stimulates"Na"reabsorption"in"proximal"
tubules,"LOH,"distal"tubules"and"CD."It"stimulates"the"Naa
KaATPase""on"basolateral"membrane."It"also"stimulates"
NaaH"exchange"in"luminal"membrane"(proximal"tubule)."
Ie"it"targets"Na"transport"across"both"luminal"and"
basolateral"membranes.""
ANSWER:(D((more(correct(c/w(F)(
"
Glomerulotubular"balance"–"kidneys"ability"to"increase"
the"reabsorption"of"solutes"(predominantly"in"proximal"
tubule)"in"response"to"an"increase"in"GFR."This"ensures"
that"the"proportion"of"solute"reabsorbed"remains"
constant.""
"
(C/w"Tubuloglomerular"feedback:"effects"of"macula"
densa"on"afferent"arteriole"in"response"to"an"increased"
solute"load"in"the"ascending"LOH)."
ANSWER:(A((more(correct(than(C)(
"
A."EPO"made"in"proximal"tubule"cells"or"peritubular"
capillaries"in"kidney."
B."ADH"produced"in"supraoptic"and"paraventricular"
nuclei"in"hypothalamus"then"transported"and"released"
C."ACE"(expressed"on"vascular"endothelium,"mainly"in"
the"lungs"but"also"in"the"kidneysa20%)"converts"AT1"to"
produce"AT2."
D."ANP"formed"in"atria"
E."Cholecalciferol"produced"in"skin,"converted"to"25a
hydrocholecalciferol"in"liver,"then"to"the"active"1,25a
dihydroxycholecalciferol"in"kidney."
53"
KD25"[Jul01]"Renal"nerve"sympathetic" ANSWER:((A(
stimulation"" "
A."Causes"increased"sodium"reabsorption"from" Kidneys"have"rich"innervation"by"sympathetic"
the"PCT"" noradrenergic"neurons"(T10aL1)"distributed"to"afferent"
B."Inhibits"renin"release"" and"efferent"arterioles,"PCT,"thick"ascending"limb"LOH,"
C."Increased"GFR"" DCT"and"JG"apparatus."Renal"sympathetic"nerves"have"
D."?"" tonic"discharge"at"rest,"rate"of"discharge"is"increased"by"
E."?"" baroreceptor"reflex,"exercise,"and"central"sympathetic"
" response."This"results"in"a"graded"response:"
"
1."Increased"sensitivity"of"JG"cells"to"nonaneural"
stimulation"for"renin"release"(β1)"
2."Increased"renin"secretion"by"direct"affect"on"JG"cells"
(β1)"
3."Increased"sodium"reabsorption"by"direct"action"of"
noradrenaline"on"renal"tubular"cells"(α1"+"β1)"the"PCT,"
DCT"and"ascending"LOH"
4."Renal"vasoconstriction:"initial"effect"is"on"efferent"
arteriole,"but"greater"stimulation"of"SNS"causes"afferent"
arteriolar"constriction"(decreases"RBF"and"GFR"–"less"
reduction"GFR"due"to"efferent"vasoconstriction)."
5."Noradrenaline"causes"contraction"of"glomerular"
mesangial"cells"""decrease"Kf"""decreased"GFR."
KD26"[Jul01]"Water"reabsorption"by"the" ANSWER:(?C((maybe(D(or(E(hold(the(key)(
kidney:"" Water"reabsorption:"follows"the"primary"active"transport"
A."90%"in"proximal"tubule"" of"sodium"(hence"is"it"secondarily"actively"transported?);"
B."60%"in"distal"tubule"" 65%"proximal"tubule,"10%"descending"thin"limb"LOH,"5"
C."By"active"transport"" to">25%"collecting"duct"(depends"on"state"of"hydration)."
D."?"" "
E."?""
"

(
(
KD27"[Jul01]"Glomerular"filtration"rate"(GFR):"" ANSWER:((C(
A."Is"independent"of"the"size"of"the"capillary" "
bed"" GFR"="hydraulic"permeability"x"SA"x"net"filtration"rate"
B."Depends"only"on"the"hydrostatic"and" GFR"="Kf"x"NFR"
osmotic"pressure"differences"across"the" GFR"="Kf"((PGC"a"∏GC)"–"(PBC"a"∏BC))"
capillary"" ""
C."Is"determined"by"the"same"forces"governing" A."incorrect"(Kf"="SA"x"hydraulic"permability)"
filtration"across"all"other"capillaries"" B."incorrect"(Kf)"
D."Depends"only"on"the"permeability"of"the" C."CORRECT"
capillary"" D."incorrect"
E."Requires"active"transport"" E."incorrect"(nil"active"transport"in"ultrafiltration)."
"

54"
" (
KD28"[Mar02]"[Mar03]"Pressure"diuresis:""
A."Due"to"decreased"reabsorption"of"Na+"&"
water"in"peritubular"capillaries""
B."Regulated"by"macula"densa""
C."Increase"ADH""
D."Increase"angiotensin""
E."Control"by"JGA""
" concentration,"which"is"why"we"need"systems"such"as"
KD29"[Mar02]"[Jul02]"[Mar03]"[Jul03]"[Feb04]"
What"is"the"minimum"amount"of"urine"
required"to"excrete"600mOsm""
A."100ml""
B."500ml""
C."1"litre""
D."2"litre""
E."4"litre""
KD30"[Mar02]"[Jul02]"Increase"in"GFR"occurs"
with""
A."Increased"sympathetic"stimulation""
B."Decreased"renal"blood"flow""
C."Hypoproteinaemia""
D."Ureteric"obstruction""
E."None"of"the"above""
" pressure"all"the"way"back"to"BC"and"hence"decreased"GFR"
ANSWER:(A(
In"response"to"elevated"renal"artery"pressure,"the"
number"of"luminal"NaaH"antiporters"and"NaaKaATPase"
pumps"are"reduced""""reducing"reabsorption"of"Na"(and"
therefore"water)."This"is"termed"pressure"natriuresis"and"
diuresis."The"problem"with"this"is"that"it"does"not"
separately"control"solute"concentration"(Na)"and"water"
ADH"and"aldosterone.""
"
B."Macula"densa"regulates"tubuloglomerular"feedback"via"
sensing"Na"+/a"Cl"in"tubule"
C"+"D."Increased"circulating"volume"causing"a"pressure"
diuresis"will"actually"decrease"activation"of"RAAS"and"
reduce"ADH"secretion"(via"RAS"+"direct"baroreceptor"
reflexes).""
E."JGA"controls"RAS"and"is"in"fact"negatively"controlled"by"
a"pressure"diuresis."
ANSWER:(B(
"
Maximum"urine"concentration"is"1200a1400mOsm/L"
"
Hence"to"excrete"600mOsm"would"need:"
between"600/1400"and"600/1200"="430"to"500mL"urine"
ANSWER:(C(
"
A."incorrect"–"decrease"in"GFR"with"increased"SNS"
stimulation"
B."incorrect"–"decreased"GFR"with"decreased"RBF"
C."CORRECT"–"see"below"
D."Incorrect"–"obstructing"ureters"""increased"tubular"
E."incorrect"
"
GFR"="hydraulic"permeability"x"SA"x"net"filtration"rate"
GFR"="Kf"x"NFR"
GFR"="Kf"((PGC"a"∏GC)"–"(PBC"a"∏BC))"
"
Hypoproteinaemia"slightly"decreases"glomerular"
capillary"oncotic"pressure"which"increases"net"filtration"
pressure"which"increases"GFR."
55"
 KD31"[Mar02]"[Feb04]"Filtration"fraction"
measured"as"inulin"clearance/"PAH"clearance"" PART(1(:(N/A(
A."?""
B."?""
" B"–"Creatinine"(not"creatine)"clearance"correlates"well"
KD31b"[Mar03]"[Jul03]"[Feb04]"Regarding"
renal"clearance:""
A."Inulin"clearance"measures"renal"blood"flow"" C"–"Filtration"fraction"="GFR/RPF(((ratio"of"GFR"to"RPF)"="
B."Creatine"clearance"correlates"with"GFR""
C."Filtration"fraction"measured"as"inulin"
Unit XIII Metabolism and Temperature Regulation
clearance/"PAH"clearance""
D."?""
(Comment:""option"B"was"creatine"&"NOT"
NH2 C CH2creatinine!")""
CH2 CH COOH CH3 C COOH
O
" NH2 + O
(Glutamine) (Pyruvic acid)
NH2 C CH2 CH2 C COOH CH3 C COOH
O O + NH
(a-Ketoglutamic acid) (Alanine)
ich are the precursors of the respective amino acids.
r instance, pyruvic acid, which is formed in large
antities during the glycolytic breakdown of glucose,
the keto acid precursor of the amino acid alanine.
en, by the process of transamination, an amino
dical is transferred to the a-keto acid, and the keto
ygen is transferred to the donor of the amino radical.
is reaction is shown in Figure 69–3. Note in this figure
at the amino radical is transferred to the pyruvic acid
m another chemical that is closely allied to the amino
ds, glutamine. Glutamine is present in the tissues in
ge quantities, and one of its principal functions is to
ve as an amino radical storehouse. In addition, amino
dicals can be transferred from asparagine, glutamic
d, and aspartic acid.
Transamination is promoted by several enzymes,
mong which are the aminotransferases, which are deriv-
ves of pyridoxine, one of the B vitamins (B6). Without
s vitamin, the amino acids are synthesized only poorly,
d protein formation cannot proceed normally.
KD32"[Mar03]"Regarding"urea:""
se of Proteins A."Urea"is"formed"from"…ornithine""
for Energy
B."10%"is"reabsorbed"by"kidney""
nce the cells are filled to their limits with stored
C."?""
otein, any additional amino acids in the body fluids are
graded and used" for energy or are stored mainly as fat
secondarily as glycogen. This degradation occurs
most entirely in the liver, and it begins with deamina-
n, which is explained in the following section.
amination. Deamination means removal of the amino
oups from the amino acids. This occurs mainly by
nsamination, which means transfer of the amino
oup to some acceptor substance, which is the reverse
the transamination explained earlier in relation to the
nthesis of amino acids.
The greatest amount of deamination occurs by the
lowing transamination schema:
a-Ketoglutaric acid + Amino acid
Glutamic acid + a-Keto acid
+ NAD+ + H2O
ANSWER:((
PART(2:(C(
A(–(inulin"clearance"is"a"measure"of"GFR"
with"GFR"(but"10%"overestimate"due"to"secretion"of"Cr"in"
proximal"tubule)(
Inulin"clearance/PAH"clearance.(
"
Inulin:"polysaccharide"that"is"filterable"but"is"neither"
reabsorbed"nor"secreted."Therefore,"the"volume"of"
plasma"cleared"of"inulin"per"unit"time"is"the"same"as"the"
glomerular"filtration"rate"(GFR)."Clearance"of"inulin"is"
thus"equal"to"the"glomerular"filtration"rate,"not"the"renal"
Transaminase
blood"flow.""
"
Creatinine"is"an"end"product"of"Creatine"metabolism"and"
is"exported"into"blood"continuously"by"skeletal"muscle"
(rate"proportional"to"skeletal"muscle"mass)."Creatinine"is"
Figure 69–3
freely"filtered"and"not"reabsorbed."A"small"amount"is"
secreted"by"the"proximal"tubule,"hence"creatinine"
Synthesis of alanine from pyruvic
acid by transamination.
clearance"is"slightly"higher"than"the"GFR"(i.e"represents"
both"a"filtered"and"secreted"component)."The"secreted"
fraction"is"normally"~"10a20%,"so"the"measured"
Note from this schema that the amino group from the
aminocreatinine"clearance"overestimates"GFR"by"the"same"
acid is transferred to a-ketoglutaric acid, which
percentage"(an"acceptable"degree"of"error"for"routine"
then becomes glutamic acid. The glutamic acid can then
assessment"of"GFR)."Note"the"secreted"component"is"a"
transfer the amino group to still other substances or
release it in the form of ammonia (NH3). In the process
relatively"larger"fraction"of"amount"excreted"for"a"patient"
of losing the amino group, the glutamic acid once again
with"a"low"GFR"–"therefore"creatinine"clearance"more"
becomes a-ketoglutaric acid, so that the cycle can be
severely"overestimates"GFR"in"patients"with"a"very"low"
repeated again and again. To initiate this process, the
excessGFR."‘B’"cannot"be"right"as"creatine"itself"is"not"cleared"
amino acids in the cells, especially in the liver,
inducebut"rather"metabolised"to"creatinine"for"clearance.""
the activation of large quantities of aminotrans-
" the enzymes responsible for initiating most
ferases,
deamination.
The"filtration(fraction"refers"to"the"fraction"of"the"renal"
plasma"entering"the"glomeruli"via"the"afferent"arterioles"
Formation by the Liver. The ammonia released
Urea
duringthat"is"filtered"into"Bowman’s"space."This"amounts"to"the"
deamination of amino acids is removed from the
bloodratio"of"GFR"to"RPF"(renal"plasma"flow)."As"the"gold"
almost entirely by conversion into urea; two mol-
eculesstandard"for"measurement"of"GFR"is"Inulin"clearance"and"
of ammonia and one molecule of carbon dioxide
combine in accordance with the following net reaction:
that"for"Renal"Plasma"Flow"is"PAH"clearance,"Inulin"
Clearance/PAH"Clearance"equates"to"GFR/RPF…"the"
2 NH3 + CO2 Æ H2N—C—NH2 + H2O
||
filtration"fraction.""
O
ANSWER:(Neither!(As"the"question"is"worded,"A"is"
Essentially
incorrect…( all urea formed in the human body is syn-
thesized in the liver. In the absence of the liver or in
"
serious liver disease, ammonia accumulates in the
blood.A"–"Urea"cycle:"arginine"breaks"down"to"ornithine"and"
This is extremely toxic, especially to the brain,
often urea."Ornithine"is"like"oxaceloacetate"and"is"regenerated"
leading to a state called hepatic coma.
Theduring"the"cycle.""
stages in the formation of urea are essentially the
following:
B"–"50%"of"urea"is"reabsorbed"
"
Ornithine + CO2 + NH3
Citrulline
-H2O
NH3
-H2O
Arginine
(Arginase)
+ H2O
Urea
" "
After "its formation, the urea diffuses from the liver cells
into the body fluids and is excreted by the kidneys.
Oxidation of 56"
Deaminated Amino Acids. Once amino acids
have been deaminated, the resulting keto acids can, in
most instances, be oxidized to release energy for meta-
bolic purposes. This usually involves two successive
processes: (1) the keto acid is changed into an appro-
" (
KD33"[Mar03]"[Jul03]"The"clearance"(or"'renal" ANSWER:(E(
regulation')"of"which"ONE"of"the"following"is" "
NOT"regulated"by"a"hormone:"" Excretion"of"Na"and"K"are"affected"by"aldosterone"
A."Sodium"" Excretion"of"Ca"and"PO4"is"affected"by"PTH.""
B."Potassium"" "
C."Calcium"" Sulfate"which"is"reabsorbed"in"proximal"tubule,"mot"
D."Phosphate"" under"any"hormone"control."
E."Sulphate""
"

57"
KD34"[Mar03]"[Jul03]"Biggest"contribution"to"
urine"concentration"by:""
A."Na+"absorption"in"thick"ascending"limb""
B."Passive"diffusion"of"urea"in"collecting"ducts""
C."Chloride"absorption"in"distal"convoluted"
tubule""
" medullary"osmotic"gradient"are:"
July"03"comment:""There"were"2"questions"on"
factors"contributing"to"the"hypertonic"
medullary"interstitium"and"permeability"of"the"
loop"of"Henle"next"to"one"another,"to"which"I"
am"sure"I"have"the"options"incorrect,"but"they"
were"something"like:""
A."Sodium"transport"into"the"ascending"limb"of"
LOH""
B."Active"sodium"transport"into"the"vasa"recta""
C."Passive"reabsorption"of"urea"in"collecting"
duct""
D."Water"reabsorption"in"thin"ascending"limb"
of"LOH""
E."Sodium"reabsorption"by"the"thin"ascending"
limb"of"LOH""""
" proximal"tubule."Urea"is"secreted"in"LOH"(thin"areas),"
Alternate"July"2003"version""
High"osmolarity"of"renal"medullary"
interstitium"is"due"to:""
A."secretion"of"H2O"into"ascending"loop"of"
Henle""
B."diffusion"of"H2O"into"ascending"loop"of"
Henle""
C."active"transport"of"Na"from"vasa"recta""
D."passive"reabsorption"of"urea"from"collecting"
duct""
E."Cl"absorption"in"distal"tubule""
" low"blood"flow"to"this"region"the"reabsorbed"urea"
" accumulates"and"raises"the"interstitial"concentration"
ANSWER:((
PART(A(E(A(
PART(B(E(C(
PART(C(E(D(
"
Main"active"components"in"the"development"of"
1."Active"NaCl"transport"by"thick"ascending"limb"(TAL)"in"
LOH"
2."Unusual"arrangement"of"blood"vessels"and"nephron"
segments"in"the"medulla"(descending"components"in"
close"opposition"to"ascending"components)""
3."Recycling"of"urea"between"medullary"collecting"ducts"
and"the"deep"portions"of"the"LOH."(50%"is"reabsorbed"in"
the"PCT,"this"is"then"secreted"back"into"the"tubule"
through"the"LOH,"and"finally"50%"reabsorbed"in"the"CD"
(50%"of"the"filtered"load"is"excreted)).""
"
About"half"of"the"peak"osmolality"is"due"to"Na/Cl,"the"rest"
mainly"due"to"urea"(500a600"mOsm/kg)."To"develop"this"
high"[urea]"there"is"a"recycling"process"in"tubules"and"VR."
Urea"is"freely"filtered"and"about"½"is"reabsorbed"in"the"
driven"by"high"urea"concentration"in"medullary"
interstitium."This"essentially"restores"the"amount"of"
tubular"urea"back"to"the"filtered"load."From"the"end"of"
the"thin"limbs"to"the"inner"medullary"collecting"ducts,"
little"urea"transport"occurs"(ie"whatever"urea"arrives"
back"at"TAL"is"still"there"at"inner"medullary"collecting"
duct)."Because"most"of"the"water"has"already"been"
reabsorbed"by"then,"the"luminal"urea"concentration"has"
risen"up"to"50x"the"plasma"value."In"inner"medullary"
collecting"ducts"some"urea"is"reabsorbed"via"specialised"
urea"uniporters"but"the"rest"is"excreted."Because"there"is"
close"to"that"of"the"lumen"(it’s"this"high"interstitial"
concentration"that"drives"secretion"in"the"thin"limbs)."So"
in"combination"with"the"Na/Cl,"urea"contributes"to"the"
medullary"osmotic"pressure"of"1000"mOsm/kg.""
"
Salt"(without"water)"is"deposited"in"the"interstitium"by"
the"TAL."That"salt"accumulates"due"to"low"blood"flow"and"
countercurrent"exchange"between"descending"and"
ascending"VR."Adding"to"the"osmolality"of"the"medulla"is"
urea,"which"recycles"from"inner"medullary"collecting"
ducts"to"the"thin"limbs"of"LOH."Urea"also"participates"in"
countercurrent"exchange"like"Na+.""
Magnitude"of"medullary"osmotic"gradient"varies"
according"to"state"of"hydration."Key"regulator"of"this"
varying"osmolality"is"ADH"which"not"only"raises"water"
permeability"in"cortical/medullary"collecting"ducts,"but"
also"raises"urea"permeability"by"stimulating"ADHa
sensitive"isoform"of"the"urea"uniport"(only"in"inner"
medullary"collecting"duct)."
"
58"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
(
" (
" (
KD35"[Feb06]"The"amount"of"H+"filtered"by"the" ANSWER:(C(
kidney"per"day:"" C"a"this"is"a"direct"quote"from"Power"and"Kam,"although"
A."3.6"mmol"" Vander"disagrees"(page"169)"and"says"<0.1mmol/day."
B."36"nmol"" Note"that"this"question"asks"for"amount"of"H+"filtered,"
C."0.68"mmol"" not"the"amount"secreted."
D."6.8"mmol"" "
E."68"mmol"" Calculations"below"differ"from"the"amounts"stated"above"
" from"text"books…"
"
H+"per"day:"
Filtered:"6.8"micromoles/day"
Excreted:"68mmol/day"
"
[H+]"plasma"="40"x"10a9"moles/litre"
GFR"="170L/day"
"
Amount"H+"filtered/day"="170"x"40"x"10a9"moles/day"
="6,800"x"10a9"moles/day"
="6,800"nmoles/day"
="6.8"micromoles/day"
="0.0068"milliomoles/day"

59"
KD36"[Feb06]"Regarding"water"reabsorption"
in"the"collecting"tubules:""
A."depends"on"aldosterone"levels""
B."collecting"tubules"able"to"reabsorb"60a70%"
of"water""
C."depends"on"renin"levels""
D."loops"of"henle"are"ONLY"located"in"the"renal"
medulla"(may"be"from"another"question)""
E."?""
" 15%"of"filtered"water"is"presented"to"the"collecting"duct"
KD37"[Feb06]"Regarding"the"Loop"of"Henle:""
A."active"transport"of"na"into"tubules""
B."active"transport"of"cl"out"of"tubules""
C."active"transport"of"k"into"tubules""
D."permeable"to"water""
E."something&else&wrong&"
" Na/Cl."
KD37"[Feb06]"(Probably"represents"same"MCQ" 3."In"ascending"limb"Na,"K"and"Cl"are"actively"reabsorbed"
as"KD03"&"KD34"Regarding"the"Loop"of"Henle:"" out"of"the"tubule"via:"
A."active"transport"of"Na+"into"tubules""
B."active"transport"of"Cla"out"of"tubules""
C."active"transport"of"K+"into"tubules""
D."permeable"to"water""
E."something&else&wrong""
KD38"[Jul10]]"Creatinine/urea"is"not"used"for"
the"measurement"of"GFR"because:""
A."It"is"not"readily"filtered""
B."It"is"secreted"in"the"ascending"loop"of"Henle"" B"–"NO"for"creatinine"as"it"is"secreted"in"proximal"tubule"
C."It"is"reabsorbed"in"the"proximal"tubule""
D."?""
E."?""
" C"–"NO"for"creatinine,"?YES"for"Urea"as"it"is"reabsorbed"
ANSWER:(A((
"
A:"YES"
Aldosterone"stimulates"salt"reabsorption"in"the"collecting"
tubules,"which"will"result"in"water"reabsorption"by"
osmosis."Aldosterone"receptor"antagonists"are"
diuretics…"See"page"378"of"Guyton"
"
B"NO"
(PCT"65%,"LoH"15%,"DCT"5%)."In"the"presence"of"ADH"
14.7%"of"this"is"reabsorbed."In"absence"ADH"2%"
reabsorbed.""
"
C"?YES"
Renin"cleaves"angiotensinogen"to"AT1."ACE"converts"AT1"
to"AT2."AT2"stimulates"ADH"secretion"from"posterior"
pituitary"""increases"permeability"of"collecting"ducts"to"
water."But"there"are"also"other"mechanisms"that"cause"
ADH"release"so"doesn’t"‘depend’"on"renin."
"
D"NO"
Cortical"nephrons"can"have"short"LOH"which"start"in"
cortex"and"descend"into"medulla."Juxtamedullary"
nephrons"have"long"LOH"which"extend"into"the"
medullary"pyramids."Thick"ascending"limbs"come"back"to"
cortex,"reaching"the"glomerulus"to"form"the"macula"
dense"btw"afferent"and"efferent"arterioles.""
ANSWER(B(
"
LOH"creates"the"high"medullary"interstitial"osmolality"
which"is"essential"for"the"production"of"concentrated"
urine"from"glomerular"filtrate.""
2."DESCENDING"limb"is"permeable"to"water"but"not"
a"NaaKa2CL"cotransporter"on"apical"membrane."
a"NaaH"antiporter"on"apical"membrane."
a"NaaKaATPase"on"basolateral"membrane."
ANSWER:(?B(and(C(for(urea(
"
A"–"incorrect"(both"freely"filtered)"
(hence"10%"inaccuracy"in"measureing"GFR)."?YES"for"
urea"as"is"secreted"in"LOH"50%"(would"lead"to"large"
inaccuracies"of"GFR)."
50%"in"PCT."
"
Creatinine"is"used"to"estimate"GFR,"although"not"as"
accurate"as"inulin."This"small"accuracy"is"due"to"small"
secretion"in"the"tubules,"leading"to"overaestimation"of"
GFR.""
"
Urea"is"absorbed"in"PCT"(50%),"actively"secreted"in"LoH,"
and"then"reabsorbed"in"medullary"CD."Urea"reabsorption"
is"further"affected"by"urine"flow,"and"level"urea"is"
affected"by"protein"diet."Due"to"complexity"of"
transportation"of"urea"and"unstable"level"in"plasma,"it"is"
not"used"to"measure"GFR"in"clinical"setting."
60"
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61"
GASTROINTESTINAL)MCQS)
GI01 [cd] [Jul98] Oesophagus at rest is:
A. Open at the top
B. Open at the bottom
C. Open at the top and the bottom
D. Closed at the top and the bottom
E. Contracted throughout its length
GI02 [Mar97] [Jul00] Na+ absorption in
small bowel
A. Occurs by active transport
B. Occurs with H+
C. Decreases with glucose ( OR: Is
facilitated by glucose)
B: Is by active transport at the brush border
membrane
C: ? passive across basolateral membrane
(??diffusion)
D. Occurs with Cl- through tight junctions
GI03 [d] [Jul98] [Jul99] [Jul02] After a fatty
meal, most of the fat would be:
A. Absorbed in the portal circulation &
transported to the liver
B. Absorbed in the portal vein & transported
in the hepatic artery
C. Absorbed into chylomicrons in the
lymphatics
D. Absorbed as triglycerides into the portal
vein & bypass the liver
D
Guyton:
- Upper oesophageal sphincter is strongly contracted between
swallows to prevent air from entering the oesophagus during
respiration
- Lower oesophageal sphincter is tonically constricted
A
Guyton:
- The principles of sodium reabsorption are similar to absorption of
sodium from the gallbladder and renal tubules
- Active transport of sodium through the basolateral membranes of
the cell reduces the sodium concentration inside the cell to a low
value (~50 mEq/L)
- Because the sodium concentration in the chyme is normally about
142 mEq/L (~equal to that in plasma), sodium moves down this steep
electrochemical gradient from the chyme through the brush border of
the epithelial cell into the epithelial cell cytoplasm
- This provides still more sodium ions to be transported by the
epithelial cells into the paracellular spaces
- Part of the sodium is absorbed with chloride ions; in fact, the
negatively charged chloride ions are mainly passively “dragged” by
the positive electrical charges of the sodium ions
Power and Kam:
- Other pathways for Na+ absorption across the intestinal mucosa are
Na+ channels at the luminal membrane and Na+/glucose or amino
acid coupled co-transport
C
Guyton:
- Almost all the fats in the diet are absorbed from the intestines into
the intestinal lymph
- During digestion, most triglycerides are split into monoglycerides
and fatty acids
- While passing through the intestinal epithelial cells, the
monoglycerides and fatty acids are resynthesised into new
triglycerides that enter the lymph as minute, dispersed droplets called
chylomicrons
62"
 812 Unit XII Gastrointestinal Physiology
GI03b [Mar99] Fat digestion: C
A. Bile salts are the most efficient Guyton:
emulsifiers Fat
(Bile + Agitation)
Emulsified fat
B. Gastric lipase is the most important Villi
C. Pancreatic lipase in the duodenum is the Emulsified fat
Pancreatic lipase
Fatty acids and Food
most important 2-monoglycerides movement

D. Digestion takes place in micelles Emulsification of fats

E. Micelles attach to enterocyte receptor - The first stepFigurein fat65–4
digestion is physically to break the fat globules
into small sizes so that the water-soluble digestive enzymes can act
on the globuleDigestion
surfacesof fats.
= emulsification
- Begins by agitation in the stomach to mix the fat with the productsValvulae conniventes
of stomach digestion
free- fatty
Then,acidsmost and
of 2-monoglycerides,
the emulsification as occurs
shown inin the duodenum under the
Not part of the question – placed here for Figure 65–4.
influence of bile, the secretion from the liver that does not contain
formatting purposes Roleany digestive
of Bile enzymesFatbut
Salts to Accelerate does contain bile
Digestion—Formation of salts Figure
and the
65–5
phospholipid
Micelles. lecithin
The hydrolysis of triglycerides is a highly
reversible
- Bothprocess;
of these, therefore, accumulation
but especially of mono- are important
the lecithin,
Longitudinal section of the small intestine, showing the
for by villi.
glycerides and free fatty acids in the vicinity of digest- conniventes covered
ing emulsification
fats quickly blocks of further
the fatdigestion. But the bile
salts- The lipase
play the enzymes
additional are water-soluble
important compounds and can attack the
role of removing
the fat
monoglycerides and free fatty acids from therefore The bile salt micelles play the same role in
the vicin- the detergent
globules only on their surfaces, function of
ing” free cholesterol and phospholipid molecu
ity of the digesting fat globules almost as rapidly as
thesebileend
salts and lecithin
products is important
of digestion for the
are formed. digestion
This tatesofthat
fatthey play in “ferrying” monoglycer
occurs in the following way. free fatty acids. Indeed, essentially no chole
Bile salts, when
Digestion in high enough concentration in
of triglycerides absorbed without this function of the micelles
water, have the propensity to form micelles, which are
small- The mostcylindrical
spherical, importantglobules
enzyme 3 tofor digestion of the triglycerides is
6 nanometers
pancreatic
in diameter lipase of 20 to 40 molecules of bile
composed Basic Principles of
salt.-These develop because
The enterocytes of theeach bile salt
small molecule
intestine Gastrointestinal
is contain
also lipase = enteric Absorption
composed of a sterol nucleus that is highly fat-soluble
andlipase,
a polarbut thisthat
group is usually not
is highly needed
water-soluble. The It is suggested that the reader review the basi
Formation
sterol of micellesthe fat digestate, forming
nucleus encompasses ples of transport of substances through ce
a small
- Bilefat globule in the middle
salts remove of a resulting micelle,
the monoglycerides and free branes discussed
fatty acids from in the
detail in Chapter 4. The fo
with polar groups of bile salts projecting outward to paragraphs present specialized applications
vicinity of digesting fat globules,
cover the surface of the micelle. Because these polar via the following…
transport processes during gastrointestinal abs
- High
groups are enough
negativelyconcentrations
charged, they allowof bilethesalts
entireform micelles = small
micelle globule cylindrical
spherical, to dissolve inglobules
the water of the diges-
tive fluids and to remain in stable solution until the fat Anatomical Basis of Absorption
- These act as
is absorbed into the blood.
a transport medium to carry the monoglycerides and
freebile
The fatty
salt acids
micelles toalso
theactbrush borders of
as a transport the intestinal
medium epithelial
The total quantitycells
of fluid that must be absorb
to carry
- Therethe monoglycerides
the monoglycerides and freeand
fatty acids,
free both
fatty day by the
acids diffuse out intestines
of the is equal to the ingest
of which would otherwise be relatively insoluble, to (about 1.5 liters) plus that secreted in the vari
micelles and into the interior of the epithelial cells
the brush borders of the intestinal epithelial cells. trointestinal secretions (about 7 liters). This c
There- Thethe bile salts are released
monoglycerides and freebackfattyinto theare
acids chymeatototal
be of
used
8 toagain for
9 liters. All but about 1.5 liters o
this “ferrying”
absorbed into the blood,process
as discussed later, but the bile absorbed in the small intestine, leaving only 1
salts themselves are released back into the chyme to to pass through the ileocecal valve into the co
be used again and again for this “ferrying” process. day.
Ganong: The stomach is a poor absorptive area of
Digestion of Cholesterol Esters and Phospholipids. Most cho- trointestinal tract because it lacks the typic
lesterol in the diet is in the form of cholesterol esters, type of absorptive membrane, and also beca
which are combinations of free cholesterol and one junctions between the epithelial cells are tig
molecule of fatty acid. Phospholipids also contain fatty tions. Only a few highly lipid-soluble sub
acid within their molecules. Both the cholesterol esters such as alcohol and some drugs like aspirin
and the phospholipids are hydrolyzed by two other absorbed in small quantities.
lipases in the pancreatic secretion that free the fatty
acids—the enzyme cholesterol ester hydrolase to Absorptive Surface of the Small Intestinal Muco
hydrolyze the cholesterol ester, and phospholipase A2 Figure 65–5 demonstrates the absorptive surfa
to hydrolyze the phospholipid. small intestinal mucosa, showing many fold

GI04 [Jul98] [Jul01] [Feb04] Vitamin B12 All correct in a way…

deficiency:
A. Due to decreased ingestion
B. Due to decreased absorption by ileum
C. Causes a deficiency in haemoglobin
D. Causes a decrease in decrease in red cell
production
E. ?
Guyton:
- A common cause of RBC maturation failure = failure to absorb
vitamin B12 from the GIT, which often occurs in pernicious anaemia
- The parietal cells of the gastric glands secrete a glycoprotein called
intrinsic factor, which binds with B12 to make it available for
absorption
- Once B12 is absorbed, it is stored in the liver then released slowly
as needed by the bone marrow
- 3 years of defective B12 absorption are required to cause maturation
failure anaemia
63"
GI05 [Jul98] [Jul99] [Mar03] [Jul03]
[Feb04] [Jul04] Iron absorption:
A. Passive
B. Binds to apoferritin in small intestine
lumen
C. Decreased with increased pH
D. Requires acidic gastric pH
E. Binds to 4 prophyrin rings in the gut
F. Vitamin C is a cofactor for haem
oxygenase
G. Haem iron is readily absorbed in the
small intestine
(Comment: Option C not on Jul 03 paper)
GI06 [Jul98] [Jul00] [Feb04] Findings in
iron deficiency:
A. Increased apoferritin synthesis
B. Decreased transferrin saturation
C. Transferrin synthesis is reduced
D. Increased amounts of ferritin
E. Haemosiderin is produced
C
D
Power and Kam:
- Occurs mainly in the duodenum
- Factors favouring the absorption of iron include gastric acid and
reducing agents, which maintain the soluble iron in the ferrous
(Fe2+) state
- Iron absorption is reduced by alkali and chelating agents which
form insoluble iron complexes
- Excess iron combines with apoferritin to form ferritin in the cell
cytoplasm, which is shed into the gut lumen when the mucosal cell
comes to the end of its life span (~3 days)
Guyton:
- The liver secretes apotransferrin to the bile, which flows through
the bile duct into the duodenum
- Here, the apotransferrin binds with free iron and with certain iron
compounds, such as haemoglobin and myoglobin from meat →
forms transferrin
- Transferrin is attracted to and binds with receptors in the
membranes of the intestinal epithelium
- By pinocytosis, transferrin is absorbed into the epithelial cells and
released into the blood capillaries in the form of plasma transferrin
- Iron absorption is slow, therefore even when large amounts are
present in food only small proportions are absorbed
Ganong:
- Fe2+ is transported into the enterocyte by an apical membrane iron
transporter
- Heme is transported into the enterocyte by a separate heme
transporter
- In the cytoplasm, heme oxygenase removes Fe2+ from the
porphyrin and adds it to the intracellular Fe2+ pool
- Some of the intracellular Fe2+ is converted to Fe3+ and bound to
ferritin
- The rest binds to the basolateral Fe2+ transporter and is transported
into the interstitial fluid
- In plasma, Fe2+ is converted to Fe3+ and is bound to the iron
transport protein transferrin
B
Katzung:
- Low serum iron with increased transferrin iron binding capacity,
resulting in a low transferrin saturation
- Low serum ferritin level
Ganong:
- Iron overload causes hemosiderin to accumulate in the tissues
64"
GI07 [Mar99] [Feb00] [Feb04] The major B
route of iron excretion is:
A. Excretion of transferrin in the gut Power and Kam:
B. Shedding of intestinal mucosal cells - Iron is lost in the faeces as desquamated epithelial cells of the gut
C. Increased renal excretion - Small amounts of iron are lost in the urine, hair and sweat
D. ?
GI08 [Mar99] [Apr01] Gastric acid A
secretion is decreased by:
A. Vagal inhibition Rang and Dale:
B. Luminal peptides & amino acids (OR:
“Ingestion of protein”)
C. Noradrenaline
D. M1 cholinergic antagonist same efficacy
at reducing gastric acid secretion
E. Distension of bowel wall
(Also remembered as “Intestinal secretion is
inhibited by: )

GI09 [Jul99] [Feb00] [Apr01] Release of A

which ONE of the following increases the
pH of duodenal contents? Guyton:
A. Secretin - Secretin is present as prosecretin in the duodenum and jejunum
B. Gastrin - When acid chyme enters the duodenum, it causes duodenal mucosal
C. Intrinsic factor release and activation of secretin, which is absorbed into the blood
D. Cholecystokinin - Secretin causes the pancreas to secrete fluid containing a high
E. Gastrin releasing peptide concentration of bicarbonate but a low concentration of chloride
F. Pepsin - Net result is then:
!"# + !"#$%3 → !"#$ + !2!"3
- Then the carbonic acid dissociates into CO2 and water, and the CO2
is absorbed into the blood and expired through the lungs, leaving a
neutral solution of NaCl in the duodenum
- Because the small intestine mucosa cannot withstand the digestive
action of acid gastric juice, this is an essential protective mechanism
to prevent duodenal ulcers
- Gastrin causes secretion of gastric juice
- Intrinsic factor is required for B12 absorption
- Cholecystokinin causes gallbladder contraction, relaxation of
sphincter of Oddi, and pancreatic digestive enzyme secretion; also
blocks the stimulatory effects of gastrin
- Gastrin releasing peptide increases gastrin release (who would have
thought…)
- Pepsin is important for protein digestion in the stomach
GI10 [Jul99] [Jul01] Speed of delivery of B
nutrients from stomach to small intestine:
A. CHO>fat>protein Ganong:
B. CHO>protein>fat - Food rich in carbohydrate leaves the stomach in a few hours
C. Protein>CHO>fat - Protein-rich food leaves more slowly
D. ? - Emptying is slowest after a meal containing fat
E. Fat>protein>CHO
GI11 [Jul00] [Mar03] [Jul03] Gastric A
emptying is slowest (OR: most prolonged)
after consuming:
A. High protein meal
B. High fat meal
C. Alcohol
D. Calcium
E. Carbohydrates

65"
GI12 [Apr01] Chyme in duodenum is
alkaline due to
A. Secretin
B. ?
GI13 [Jul01] In the small intestine, glucose
is absorbed
A. Passively
B. In combination with Sodium
C. By facillitated difussion
D. By cotransport with Chloride
E. Actively by insulin dependent uptake
(Q 49 Jul 01)
GI14 [Jul01] After ingestion of a meal:
A. Digestion of fat and carbohydrate begins
in the mouth while protein digestion begins
in the stomach
B. Carbohydrate in the mouth and protein in
the stomach.
C. Protein in mouth and fats and
carbohydrate in stomach
D. Most fluid and electrolytes are absorbed
in the large bowel
E. Composition of the food has no effect on
transit time through the bowel
(?F. Drugs have no effect on gastric
motility)
A
B
Guyton:
- Virtually all the monosaccharides are absorbed by active transport
- Glucose is transported by a sodium co-transport mechanism
- There is active transport of sodium ions through the basolateral
membranes of the intestinal epithelial cells into the blood, which
causes sodium to move from the intestinal lumen into the cells with
glucose
- Once inside the epithelial cell, other transport proteins cause
facilitated diffusion of glucose through the basolateral membrane into
the paracellular space then into the blood
A
Guyton:
- Carbohydrates: when food is chewed, it is mixed with salivary
amylase from the parotid glands which hydrolyses starch; starch
digestion continues in the stomach for one hour before the food
becomes mixed with stomach secretions until amylase is inactivated
by pH; pancreatic amylase (more powerful) completes digestion in
the small intestine
- Proteins: protein digestion begins in the stomach with pepsin; one
of the most important features is its ability to digest collagen, which
is affected little by other digestive enzymes; most protein digestion
occurs in the small intestine, under the influence of proteolytic
enzymes from pancreatic secretion
- Fats: small amount is digested in the stomach by lingual lipase
secreted by lingual glands in the mouth and swallowed with saliva
- The total quantity of fluid that must be absorbed each day by the
intestines = ingested fluid (~1.5 L) plus gastrointestinal secretions
(~7 L), total 8-9 L
- All but 1.5 L is absorbed in the small intestine, leaving only 1.5 L to
pass through the ileocecal valve into the colon each day
66"
980 Unit XIV Endocrinology and Reproduction

ofGI15 [Jul01]changes
the heart, Calcium in uptake
cellular in the activities,
enzyme Calcium
increased
intestine:membrane permeability in some cells (in
intake Cells
(350 mg/day) (13,000 mg)
addition to nerve cells), and impaired blood clotting.
A. Is passive Bone
(1,000,000 mg)
B. Requires
Hypercalcemia a carrier
Depresses protein
Nervous onand
System the mucosal
Muscle Activity.
When
side the level of calcium in the body fluids rises
Absorption Deposition
(350 mg/day) (500 mg/day)
above normal, the nervous system becomes depressed Extracellular
C. reflex
and Is by activities
facilitatedof diffusion
the central nervous system are fluid
D. Is less
sluggish. than
Also, 10% than
increased dietary
calcium ionintake
concentration Secretion
(1300 mg)
Absorption
decreases the QT by
E. Is facilitated interval of the heart and causes
phosphate (250 mg/day) (500 mg/day)
lack of appetite and constipation, probably because of Filtration Reabsorption
depressed contractility of the muscle walls of the gas- (9980 mg/day) (9880 mg/day)
trointestinal tract. Feces
These depressive effects begin to appear when the (900 mg/day) Kidneys
blood level of calcium rises above about 12 mg/dl, and Urine
(100 mg/day)
they can become marked as the calcium level rises
above 15 mg/dl. When the level of calcium rises above
B
about 17 mg/dl in the blood, calcium phosphate crys- Figure 79–3
tals are likely to precipitate throughout the body; this Guyton:
Overview of calcium exchange between different tissue compart-
condition is discussed later in connection with - Calcium
ments in aions areingesting
person actively absorbed
1000 intopertheday.blood
mg of calcium Note especially from
parathyroid poisoning. that most of the ingested calcium is normally eliminated in the
the feces,
duodenum
although the kidneys have the capacity to excrete large
amounts
- The amountby reducing tubular reabsorption
of calcium of calcium.
ion absorption is tightly controlled to supply
Absorption and Excretion of Calcium exactly the daily need of the body for calcium
and Phosphate
- Vitamin
selective,Ddepending
increaseson formation
the calcium ofion
a calcium-binding
concentration protein in the
Intestinal Absorption and Fecal Excretion of Calcium and Phos-
in the blood.
intestinal epithelial cells, which functions in the brush border to
phate. The usual rates of intake are about 1000 mg/day
When calcium concentration is low, this reabsorp-
transport
tion is calcium into almost
great, so that the cellnocytoplasm
calcium is lost in the
each for calcium and phosphorus, about the amounts
in 1 liter of milk. Normally, divalent cations such as
- Calcium intake is usually
urine. Conversely, even a 1000
minutemg/day
increase in blood
calcium ions are poorly absorbed from the intestines. calcium
- 35% ion concentration
of ingested calcium (350 above normalisincreases
mg/day) usually absorbed, and the
calcium excretion markedly. We shall see later in the
However, as discussed later, vitamin D promotes remainder is excreted in the faeces
chapter that the most important factor controlling this
calcium absorption by the intestines, and about 35 per - Anreabsorption
additional of 250 mg/day of calcium entersofthe
cent (350 mg/day) of the ingested calcium is usually calcium in the distal portions theintestines via
absorbed; the calcium remaining in the intestine is nephron,
secreted and therefore controlling
gastrointestinal juices andthe rate of calcium
sloughed mucosal cells
excreted in the feces. An additional 250 mg/day of excretion,
- Thus, ~90%is (900
PTH. mg/day) of the dietary intake of calcium is
calcium enters the intestines via secreted gastroin- Renal phosphate excretion is controlled by an over-
excreted in the faeces
flow mechanism, as explained in Chapter 29. That is,
testinal juices and sloughed mucosal cells. Thus, about
90GI16 [Mar03]
per cent [Jul03]ofBacteria
(900 mg/day) in the of calcium
the daily intake E when phosphate concentration in the plasma is below
isintestines:
excreted in the feces (Figure 79–3). the critical value of about 1 mmol/L, all the phosphate
Intestinal in the glomerular filtrate is reabsorbed and no phos-
A. Reducedabsorption of phosphate
by the continuous occurs of
movement very Ganong:
phate is lost in the urine. But above this critical con-
easily. Except for the portion of phosphate that is
contents through GIT
excreted in the feces in combination with nonabsorbed - The gut becomes
centration, colonised,
the rate almostloss
of phosphate fromis birth, with commensal
directly
B. Small
calcium, intestine
almost all theisdietary
sterilephosphate is absorbed proportional
bacteria to theinadditional
(particularly the colon)increase. Thus, the
kidneys regulate the phosphate concentration in the
C. Bacteria
into the blood in small
from the intestine andexcreted
gut and later large in the - The ileum is linked
extracellular fluid bytoaltering
the colonthe by
ratea structure
of phosphate known as the
urine.
intestine – same in number but different ileocecal valve, which restricts reflux of colonic contents, and
excretion in accordance with the plasma phosphate
species
Renal Excretion of Calcium and Phosphate. Approximately
concentration
particularly and the
the large rate of phosphate
numbers of commensalfiltration by
bacteria, into the
10D.per the kidneys.
Required
cent (100formg/day)
the absorption?/ breakdown
of the ingested calcium is relatively sterile ileum
However, as discussed later in the chapter, PTH can
excreted
of? in the urine. About 41 per cent of the plasma
calcium is bound to plasma proteins and is therefore greatly increase phosphate excretion by the kidneys,
E. filtered
not Reduced by in
thesmall intestine
glomerular due to The
capillaries. gastric
rest is thereby playing an important role in the control of
acid & fast
combined withmotility
anions such as phosphate (9 per cent) plasma phosphate concentration as well as calcium
orGI17
ionized (50 per[Jul03]
cent) and is filtered throughofthe concentration.
[Mar03] [Feb08] Functions A
glomeruli into the renal tubules.
the liver include ALL EXCEPT:
Normally, the renal tubules reabsorb 99 per cent of
A.filtered
the Synthesis of immunogloubins
calcium, and about 100 mg/day is excreted
Bone
Haven’t and
seen thisIts Relation
question before #
inB.
the urine. Approximately
Synthesis of clotting 90 per cent of the calcium
factors to Extracellular Calcium
in the glomerular filtrate is reabsorbed in the proximal
C. Conjugation of bilirubin and Phosphate
tubules, loops of Henle, and early distal tubules.
D. ?cholesterol
Then in the late distal tubules and early collecting Bone is composed of a tough organic matrix that is
E. Inactivation
ducts, reabsorptionof of steroids
the remaining 10 per cent is very greatly strengthened by deposits of calcium salts.
GI18 [Feb04] [Jul04] Gastrin secretion is D
decreased by:
A. Vagus Ganong:
B. Amino acids - Acid in the antrum inhibits gastrin secretion, partly by a direct
C. Food in the stomach action on G cells and partly by release of somatostatin, a relatively
D. H+ ions in the antrum potent inhibitor of gastrin secretion
E. Hyperglycaemia - The effect of acid is the basis of a negative feedback loop regulating
gastrin secretion

67"
GI19 [Feb04] [Jul04] Gastric acid secretion B
A. Misoprostolol decreases gastric acid
secretion and causes constipation Rang and Dale:
B. Acetylcholine and gastrin cause acid
secretion by direct and indirect mechanisms
C. Omeprazole causes reversible inhibition
of the proton pump on the parietal cell
membrane
D. Pirenzepine is more effective than
omeprazole at reducing gastric acid

Me thinks this picture is important!

- PPIs irreversibly inhibit the H+/K+ ATPase

- Misoprostol is an analogue of PGE1, inhibits gastric acid secretion
and increases mucosal blood flow and secretion of mucous and
bicarbonate; causes diarrhoea

Goodman and Gilman’s:

- Pirenzepine = M1 muscarinic receptor antagonist, inhibits gastric
acid secretion at doses that have little effect on salivation or heart
rate; has poor efficacy and anticholinergic SE so rarely used today
GI20 [Jul04] When the liver's glycogen D
stores are saturated it converts glucose to
A. ? Guyton:
B. Ketone bodies - When glucose is not immediately required for energy, it is either
C. Amino acids stored as glycogen or converted into triglycerides and stored in the
D. Triglycerides adipose tissue
GI21 [Jul04] Which of the following is not B and D
produced in the liver?
A. Conjugated bilirubin
B. Immunoglobulins
C. Cholesterol
D. Cholecalciferol
GI22 [Jul06] Which of the following is A
absorbed via micelles? (OR: Micelles aid
the absorption of:) Ganong:
A. vitamin D - Fat-soluble vitamins (vitamins A, D, E, and K) are poorly absorbed
B. Glycerol in the absence of bile or pancreatic lipase
C. Bile acids
D. Other options more readily identifiable
as wrong.
E. ?
GI23 [Feb12] Blood supply to the liver: ! A wrong - it CAN be this, but more commonly the figures
A. Half from portal vein and half are as per below
from hepatic ! B is correct "The portal vein normally accounts for 3/4 of
B. Oxygen is supplied by both the blood supply, but the hepatic artery provides 3/4 of the
portal vein and hepatic artery. oxygen consumed by the liver." Power and Kam pp 173.
C. Pressure in portal vein is Side note - Brandis quotes oxygen DELIVERY which is a
5mmHg different thing, as majority portal
D. Pressure in hepatic artery is ! C wrong - Ganong ed 21 pp 627 "Portal venous pressure
10mmHg is normally about 10 mmHg in humans"
E. 35% of cardiac output ! D wrong.. obviously, whatever systemic MAP is
! E wrong,30%

68"
MATERNAL)AND)FOETAL)MCQS)

MF01 [a] The hyperventilation of A

pregnancy is due to:
A. Progesterone
B. Decreased resistance
C. ? D. ?
MF02 [a] Normal maternal ABG ?
at term: Should be pH 7.4 and pCO2 32 mmHg due to increased minute ventilation and renal
A. pH 7.36, pCO2 36 mmHg compensation.
B. pH 7.42, pCO2 36 mmHg
C. pH 7.44, pCO2 30 mmHg
D. ?
E. pH ? pCO2 ?
MF03 [cl] Closure of the ductus D
arteriosus occurs due to:
A. Prostaglandins Prostaglandins – No. Keeps ductous arteriosus open. Hence giving indomethacin to
B. Oxygen close the duct. Use of prostaglandins to keep open in cyanotic heart disease –
C. Aortic pressure exceeds transposition of the great vessels.
pulmonary artery pressure
D. Vascular smooth muscle
contraction in the presence of
oxygen
E. ?
MF04 [cfkmr] With regard to the B
foetal circulation:
A. ? Goes into the left atrium
B. Ductus venosus drains into the
IVC directly
C. Oxygen saturation is 40% in
umbilical vein
D. Oxygenated blood flows from
the SVC through the foramen
ovale to the head
E. Ductus arteriosus directs
oxygenated blood to the head

Power and Kam:

- 60% of umbilical vein blood bypasses the liver through the ductus venosus, a shunt
between the portal vein and IVC
- C: Umbilical vein saturation = 80%
- D: 60% of oxygenated blood flows from the IVC through the foramen ovale to the
head
- E: Ductus arteriosus directs blood from the pulmonary artery into the aorta to
perfuse the lower half of the body or returns to the placenta

69"
Apr 2001: With regard to the B
foetal circulation:
A. Blood from SVC goes into the
left atrium via the ductus arteriosis
B. Ductus venosus drains into the
IVC directly
C. Oxygen saturation is 40% in
umbilical vein
D. ?
Mar 02: In the foetal circulation: A
A. Umbilical vein straight into
IVC Power and Kam:
B. SVC blood to LA via foramen - This is 60% true for blood which bypasses the liver via the ductus venosus
ovale - HbF accounts for 90% of all Hb production: by 6 months after birth it is replaced
C. Only has foetal haemoglobin by HbA
D. ?
E. ?
(see also]] [[MF09)
MF05 [diqr] Brown fat: C
A. Produces ATP and Heat
B. Insulates the great vessels of Power and Kam:
the neck - Heat production in the neonate is by non-shivering thermogenesis, with increased
C. Is autonomically mediated metabolism of brown fat
D. Extramitochondrial uncoupling - Brown fat has high mitochondrial content and a rich sympathetic innervation that
of oxidative phosphorylation can be activated by stimulation of the ventromedial nucleus of the hypothalamus
- Brown fat is found in the interscapular region, mediastinum, perinephric tissues,
axillae and near major blood vessels in the neck
- Cold exposure → ↑ SNS activity → NA binds to β3 receptors → activation of
adenylate cyclase and protein kinases → ↑ actions of lipase → hydrolysis of
triglycerides to free fatty acids and glycerol
MF06 [d] Highest O2 saturation in A
the foetal circulation is in:
A. Thoracic IVC Power and Kam:
B. Right atrium - IVC saturation = 67%
C. Ascending aorta
D. Pulmonary vein
E. Ductus arteriosus
MF06b [o] With regard to fetal B
circulation:
A. Fetal umbilical vein has higher Power and Kam:
PO2 than maternal vein - Blood leaves the foetal side of the placenta from two umbilical arteries and returns
B. Fetal umbilical vein has higher to the foetus via a single umbilical vein
PO2 than fetal umbilical artery - Umbilical vein PO2 = 30 mmHg (80% saturation)
C. ? - Umbilical artery PO2 = 20 mmHg
Alt version Jul03: Foetal A
circulation:
A. O2 tension (not saturation) of Power and Kam:
umbilical artery is lower than in - PO2 of maternal blood in the intervillous space is 50 mmHg while PO2 of
maternal uterine vein. umbilical artery = 20 mmHg, therefore there is an oxygen partial pressure gradient
B. Foetal haemoglobin has a lower of 30 mmHg, which is the driving force for diffusion of oxygen from the maternal to
affinity for O2 than which foetal blood
increases delivery to foetal tissues. - HbF has two α and γ chains and has ↑ affinity for oxygen because of ↓ 2,3-DPG:
C. ? HbO2 dissociation curve is shifted to the left, with a P50 of 19 mmHg (rather than
26 mmHg)
MF07 [e] Which of the following C
is immediately due to onset of
ventilation in the newly born? Power and Kam:
A. Increased left atrial pressure - At birth, the lungs expand → ↓ PVR and RVEDP
B. Closure of ductus venosus - PVR gradually falls further under the influence of ↑ PaO2 and pH and ↓ PaCO2
C. Decreased RV pressure (loss of hypoxic pulmonary vasoconstriction)
D. ? - ↑ blood flow through the lungs and ↑ LVEDP → ↑ left atrial pressure
- Closure of the ductus venosus occurs a few hours after birth; exact mechanism
unknown

70"
MF07b [f] Which effect is due to A
spontaneous ventilation in
neonate? (Or: The first breath in a
neonate has a predominant role
in:)
A. Decreasing RV outflow
pressure
B. Closure of ductus venosus
C. Closure of foramen ovale
D. Increased systemic vascular
resistance
E. Increased LV pressure
MF08 [gi] FRC in the neonate: C
A. 1 ml/kg
B. 15 ml/kg Nunn’s:
C. 30 ml/kg - FRC in the neonate = 30 mL/kg
D. 70 ml/kg - Most of the impedance to expansion is due to the lung and depends on the presence
of surfactant
- The chest wall is highly compliant
- This contrasts with the adult, in whom compliance of lung and chest wall are equal
MF09 [g] Foetal circulation: A
A. Inferior vena cava blood has
high pO2 because of ductus Power and Kam:
venosus - 60% of umbilical vein blood bypasses the liver through the ductus venosus, a shunt
B. Inferior vena cava blood enters between the portal vein and IVC
the head via ductus arteriosus - IVC saturation = 67%
C. ? - Ductus arteriosus directs blood from the pulmonary artery into the aorta to perfuse
the lower half of the body or returns to the placenta
MF10 [hq] The reason for A
increased aortic pressure after
birth: Power and Kam:
A. Removal of placental At birth, the low-resistance placenta is excluded, as the umbilical cord vessels are
circulation clamped and closed → ↑ SVR and LVEDP (also ↓ IVC flow → ↓ right atrial
B. Duct closure pressure)
C. Increased pulmonary flow
D. ?
MF11 [i] Tidal volume of a C
neonate:
A. 1 ml/kg Sydney course notes, Power and Kam:
B. 3 mls/kg - Tidal volume is fixed at 7 mL/kg
C. 7 mls/kg - RR is 40/min (minimises WOB)
D. 15 mls/kg - Doubled oxygen consumption, minute ventilation and alveolar ventilation
E. 30 mls/kg
MF11b [j] Tidal volume in a 2.3kg C
neonate:
A. ?
B. 10ml
C. 15ml
D. 30ml
E. ?
MF11c [j] The FVC of a neonate B
weighing 2.3 kg is:
A. 100 ml Vital capacity = 65 mL/kg
B. 150 ml
C. 200 ml
D. 250 ml
E. 300 ml

71"
MF12 The neonate has A
A. Less plasma cholinesterase B
B. Higher volume of distribution
for neuromuscular blockers SAQ 2008 b5:
C. Higher levels of alpha-1 acid - ↑ ECF volume → ↑ volume of distribution which would tend to ↓ activity of
glycoprotein suxamethonium; this is countered for by ↓ pseudocholinesterase levels
D. High levels of cytochrome - ↓ α1 acid glycoprotein → ↑ propensity for bupivacaine toxicity
P450 enzymes - ↓ hepatic clearance → ↑ half life of morphine
MF13 [j] Maternal-fetal ABO B
incompatibility is less common
than Rhesus incompatibility ABO antibodies are IgM, which do not cross the placenta
because:
A. Fetal antibodies to ABO are
less developed
B. Maternal ABO antibodies do
not cross the placenta
C. Maternal ABO antigens do not
cross the placenta
D. Fetal ABO antigens are less
immunogenic
Alternative recalled options: B
B: Maternal Ab’s rarely cross
placenta
C: Foetal RBC’s rarely enter
circulation
D: Foetus have immature ?
Ab’s/Ag’s
E: Foetus have absent ?Ab’s/Ag’s
MF14 [kq] With regard to the C
neonate
A. Static compliance is greater Specific compliance = static compliance divided by FRC
than adult values
B. Dynamic compliance is greater SAQ 2010 a14:
than adult values Compliance increases with increased size but specific compliance is unchanged
C. Specific compliance is the same
as adult values
D. Dynamic compliance is the
same as adult values
E. Static compliance is the same as
adult values.
Alt version: Comparing the A
neonate to adult lung C
A Dynamic compliance of the
lung is less in the neonate
B Static compliance of the chest
wall is more in the neonate
C Specific static compliance is
about the same
D. ?
E. ?
MF15 [l] (. .??. . paO2 in maternal C
uterine blood. . .) but foetus can
maintain adequate O2 because: Power and Kam:
A. Large placental surface area - HbF has two α and γ chains and has ↑ affinity for oxygen because of ↓ 2,3-DPG:
B. Double Haldane effect HbO2 dissociation curve is shifted to the left
C. Foetal haemoglobin
D. ?
E. ?

72"
MF16 [m] (“Given a normal set of D
maternal blood gases at term,
asked to comment on Respiratory alkalosis (PaCO2 30 mmHg) with renal compensation (HCO3- 20
results”) mmol/L)
A. Metabolic alkalosis, abnormal -
something wrong going on
B. ?
C. Abnormal ABGs, expect lower
bicarb (in gas is about 22)
D. Metabolic alkalosis, normal for
pregnant/term mother
E. ?
MF17 [mpq] Foetal haemoglobin: B
A. All is in the form of HbF
B. HbO2 dissociation curve is Power and Kam:
shifted to the left HbF has two α and γ chains and has ↑ affinity for oxygen because of ↓ 2,3-DPG:
C. ? HbO2 dissociation curve is shifted to the left, with a P50 of 19 mmHg (rather than
D. ? 26 mmHg)
E. ?
(Alt: "there was a question on
foetal and maternal hemoglobin
and the effect of shift of odc ")
MF18 [op] The Thermoneutral None
Zone is best correlated with:
A. Core temp with no energy Power and Kam:
consumption - Thermoneutral zone = range of environmental temperatures over which a naked
B. Ambient temp in which core individual can maintain body temperature by changes in skin blood flow alone, with
temp can be maintained without minimal oxygen consumption
sweating. - Term neonates: 32-34°C
C. Peripheral temperature at - Low-birth-weight babies: 35-36 °C
which.. ? . . . . - Adults: 22-28 °C
D. Core temperature at which... ? . - The main danger of hypothermia in the neonate is ↑ oxygen consumption and
... mortality from hypoxaemia
E. ?

73"
NEUROPHYSIOLOGY)MCQS)
NU01"[al]"The"Nernst"equation"
represents"the"potential"at"
which:""
A."Electrical"neutrality"exists""
B."Concentration"of"ions"on"each"
side"of"membrane"equal""
C."Potential"at"which"there"is"no"
net"movement"of"ions""
D."(?Balance"of"chemical"&"
electrical"forces?)""
E."Both"sides"are"equiosmolar""
"
NU02"[g]"Shivering"that"
is"?mediated"by"the"
hypothalamus:""
A."."."?"."."muscle"spindle"to"
increase"tone""
B."."."?"."."via"red"nucleus""
C."."."?"."."rhythmic"stimulation"of"
anterior"horn"cells""
D."Activation"of"shivering"centre"
in"brainstem""
(see"NU04)""
" Shivering""
NU03"[hopq]"Transection"of"a"
motor"nerve"leads"to:""
A."?Muscle"fibre"hypertrophy""
B."?Increased/decreased"RMP""
C."?Increased/decreased"
receptors""
D."Increased"spontaneous"
muscle"activity""
"
NU04"[j]"The"mechanism"for"
shivering"is"via:""
A."Anterior"horn"motor"
neurones"set"up"oscillating"
signals"to"muscle.""
B"a"E."??""
ANSWER:(C(
"
The"Nernst"equation"calculates"the"potential"difference"that"any"ion"would"
produce"if"the"membrane"was"permeable"to"it"(at"equilibrium"ie"no"net"
movement"of"ions)."
Eion = RT/zF ln [ion]o/[ion]i = 61.5 log [ion]o/[ion]i at 37 degrees
Eion = equilibrium potential of the ion (mv)
R = gas constant
z = valency of the ion
F = faraday's constant
"
ANSWER:(A(
Primary"motor"centre"for"shivering"is"in"posterior"hypothalamus"(wall"of"3rd"
ventricle)."Normally"inhibited"by"heat"centre"of"hypothalamus."Excited"by"
cold"signals"from"skin/spinal"cord."When"excited,"signals"are"sent"bilaterally"
down"brain"stem,"then"lateral"column"of"spinal"cord,"to"anterior"horn"of"
motor"neurons."Signals"are"NONaRHYTHMIC,"and"cause"increase"in"muscle"
tone"which"is"thought"to"trigger"feedback"oscillation"of"the"muscle"spindle"
stretch"reflex"mechanism"""shivering."
Mechanisms(activated(by( Mechanisms(activated(by(
cold(( heat((
Increase"heat"production" Decrease"heat"production""
Sweating""
Hunger"" Anorexia""
Increased"voluntary" Apathy"and"inertia"
activity""
Increased"secretion"of" Increased"respiration""
norad"and"adrenaline""
Decrease"heat"loss"" Increase"heat"loss""
Cutaneous" Cutaneous"vasodilation""
vasoconstriction""
Curling"up"" "
Horripilation"(goose" "
bumps"a"no"apparent"
"
useful"purpose)""
ANSWER:(D(or(C(if(increased(receptors(
Transection"of"motor"nerve:"
1."Muscle"atrophy"
2."Denervation"hypersensitivity"to"circulating"Ach"due"to"extrajunctional"
foetal"gamma"subunit"nicotinic"receptors"
3."Muscle"fibrillations"(contractions"that"are"not"visible"under"skin,"diagnosed"
on"EMG)"
(Fasciculations:"pathological"discharge"of"motor"neurons"
ANSWER:(A(
See"previous"question"2."
74"
NU05"[j]"The"setpoint"in"
temperature"regulation"controls"
the"body's"response"to""
changes"in"temperature."The"
location"of"sensory"receptors"
which"regulates"the"setpoint"is:""
A."Anterior"hypothalamus""
B."Posterior"hypothalamus""
C."Spinal"cord""
D."Skin""
E."Great"veins""
" itself."Each"contribute"20%"of"the"information"for"integration"by"the"
Alternative"version:""
The"efferent"limb"of"
thermoregulation"comes"from""
A."?""
B."?""
C."Anterior"hypothalamus""
D."Posterior"hypothalamus""
E."?""
NU06"[k]"Chemoreceptor"trigger"
zone:""
A.Both"D2"and"5aHT3"receptors""
B."?(something"about"motion"
sickness)""
C."Stimuli"from"blood"and"CSF""
D."?""
E."?""
" the"level"of"CTZ."
NU07"[mn]"(“Question"about"
Pain”"?details)""
A."Substance"P"acts"on"pain"
receptors""
B."Any"peripheral"stimuli"can"
activate"pain"receptors""
C."Dull"and"sharp"pain"travel"via"
the"same"fibres""
D."?""
E."A"delta"&"C"fibres"act"on"the"
same"receptor""
" receptors"(AMPAaR)."
ANSWER:(
Part(1:(?C(and(D(
Part(2:(C:(sweat/vasodilate(ANTERIOR(hypothal(
(((((((((((((D:(shivering(from(POSTERIOR(hypothal(
"
Posterior"hypothalamus"establishes"the"set"point"around"which"the"body"
temperature"is"maintained."Set"point"may"be"determined"by"the"ratio"of"
Na/Ca"ions"in"the"posterior"hypothalamus.""
"
Sensory"receptors"for"body"temp"control"are"located"in"skin,"deep"tissue,"
spinal"cord,"extraahypothalamic"portions"of"the"brain"and"the"hypothalamus"
hypothalamus.""
"
Effector"mechanism:"efferent"limb"for"shivering"comes"from"posterior"
hypothalamus,"efferent"limb"for"sweating/vasodilatation"comes"from"
anterior"hypothalamus.""
ANSWER:(A(best(answer((
((?&Also&B&indirectly&correct;&and&C&possibly&correct&as&blood&correct&and&?CTZ&
bathed&in&CSF)&
"
CTZ:"bilateral"set"of"centres"in"brainstem"lying"under"floor"of"4th"ventricle."
They"function"as"emetic"chemoreceptors"for"the"vomiting"centres."Chemical"
abnormalities"in"the"body"(uraemia,"hypoxia,"DKA)"are"sensed"in"CTZ"which"
then"send"excitatory"signals"to"vomit"centres."Many"antiaemetic"drugs"act"at"
"
RANG:"
Receptors"in"CTZ"include"D2"and"5aHT3""
CTZ"receives"input"from:""
1."Blood"(endogenous"toxins,"drug)"
2."Drugs"that"cause"release"of"emetogenic"agents"(5HT,"prostanoids,"free"
radicals)"
3."Motion"sickness"is"via"labyrinth"""vestibular"nuclei"(H1"and"mACh"
receptors)"""input"into"CTZ"
4."Visceral"afferents"(?5HT3)"
ANSWER:(A(is(best(answer(
A"–"correct"
B"–""?"possible"
C"–"incorrect"
E"–""incorrect"
Susbstance"P:"transmitter"released"by"primary"afferents"in"dorsal"horn,"and"it"
acts"on"neurokinin"receptors."In"reponse"to"pain,"primary"afferents"also"
release"other"substances"eg"neurokinin"A"and"CGRP)."
"
Aadelta"fibres"release"glutamate,"C"fibres"release"substance"P."Substance"P"
acts"on"neurokinin"1"and"substance"P"receptors."Glutamate"acts"on"glutamate"
"
Dull"and"sharp"pain"travel"via"different"fibres"(SHARP"via"AaDelta"fibres,"
DULL"via"C"fibres)."
75"
NU08"[m]"Cerebrospinal"fluid"
(CSF):""
A."Production"is"150"ml"/"day""
B."Volume"is"50"ml""
C."Produced"by"choroidal"blood"
vessels"and"ependymal"cells""
D."?""
NU09"[opq]"Which"ONE"of"the"
following"is"characteristic"of"
type"A"nerve"fibres:""
A."Nociception""
B."Slower"conduction"than"C"
fibres""
C."Myelinated""
D."Substance"P""
E."Sensory"only""
F."Do"not"carry"pain"sensation""
" Nociceptive"systems"include"myelinated"Aadelta"(fast"pain"–"12a120m/s)"and"
NU10"The"sharp"initial"pain"
associated"with"injury"is"
transmitted"by:""
A."Unmyelinated"C"fibres.""
B."Unmyelinated"Aδ"fibres.""
C."Nerve"fibres"with"a"
conduction"velocity"of"
approximately"15"m/s.""
D."Nerve"fibres"which"project"to"
the"anterior"horn"and"the"
spinothalamic"tract.""
E."Nerve"fibres"with"a"diameter"
of"less"than"2"µm""
ANSWER:(none(C(correct(if(it(says(choroidal(PLEXUS(
A&and&B&incorrect.&C&would&be&correct&if&it&said&choroidal&PLEXUS&(choroidal&
blood&vessels&are&in&the&eye!)&
"
Total"CSF"volume"is"150mL."Body"makes"550mL/day"(CSF"turns"over"3a4"
times"a"day)."CSF"formed"by"choroid"plexus"(50%)"and"from"walls"of"
ventricles"(50%)."Ependymal"cells"are"a"type"of"glial"cell"(aka"
ependymocytes)"and"line"the"walls"of"the"ventricles."They"secrete"CSF"and"
beat"cilia"to"help"circulate"CSF.""
ANSWER:(C((better&than&option&A,&as&A&fibres&do&more&things&than&nociception)(
"
Mammalian"nerve"fibres"are"divided"into"groups"A"B"and"C."Type"A"fibres"are"
further"classified"into"alpha,"beta,"gamma"and"delta.""
"
Alpha:"proprioception/somatic"motor"function"
Beta:"touch/pressure"
Gamma:"motor"to"muscle"spindles"
Delta:"pain/cold/touch"
"
unmyelinated"C"fibres"(slow"pain"0.5a2.3m/s)."Type"A"and"B"fibres"are"
myelinated,"type"C"are"not.""
"
Substance"P"is"the"polypeptide"that"acts"as"a"transmitter"in"slow"C"fibres."
Glutamate"is"the"synaptic"transmitter"released"by"primary"afferent"fibres"in"
fast"mild"pain"(Aadelta)"
"
"
ANSWER:(C((
Aadelta"fibres"result"in"shortalasting,"sharp"pain:"
1."Myelinated"
2."Conduction"is"12a30m/sec"(Ganong"+"Brandis)"
3."Axon"diameter"is"2a5"µm"(Brandis)"
4."Cell"body"in"dorsal"root"ganglion"""laminae"I"V"and"X"of"dorsal"horn"
76"
NU11 [Feb07] Which of the ANSWER:(B((
following is an excitatory ! A Glycine - inhibitory
neurotransmitter ! B. Glutamate - excitatory
! C. Gamma amino butyric acid - inhibitory
A. Glycine ! D. Serotonin - inhibitory (has some excitatory effects)
B. Glutamate ! E. Dopamine - inhibitory
C. Gamma amino
butyric acid
D. Serotonin
E. Dopamine
"
NU12 [Feb12] Nernst equation: ANSWER:(E"
RMP = 6.1 + log "
[outside]/[inside]?? ... Some
three letter acronym means
what.

A. units are mcV

B. measured at 20
degrees C
C. if a negative ion, will
be positive
D. calculates the
potential inside the cell
E. can be calculated
for an ion of any
valency
NU13 [Feb12] Duration of a ANSWER:(A"
typical Action potential of a
large nerve fibre

A. 0.4msec
B. 0.04msecs
C. 4msecs
D. 40mses
E. 400msec

77"
MUSCLE)PHYSIOLOGY)MCQS)

MU01)[a])Characteristics)of)muscle) ANSWER:#A,#B,#C#
action)potential:)) )
A.)RMP)%90)mV)) Ganong)
B.)APD)2)to)4)msec)) A:)Yes)%)resting)membrane)potential)%90mV)
C.)ERP)1)to)3)msec)) B:)Yes)%)Action)potential)duration)2%4msec)
D.)Conduction)velocity)0.25)to)0.5) C:)Yes)%)Absolute)refractory)period)1%3msec)
m/sec)) D:)No)%)Conduction)velocity)is)5m/s))
E.)All)of)the)above))
)
MU02)[ad])During)muscle)contraction:)) ANSWER:##?B#best#(wording#of#B)#
A.)Myosin)heads)hydrolyse)ATP)) )
B.)Z%lines)move)together)) A:#?Yes)%)Muscle)contraction)–)myosin)head)hydrolyses)ATP)(but)is)it)the)
C.)Myosin)cross%links)&)swivels)90) actin/myosin)complex)that)hydrolyses)ATP)as)‘actin)potentiates)ATPase)
degrees)) activity)of)myosin’)–)Power/Kam).)Also)pointed)out)that)hydrolysis)of)ATP)
D.)Interaction)between)actin)&) occurs)after)muscle)contraction)to)re%cock)myosin)head.))
tropomyosin)occur)) B:#?Yes:)width)of)A)bands)constant,)Z)lines)move)closer)together)when)
E.)Calcium)passively)passes)into)SR)in) muscle)contracts)and)further)apart)when)stretched)
relaxation) C:##No)–)powerstroke:)myosin)head)attaches)to)actin)at)90)degrees)and)then)
bends)to)45)degrees)producing)relative)meovement)between)the)filaments)
D:#No)–)Interaction)is)between)actin)and)myosin.)Calcium)binds)to)Troponin)
C)which)interacts)with)Troponin)I)resulting)in)displacement)of)tropomysoin)
from)actin,)revealing)its)myosin%binding)site.)
E:#No)–)calicum)actively)taken)up)into)SR)during)relaxation)via)Ca%Mg%
ATPase)pumps.)
)
Troponin)molecules)are)small)globular)units)located)at)intervals)along)the)
tropomyosin)molecules.)Types:)
1. Troponin)T:)binds)the)other)troponin)compoenents)to)tropomyosin)
(T)=)Tether))
2. Troponin)I:)inhibits)the)interaction)of)myosin)with)actin)(I)=)
inhibitory))
3. Troponin)C:)contains)the)binding)sites)for)calcium)that)initiates)
contraction)

78"
MU03)[a])Muscle)spindle)functions:))
A.)Increased)gamma)efferent)tone)
smooths)contraction))
B.)Increased)alpha)efferent)tone)
smooths)contraction))
C.)?))
D.)?)
MU04)[d])To)prevent)clonus)
(oscillation))of)the)muscle)spindle:))
A.)Increase)in)alpha%efferent)discharge))
B.)Increase)in)gamma%efferent)
discharge))
C.)There)is)a)delay)in)the)circuit))
D.)Increased)tone))
E.)All)of)the)above))
(Also)remembered)as:)'Clonus)is)more)
likely)if:'))
ANSWER:#A#
)
Muscle)spindles)are)a)small)group)of)muscles)enclosed)in)a)connective)
tissue)capsule)called)intrafusal)fibres)as)compared)to)extrafusal)fibres)which)
are)the)normal)contractile)fibres)in)the)muscle.)
2)Types)of)intrafusal)fibres:)
1. Nuclear)bag)
2. Nuclear)chain)
)
2)Types)of)sensory)endings)in)each)spindle:)
1. Primary)(annulospiral)on)the)nuclear)bag))–)Ia)afferents.)Dynamic)
response.)Discharge)when)the)muscle)is)being)stretched)and)less)
rapidly)during)sustained)stretch.)
2. Secondary)(flower)spray)on)the)nuclear)chain))–)II)afferents.)Static)
response.)Discharge)at)an)increased)rate)throughout)the)period)
when)a)muscle)is)stretched.))
2)Types)of)motor)supply:)
1. Aγ)efferents)with)plate)endings)on)the)nuclear)bag)and)trail)
endings)on)the)nuclear)chain)
2. Aβ)efferents)(innervate)both)intrafusal)and)extrafusal))
The)spindle)and)its)reflex)connections)constitute)a)feedback)device)that)
operates)to)maintain)muscle)length;)if)the)muscle)is)stretched,)spindle)
discharge)increases)and)reflex)shortening)is)produced,)whereas)if)the)
muscle)is)shortened)without)a)change)in))efferent)discharge,)spindle)
discharge)decreases)and)the)muscle)relaxes.)
The)response)of)the)primary)ending)to)the)phasic)as)well)as)the)static)
events)in)the)muscle)is)important)because)the)prompt,)marked)phasic)
response)helps)to)dampen)oscillations)caused)by)conduction)delays)in)the)
feedback)loop)regulating)muscle)length.)Normally)a)small)oscillation)occurs)
in)this)feedback)loop.)This)physiologic)tremor)has)a)frequency)of)
approximately)10)Hz.)However,)the)tremor)would)be)worse)if)it)were)not)
for)the)sensitivity)of)the)spindle)to)velocity)of)stretch.)
ANSWER:#E#with#alternate#stem#
)
A:#No)%)Alpha)(Ia/Ib))fibres)are)AFFERENT)fibres.)Ia)have)two)branches,)one)
to)the)nuclear)bag)fibre)and)another)to)the)nucelar)chain)fibre.)
Experiementally)these)have)been)shown)to)link)directly)onto)motor)
neurons)supplying)extrafusal)fibres)of)ths)ame)muscle)and)contribute)to)the)
stretch)reflex.)This)stretch)relfex)may)contribute)to)clonus.))
B:#No)–)A)characterstic)of)states)in)which)increased)gamma)efferent)
dischare)is)present)is)clonus.)
C:#No)–)When)muscle)is)stretched)in)the)case)of)hyperctive)spindles,)the)
burst)of)discharges)supplying)to)motor)neuron)causes)the)muscle)to)
contract,)stopping)the)spindle)discharge.)This)causes)a)reduction)in)Ia)
stimulation)and)increase)in)Ib)stimulation,)causing)the)muscle)to)relax.)
However)the)muscle)is)still)streched)and)the)cycle)is)repeated.)The)delay)in)
the)circuit)is)what)gives)clonus)its)charactersitic)beat.))
D:#No)–)Increased)tone)is)generally)a)result)of)increased)gamma)efferent)
discharge,)thus)more)likeyl)to)produce)clonus.)
E:#Yes)if)different)stem)
79"
MU05)[dk])In)skeletal)muscle:))
++
A.)Relaxation)is)due)to)passive)Ca )
uptake)by)sarcoplasmic)reticulum))
++
B.)Contraction)is)due)to)Ca )release)
from)T)tubules))
++
C.)Contraction)is)due)to)Ca )binding)to)
tropomyosin))
D.)Z)lines)move)together)in)contraction))
(See)also)MU09)&)its)variations)as)it)
seems)there)are)2)or)more)questions)
and)the)options)seem)to)be)a)little)
jumbled))
MU06)[d])In)smooth)muscle:))
A.)Spontaneous)pacemaker)potentials)
are)generated))
B.)An)action)potential)is)required)for)
contraction))
++
C.)Ca )is)released)from)sarcoplasmic)
reticulum))
D.)Multiple)spiking)action)potentials)
occur)with)increased)membrane)
potential)
ANSWER:##D#
)
A:#No)–)active)uptake)of)calcium)into)SR)via)Ca%Mg%ATPase)pump)
B:#No)–)T)tubule)system)is)a)grid)like)network)of)invaginations)of)the)
sarcolemma)(cell)membrane)of)muscle)cells).)The)T%tubes)are)are)in)
continuity)with)the)ECF.)Their)function)is)to)allow)rapid)propagagion)of)the)
AP)from)the)cell)membrane)on)the)outside)of)the)muscle)cell)to)the)
contractile)elements)within.)In)skeletal)muscel)the)AP)is)solely)due)to)Na+)
influx)(depolarisation))and)K+)efflux)(repolarisation))NOT)calcium.)T%tubule)
depolarisation)activates)voltage%gated)dihydropyridine)receptors)in)T%
tubule)membrane)which)directly)activate)non%voltage)gated)Calcium)
channels)(‘Ryanodine)receptors’))in)the)SR.)Opening)of)these)channels)
causes)a)large)outflow)of)Ca2+)from)SR)into)the)cytoplasm)")activates)
contractile)mechanism.)))
C:#No)–)calcium)binds)to)Troponin)C)(not)tropomyosin).)Tropomyosin)
molecules)are)long)filaments)which)sit)in)the)double)helix)groove)formed)by)
the)actin)chains)and)at)rest,)tropomyosin)covers)the)myosin)binding)sites)on)
actin)
D:#Yes)–)when)muscle)contracts,)A)bands)(which)=)length)of)thick)myosin)
chain))stay)constant)whereas)Z)band)shortens.)
ANSWER:#A#
)
Ganong:#
A:#Yes#%)Majority)of)smooth)muscle)contains)pacemaker)cells)which)
discharge)irregularly.)))
B:)No)–)Visceral)smooth)muscle)(unlike)other)smooth)muscle))contracts)
when)stretche)in)the)absecne)of)any)extrinsic)innervation.))
C:#No#–)Calcium)is)involved)in)the)initiation)of)smooth)muscle)contraction.)
Visceral)smooth)muscle)has)poorly)developed)SR)and)the)increase)in)the)
intracellular)[Ca2+])that)initiates)contractio)is)due)primarly)to)calcium)inclux)
from)the)ECF)via)voltage)gated)and)ligand)gated)ion)channels.)
D:#No)–)Increase)in)membrane)potential)resutls)in)decrease)in)number)of)
action)potentials,)decrease)in)membrane)potential)results)in)increased)
number)of)APs.))
80"
MU07)[efklop])Contraction)in)smooth)
muscle)is)different)from)skeletal)
muscle:))
++
A.)Source)of)Ca )is)different))
B.)Force)is)greater)in)?smooth)
muscle)?skeletal)muscle))
C.)Unable)to)produce)same)force)of)
contraction))
D.)Unable)to)maintain)same)duration)of)
contraction))
E.)Has)prolonged)latency))
F.)Sarcomere)of)skeletal)muscle)is)>)
smooth)muscle))
G.)Increased)actin:myosin)ratio))
H.)Increased)numbers)of)mitochondria))
I.)More)developed)endoplasmic)
reticulum)
) G:#Yes)–)Smooth)muscle)has)1/3)amoutn)of)myosin,)2x)amount)of)actin))
MU07b)[q])Vascular)smooth)muscle)
differs)from)skeletal)muscle)in:))
A.)Different)source)of)Calcium))
B.)Absence)of)tropomyosin))
C.)Contraction)not)dependant)on)
interaction)between)actin)and)myosin))
D.)Force)developed)is)less)
MU08)[el])Force)developed)during)
isotonic)contraction)is:))
A.)Dependent)on)the)load)condition))
B.)Independent)of)the)load)condition))
C.)Independent)of)muscle)fibre)length))
D.)?)
ANSWER:#A,#E,#G#
)
A:#Yes#%)Skeletal)muscle)source)of)calcium)is)SR,)in)smooth)muscle)this)is)
from)ECF)via)voltage)gated)Ca)channels.))
B#and#C:)No#B#contractions)are)relatively)slow,)develop)high)forces)and)are)
maintained)for)longer)duractions)when)compared)to)striated)(ie)skeletal))
muscle)fibres)(Pinnock).)
D:)No)–)contraction)in)smooth)muscle)if)for)longer)periods,)tonic)
contractions)typical)‘latch%bridge’)mechanism)
E:#Yes)(Guyton))–)latent)period)for)smooth)muscle)is)50x)as)great)as)that)for)
skeletal)muscle.)Slower)onset)of)contractino)and)more)prolonged)
contracitno)of)smooth)muscle)c/w)skeletal)muscle)because)of)the)slowness)
of)attachment)and)detachment)of)cross%bridges)and)slower)excitation%
contraction)coupling)–)(role)of)calmodulin).))
F:#?Yes#or#No#(I#don’t#like#wording#of#this#one)#–)no)sarcomere)in)smooth)
muscle,)no)regular)arrangement)between)actin/myosin/tropomysin)
(Pinnock))
(Pinnock))
H:#No)–)smooth)muscle)only)has)few)mitochondria)–)cellualr)metabolism)
depends)largely)on)glycolysis)(Pinnock))
I:#No)%)Less)developed)sacroplasmic)reticulum)
)
07b#:#A)
Ganong:)
A:#Yes)–)as)in)previous)question)
B:#No#–)smooth)muscle)does)contain)tropomyosin)but)does)NOT)contain)
troponin)
C:#No)–)actin)and)myosin)are)present)and)they)slid)on)each)other)to)
produce)contraction)
D:#No)–)as)in)previous)question)
ANSWER:#A#
Ganong:#
Force)developed)within)skeletal)muscle)is)dependent)on)the)load)which)
affects)the)muscle)fibre)length.)On)a)microscopic)level,)the)muscle)fibre)
length)affects)the)amount)of)overlap)between)the)actin)and)myosin.)
Muscular)contraction)involves)shortening)of)the)contractile)elements,)but)
because)muscles)have)elastic)and)viscous)elements)in)series)with)the)
contractile)mechanism,)it)is)possible)for)contraction)to)occur)without)an)
appreciable)decrease)in)the)length)of)the)whole)muscle)=)isometric)
contraction.)
Contraction)against)a)constant)load,)with)approximation)of)the)ends)of)the)
muscle,)is)isotonic)("same)tension").))
Work)=)force)x)distance)")isotonic)contractions)do)work,)whereas)
isometric)contractions)do)not)do)external)work.))
In)other)situations,)muscle)can)do)negative)work)while)lengthening)against)
a)constant)weight.))
81"
MU09)[f])Muscle):))
A.)The)A)band)is)dark)because)it)
contains)thick)actin)filaments))
B.)Myosin)filaments)are)attached)to)the)
Z)line))
C.)Sarcomere)is)the)area)between)2)
adjacent)M)lines))
D.)?))
) )
MU09b)[hij])Isotonic)contraction)of)a)
skeletal)muscle)fibre)is)not)associated)
with)a)change)in)?)distance)between:))
A.)Sarcomere)length))
B.)A)bands))
C.)I)bands))
D.)Z%lines)move)closer)together))
E.)M%lines)move)closer)together))
) myosin)chains)so)doesn’t)change)for)isometric)or)isotonic)contraction.)
MU09c)[k])During)Isotonic)contraction)
of)a)skeletal)muscle)fibre:))
A.)Calcium)enters)from)the)T)tubular)
system)near)the)myofibrils))
B.)?))
C.)?))
D.)Z%lines)move)closer)together))
MU10)[fgk])Tetany)does)NOT)occur)in)
cardiac)muscle)because:))
A.)Long)absolute)refractory)period))
B.)Acts)as)a)syncitium))
C.)Pacemaker)signal)can)overcome)any)
tetany))
D.)?))
E.)?)
MU11)[gn])Sarcomere:))
A.)From)I)line)to)I)line))
B.)Actin)filament)attached)to)M)line))
C.)?))
D.)Z)line)crosses)across)myofibrils)&)
from)muscle)fiber)to)muscle)fiber))
E.)Smooth)muscle)cells)are)larger)than)
skeletal)muscle)cells)
MU12)[fghlopq])The)soleus)muscle:))
A.)High)glycogen)stores))
B.)Few)mitochondria))
C.)Large)nerve)fibre))
D.)Long)duration)of)contraction))
E.)Large)muscle)fibre)(OR:)Large)muscle)
diameter)))
F.)High)capacity)for)glycolysis)
ANSWER:#
?#B#B#best#of#a#bad#bunch#
A:#No)–)A)band)is)dark)because)it)contains)thick)MYOSIN)filaments)
B:#?Yes)(?indirectly)attached))–)ACTIN)filaments)are)attached)to)the)Z)line.)
Myosin)chains)attach)tail)to)tail)to)form)the)M)line.)Actin)is)anchored)to)the)
Z)line)via)actinin)(Ganong)20ed)p64).)"Titin,)a)large)protein,)connects)the)Z)
lines)to)the)M)lines)and)provides)the)scaffolding)for)the)sarcomere.”)
C:#No)–)Sarcomere)is)the)area)between)two)adjacent)Z)lines.)
Isometric:)no)appreciable)change)in)muscle)length)
Isotonic:)contraction)against)a)load)with)approximation)of)the)ends)of)the)
muscle)(ie)same)tension)but)muscle)gets)shorter))
)
09b:#B)
A:#No)%)sarcomere)length)decreases)as)actin)and)myosin)overlap)(Z’s)closer)
together))
B:#Yes)–)A)band)ALWAYS)stays)constant)as)it)is)fixed)by)the)length)of)the)
C:#No:)I)band)can)shorten)(area)containing)only)thin)actin)filaments))
D:#No)–)Z)lines)move)closer)together)(see)option)A))
E:#No:)M)lines)move)closer)together)in)isotonic)contraction)
)
09c:#D#
A:#No)–)T)tubules)contain)ECF)")SR)release)Calcium)ion)directly.)
D:#Yes)–)see)question)above)
ANSWER:#A#
Ganong:#
Because)it)has)a)prolonged)AP,)cardiac)muscle)is)in)its)refractory)period)and)
will)not)contract)in)response)to)a)second)stimulus)until)near)the)end)of)the)
initial)contraction.)Therefore,)cardiac)muscle)cannot)be)tetanized)like)
skeletal)muscle)
ANSWER:#C!#
Ganong:)
A:#No)–)from)Z)line)to)Z)line)
B:#No)–)myosin)filaments)attach)to)M)line)
D:#No)–)Titin)connects)Z)lines)to)the)M)lines)and)provides)scaffolding)for)the)
sarcomere.)Desmin)binds)the)Z)lines)to)the)plasma)membrane.))
E:#No)–)Smooth)muscle)fibres)are)2%5)micrometeres)in)diameter)and)20%500)
micrometers)in)length)(skeletal)muscle)20)times)as)thick)and)thousands)of)
times)as)long).)
)
ANSWER:#D#
Soleus)muscle)has)fatigue)resistant)(red))muscle)fibres,)and)in)constrast)
gastrocnemius)tends)to)have)white)muscle)fibres.))
Fatigue)resistant)muscles)are)red)because)of)the)high)myoglobin)content.)
Tehse)types)of)muscle)fibres)have)high)mitochondrial)content)(aerobic)
metabolism),)slow)myosin)ATPase)(therefore)strong,)sustained)contractions)
up)to)100ms),)and)low)levels)of)glycolytic)enzymes)(unable)to)function)
anaerobically)by)glycolysis).)Fast)twitch)muscle)fibres)are)at)least)twice)the)
diameter)of)slow)twitch)fibres.))
82"
MU13)[g])Skeletal)muscle)action)
potential:))
A.)Na)&)K)conductance)begin)to)
increase)at)same)time))
B.)Units)of)conductance)are)mA/cm3))
C.)?)
MU14)[i])An)increase)in)force)of)a)
skeletal)muscle)contraction)is)initially)
achieved)by:))
A.)Recruitment)of)nerve)fibres))
B.)Recruitment)of)muscle)fibres))
C.)Recruitment)of)motor)units))
D.)Increased)intracellular)calcium))
E.)None)of)the)above))
) 3. Length)of)muscle)fibre)
Alt)version:))
A.)Increased)calcium)release)in)
contracting)myocytes))
B.)Recruitment)of)myofibres))
C.)Recruitment)of)motor)units))
D.)Increasing)force)of)skeletal)muscle)
contraction)is)due)to)
MU15)[io])In)a)large)nerve)fibre,)the)
typical)action)potential)duration)is:))
A.)0.03)millisecs))
B.)0.3)millisecs))
C.)3)millisecs))
D.)30)millisecs))
E.)300)millisecs))
MU16)[j])The)muscular)contractions)in)
skeletal)muscle)working)at)what)level)
of))
efficiency?))
A.)10%))
B.)15%))
C.)35%))
D.)50%))
E.)75%)
MU17)[j])Annulospiral)endings)are)
involved)in:))
A.)afferent)to)receptors)measuring)
tension))
B.)afferent)to)receptors)measuring)
length))
C.)supply)to)intrafusal)&)extrafusal)
fibres))
D.)?)
MU18)[kq])Denervated)muscle)
extrajunctional)receptors)differ)from)
the)motor)end)plate)receptors…))
A)Have)1)alpha)subunit))
B)Open)for)shorter)time))
C)Not)produced)in)the)end)plate))
D.)?))
E)None)of)the)above)
ANSWER:#Neither#
Sodium)conduction)increases)first,)then)potassium)conductance)(same)as)
for)nerve)APs).))
)
SI)unit)for)electrical)conductance)(g))(the)reciprocal)of)electrical)impedance)
or)‘z’))is)siemens.)This)replaces)the)inverse)ohms)(mho).)Units)of)
2
conductance)are)used)in)Ganong)are)mmho)per)cm )
ANSWER:#
14:#C#
Alt#Version:#C#
))
Factors)resopnsible)for)grading)of)muscle)contraction:)
1. Recruitment)of)motor)units)(motor)unit)=)single)nerve)fibre)and)
the)all)the)muscle)fibres)it)innervates))
2. Frequency)of)discharge)of)motor)units)
4. Asynchronous)firing)of)motor)units)
ANSWER:#?B#
Ganong:))
Large)nerve)fibre:)largest)is)Type)A)alpha)nerve)fibre)which)has)spike)
potential)of)…)As)AP)duration)is)about)70%)of)spike)potential,)AP)duration)=)
0.6%0.7)ms)
ANSWER:##D#
)
Efficiency)=)work)tone/total)energy)expenditure)
)
Overall)mechanical)efficiency)of)skeletal)muscle)ranges)up)to)50%)while)
lifting)a)weight)during)isotonic)contraction)(Ganong).)
ANSWER:#B##
Ganong#
Annulospiral)ending)is)the)sensory)nerve)terminal)whose)discharge)rate)
increases)as)the)sensory)ending)is)stretched.)It)is)named)so)as)it)is)
componsed)fo)a)set)of)rings)in)a)spiral)configuration.)This)terminal)is)
wrapped)around)the)muscle)spindle)(intrafusal)fibres))but)NOT)the)fibres)
that)make)up)the)bulk)of)the)muscle)(extrafusal)fibres).)Muscle)spindles)
sense)muscle)LENGTH)and)changes)in)muscle)length.)
ANSWER:))E)
A:#No)–)both)extrajunctional)and)junctional)nicotinic)receptors)have)2)alpha)
units)that)bind)to)acetylcholine.)Gamme)unit)is)substituted)for)epislon)unit)
in)extragunctinoal)nicotinic)receptor)(Miller).)
B:#No)–)extrajunctional)receptors)have)a)2%10x)longer)opening)time)than)
mature)junctional)receptors)(BJA))
C:#No)%)extrajunctional)or)immature)receptors)may)be)expressed)anywhere)
in)the)muscle)membrane)(Miller))
E:#Yes#
83"
MU19)[mnop])()“question)about)energy)
source)for)muscles”)))
A.)?))
B.)?))
C.)Skeletal)muscle)uses)creatine,)
cardiac)and)smooth)use)ATP))
D.)Skeletal)and)cardiac)muscle)uses)
creatine)and)smooth)muscle)uses)ATP))
E.)All)muscles)utilise)creatine))
) is)replenished)from))
Alt)version:)An)immediate)available)
energy)source)in)muscle)is:))
A.)ATP)in)all)3)muscles))
B.)ATP)in)smooth,)phosphorylcreatine)
in)skeletal)and)cardiac)muscle))
C,D,E.)()“combinations)of)the)above”))
MU20)[p])Cardiac)muscle)is)different)
from)skeletal)muscle)because)of:))
A.)Fast)Ca)channels))
B.)Slow)Ca)channels))
C.)Fast)Na)channels))
D.)Actin)and)myosin))
E.)?)
MU21)[qr])Intrafusal)fibres))
A.)Shorter)than)extrafusal)fibres))
B.)Measure)tension)in)muscle))
C.)Contain)contractile)elements)
ANSWER:#D#then#E#in#Alt#version)#
)
Power)and)Kam:)"ATP)is)the)only)energy)source)that)contractile)proteins)
can)use,)but)muscles)only)store)enough)for)eight)twitches.)During)muscle)
contraction)ATP)is)rapidly)regenerated)from)ADP)by)utilization)of)the)more)
plentiful)creatine)phosphate)stores.)The)net)result)is)the)hydrolysis)of)
creatine)phosphate,)not)ATP."))
)
ATP)is)the)energy)source)in)all)3)muscles)it)just)depends)on)where)the)ATP)
1.)phosphorylcreatine))
2.)anaerobic)glycolysis))
3.)aerobic)glycolysis))
)
ANSWER:##B#
Cardiac)muscle)has)a)very)long)AP)compared)to)skeletal)muscle.)It)has)a)
plateau)(phase)2))druing)the)AP)=)prolonged)period)of)deploarisation)
(skeletal)muscle)does)not)have)this)plateau).)Both)of)the)above)are)caused)
by)slow)Ca)channels)which)are)slower)to)open)that)fast)Ca)channels)in)
skeletal)muscle)and)are)open)for)longer.)This)prevents)cardiac)muscle)from)
going)into)tetany.))
Cardiac)muscle:)
Large)numbers)of)mitochondria)
Is)not)able)to)go)into)oxygen)debt)
Requires)a)constant)oxygen)supply)
ANSWER:#A#and#C#
Power#and#Kam:#
A:#Yes)–)intrafusal)fibres)of)muscle)spindle)are)much)shorter)than)most)
extrafusal)fibres.))
B:#No)–)muscle)spindles)detect)muscle)length)and)movement,)whilst)tendon)
organs)sense)tension)
C:#Yes#
)
Muscle)Spindles:))
%)are)innervated)by)primary)and)secondary)afferents)and)γ)motor)nerves))
%)The)γ)motor)fibres)supply)the)contractile)ends)of)the)spindle))
%)The)sensory)nerves)are)excited)by)any)stretching)of)the)non%contractile)
centre)
%)The)primary)endings)(Ia))are)more)sensitive)to)movement)and)are)called)
'Dynamic'.))
The)secondary)endings)(II))are)more)sensitive)to)absolute)length,)and)are)
called)'Static'.))
Spindle)change)in)length)reflexly)excite)the)motor)neuron)to)the)extrafusal)
fibres)of)the)muscle)in)which)they)lie.))
%)γ)efferents)are)involved)in)"The)γ)Loop",)a)reflex)contraction)of)the)
skeletal)muscle)due)to)activity)in)the)Extra%Pyramidal)System.)This)is)
referred)to)as)"α%γ)linkage".)The)control)of)γ)efferent)discharge)adjusts)the)
sensitivity)of)the)spindles,)which)aids)postural)control.))
84"
RESPIRATORY)PHYSIOLOGY)MCQS)

QUESTION ANSWER
RE01 [Mar96] ANSWER E: none of the above
Which of the following is a normal characteristic of lung?
A. 3,000,000 alveoli Mean total alveoli 480 million (Nunns)
B. Alveolar diameter 3 mm Diameter 1/3 mm (at FRC 0.2mm diameter, Nunns)
C. External surface area: 10 m2 Alveolar SA = 50-100m2
D. Alveolar surface area: 5 to 10 m2 External SA much less than 10m2
E. None of the above
RE02 [Mar96] [Mar99] [Apr01] ANSWER: PART A: C (not A as normal PaO2)
A young man collapses one lung. His ABGs on room air PART B: D
would be:
A. pO2 80, pCO2 50 mmHg This question is about shunt, will have lowered PaO2.
B. pO2 50, pCO2 80 mmHg PaCO2 will remain normal with one normal lung
C. pO2 50, pCO2 50 mmHg Low Pa02 and raised PaCO2 will increase VE "
D. ? PaCO2 normalise (linear CO2 dissociation curve).
Hence will have low Pa02 and normal or low PaC02.
RE02 [Jul96]] [Mar97]
The ABGs in a healthy young 70kg male with one collapsed Factors to consider:
lung are: 1. Shunt usually does not result in a raised
A. paO2 50 mmHg, pCO2 25 mmHg PaCO2 because chemoreceptors sense the
B. paO2 95 mmHg, pCO2 40 mmHg ↑PaCO2 and ↑RR to normalise PaCO2.
C. paO2 60 mmHg, pCO2 45 mmHg West p60
D. paO2 60 mmHg, pCO2 25 mmHg 2. Maximal response from peripheral
chemoreceptors to hypoxia only occurs when
PaO2 < 50mmHg
3. Hypoxic vasoconstriction should improve
V/Q mismatch.
4. A-a gradient calculation
- A-a(O2) = FiO2 (Patm – PH2O) –
(PaCO2/0.8) – PaO2
= 0.21 (760-47) – PaCO2/0.8 –
PaO2
- A: 6.5 mmHg
- B: -0.17 mmHg
- C: 37.23 mmHg which seems more
realistic

85"
RE03 [Mar96] [Mar99] [Feb04] ANSWER: PART A: A
Pulmonary vascular resistance: PART B: D – only correct after
A. Is minimal at FRC recruitment + distension has occurred or in
B. ?Increases/?decreases with increase in lung volume pathology
C. Increases with elevated CVP • PVR"=("PAP"–"PVP)/CO"
D. ? • PVR"falls"with"either"rise"in"PAP"or"PVP"
(PAP>PVP).""
RE03b [Jul00] • PVR"minimal"at"FRC,"increases"at"low"
Pulmonary vascular resistance is increased in : (extraaalv"vessels"contracted)"AND"high"
A. Increase in pulmonary arterial pressure (stretch"caps)"lung"volume."
B. Hypocarbia CAUSES OF CAUSES OF
C. Alkalosis INCREASED PVR DECREASED PVR
D. Increased left atrial pressure Increased PaCO2 Decreased PaC02
E. ? Decreased pH Increased pH
Decreased PaO2 Increased PaO2
Adrenaline Isoprenaline
Noradrenaline Acetylcholine
Thromboxane A2 Prostacyclin (PGI2)
Antiogensin II Nitric Oxide
Serotonin Increased peak airway P
Histamine Increased pulm venous P
Low or High lung Volatile anaesthetics
volumes
Lung at FRC

RE04 [Mar96] [Jul97] [Jul02] ANSWER: A

The greatest increase in (?physiological) dead space would Looking for are which is ventilated and NOT
be expected with: PERFUSED.
A. Pulmonary embolism
B. Atelectasis (or: collapse of one lung) Physiological DS: part of VT that doesn’t take part in
C. Pneumothorax gas exchange (ie alveolar + anatomical DS)
D. Bronchoconstriction Anatomical DS: volume in conducting airways
E. Obesity Alveolar DS: alveoli ventilated but not perfused

86"
RE05 [Mar96] [Jul00] [Apr01] [Jul01] [Jul02] [Feb04] ANSWER: PART A: D and G
As go from the top of the erect lung to the bottom: PART B: D (presume PAO2/CO2)
A. Water vapour pressure remains constant
B. pN2 remains constant Water vapour constant throughout lung (47mmHg at
C. pCO2 at apex is higher than at the base 37°C).
D. pO2 at base is lower than at the apex PN2 mmHg: base 582, apex 553
E: V/Q is higher at base than apex PCO2 mmHg: base 42, apex 28
F. Ventilation goes up as go up lung PO2 mmHg: base 89, apex 132
G. Compliance is more at base than apex V/Q higher at apex than base (both V and Q decrease
from base to apex, but Q dec more).
Alt remembered version: Compliance is greater at BASE than apex.
The difference between the apical and basal alveoli in a erect
lung:
A. Apical PaO2 < basal PaO2
B. Apical PaCO2 > Basal PaCO2
C. V/Q mismatch Apical < Basal
D. Compliance Basal > Apical

RE06 [Mar96] [Mar99] [Jul01] ANSWER: D

Distribution of pulmonary ventilation & perfusion in the V and Q both decrease as go from base to apex (but Q
erect position: dec more).
A. Gradient of change in ventilation is greater than that for V:Q ratio (apex 3.3, mid zone 1.0, base0.63)
perfusion
B. Ventilation increases as go up the lung
C. Perfusion increases as go up the lung
D. V:Q ratio at apex is greater than at base
E. None of the above
RE07 [Mar96] ANSWER: A
Oxygen unloading: Factors that shift curve to R (ie offload O2):
A. Increases with increased paCO2 Increasing [H+]
B. Decreases with increase in temperature Increasing temperature
C. Decreases with increase in 2,3 DPG Increasing PaCO2
D. ? Increasing 2,3-DPG

87"
RE08 [Mar97] ANSWER: PART A: A + C
Alveolar dead space: PART B: D
A. Is less than physiological dead space
B. Is decreased with mechanical ventilation Anatomical DS: volume in conducting airways
C. Is increased with hypotension (measured using Fowlers method)
D. Is measured by Folwer’s method.
Alveolar DS: alveoli ventilated but not perfused.
RE08b [Jul98] [Jul99] [Feb00] [Jul02]
Alveolar dead space is increased with: Physiological DS: part of VT that doesn’t take part in
A. Pleural effusion gas exchange (ie alveolar + anatomical DS)
B. CCF
C. Pneumothorax Alveolar DS: increases with IPPV, hypotension eg
D. Hypotension severe haemorrhage (both cause increase zone 1)
E. None of the above
(see also RE33)
RE09 [Mar97] [Jul97] [Mar99] [Jul00] [Jul01] ANSWER: C
If dead space is one third of the tidal volume and arterial BOHR:
pCO2 is 45 mmHg, what is the mixed expired pCO2? VD = PaCO2 – PeCO2
A. 20 mmHg VT PaCO2
B. 25 mmHg
C. 30 mmHg ie 1/3 = (45-x)/45
D. 45 mmHg 15 = 45-x
E. 60 mmHg -30 = -x
(Comment: Simple application of the Bohr equation) x = 30
RE10 [Mar97] [Jul98] [Mar99] [Jul00] [Jul01] [Mar03] ANSWER: PART A: ?A,C or D by increasing SaO2
[Jul03] PART B: ?
With constant FIO2, CO and VO2, an increase in mixed PART C:
venous O2 content would be seen with: PART D: B
A. Hypothermia ! Beware oxygen TENSION vs CONTENT
B. Increased paCO2 !
C. Decreased 2,3 DPG ! O2 content = 1.34*Sat%*Hb + 0.003*pO2
D. Alkalosis ! Hence anaemia = lower Hb = lower O2
E. None of the above content
Anaemia does not impact on PaO2.
Alt wording: Without a change in body oxygen consumption
or cardiac output, mixed venous oxygen tension increases VO2 = Q (CaO2 – CvO2)
with: ∴ CvO2 = CaO2 - VO2 / Q
∴ CvO2 = SaO2 * Hb * 1.34 + 0.003 * PaO2 – VO2
Alt wording (March 03): With constant FIO2 and cardiac /Q
output and no change in position of ODC, mixed venous ∴ If FiO2, CO and VO2 are constant, factors ↑
blood oxygen tension increases with: mixed venous O2 content are:
(see also CV47 ??same Q) ! ↑SaO2
! ↑Hb
Jul03: If CO constant and ODC unchanged, mixed venous ! None of answers fit.
oxygen tension is decreased in:
A. Cyanide toxicity
B. Anaemia
C. Hypothermia
D. Hypercarbia
E. ?

88"
RE11 [Jul97] [Jul01] ANSWER: PART A: A
With altitude: PART B: E = best answer
A. Increased 2,3 DPG A correct in long term (due to alkalosis) B correct in
B. Increased oxygen unloading in peripheries short term (inc 2,3-DPG), C incorrect, D: incorrect
C. Increased oxygen uptake in the lungs (L shift, inc Hb-02 affinity), E correct as inc 2-3 DPG
D. ? + alkalosis L shift
E. ? PART C: E (inc CO, hyperVE, inc 2,3-
DPG, polycythaemia chronic change +APO occurs if
Alt versions: they DON’T acclimitise)
RE11b
In acclimatisation to altitude: Acute Altitude Sickness: Low PaO2 sensed by
A. P50 is reduced, improving O2 uptake in the lungs peripheral chemoreceptors " increased VE " low
B. P50 is increased, improving O2 offloading in the tissues PaCO2 " severe resp alkalosis " loss night time
C. 2,3 DPG levels are reduced, improving O2 offloading in vision, dizzy, CNS (amnesia etc), APO (50% die if no
the tissues Rx), cerebral oedema. Rx: 02, descend, nifedipine in
D. Alkalaemia reduces the affinity for O2, increasing p50 HAPE. Acetazolamide: CA inhibitor, interferes with
E. Increase in 2,3 DPG and a decrease in P50 transport of CO2 out of cells " intracell academia in
medull chemoR " drives resp " accelerates
RE11c acclimitisation. Renal effects: induces metabolic
With acute acclimitisation to altitude: acidaemia (further VE drive).
A. Hypoventilation
B. Decreased cardiac output Acclimitisation: initial hypoxic drive to ventilation
C. Pulmonary oedema short lived (Pa02 remains low, PaCO2 low normal).
D. Polycythaemia Next few days: VE slowly inc, dec PaC02, small inc
E. Increase in 2,3 DPG PaO2 " enough to improve Sx. Speed of
acclimitisation depends on speed of ascent + peak
altitude. ? VE changes due to restoration of CSF pH
back to normal via HCO3 transport (studies: NO).
Potentially due to increased resp centre + central
chemoreceptor responsiveness to hypoxia. Over few
days renal HCO3 excretion to counteract alkalosis "
metabolic acideamia " VE drive. Inc 2,3-DPG "
easier unloading of 02 to tissues.

Adaptation: inc EPO within 3hrs, peak 24-48hr then

decline, causing increased Hb concentration
(polycythaemia Hb 19.3) " sats 54% = 15mL/dL 02
content. 2,3-DPG increases from 1.7 to 3.8mmol/L
(RIGHT shift) countered by alkalosis (overall LEFT
shift ie 02 loading in lungs prioritised). Inc 2,3-DPG "
easier unloading of 02 to tissues.

Long term residents: dec VE response to hypoxia, slight

rise towards N PaCO2. ?inc pulmonary diffusion
capacity in kids (devpt alveoli by septation of saccules
in first years of life – hence if move to high alt later in
life won’t get same response).

Chronic mountain disease: Monge’s disease: very poor

VE response to hypoxia " low PaO2, high PCO2
(cyanosis, clubbing, pulm HTN, RHF, SOB etc)

89"
RE12 [d] [Jul98] [Jul01]
Central chemoreceptors:
A. Bathed in CSF
B. Respond to increase in CSF pH
C. Bathed in ECF
D. In medullary respiratory centre
90"
ANSWER: C
Central chemoR: lie on surface of anterior medulla in
retrotrapezoid nucleus, glutaminergic neurons (NOT in
medull resp centre). Bathed in ECF (composition of this
determined by CSF, local blood flow, metabolism).
CO2 from blood crosses BBB (impermeable to H+) "
H+ prodn " stimulates central chemoR. Mediated via
muscarinic ACh. Chronic abnormal CSF PCO2 "
change CSF HCO3 eg hypoCO2 at altitude.
RE13 [d] [Jul98] [Mar99] [Apr01] [Jul01] [Jul02] [Mar03] Peripheral ChemoR:
[Jul03] [Feb04] FAST RESPONDERS, carotid/aortic bodies.
The peripheral chemoreceptors: A – CORRECT: Non-linear PaO2 response (response
A. Have a nonlinear response to paO2 changes begins PaO2 500, kicks in around 70, max at 50)
B. Have an intact response at 1MAC B – INCORRECT: response eliminated by as little as
C. Respond to a fall in paCO2 0.1 MAC (difficult in CO2 retainers)
D. Respond slowly to rise in paCO2 C – INCORRECT: respond to increase PaCO2
E. Respond to alkalaemia D – INCORRECT: respond 5x faster c/w central ones
F. Respond only to ?incr-/decr-eased H+ E – INCORRECT: respond to dec PO2 (not content ie
G. Respond only to arterial hypoxaemia not responsive if COHb, anaemia, methoxyHb),
H. Innervated by glossopharyngeal nerve acidaemia, inc PCO2, + reduction in their perfusion rate
I. Low metabolic rate F – INCORRECT
J. Stimulated by carbon monoxide G – INCORRECT
K. Stimulated by cyanide H – CORRECT: carotid bodies: glomus/type 1 cell in
L. Blood flow of 2 ml/gram/min (OR Blood flow of synaptic contact with axons from glossopharyngeal
200mls/G/min) nerve " dorsal resp centre medulla
M. Aortic body innervated by vagus I – INCORRECT: have high metabolic rate, higher
N. Changes in arterial oxygen content perfusion than this though
O. Low O2 extraction (OR: Low A-V O2 difference J – CORRECT: Nunns: chemical stimulation includes
P. Have glomus cells nicotine/ACh type and then chemical stimulants eg
cyanide, CO (block cytochrome system " prevents
Feb 04 Version oxidative metabolism)
Peripheral chemoreceptors: K – CORRECT
A. In the carotid sinus L – INCORRECT: blood flow is 2,000
B. Have glomus cells mL/100mg/min or 200mL/mg/min
C. Low A-V difference M – CORRECT Aortic bodies " CN X " dorsal
D. Innervated by glossopharyngeal nerve medullary resp centre
E. Blood flow of 200mls/g/min N – INCORRECT – respond to low PaO2 not content
O - CORRECT: ridiculously high perfusion, minimal
[NOTE: The large number of options suggests this listing o2 extraction despite high metabolic needs – minimal
here represents an amalgam of several similar questions] A-v 02 difference
P – CORRECT
RE13b [Feb04]
Carotid bodies (Similar to RE13) 04:
A. Have glomus cells A – INCORRECT: carotid bodies art at carotid
B. Innervated by vagus bifurcation near carotid sinus.
C. Blood flow of 200mls/g/min B - CORRECT
D. High A-V difference C - CORRECT
D – CORRECT: carotid via CN XI, aortic via CN X
(See also:RE36) E - INCORRECT

04B – A
A - CORRECT
B - INCORRECT: carotid via CN XI, aortic via CN X
C – INCORRECT
D - INCORRECT
E – INCORRECT

91"
RE14 [d] [Jul98] [Jul99] [Jul00] ANSWER:
Surfactant: PART A: A – YES/NO Surfactant likely
A. Causes hysteresis (Or: Is the ONLY cause of hysteresis) involved in hysteresis but not the only contributing
B. Is produced by type 1 pneumocytes factor, B – NO, C-NO, D: Yes (detergent molecules
C. Is commonly deficient in term neonates hydrophobic + repel each other reducing attractive
D. Acts like detergent in water forces btw H2O molecules), E: YES (dec ST reduces
E. Reduces the amount of negative intrapleural pressure static lung recoil pressure " reduces amount of
F. Production is slow negative IPP), F: NO (production fast), G: YES: it
G. Increases pulmonary compliance increases pulm compliance.
PART B: A: YES, B: NO, C: NO, D: NO
RE14b [Jul04] (stabilises alveoli to prevent small ones emptying into
Surfactant larger ones) E: NO
A. Surface tension is inversely proportional to surfactant
concentration
B. Lung compliance decreases with surfactant
C. Is produced by alveolar type 1 cells
D. Stabilises alveoli to allow smaller alveoli to empty into
larger ones
E. Increases surface tension in smaller alveoli to promote
stability

La Place: Pressure = 2 x surface tension

radius
80% of surfactant is phospholipid called DPPC
(dipalmitoyl phosphatidyl choline). 4 types of
surfactant proteins (deficiency SP-B: slow progressive
resp failure. Surfactant produced by type II
pneumatocytes. Lamellar bodies contain surfactant –
released into alveolus by exocytosis in response to high
volume lung inflation, inc RR or endocrine stimulation.
t½ alveolar surfactant: 15-30hrs (components recycled
in type 2 cells). Surfactant acts by decreasing surface
tension during expiration as alveoli get smaller, and
maintains stability of alveoli. ‘Squeeze out’ hypothesis:
as surfactant monolayer compressed, less stable
phospholipids squeezed out " increases amount of
stable DPPC molecules " greatest effect on reducing
ST.
Surfactant reduces ST " diminishes pressure gradient
(helps prevent transudation).
Surfactant also plays immunological role in lung
(antioxidant, activate neutrophils/macrophages).
Premature babies often deficient in surfactant.
Hysteresis: if lungs slowly inflated then slowly
deflated, the pressure volume curve for static points
during inflation differs from that obtained in deflation
(ie form loop on graph). Rather more than the expected
pressure is required during inflation, and rather less
than expected recoil pressure is available during
deflation.
RE15 [Jul97] [Apr01] ANSWER: B
In quiet breathing, exhalation is:
A. Passive due to elastic tissue alone WOB = work to overcome elastic recoil + work to
B. Passive due to surface tension in the alveoli and elastic overcome resistance forces.
tissue recoil Lung’s elastic recoil due to ST + elastic tissues.
C. Active due to intercostal contraction Quiet breathing is PASSIVE, use stored elastic energy
D. ? achieved during inspiration.
E. ?

92"
RE16 [d] [Mar98] [Jul98] [Apr01] [Mar03] [Jul03] ANSWER: B
The normal arterio-venous difference for CO2 is: Mixed venous blood = 52 mlsCO2/100mls blood
A. 2 ml/100ml Arterial blood = 48 mlsCO2/100 mls blood
B. 4 ml/100ml
C. 6 ml/100ml
D. 8 ml/100ml
E. 10 ml/100ml

RE17 [d] [Jul98] [Mar99] [Jul00] [Apr01] [Jul01] [Mar02] ANSWER:

[Jul02] [Jul04] PART 1: A, E correct
The lung: PART 2: E
A. Removes/inactivates serotonin (5HT) PART 3: B, C, E correct
B. Activates bradykinin PART 4: D
C. Converts angiotensin II to I PART 5: A, C, D correct
D. Inactivates aldosterone
E. Takes up noradrenaline Endothelium: most metabolically active cell type in the
lungs.
Alt version:
Which of the following substances is removed (?inactivated) Those removed by lung (uptake/degradation): 98%
by the lungs? serotonin , 80% bradykinin (ACE), 30% noradrenaline
A. Serotonin (metabolised by MAO and COMT).
B. Noradrenaline Converts AT1 to AT2 (ACE).
C. Angiotensin I
D. Bradykinin Unchanged: dopamine, isoprenaline, histamine,
E. All of the above adrenaline, vasopressin, aldosterone

July 2000: Lung: site of synthesis, uptake, metabolism and release

Which of the following is inactivated in the lung: of arachadonic acid metabolites. PGE2/F2α,
A: Angiotensin II leukotrienes removed. PGA2/prostacyclin unaffected.
B: Angiotensin I
C: Bradykinin
D: Vasopressin
E: Noradrenaline

Jul 2001 version:

Metabolic functions of the lung include which one of the
following?
A. Inactivates ADH
B. Converts Angiotensin II to Angiotensin I
C. Activates bradykinin
D. Inactivate serotonin (5HT)
E. Activation of prostaglandins

Mar 02:
Which biologically active substances are partially ?degraded
by the lung?
A. Surfactant
B. Histamine
C. Angiotensin
D. Noradrenaline
E. ?all/?none of the above

RE18 [] [Mar98] [Jul98] ANSWER: A

Breathing oxygen :
A. Causes pain on re-expansion of collapsed alveoli Breathing FiO2 100% can cause absorption atelectasis
B. Reduces vital capacity " reduced VC. But question does not state this.
C. ?
D. ? Nunn: voluntary maximal inspiration can clear areas of
absorption atelectasis in pts breaking O2 near esidual
volume but the process imparts a distinctive TEARING
sensation in the chest, but rapidly restores PO2 and
CXR to normal.

93"
 RE19 [] [Mar98] [Jul98] [Feb00] [Mar02] [Jul02] ANSWER: B (if asking for A-V difference)
Contribution to the increase in CO2 carriage as blood passes
from artery into vein: CO2 carried in body as HCO3, dissolved and
Carbamino HCO3 Dissolved carbamino compounds:
A. 5% 90% 5% Arterial (%) A-V difference (%)
B. 30% 60% 10% Dissolved 5 10
C. ? HCO3 90 60
D. ? Carbamino 5 30
(See also RE38 )

RE20 [Mar98] [Mar03] ANSWER:

Increased physiological dead space with: BOHR: VD = (PaCO2 – PECO2)
A. Decreases with age VT PaCO2
B. Anaesthesia
C. Supine position PART A: B
D. Calculated from Bohr equation using end-tidal CO2 A: NO – DS increases with age (1mL/yr from early
E. Calculated from endtidal CO2 and arterial CO2 adulthood).
F. Decreases with increase in anatomical dead space B: YES: increase in alveolar dead space with
G. Increases with PEEP anaesthesia (mechanism unclear ? due to
(see RE04 & RE08) misdistribution with over-VE of relatively under-
perfused alveoli). No evidence to suggest its due to
RE20b [Jul98] [Feb00] pulm hypotension " creation zone 1.
Physiological dead space increases with: C : NO
A. Pulmonary hypertension D: NO (Bohr equation correct but use PaC02 from
B. Hypotension ABG as measure of alveolar PO2 , not ET CO2)
C. Atelectasis E - NO
D. Pleural effusion F - NO
E. None of the above G – YES
NUNN: Acute application moderate PEEP causes only
slight increase VD/VT ratio. Increased alveolar DS in
patients with lung injury with VE + significant PEEP
(this can cause inc lung volume " CO falls, PVR
rises). Perfusion to overexpanded alveoli is reduce and
areas of lung with high VQ ratio develop (= alveolar
DS). Normal lungs: this doesn’t occur until PEEP >10-
15cmH20. Long term PEEP may " very large increase
in DS (?due to bronchiolar dilatation).

PART B: B
A - NO
B – YES – systemic hypotension increases
physiological DS
C – NO (atelectasis = non-ventilated lung)
D – NO occurs outside lung
E - NO

• VD"men"50mL">"women"but"men"larger"VT"
hence"little"difference"in"ratio.""
• VD"increases"with"increased"weight,"17mL"
increase"per"10cm"increase"height.""
• VD/VT:"34%"upright,"30%"supine"due"to"
changes"in"anatomical"dead"space"(anatom"
DS:"150mL"sitting,"100mL"supine)""
• Changes"in"VD"with:"PE,"smoking,"
anaesthesia,"artificial"ventilation."

94"
RE21 [Mar98] [Mar99] [Feb00] ANSWER: E
Shunt can be calculated by knowing: QS = (CcO2- CaO2)
A. Cardiac output QT (CcO2 – CvO2)
B. Arterial oxygen content
C. Mixed venous oxygen content CcO2 = end capillary O2 content
D. End pulm. capillary oxygen content CvO2 = mixed venous O2 content
E. All of the above CaO2 = arterial blood O2 content
QS = shunt blood flow
QT = total blood flow (ie CO)

RE22"[Jul98]"" ANSWER:
PART 1: B + D correct
Alveolar"pressure:"" PART 2: D correct

Normal quiet breathing alveolar pressure oscillates

A."Is"always"negative"throughout"normal"quiet"breathing""
B."Is"zero"(atmospheric"pr)"during"pause"between"
inspiration"and"expiration""
C."Is"greater"than"5a6"cm"H2O"during"quiet"expiration""
D."Is"less"than"5a6"cms"H2O"during"quiet"inspiration""
between -1 to +1 cm H20. It is zero between inspiration
and expiration.
Nunn: At all times alveolar/ambient pressure gradient is
the sum of alveolar/intra-thoracic (or transmural) and
intra-thoracic/ambient pressure gradients. This is
independent of whether patient
ventilated/spontaneously breathing.

"

Also"remembered"as:""

Alveolar"pressure"during"quiet"breathing:""

A."5"cmsH2O"negative"at"inhalation""

B."5"cmsH2O"positive"at"expiration""

C."Follows"intrapleural"pressure"closely""

D."Is"atmospheric"between"inhalation"&"exhalation""

95"
RE23 [Mar99] [Apr01] [Jul03] [Feb04]
Patient with chronic airflow limitation:
A. Gradient maximal in effort independent part of flow
volume loop
B. Will have increased total lung capacity
C. Has increased static compliance
D. ?
ANSWER: C
A: NO – gradient maximal in effort-dependent section
(ie at the beginning of exp curve)
B: NO – Obstructive defect = normal TLC
C: YES if referring to emphysema
(see figure to left)

(figure below not provided in question – collated as part of
best answer – placed her for formatting purposes)
Chronic airflow limitation ie COPD (B above):
All flow rates are diminished, but exp prolongation
predominates. PEFR < PIFR. Peak exp flow is
sometimes used to estimate degree of airflow
obstruction but is dependent on patient effort. TLC the
same.

COPD = progressive chronic airflow limitation

(compared to asthma which has intermittent airflow
limitation). COPD: smoking, activation of
neutrophils/macrophages. Neutrophils release protesase
enzymes (eg neutrophil elastase) " degrades
pulmonary elastin " loss of lung tissue elasticity.
Pathophysiological changes in COPD:
1. Emphysema: permanent enlargement of airspaces
distal to terminal bronchiole + destruction of alveolar
walls (both V + Q diminished).
2. Mucous hypersecretion in large airways: goblet cell
hypersecretion " excessive mucous
3. Small airway obstruction: part of expiratory airflow
limitation from emphysema but also likely due to
changes in airway wall (hypertrophy of bronchial
smooth muscle, collagen deposition).
4. Hyperinflation: Airflow limitation in small airways
due to airway narrowing + loss of elastic recoil of
lungs. Loss of elastic recoil impt in maintaining patency
of airways <1mm diameter. Expiratory flow limitation
prolonged expliratory time constants " incomplete
expiration (gas trapping). Hyperinflation " signif
reduction in efficiency of resp muscles (flat diaphragm)
" barrel chest.
5. Respiratory muscles: these are abnormal in COPD.
Have more fatigue-resistant fibres (Type 1) and
contractile mechanisms become less efficient.

RE25 [Jul98] [Mar99] [Mar03] [Jul03] ANSWER: B

The partial pressure of oxygen in dry air at sea level:
A. 163 mmHg Barometric P at sea level = 760mmHg
B. 159 mmHg FiO2 = 0.21
C. 149 mmHg Dry air PH2O = 0mmHg
D. 100 mmHg
E. ? PIO2 = FIO2 x Patmos
PIO2 = (0.21)x(760-0) = 159.6
RE26 [Mar99] [Jul04] ANSWER: A in acute phase is postulated.
Cause of increased minute ventilation with exercise: B/C/D if severe prolonged exercise. A only postulated
A. Oscillation in paO2 & paCO2 some maybe they want E.
B. Hypercarbia
C. Hypoxaemia Nunns: Peripheral chemoR responsible for exercise
D. Acidosis related inc VE. This may be due to oscillations in
E. None of the above PO2/PCO2. Humoral factors become important in
heavy exercise (eg lactic acidaemia, high temp).

96"
RE27 [Jul99] [Feb00] [Apr01] ANSWER: A
Work of breathing (as % of total VO2) in normal healthy WOB = work to overcome elastic recoil + work to
adult:: overcome resistance forces
A. 1%
B. 5% WOB at rest = 3mL/min or 1% of basal O2
C. 10% consumption (<2% in Nunn).
D. 20%
If question was regarding efficiency:
Efficiency % = Useful work/Total Energy expended (or
O2 cost) x 100. Efficiency of lung WOB is usually 5-
10%.
RE28 [Feb00] [Mar03] [Jul03] PEEP: ANSWER: D
A. Has a variable effect on FRC Functions of PEEP:
B. Reduced lung compliance • Increases"FRC"
C. Reduces lung water • Increases"lung"compliance"in"lower"
D. Reduces airway resistance dependent"parts"of"lung,"reduces"
E. No effect on lung compliance compliance"in"nonadependent"parts"of"lung"
""improved"VQ"matching.""
• Reduces"airway"resistance,"helps"to"prevent"
gas"trapping"(CPAP"if"awake,"PEEP"if"
ventilated)"
• Dose"not"reduce"lung"water,"but"causes"
greater"proportion"to"be"in"extraaalveolar"
insterstitial"space"and"increased"lymphatic"
drainage"
RE29 [Feb00] [Jul02] ANSWER: C
At an atmospheric pressure of 247 mmHg, what is the moist
inspired p02? PIO2 = (0.21) x (247-47) = 0.21 x 200 = 42mmHg
A. 200 mmHg
B. 2 mmHg Lots of argument as to whether or not water vapour had
C. 40 mmHg already been subtracted to give 247 figure. I disagree.
D. 50 mmHg
(see also CM08)
RE30 [Feb00] ANSWER:
Type II pneumocytes PART 1: D (NB ?phagocytose surfactant and stimulate
A. Develop from type I pneumocytes macrophages, but are not macrophages themselves b/c
B. Are macrophages are a stem cell, not differentiated monocytes).
C. Are very flat and practically devoid of organelles PART 2: B
D. ?Metabolise surfactant
Type II pneumocytes (16% of total cells, 5% of SA):
RE30b [Jul00] Produced surfactant. Don’t take part in gas exchange..
Type I pneumocytes Involved in immune response: secrete cytokines,
A: Give rise to Type II pneumocytes contribute to pulm inflammation. Resistant to O2
B: Are flat & minimal organelles toxicity (proliferate + replace type 1 cells in O2
C: Bind surfactant (? receptors) on their brush border toxicity). Have SP-A receptors which when stimulated
D. ? produce negative feedback on type 2 cells (increases
uptake of surfactant). They have microvilli on outer
layer. Surfactant stored in striated osmiophiluc
organelles called lamellar bodies. Surfactant works by
sitting on top of the water layer. Surfactant helps to
hold alveoli open partic at end of expiration.

Type I pnemocytes (95% of SA):

Flat, minimal organelles. Easily damaged, replaced by
proliferating type 2 pneumatocytes that then
differentiate into type 1 pneumatocytes. Very sensitive
to O2 toxicity.

Pneumocytes are naughty when no one is looking ‘2

become one.’ (for further information please see ‘2
Become 1’ lyrics by the Spice Girls).

97"
RE31 [Jul00]
Control (?inspiratory) of the diaphragm originates in:
A. Pneumotactic centre
B. Apneustic centre in pons
C. Dorsal medullary (?neurons of) respiratory centre
D. Ventral medullary (?neurons of) respiratory centre
ANSWER: C
Acronym: DIVE (dorsal inspiration, ventral
expiration).
Diaphragm innervated by C3,4,5. SA 900cm. Most
important inspiratory muscle. Very active muscle fibres
(can reduce length by 40% c/w 14% soleus muscle).

RESPIRATORY CENTRE IN MEDULLA:

Ventral resp group (VRG) EXPIRATORY:
• Caudal"(cVRG)"
o Nucleus"retroaambigualis"(expiratory,"UMN"
pass"to"contralateral"expiratory"muscles)"
o Nucleus"paraaambigualis"(inspiratory,"
controls"force"of"contraction"of"contralateral"
insp"mm)"
• Rostral"(rVRG):""
o Nucleus"ambiguous"–"airway"dilator"
functions"of"larynx,"pharynx"+"tongue"
• PreaBotzinger"complex"
o Anatomical"location"of"central"pattern"
generator"
• Botzinger"Complex:"
o Widespread"expiratory"functions"

Dorsal resp group (DRG) INSPIRATORY:

• Close"to"nuclear"tractus"solitarius"(NTS),"its"
where"visceral"afferents"from"CN"IX/X"
terminate."Predominately"INSPIRATORY"
neurones."Concerned"with"the"timing"of"the"
respiratory"cycle"

PONTINE RESPIRATORY GROUP

Pneumotaxic centre:
Upper pons, inhibits the inspiratory ramp (hence
regulates insp volume and time).
Apneustic centre:
Lower pons, has excitatory effect on inspiratory area of
medulla " prolongs ramp action potentials.

98"
RE32]] [Jul00] ANSWER: D
For a normal Hb-O2 dissociation curve, the most correct
relationship is:
A. PaO2 340mmHg, SaO2 99%
B. PaO2 132mmHg, SaO2 98%
C. PaO2 68mmHg SaO2 ?
D. PaO2 60mmHg, SaO2 91%
E. None of the above

99"
RE33 [Jul00] ANSWER: N/A
Alveolar dead space ??? Fowlers method – ANATOMICAL dead space
A. Measured by Fowler’s method Bohr equation – PHYSIOLOGICAL dead space
B. ?? Alveolar DS = Bohr - Fowlers
(may be same Q as RE08)
RE34 [Jul00] ANSWER: D and F
Oxygen toxicity:
A: Is caused by superoxide dismutase (OR: Increased by A – NO (SOD is antioxidant, protects against O2 tox)
increased SOD) B - NO
B: Causes CNS toxicity at over 100kPa C – NO (result of it)
C: Is caused by absorption atelectasis D - YES
D: Is due to formation of superoxide radicals E - NO
E: Prolonged ventilation at 50kPa causes pulmonary toxicity F - YES
F. Causes lipid peroxidation Acute use Fi02 100% (Pa02 >600mmHg) won’t cause
(see also MD30) O2 toxicity (at normobaric conditions, would need
chronic exposure to this). 02 toxicity depends on Pa02
and length administered
At 1 ATA 100% 02 for 12 hours " pulmonary toxicity
• tracheobronchial"irritation"(cough/substernal"
pleuritic"chest"pain)"
• after"few"days"""alveolar"cap"membrane"
thickening""
• absorption atelectasis: reduces VC by 500-800mL as
high Fi02 causes alveolar collapse beyond obstructed
bronchiole (ie segments low V/Q ratio) – as lack
nitrogen to splint alveoli open
• bronchopulmonary dysplasia in infants
• retrolental fibroplasia in infants
• hyperbaric 02 therapy (HBOT) " hyperoxic seizures
(Paul-Bert effect)
o HBOT used for CO poisoning, anaerobic infections,
diabetic wounds, acute decompression illness/gas
embolism, severe anaemia (increased dissolved 02)
• mechanism
o inactivation of enzymes with sulfhydryl groups
o production of oxygen free radicals (dioxygen
molecule)
o reduction of oxygen to superoxide anion free radical
is via grabbing electron from change of Fe3+ " Fe2+
o antioxidation enzymes important: superoxide
dismutase (SOD), catalase (CAT)
o hydrogen perioxide H202 also causes 02 toxicity
o H202 and superoxide anion interact (Fenton or
Haber-Weiss equation) to form hydroxyl free radical
and singlet oxygen
o 02 radicals target cell membranes (lipid
peroxidation) and DNA
o things that favour free radicals:
! high P02, increasing 02 consumption, ferrous iron,
paraquat poisoning, bleomycin (**bleo inhibits SOD
" 4% pulm toxicity so keep Fi02<30%, pre-treat
with corticosteroids)
o protecting factors
! SOD, CAT, glutathione peroxidase system, Fe
chelation, antioxidants (vitamin C, Vit E, NAC,
?steroids)

100"
RE35 [Jul00] [Apr01] ANSWER: C
Pulmonary stretch receptors:
A. ? Pulmonary stretch receptors lie in airway smooth
B: Are only stimulated by maintained stretch muscle. Discharge in response to distension of lung,
C: Show (?slow) adaptation activity is sustained with lung inflation (show little
D: Cause an immediate decrease in tidal volume adaptation). Impulses travel via vagus.
E. ?
Slowly adapting receptors: ability to maintain firing
rate when lung inflation is maintained therefore act as
lung volume sensor.

Rapidly acting receptor: located in mucosal layer,

stimulated by changes in VT, RR or lung compliance.
They are nociceptive, chemosensitive.

Afferent nerves from both SAR/RAR converge of NTS

of medulla.

Inflation Relfex ‘Hering-Breur’: inhibition of

inspiration in response to increased pulmonary
transmural pressure gradient (eg in sustained inflation
of lung) Inflation oflungs tends to inhibit further insp
muscle significance. Largely inactive in adults unless
VT >1L. Also BSLTx – normal breathing patterns. Impt
in neonates.

Deflation Relfex: Augmentation of inspiration in

response to deflation of lung (lung deflation has a reflex
excitatory effect on breathing).

Heads Paradoxical Reflex: Reversal of inflation reflex.

Sudden inflation of lungs in animals " transient
inspiratory effort before onset of apnoea. Anaesthesia:
after giving resp depressants, transient increase in
airway pressure " ‘gasping’ inspiration.
RE36 [Jul00] ANSWER: B
The peripheral chemoreceptors are located:
A. Carotid sinus Peripheral chemoreceptors – carotid BODY and aortic
B. Carotid bodies BODY.
C. The vasomotor centre
D. ? “(Carotid) body doesn’t belong in the ‘baro’”
(see also RE13)

101"
RE37 [Apr01] [Mar03] [Jul03]
Mixed venous blood:
A. Higher haematocrit than arterial
B. Saturation of 48%
C. Higher pH than arterial Blood
D. Can be sampled from the right atrium
E. pO2 lower than coronary sinus blood
F. Coronary sinus O2 saturation of 30%
ANSWER: F
A: NO
Haematocrit: proportion of blood volume that is
occupied by red blood cells (men 48%, women 38%).
For each CO2 molecule which diffuses into RBC either
an HCO3 or CL atom enters cell (Cl shift). This results
in one osmotically active particle for each CO2, which
attracts H2O and causes RBC to swell slightly. This
together with very small amount of fluid returning to
lymphatics means that venous blood haematocrit is
normally 3% greater c/w arterial blood.
B: NO (Normal SVO2 75%)
C: NO (generally lower pH c/w arterial as more CO2)
D: NO (Sampled from pulmonary artery (PA catheter)
as blood not adequately mixed in RA)
E: NO (Coronary sinus PO2 = 20mmHg - Brandis)
F: ?YES (Coronary sinus Sat O2 approx 30-35%)

ASSAY ABG MIXED

VENOUS
pH 7.35-7.45 7.32-7.36
PCO2 35-45 46
PO2 80-100 40
Saturation O2 95-99% 60-80%
HCO3 20-26 25.7

RE38 [Apr01] ANSWER: ?C

Carbon dioxide carriage:
a) 10% dissolved Depends if they are asking for arterial or AV difference
b) 30% carbamino values (see table in another question).
c) 85% bicarbonate
d) 60% bicarbonate Haldane effect: deoxygenated blood has increased
e) Unaffected by pO2 affinity for binding CO2 (ideal in tissues after O2
offloading, CO2 jumps on).

102"
RE39 [Apr01] ANSWER: B
Factors that favour formation of carbamino-haemoglobin
include: Hb.NH2 +CO2 $" Hb.NHCOOH $"Hb.NHCOO-
A. Carbonic anhydrase + H+
B. A decrease in oxygen tension
C. An increase in oxygen tension A: NO - NUNN: ‘formation of carbamino compounds
D. A decrease in pH does not require the dissolved CO2 to by hydrated and
E. None of the above so is independent of carbonic anydrase.’

B ?NO + C NO: Deoxygenated (ie low SaO2) blood

favours binding of Hb to CO2 " carbaminoHb.
However would require large drop in PaO2 to effect
SaO2, so B probably incorrect.

D: ?YES – Deoxygenated Hb binds CO2 better. Hence

things that favour O2 offloading (ie shift of curve to R
with acidaemia, high CO2, inc temp) will favour
formation carbaminoHb. NB 2,3-DPG decreases
carbaminoHb as competes for binding at beta Hb chain.

RE40 [Apr01] ANSWER: A

CO2 diffusion limited because CO forms very tight bonds with Hb therefore large
A. Combines avidly with Hb amount can be taken up by the red cell with almost no
B. Partial pressure in blood increases as partial pressure in increase in partial pressure. Nil partial pressure gradient
air increases hence diffusion limited. Used for measuring DLCO.
C. ?
RE41 [Jul01] [Jul05] ANSWER: ?E (A/B/C wrong)
Oxygen toxicity may be seen:
A. In CNS and lungs if breath 100% at 1 ATA (?) for 24 Resp toxicity: 1st measurable signs occur after 24hrs of
hours 100% oxygen (1 ATA).
B. In CNS and lungs if breath 30% at 1 ATA (?) for 24 hours
C. In CNS if breathe 100% oxygen for 48 hours CNS toxicity: require ATA >2. HBOT (100% O2 <3
D. ? ATA short term) possible but unlikely to have seizures.
E. CNS toxicity seen with O2 concs far greater than
760mmHg
RE42 [Jul01] ANSWER: E - 0.04% CO2 is what we breathe!
Breathing 0.04% CO2 in one atmosphere for 30 minutes, EARTH AIR: (Nunns)
you would see: N2 = 78.08%
A. Periodic apnoeas (or: ‘periods of apnoea’) O2 = 20.95%
B. Hyperpnoea Argon = 0.93%
C. Signs of acidosis CO2 = 0.039%
D. Signs of alkalosis Neon 18.2
E. No change Helium 5.2
Methane 1.8 ppmv

103"
RE43 [Jul01] [Feb04] ANSWER: B
In the lung, airway resistance !"#$$%"#
!"#$#%&'(" =
!"#$
A Mainly in small airways
B Varies with change in lung volume
AWR: Pressure drop from mouth to alveolus
C Increased by stimulation of adrenergic receptors
Flow
D Can be measured by flow rate divided by pressure
Airways resistance results from frictional resistance in
difference between mouth and alveolus
the airways. Normally, airways resistance is low, ~2
E Increased by breathing helium-oxygen mixture
cmH2O/L/second. In normal lungs, changes in airway
diameter will alter airways resistance. Resistance is
mainly from medium size airways (up to gen 7). AWR
decreases with increased lung volume due to radial
traction increasing airway calibre (pulled open). B2
adrenoceptor stimulation causes airway smooth m
relaxation " dilates airways " decreases AWR.
Helium has low density so breathing He-O2 "
decreased AWR.

104"
RE44 [Jul01] ANSWER: E (if laminar flow), or 32 (if turbulent
The effect of decreasing airway diameter has the following flow).
effect on airway resistance:
A. 1/8 Laminar flow: resistance is increased with length +
B. ¼ viscosity, but dramatically increased by a reduction in
C. ½ radius as per Poiseuille’s law:
D. 4 times !!"
!= !
!!
E. 16 times
Transitional flow occurs primarily at branches of tubes
and with rising flow rates, and is a mixture of laminar
and turbulent flow

Turbulent flow: resistance is high when compared

with laminar flow. Viscosity is not important, but the
required pressure is proportional to the density of the
gas. The driving pressure is also inversely proportional
to the fifth power of the radius

Reynolds number (determines type of flow) increases

with a rise in radius, velocity and density, and a fall in
viscosity:
2!"#
!" =
!
Re >2000 "turbulent flow
Turbulent flow is likely in the trachea
Transitional flow in the bronchial tree
Laminar flow in very small airways

RE45 [Mar02] [Jul02] [Mar03] [Jul03] ANSWER: E closest

Gas composition of air? EARTH AIR: (Nunns)
PO2 PCO2 PN2 Other Partial Pres %
A 20.98 0.4 ? ? (mmHg)
B 20.98 0.4 ? ? N2 597 78.08
C 21 0.04 ? ? O2 159 20.95
D 20.98 0.04 78.52 ? Argon 0.93
E 20.98 0.04 78.2 ? CO2 0.3 0.04
Neon 18.2 ppmv
Helium 5.2 ppmv
Methane 1.8 ppmv

105"
RE46 [Mar02] [Jul02] [Feb04]. ANSWER: B
What happens to lung function in COAD
A. Decreased static compliance COPD:
B. Increased TLC A – NO: increased compliance in emphysema
C. Decreased airway resistance B – ?YES: Normal or increased TLC
D. Increased FEV1 C – NO: Increases AWR
E. ?? D – NO: Decreased FEV1

Expiratory flow limitation (EFL) is the

pathophysiological hallmark of COPD. EFL due to 1)
permanent parenchymal destruction (emphysema) 2)
airway dysfunction. Airway destruction: small airway
inflammation (mucosal oedema, airway remodelling
and mucous impaction) plus increased cholinergic
airway smooth muscle tone.

Emphysema " reduced lung elastic recoil pressure "

reduced driving pressure for expiratory flow through
narrowed and poorly supported airways in which
airflow resistance is significantly increased. EFL
"expiratory flow rates independent of expiratory
muscle effort, EFL determined by the static lung recoil
pressure and the resistance of the airways upstream.

The volume of air remaining in the lung at the end of

spontaneous expiration (i.e. end expiratory lung volume
(EELV)) is increased in COPD compared with health.
EELV is synonymous with FRC.

106"
RE47 [Mar03] [Jul03] [Feb04] [Jul04] [Mar05] ANSWER: B
The amount of oxygen dissolved in plasma is Dissolved O2 in plasma:
A. 0.03ml O2/100ml at PaO2 100mmHg
B. 6ml O2/100ml breathing 100% O2 at 3 atmospheres
C. 6ml O2/100ml breathing room air at 3 atmospheres
D. 0.3ml O2/l breathing room air at 1 atmosphere Arterial blood RA: 0.25-0.3mL O2/100mL blood
E. 6 mlO2/100mls breathing 100% O2 Black Bank:
100% O2 at 2ATA: 2ml O2/100mL blood
100% O2 at 3ATA: 6mL O2/100mL blood

My calculations:
PO2 = (FiO2 x Patmos) mmHg
2ATA PO2 = 1.0 x (760x2) = 1520
3 ATA PO2 = 1.0 x (760x3) = 2280

Dissolved O2 = 0.003 x PO2 (NB FiO2 100%)

1 ATA = 0.003 x 760 = 2.28 (mL O2/100mL blood)
2 ATA= 0.003 x 1520 = 4.56 (mL O2/100mL blood)
3 ATA = 0.003 x 2280 = 6.84 (mL O2/100mL blood)

RE48 [] [Mar03] [Jul03] [Jul04] ANSWER: Nil correct (E would be if it said erect)
Closing capacity (in young adults) Airways/alveoli in dependent areas of lung are smaller
A. Increases with anaesthesia than those at top of lung (except at TLC all the same
B. 10% vital capacity size). As lung volume is reduced towards residual
C. Decreases with age volume, there is a point at which the dependent airways
D. Responsible for relative hypoxaemia in healthy adult begin to close. The lung volume at which this occurs is
patients under anaesthesia called closing capacity (CC).
E. The same as FRC in elderly supine patients Closing volume(CV) = CC – RV. Normal CV in young
normal subjects = 10% FVC. CV measured with single
breath N2 test or tracer gas test.

CC increases linearly with age due to changes in small

airways. CC=FRC at 44yrs supine and 75yr upright.
FRC is dependent on body position, CC is not. If
FRC<CC some blood flow will go to closed airways
(usually in dependent parts of lung) " shunt.

Brandis: CC = the lung volume at which the small

airways in lung first start to close (first in dependent
parts of lung).

Anaesthesia " FRC reduced. This impacts on closing

volume (rather than capacity) ie increased RV "
decreased CV.

(at 66yo erect FRC = CC, so supine FRC >>CC)

Factors that Inc CC Factors that Dec FRC

Increasing age
Smoking tobacco
Bronchitis
Prolonged recumbency
Over-transfusion
Inc LA pressure
Dec plasma oncotic P
Asthma/emphysema
Position:
supine/trendelenberg
Subatmospheric P
Coughing
Obesity/preggas
APO
Increase LA pressure
Dec plasma oncotic P
atelectasis (anaesthesia)
Pulm fibrosis
kyphoscoliosis
PTx/pleural effusion
Pain

107"
RE49 [Mar03] [Jul03] [Feb04]
Measurement of Functional residual Capacity (FRC):
A. Helium dilution does not measure unventilated spaces on
chest
B. Body plethysomography inaccurate if high FIO2 used
C. Helium used to decrease airflow viscosity
D. Body plethysomography requires oesophageal probe
E. ?
ANSWER: A
FRC: the lung volume at the end of normal expiration.
FRC = (5.9 xheight) + (0.019xage) – (0.086xBMI)-5.3
Females FRC 10% less than males. FRC increases with
age (16mL/year). Obesity " marked reduction in FRC.
Residual end expiratory muscle tone is major feature of
FRC in supine position (hence 400mL increase in
relaxing GA). Increased elastic recoil of lungs and/or
thoracic cage (ovesity, fibrosis, pleural thickening) "
dec FRC. Decreased elastic recoil of lungs
(emphysema) increases FRC.

Measurement FRC:
1. Nitrogen washout, breathing FiO2 100%. Total
quantity of N2 elminiated is measured (expired volume
x N2 conc).
2. Wash in of tracer eg helium. He used because of its
low solubility in blood.
3. Body plethysmography: pt in gas tight box, breathes
against occluded airway. Changes in alveolar P
recorded at mouth and c/w small changes in lung
volume. Application of Boyles Law " calculation of
lung volume. This is the only technique for FRC
measurement that includes gas trapped within the lung
distal to closed airways.

RE50 [Mar03] [Jul03] [Feb04] ANSWER: D

The absolute humidity of air saturated at 37C:
A. 760 mmHg Absolute humidity: The absolute amount of water
B. 47 mmHg vapour in a gas expressed in either mg/L of gas mixture
C. 100% or mmHg (partial pressure).
D. 44mg/m3
E. 17mg/m3 Relative humidity: Amount of water vapour in a gas
expressed as a percentage of that which could be held
by the gas if it were fully saturated at the same
temperature, i.e.
R.H. = Actual water content / Water content fully
saturated %
R.H. = Actual vapour pressure / Saturated vapour
pressure %

Saturated absolute humidity 0C: 4.8mg/L

Saturated absolute humidity 20C: 17mg/L
Saturated absolute humidity 37C: 44mg/L
RE51 [Jul03] [Feb04] [Jul04] ANSWER: A + B
Surface Tension
A. Is inversely proportional to the concentration of surfactant Discussing SURFACE TENSION.
molecules per unit area
B. Cause the small alveoli to collapse into the larger ones
C. ?
D. ?
(This question renumbered from CM31)
RE52 [Jul03] ANSWER: E
Atelectasis causes hypoxaemia because of:
A. ? Atelectasis " Shunt + V/Q mismatch " hypoxaemia.
B. ?
C. ?
D. ?
E. Increased shunt

108"
RE53 [Feb04] ANSWER: ?A
Which of the following is closest value for mixed venous Mixed venous pO2 normally = 40mmHg
PO2 breathing 100% oxygen? Modified Fick:
A. 50 mmHg PvO2 = (SaO2 x Hb x 1.34) – VO2/Q
B. 75 mmHg
C. 100 mmHg Can’t find good reference for figure above. From my
dodgy calculations.
RE54 [Feb04] [Jul04] ANSWER: B
Which of the following is the best explanation for the NUNNS:
different effects on PaO2 and PaCO2 of VQ mismatch? Venous admixture: degree of admixture of mixed
A. Different solubilities of O2 and CO2 venous blood with pulmonary end-capillary blood that
B. Different dissociation curves would be required to account for observed difference
C. Effect of compensatory hyperventilation PaO2 and PAO2. It results from West zones (areas of
different V/Q) and contributes to shunt. Venous
admixture affects overall efficiency of gas exchange
and decreases PaO2. This relates to the venous
admixture causing slight decreased O2 content in
arterial blood " shifts position on Hb-O2 curve
causing large fall PaO2.
Effect of venous admixture on artieral CO2 content is
similar in magnitude to that of O2 content. However
due to steepness of CO2 curve near the arterial point,
the effect on PaCO2 is very small and far less than the
change in PaO2. Hence PaO2 on ABG is the best
measure of shunt, and would need large amount of
venous admixture to change PaCO2.
CO2 and O2 dissociation curves are in another q.
RE55 [Feb04] ANSWER: B
Functional Residual Capacity Nunns: ‘FRC increases with age (16mL/year)’
A. Decreases with age Factors that Dec Increase FRC
B. Decreases with obesity FRC
Position: Increase height
supine/trendelenberg
Subatmospheric P Supine to erect position
(30% increase)
Coughing Reduced elastic recoil
(emphysema
Obesity/preggas
APO FUCNTIONS FRC
Increase LA pressure Oxygen store
Dec plasma oncotic P Arterial PO2 buffer
atelectasis Minimize PVR, AWR, V/Q
(anaesthesia) mismatch, WOB
Pulm fibrosis Improves position on
compliance curve
kyphoscoliosis Prevents atelectasis
PTx/pleural effusion
Pain
RE56 [Jul04] ANSWER: A
Correction of hypoxaemia in anaesthetised patient: A. Presume they refer to PEEP, which would improve
A. Increase airway pressures between breaths oxygenation in atelectasis (common in GA). This would
B. V/Q matching inflate dependent portions of lung and improve V/Q
C. Decrease dead space matching (posterior part of lung if supine).
B. V/Q matching ie shunt - NO
C. Decrease dead space - NO

109"
RE57 [Jul04] ANSWER: D + A
Lung compliance Compliance is the volume change in the lung per unit
A. Measurement requires a respiratory laboratory pressure change (eg ml/cmH2O).
B. dynamic greater than static (or other way round) This may apply to the lungs, chest wall or both summed
C. Static and dynamic same in emphysema together (total compliance). In series their inverses are
D. Difference between static and dynamic due to airflow added:
resistance 1/total compliance = 1/Lung + 1/Chest wall =
E. Due to surface tension - Static compliance (Cstat) is that measured at different
degrees of deflation when no air is flowing.
- Dynamic compliance refers to those curves of lung
compliance during normal rhythmic breathing and
therefore also includes airway resistance, therefore the
dynamic compliance is always less than the static
- Specific compliance expresses changes in lung
volume and pressure to the subject’s FRC.

Increase"compliance" Decrease"compliance"

Decreased"surface" Loss"of"surfactant:"
tension"with"surfactant" premature"babies"
a"intermolecular"
repulsive"forces"
prevent"collapse"and"
improve"compliance"

" Impediment"of"chest"wall"
movement:"obesity,"rib"
fractures,"extensive"
burns/scarring."Or"
impediment"of"abdominal"
movement:"pregnancy,"
peritonitis,"ascities,"
pneumoperitoneum"

Upright"(note"that" Supine"posture"
compliance"is"better"in"
lower"zones"than"
upper"zones"in"upright"
posture)"

Closest"to"FRC"and" Extremes"of"lung"volume"
larger"FRC"(ie"larger" (very"high"volumes""lungs"
lungs)" are"stretched"to"near"
elastic"limit"while"with"
low"volumes"and"
atelectasis"greater"
pressure"is"required"to"
recruit"alveoli)"

Decreased"collagen," Increased"collagens"and"
increased"tissue" decreased"elastins/fibrous"
elasticity"eg"normal" lung"tissue"eg"pulmonary"
ageing"lung," fibrosis"
emphysema"

Asthma"attack"(unclear" Increased"pulmonary"
mechanism)" venous"pressure"(lung"
engorged"with"blood)"

" Alveolar"and"parenchymal"
problems:"alveolar"
oedema,"alveolar"
haemorrhage,"pulmonary"
110" contusions,"ARDS,"
pneumonia"
Measurement:
Dynamic: uses oesophageal balloon, in resp lab
RE58 [Mar05] Barometric pressure is half that of sea level ANSWER: C
at: Barometric P (mmHg) decreases in exponential
A. 550m manner. Highest human habitation 5000m in Andes.
B. 1500m Everest summit 8848m, PiO2 43mmHg. At 20,000m
C. 5500m barometric P is 47mmHg (FiO2 = 0mmHg).
D. 7000m Sea-level = 760
E. 19500m 600m = 700
Options also remembered as: A. 1000m, B. 2500m, C. 1500m = 630
5000m, D. 7500m, and E. 10,000m 5500 = 380
& as: A. 500m, B. 3500m, C. 5500m, D. 7500m, E. 10500m 7000 = 300
19200 = 47
RE59 [Mar05] [Jul05] ANSWER: C
Regarding O2 carriage in blood (or regarding red blood Haemoglobin Result
cells): HbA Normal adult Hb, 2α2β. Binding
A. capacity = 1.39 x (tHb – (metHb +
B. COHb))
C. HbS less soluble than HbA HbA2 2% of adult blood, 2α2δ
D. HbF Fetal: 2α2ϒ, much greater affinity
E. MetHb has 85% the O2 carrying capacity of normal Hb O2 c/w HbA (made to operate at
lower PO2)
HbS (sickle • chain"altered"(glutamine""
cell anaemia) valine)"""loss"of"solubility"
Homozygous • Deoxy"form"it"starts"to"
polymerise,"precipitate"out"of"
solution"(distorts"RBC"""
rigid,"sickle"shape)"
• Repeat"sickling"""permanent"
changes"RBC"membrane"""
phagocytosed"by"
liver/spleen/bone"marrow.""
• Can"get"clumps"of"cells"in"
spleen/fingers/heads"of"
femur"""infarcts,"long"term"
pulm"HTN"
• Any"thing"causing"widened"Aa
V"O2"difference"(eg"infection)"
""sickle"crisis"
Thalassaemia Supression of formation of HbA,
compensatory production HbF.
Causes curve shift to left.

Methaemaglobin: Hb in which the iron has been

oxidised (ferrous 2+ to ferric 3+ form). Syndrome if
MetHb > 1% of total Hb. Causes: OxyHb scavenges
nitric oxide, drugs (prilocaine,benzocaine, nitrites,
dapsone). MetHb can’t combine with oxygen and is
slowly reconverted to Hb (can be Rx with ascorbic acid,
methylene blue). Methods:
1. NADH-MetHb reductase enzymes in RBC (most
important)
2. Ascorbic acid via direct chemical reaction (16%)
3. Glutathiaone-based reductive enzymes.
4. NADPH-dehydrogenase in RBC (considered
‘reverse’ metHb reductase).
RE60 [Jul05] ANSWER: N/A
The greatest increase in venous admixture is due to: This makes no sense. Please see previous questions
A. Hypoventilation about venous admixture. Greatest increase usually due
to congenital cardiac abnormalities, then any
pulmonary pathology causing shunt.

111"
RE61 [Jul05] ANSWER: C best (E also correct).
Static Compliance
A. Static compliance (Cstat) is that measured at different
B. Depends on airway resistance degrees of deflation when no air is flowing. Normally
C. Depends on surfactant levels 200mL/cmH20. Affected by lung volume, FRC
D. variation, pulmonary blood volume, alveolar collapse,
E. Due to surface tension lung disease.
Determinants of lung compliance officially intrinsic
elasticity and surface tension.
RE62 [Jul05] Gas solubilities with decreased temperature ANSWER: E
(Also remembered as “Under a general anaesthetic, if a
patient becomes hypothermic, you can expect to see:) Henry’s Law: gas content dissolved in a solution is
directly proportional to the solubility coefficient x
A. Increased PACO2, Decreased PAO2 partial pressure in the gas phase. Solubility coefficient
B. Increased PACO2, Increased PAO2 increase as temperature decreases.
C. No change in PACO2 or PAO2 (OR: PAO2 no change,
decreased PACO2) PP = [dissolved gas]/solubility coefficient (ie inverse
D. Decreased PACO2, Increased PAO2 relationship between partial pressure and solubility
E. Decreased PACO2, Decreased PAO2 coefficient).

Hence hypothermia " increased solubility of a gas "

increased dissolved amount. This will cause a decreased
paritial pressure.

IE if a closed system: partial pressure falls with a fall in

RE63 [Feb06] Anatomical dead space
A. measured by carbon monoxide inhalation
B. 2ml/kg in average adult.
C. ?
RE64 [Feb06]
With regard to dead space:
A. Bohr equation can be used for anatomical dead space
B. Nitrogen washout can be used for alveolar dead space
C. Physiological dead space calculated from end-tidal CO2
D. Physiological dead space can be calculated from end-tidal
CO2 and alveolar CO2
temperature as the solubility of the gas increases. (Only
applicable when there is no reaction with the solvent).
ANSWER: B
Anatomical DS: volume in the conducting airways.
150mL sitting (ie2.2ml/kg in adult), 100mL supine.
Measured via Folwers method: single inspiration of
100% O2 followed by measurement of expired N2).
Increasing conc of expired N2 is plotted against expired
volume.
ANSWER: A
A YES- NUNNS: By utilising and modifying Bohr
equation, anatomical dead space can be calculated-by
replacing alveolar with end-expiratory gas in the Bohr
equation. Hence, Bohr equation can theoretically be
used to calculate anatomical dead space.

112"
RE65 [Feb06] Regarding the work of lungs in breathing:
A. ?
B. Most work is to overcome airway resistance
C. Increased by increasing respiratory rate
D. ?
E. Work done is determined by integral of pressure volume
loop
RE66 {Feb06] A-a gradient is increased with:
A. atelectasis
B. venous admixture
C. Hypoventilation
D. reduced cardiac output
E. increased diffusion distance for oxygen
Alt stem wording: RE66b A-a gradient of 50mmHg in a
patient breathing room air is most likely due to (stem
definitely correct):
ANSWER: E
On"a"plot"of"respiratory"rate"vs"work"of"breathing,"as"
respiratory"rate"increases"work"to"overcome"elastic"
forces"decreases"and"work"to"overcome"airway"
resistance"increases."The"total"work"is"minimal"
when"both"elastic"work"and"airway"resistance"work"
contribute"50%."The"total"work"vs"respiratory"rate"
curve"is"Uashaped"and"is"minimal"at"rest"respiratory"
rates."However"this"minimum"work"point"occurs"at"
higher"rates"in"pathologies"that"increase"elastic"
work"(such"as"pulmonary"fibrosis)"and"at"lower"
rates"in"pathologies"that"increase"airway"resistance"
work"(such"as"COPD).""
"
Components"that"make"up"the"work"of"breathing"
during"quiet"inspiration:""
• Nonelastic"work"(Viscous"resistance"
(7%)AWR"(28%))""
• Elastic"work"(65%)""
The"higher"the"breathing"rate"the"faster"the"flow"
velocity"(which"by"using"Reynold's"number"a"is"more"
likely"to"cause"turbulent"flow,"and"require"increasing"
pressure"changes"for"the"same"volume)"and"the"
larger"the"work"done"in"overcoming"non"elastic"
work."The"work"done"in"overcoming"the"elastic"
forces"is"decreased"as"respiratory"rate"increases.""
"
Therefore,"people"with"highly"compliant"lungs"and"
high"airways"resistance"a"breath"at"higher"volumes"
and"mroe"slowly"(ie,"emphysema)"people"with"less"
compliant"lungs"breathe"at"faster"rates,"and"more"
shallow"volumes"(ie,"pulmonary"fibrosis)""
ANSWER: A
Venous"admixture"in"normal"lungs"at"room"air,"is"
only"1a2%.""
Diffusion"distance"would"have"to"be"greatly"
increased"for"this"to"be"a"cause"(given"that"in"normal"
lungs,"oxygen"from"the"alveoli"equilibrates"with"the"
pulmonary"capillary"blood"1/3rd"of"the"way"along"
the"capillary)""
An"Aaa"gradient"(on"room"air)"of"50mmhg"roughly"
corresponds"to"a"venous"admixture"of"near"50%"a"
plausible"with"atelectasis."

RE67 [Jul10] What percentage of total blood volume is ANSWER: A

found in the pulmonary capillaries? Total blood volume (TBV) = 5000mL
A. 1% Pulmonary capillary blood volume 80mL (80/5000 x
B. 3% 100 = 1.6%).
C. 9% Pulmonary circulation = 400-500mL ( = 8-10% of
D. 11% TBV)
E. 15%

113"
RE68"[Feb11]"Blood"draining"from"an"unventilated"part" ! Answer is B
of"lung"will"have"an"O2"composition"identical"to" Blood draining from an unventilated part of the lung
will have no opportunity to gain O2 and should not lose
A. Coronary sinus any either. Therefore it should have a composition
B. Pulmonary artery identical to the blood supplying that part of the lung,
C. Bronchial artery i.e. the pulmonary artery.
D. Alveolar gas
Consideration of the other options reveals

! a. coronary sinus - Incorrect. The primary venous

drainage of the myocardium, has a high
O2 extraction and pO2 of ~20mmHg, far lower than
mixed venous O2
! b. pulmonary artery - correct answer - see above
! c. bronchial artery - Incorrect. These arise from
origins in the aorta and therefore have a normal
systemic PaO2. (Typically ~100mmHg, allowing
for a PAO2 of 105 - physiological Aa gradient.)
! d. Alveolar Gas - Incorrect. PAO2 is described by
the alveolar gas equation as (760-47 * 0.21) -
pCO2 / respiratory quotient = ~150 - 45 =
105mmHg. Clearly impossibly high as higher than
arterial O2
RE69"[Feb12]"Most"likely"cause"of"hypoxaemia"post" ! A: Could be, I think most likely , from Miller (e-
abdominal"surgery?" version no page sorry - chapter on PACU),
"Atelectasis and alveolar hypoventilation are the
A. Increased shunt most common causes of transient postoperative
B. Increased dead space arterial hypoxemia in the immediate postoperative
C. Hypoventilation period." So in other words, could be A or C
D. ? ! B - no
E. ? ! C - could be right see above

RE70"The"anatomical"dead"space"is"increased"by:" ! A. Intubation - decrease (anatomical dead space as

distinct from apparatus dead space)
A. Intubation ! B. Chin tuck position - decrease
B. Chin tuck position ! C. Moving from supine to erect - increase - the
C. Moving from supine to erect correct answer
D. Moving from sitting to semi-recumbent ! D. Moving from sitting to semi-recumbent -
E. Bronchospasm decrease
! E. Bronchospasm - decrease
Supine 101mls, sitting 147mls, semi recumbent 124mls
Anatomic dead space increases
NUNN
A. supine to erect
B. erect to semi-reclining
C. on intubating the patient
Nunn, factors affecting anatomical dead space:
D. when neck is flexed and chin is pushed down
! size of subject
! age (decrease birth to 6yr; increases early
adulthood onwards)
! posture (supine = 2/3 sitting)
! position neck and jaw (increases from neck flexion
to extension)
! lung volume end inspiration (increases with
increasing volume)
! intubation/LMA (apparatus dead space bypassing
1/2 anatomical dead space)
! drugs (bronchodilators increase)
! Vtidal + RR (reducing Vt reduces dead space as
measured by Fowler's method; due to air flow
changes)

114"
RE71"[Jul10]"[Feb12]"The"VO2"max"for"a"sedentary"40"
year"old"male"is"about?"
A. 3ml/kg/min
B. 11ml/kg/min
C. 40ml/kg/min
D. 90ml/kg/min
E. 250ml/kg/min
RE72"[Mar03]"[Jul03]"[Mar10]"Respiratory"exchange"
ratio:"
A. Always equals respiratory quotient
B. Increases in strenuous exercise
C. Decreases after payment of oxygen debt
D. Is measured at steady state
E. ?
The respiratory exchange ratio:
A. is the same as the respiratory quotient
B. is always measured at rest
C. decreases during severe exercise
D. increases when repaying an oxygen debt
E. ?
RE73"[Feb08]"[Feb12]"During"normal"tidal"ventilation"
A. Intrapleural pressures between -5 & -8mmHg
B. Alveolar pressures between -2 & +2 cmH2O
C. Tracheal flow is sinusoidal
D. Peak flow is 5L/s
E. ?intrapleural pressure curve is sinusoidal
Alt"version:"In"a"normal"
healthy"75kg"person:"
A. Intrapleural pressure during tidal breathing is
between -5cmH2O to -8cmH2O
B. Alveolar pressure during tidal breathing is
between +5cmH2O to -5cmH2O
C. Tidal volume is 400ml
D. inspiration last 1 second, expiration last 4 secs
115"
Nunn says, a fit young person should be able to
attain a V02max of 3L/min. Athletes should be
able to get up to 5L/min. This "sedentary" 40 year
old is thus not an athlete and would have the usual
V02 max of 3L/min.
Assuming he's 70kg, that would mean 3000L/min =
42ml/kg/min therefore C is the correct answer.
Comments for A-D in the 2nd version above
! A. - Incorrect => "Not to be confused"
! B - Incorrect - This is metabolic rate - R can be
measured at any instant in time and does not
require equilibrium to have been reached
! C - Incorrect - Increases during severe exercise as
CO2 increases - can rise to 2
! D - Increases - Decreases whilst repaying oxygen
debt - can fall to 0.5
Hence E must have been something correct or others
remembered differently
a)"correct"p109"west,"but"isn't"tracheal"flow"
sinusoidal."Peak"flow"is"0.5L/s."and"technically"
alveolar"pressures"are"between"those"values"(a1"to"
+1)."
intrapleural"pressure"curve"is"not"sinusoidal."
"
2012
A."Correct"a"intrapleural"pressure"varies"between"a5"
cmH2O"to"a8"cmH2O"per"(West"9th"Ed,"Fig"7a13"p"
112)"
B."Partly"correct"a"Alveolar"pressure"during"tidal"
breathing"varies"from"+1"cmH2O"to"a1"cmH2O,"
which"is"within"the"range"but"a"significantly"
different"number."Making"this"clear"is"probably"why"
the"question"was"changed"from"+/a2"cmH2O"to"+/a5"
cmH2O."
C."Wrong"a"Vtidal"~"7"mL/kg"which"is"about"525"mL"
in"a"healthy"75"kg"person"
D."Wrong"a"RR"12/min"and"I:E"4"is"pathological"
"Most"correct""answer"is"'A'."
RE74"[Jul06]"[Feb12]"FEF"25a75%"
A. Includes the effort dependent part
B. Measured during first half of expiration
C. always related to FEV1
D. fastest / steepest in 1 sec?
E. Increased in COPD
FEF 25-75%
A. ?
B. ? the same in restrictive & obstructive lung disease
C. Is independent of expiratory effort
D. Measured in the first half of expiration
E. Relates? to FEV1
RE75"[Feb12]"With"regards"to"blood"sampled"from"the"
distal"lumen"of"a"pulmonary"artery"catheter"(when"it"is"
wedged)"
A. PO2 will be the equal to mixed venous PO2
B. PO2 will be less than mixed venous PO2
C. PCO2 will be equal to mixed venous PCO2
D. PCO2 will be less than mixed venous PCO2
E. PCO2 will be more than mixed venous PCO2
116"
! A. Wrong - specifically designed to exclude effort
dependent expiration
! B. Wrong - measured in middle half
! C. Partly correct - FEV1 and FEF both vary with
obstruction/ restrictive disease
! D. Wrong - time is not a consideration in a flow-
volume relationship
! E. Wrong - COPD will typically have some early
dynamic airway closure, reducing FEF (which is
also why they have a longer expiratory phase).
Most correct answer: 'C'
ALTERNATE:
C – is independent of expiratory effort
My reading is that this is about sampling blood distal to
the wedge.
After aspirating an intermediate 5 mL sample, blood
aspirated distal to the wedge should be similar to an
ABG. This technique is used to confirm correct
placement, hence validate PCWP measurements.
Hence "most correct" answer: 'D'
CARDIOVASCULAR)MCQS)
#
CV80)Feb12)A)prolonged)PR)interval,)ST)segment) ! A.)Wrong)%)nil)U)wave)
flattening,)and)the)appearance)of)a)U%wave)is) ! B.)Correct)%)U)waves,)PR)prolongation)
consistent)with:)*new*) ! C.)Correct)if)the)option)was)hypomagnesaemia)%)U)waves,)
sometimes)PR)prolongation)
A.)Hyperkalaemia.) ! D.)Hypocalcaemia)%)main)feature)is)prolonged)QT)interval)
B.)Hypokalaemia.) ! E.)None)of)the)above)
C.)Hypomagneseamia.) "Most)correct")answer)'B')
D.)Hypocalcaemia.) )

E.)None)of)the)above)
)
CV81)Feb12)The)R)wave)in)lead)2)of)an)ECG) ! A:)wrong)%)is)earlier)than)this)(Ref:)Berne)and)Levy)Ed)9)pp)
corresponds)to:) 67)"Wiggers)diagram"))
! B:)maybe..)but)seems)to)coincide)on)the)diagram)with)MV)
A.)Aortic)valve)opening) closure,)not)come)afterward)
B.)Just)after)closure)of)mitral)valve) ! C:)wrong)%)R)wave)is)after)this)
! D:#most#likely)
C.)Peak)of)atrial)contraction)
)
D.)Start)of)isovolumetric)contraction)
E.)?)
)
CV82)Feb12)All)of)the)following)are)ion)channels)in)
B)
the)heart)EXCEPT:)

A.)Inward)rectifier)K)channels)
B.)Transient)inward)K)channels)
C.)Delayed)rectifier)K)channels)
D.)Ca)channels)
E.)Na)channels)
)
CV83)Feb12)The)U)wave)on)an)ECG)represents)")(...I)
Ganong)23ed)Ch)30:)The)U)wave)is)an)inconstant)finding,)
dont)remember)this)question)at)all?)")
believed)to)be)due)to)slow)repolarization)of)the)papillary)
A.Atrial)repolarisation) muscles.)
B.Atrial)and)ventricular)repolarisation)
% )
C.Some)electrolyte)abnormality)(can't)
remember)which)electrolyte/s)it)had))
)

117"
CV84)Feb12)Comparing)the)aorta)and)the)radial)
artery)
A.)MAP)higher)in)aorta)
B.)Dicrotic)notch)more)pronounced)in)
radial)artery)
C.)Systolic)pressure)higher)in)aorta)
D.)Diastolic)pressure)higher)in)aorta)
E.)Faster)systolic)peak)in)radial)
) pulse)pressure.)Furthermore,)there)is)a)delay)in)arrival)of)
CV85)Feb12)Effects)of)long)term)exercise:)
A.)Increased)maximal)heart)rate)
B.)Increased)stroke)volume)
C.)Decreased)muscle)capillaries)
D.)Decrease)muscle)blood)flow)for)the)
same)level)of)work)(?)Maybe)worded)like)
this))
E.)increased)lactate)production)for)same)
amount)of)work)
)
CV86)Feb12)Lead)II)of)an)ECG)
A.)PR)interval)<0.12)seconds)
B.)Q)waves)may)or)may)not)be)
pathological)
C.)Needs)3)electrodes)to)record)
D.)Positive)electrode)on)left)arm,)negative)
electrode)on)right)arm)
)
! A)%)correct,)see)below)
! B)%)false)
! C)%)false,)radial)has)higher)peak)
! D)%)correct,)see)below)
! E)%)this)is)false,)delayed)due)to)distance)from)heart)
! this)quote)from)Miller)e%version)%)chapter)on)CV)
monitoring)"Thus,)when)compared)with)central)aortic)
pressure,)peripheral#arterial#waveforms#have#higher#
systolic#pressure,#lower#diastolic#pressure,)and)wider)
the)pressure)pulse)at)peripheral)sites,)so)the)systolic)
pressure)upstroke)begins)approximately)60)msec)later)in)
the)radial)artery)than)in)the)aorta.)Despite)morphologic)
and)temporal)differences)between)peripheral)and)central)
arterial)waveforms,)MAP#in#the#aorta#is#just#slightly#
greater#than#MAP#in#the#radial#artery.")
So)I)guess)one)of)these)options)badly)remembered)
)
This)is)answered)from)one)paragraph)in)Ganong.)Ed)21,)pp637)
"training")
! A:)Wrong)%)sounds)plausible)in)that)although)HR)=)220)%age,)
the)ability)to)actually)get)there)(to)max)HR))would)require)
some)training,)but)not)best)answer.)
! B:#Yes)%)"both)at)rest)and)at)any)given)level)of)exercise,)
trained)athletes)have)a)larger)SV)and)lower)heart)rate)than)
untrained)individuals")
! C:)No)%)"increased)number)of)capillaries)with)better)
distribution)of)blood)to)the)muscle)fibres")
! D:)Unsure..)thre)is)a)statement)"less)increase)in)blood)flow)
to)muscles)as)well,)and)because)of)this,)less)increase)in)HR)
and)CO)than)untrained)individuals")B)still)simplest)and)best)
answer)though,)given)uncertain)wording)from)
remembered)Q)
! E:)"..less)increase)in)lactate)production)
)
! A:)Wrong)%)less)than)200ms)
! B:)Correct)%)non%pathological)Q%waves)can)exist)in)a)lead,)
provided)contiguous)leads)do)not)have)associated)Q%waves)
! C:)Wrong)%)lead)II)needs)a)right)arm,)and)left)leg)electrodes)
! D:)Wrong)%)lead)II)uses)right)arm)and)left)leg)leads)
)
118"
CV87)Question)about)conductance)of)blood)flow) ! Conductance)is)the)reciprocal)of)resistance)NOT)A)
! Factors)affecting)resistance)can)be)described)by)the)Hagen)
A.)is)directly)related)to)resistance) Poiseuille)equation)with)resistance)proportion)to)1/radius)
B.)directly)related)to)the)diameter)squared) to)the)power)of)4)Not)B)
! Reciprocal)of)the)pressure)difference)%)NOT)C)
C.)same)as)pressure)difference)between)
! Resistance)in)parallel)are)added)as)1/Rtotal)=)1/R1)+)1/R2)
arterial)and)venous)system) etc)therefore)total)conductance)=)the)addition)of)individual)
D.) conductance)in)parallel)%)E#is#correct)
)
E.)??addition)in)parallel)circuits)to)get)total)
conductance??)
)

119"
CLINICAL)MEASUREMENT)MCQS)

CM01)As)ambient)temperature)
increases,)heat)loss)increases)by)
A)Radiation)
B)Convection)
C)Conduction)
D)Evaporation)
E)Vasodilation)
F)None)of)the)above)
) body)on)cold)table.)
Alternative)versions)of)the)stem:)
))))*)In)hot)climates,)most)heat)is)lost)by:.))
))))*)As)ambient)temperature)increases)
above)body)temperature,)the)greatest)%)
heat)is)lost)by:))
))))*)In)operating)room,)increased)
contribution)of)heat)loss)from:))
D)
Radiation)transmits)heat)energy)from)one)object)to)another)which)are)not)
in)contact%)radiant)heat)losses)increased)by)cold)environment,)decreased)
by)warm)environment.)
In)convection,)the)air)layer)adjacent)to)the)surface)of)the)body)is)warmed,)
expands)&)rises,)which)causes)a)convection)current)away)from)the)body)%)
occurs)less)if)warm)environment.)
Conduction)%)similar)to)convection)but)without)current)drawn)away,)eg)
Evaporation)%)loss)of)heat)through)latent)heat)of)vaporization)of)moisture)
on)skin,)loss)of)heat)is)dependent)on)water)vapour)pressure)gradient)
(warmer)air)can)have)more)water)vapour)in)it))&)total)area)of)moist)skin.)
[Davis)&)Kenny)p104])

CM02)All)are)ways)of)measuring)O2)in)a) C)
gas)mixture)except:) Methods)of)measuring)O2)include)spectrophotometric)(seen)in)oximeters)
A)Paramagnetic)analyser) &)pulse)oximeters),)oxygen)tension)measurement)using)the)Clark)
B)Clark)electrode) electrode)or)fuel)cell,)and)the)paramagnetic)analyser)(oxygen)is)attracted)
C)Infrared)absorption) into)a)magnetic)field))
D)Mass)spectroscopy) Gases)that)have)2)or)more)different)atoms)in)the)molecule)absorb)infrared)
E)None)of)the)above) radiation,)ie)oxygen)can’t)be)measured.)
[Davis)&)Kenny,)chapter)18+p214])
)
The)polarographic)O2)electrode)may)be)used)to)measure)concentration)of)
O2)in)gas)mixtures.)The)electrolye)is)in)the)form)of)a)gel.)
)
Mass)spectroscopy)–)A)molecular)leak)permits)a)few)molecules)of)the)
sample)to)diffuse)into)an)ionisation)chamber)where)they)are)bombarded)
by)a)beam)of)electrons)passing)from)the)hot)cathode)to)the)anode.))When)
the)molecules)of)gas)are)hit)by)electrons,)some)of)them)become)charged)
ions)which)are)then)accelerated)out)of)the)chamber)in)a)narrow)beam.)The)
stream)of)ions)then)passes)through)a)strong)magnetic)field.)The)charged)
ions)are)deflected)in)an)arc)by)the)magnetic)field.)The)amount)of)
deflection)depends)on)their)mass.)Lighter)the)most.)Heavier)the)least.)
)
Principle)of)a)Clark)electrode)is:)
Platinum)cathode)
Silver/Silver)chloride)anode)
Potassium)chloride)solution)
Voltage)of)0.6V)applied)
)
At)the)anode:)
4Ag)⇒)4Ag+)+)4e%)(OXIDATION))
At)the)cathode:)
O2)+)4e%)+)2H2O)⇒)4OH%)(REDUCTION))
)
The)more)O2)available,)the)more)electrons)which)can)be)taken)up)at)the)
cathode)and)consequently)the)greater)the)current)flow.)

120"
CM03)With)regard)to)oxygen:)
A)The)only)gas)that)can)reignite)a)
glowing)splint)
B)Causes)pulmonary)(?oxygen)
toxicity/?hypertension))at)<100kPa)
C)Some)CNS)toxicity)occurs)at)100kPa)
D)Medical)grade)is)95%)pure)
E)Produced)commercially)by)hydrolysis)
of)water)
F)May)result)in)the)reduction)of)alveolar)
lung)volume)if)given)at)an)FiO2)of)1.0)
CM04)A)naked)70kg)man)in)a)theatre)at)
20C)will)lose)most)heat)by:)
A)Conduction)to)air)molecules)next)to)
the)patient)
B)Conduction)to)the)table)
C)Radiation)to)OT)equipment)and)walls)
D)Convection)
E)None)of)the)above)
CM05)A)pulse)oximetry)reading)is)
underestimated)by:)
A)Methaemoglobinaemia)
B)Carboxyhaemoglobinaemia)
C)Foetal)haemoglobin)
D)Sickle)cell)anaemia)
CM05b)Normal)two%wavelength)pulse)
oximetry)will)underestimate)oxygen)
saturation)in)the)presence)of:)
A)Methaemoglobinaemia)
B)Carboxyhaemoglobinaemia)
C)Hyperbilirubinaemia)
D)Haemoglobin)F)
E)Haemoglobin)S)
CM06)With)respect)to)one)mole)of)each)
of)CO2)and)N2O,)which)is)untrue?)
A)Same)weight)
B)Same)density)
C)Same)viscosity)
D)Same)volume)at)STP)
CM07)Remains)constant)with)adiabatic)
expansion)of)a)gas:)
A)Density)
B)Pressure)
C)Volume)
D)Temperature)
E)None)of)the)above)
B,)F)
)
Although)need)long)time)for)B)to)be)true.)
CNS)toxicity)>1atm)(usually)>2atm).)
Medical)grade)A%G)=)99.0%99.995)
Oxygen)is)manufactures)by)the)fractional)distillation)of)air.)
C)
)
Heat)loss)type))))))))))Approx)contribution))
Radiation))))))))))))))))))50%)
Convection/Conduction)))))))))))))))30%)
Evaporation))))))))))))))20%)
Respiration)))))))))))))))10%)
[Davis)&)Kenny)p103])
A)
Pulse)oximeters)use)2)wavelengths)&)“assume”)the)presence)of)only)2)
light)absorbers)%)oxyHb)and)deoxyHb.)
Pulse)oximeter)limitations:)unreliable)with)poor)signal,)don’t)tell)about)
CO2,)delays)in)signal)change,)carbon)monoxide)false)high)reading,)false)
under%read)with)methaemoglobin)or)IV)dyes)(eg)methylene)blue),)
HbF/HbS/sulphHb)make)little)difference)
A)
see)above)
)
C)
Both)have)MW)~)44,)so)one)mole)of)each)should)weigh)the)same.)Density)
is)mass)per)volume)%)as)have)the)same)mass)should)have)same)volume)and)
density)under)STP)
STP)=)standard)temperature)and)pressure)
E)
Gas)laws)describe)changes)in)pressure,)temp)&)volume)when)one)of)these)
is)constant.)For)these)gas)laws)to)apply,)heat)transfer)is)needed)for)
change.)An)adiabatic)change)is)where)the)state)of)a)gas)can)be)altered)
without)allowing)the)gas)to)exchange)heat)energy)with)its)surroundings.)
[Davis)&)Kenny)p41)
121"
CM08)At)an)altitude)of)5500m) A)
(barometric)pressure)380mmHg),) )
assuming)a)normal)pCO2)of)40mmHg,) pAO2)=)(FiO2)x)(Pb)%)47)))%)PaCO2/0.8)
pAO2)will)be:) =)(%.21)x)333))%)50)
% 20mmHg) =)70)%)50)
% 30mmHg)
% 40mmHg)
% 50mmHg)
% 60mmHg)
CM09)According)to)the)Hagen%Pouseille) A)
law:)
A)Flow)varies)inversely)with)resistance)
B)Viscosity)varies)inversely)with)length)
)
C) )

)
)

CM10)Turbulence)is)more)likely)with:) B)
A)Small)tube)diameter) D)if)was)decreased)viscosity)
B)High)density)fluid)
C)?Increased/decreased)length)of)tube)
D)?Increased/decreased)viscosity)
E)None)of)the)above)

CM11)Pneumotachograph)
A)Can)be)used)to)measure)peak)airflow)
B)Measures)velocity)and)not)flow)
(??accurate)in)turbulent)&)laminar)flow))
C)Is)accurate)at)all)flow)rates)
D)Variable)orifice)flowmeter)
E)Can)be)used)to)measure)volume)
F)Unaffected)by)temperature)
Best)=))E)
A)=)possible,)but)must)eliminate)turbulent)flow)
Pneumotachograph)is)a)device)used)to)measure)gas)flow,)based)on)Hagen%
Pouiselle)laminar)gas)flow.)Measures)pressure)difference)across)fixed%
orifice)resistance)to)determine)flow.)Variable)with)gas)composition,)
high/low)flow)and)temperature)%)affects)accuracy.)Can)be)used)to)measure)
volume)if)flow)integrated)with)respect)to)time.)
[Davis)&)Kenny)p30])

CM12)Cardiac)output)measurement)is) A)
most)accurate)with)which)method?) ?F)
A)Direct)Fick) This)is)debated:)either)direct)Fick,)thermodilution)or)“no)gold)standard”)is)
B)Radionuclide)angiocardiography) referred)to)in)the)literature.)
C)Gated)pooling) Stoelting)say)pulmonary)artery)thermodilution)(p731))is)the)“clinical)
D)LV)angiogram) standard.)
E)Transthoracic)echocardiography)
F)Thermodilution)

CM12b)Cardiac)output)is)best)measured) A)
by:) Thermodilution)is)the)gold)standard,)none)are)correct.)
A)Direct)Fick) Fick)is)probably)the)best)choice)here.)
B)Gated)radionuclear)
C)Echocardiography)
D/E)?)

122"
CM13)Impedance)
A)Increases)as)the)frequency)of)an)AC)
current)increases)across)a)capacitor)
B)Decreases)as)the)frequency)of)an)AC)
current)increases)across)an)inductor)
C)Is)constant)across)a)resistor)
D)All)of)the)above)
E)None)of)the)above)
13b)As)the)frequency)of)an)alternating)
current)increases:)
A)Impedance)increases)in)a)resistor)
B)Impedance)increases)in)a)capacitor)
C)Impedance)increases)in)an)inductor)
D)All)of)the)above)
E)None)of)the)above)
13c)Impedance)as)AC)frequency)
increases:)
A)In)a)resistor)%)no)change)
B)In)a)capacitance)%)increases)
C)In)an)inductor)%)decreases)
D)All)of)the)above)
E)None)of)the)above)
CM14)Oxygen)manufacture:)
A)Hydrolysis)of)water)
B)??)95%)pure)
C)?))
CM15)According)to)Fick’s)law,)diffusion)
is)related:)
A)Directly)to)thickness)
B)Inversely)to)concentration)gradient)
C)Inversely)to)surface)area)
D)Inversely)to)thickness)
CM16)Stroke)volume)is)most)accurately)
measured)with:)
A)Thermodilution)
B)Thoracic)bioimpedance)
C)Doppler)
D)Electromageto%?)
E)Echocardiography)
CM17)When)indocyanine)green)is)used)
to)measure)hepatic)blood)flow,)levels)
are)taken)from:)
A)Hepatic)vein)&)portal)vein)
B)Hepatic)artery)&)portal)vein)
C)Radial)artery)&)hepatic)vein)
D)Hepatic)artery)&)hepatic)vein)
E)Radial)artery)&)right)atrium)
C)
The)term)impedence)is)preferred)to)resistance)where)there)is)a)
dependency)on)frequency)or)electric)current)flowing.)The)unit)of)
impedance)is)the)same)as)resistance)(the)ohm),)but)is)indicated)by)the)
symbol)Z.)
The)impedence)of)a)resistor)to)the)flow)of)alternating)current)(AC))does)
not)vary)with)the)frequency)of)the)current.)
Capacitor:)transmit)AC)with)high%frequency)current)passing)more)easily)
Inductor:)transmit)AC)with)low%frequency)current)passing)more)easily)
[Davis)&)Kenny)p162])
CHIL:)Capacitor)high,)inductor)low)(for)amount)of)current)that)get)through,)
ie)lower)impedence))
C)
Impedence)&)resistance)both)measured)in)Ohm.)Z)=)impedence,)X)=)
reactance)(ability)to)resist)AC)current),)R)=)resistance)(ability)to)resist)DC)
current))
2 2
Z)=)square)root)of)(R )+)X ))
A)
see)above)
None)of)these)
Oxygen)is)manufactured)by)the)fractional)distillation)of)air.))
Air)is)compressed)to)5ATM)&)cooled)to)%181C)using)reverse)heat)
exchangers)and)passed)through)filters)to)yield)>99.5%)pure)O2)(0.4%)
argon))
D)
Diffusion)=)(pressure)difference)x)area)x)solubility))/)(thickness)x)√MW))
)E)–)via)TOE)
Thermodilution)is)gold)standard)for)cardiac)output)&)SV)could)be)derived)
from)this.)
Most)articles)talked)about)TOE)as)the)“non%invasive)gold)standard”)for)
assessing)SV.)
)
C)
Output)is)hepatic)vein)
Dual)input)of)hepatic)artery)&)portal)vein)is)estimated)by)radial)artery)
[UptoDate])
123"
CM18)Specific)heat)capacity)of)which)of) D)
the)following)is)the)highest?) Specific)heat)capacity)(SHC))=)the)amount)of)heat)required)to)raise)the)
A)Stored)whole)blood) temperature)of)1kg)of)a)substance)by)1)kelvin)(or)celcius).)SHCs:)
B)Red)blood)cells) Air)1010J/kg/C)(gases)have)low)SHC)
C)Muscle)tissue) Whole)blood)3600)J/kg/C))
D)Water) Gelofusion)4082)J/kg/C))
E)Air) N.Saline)4139)J/Kg/C)
Hartmans)4153)J/kg/C)
Distilled)H2O)4180)J/kg/C)(Specific)heat)of)most)other)substances)is)less)
than)that)of)water))
[Davis)&)Kenny)p108)+)MCQ)website])

CM18b)The)specific)heat)capacity)is) C)
greatest)in:) http://bja.oxfordjournals.org/content/84/1/28.full.pdf+html)
A)Packed)red)blood)cells) Air)low)SCH)(approx)1010))
B)Whole)blood) Blood)SCH)<)other)fluids)SCH)<)water)SCH)
C)Water)
D)Saline)

124"
 %kx
CM19)[Graph])Is)this:) Washin)curve)y=1)%)e )
%kx
A)Washin)curve) Washout)curve)y=e )
B)Washout)curve)
C)y)=)10)+)2x2)
D)y)=)10)+)0.2(1/X2))
E)Linear)regression)

)
)y=10+2x2

y=10+0.2(1/x2))
Linear)regression)

)
) 125"
CM20)Solubility)of)gases)in)blood)(?at)
37C):)
A)O2)>)CO2)>)N2)
B)N20)>)CO2)
C)CO2)>)N2)>)O2)
D)...)
E)N2O)<)O2)
CM20b)Regarding)the)solubility)of)gases)
in)PLASMA:)
A)N2O)is)less)soluble)than)CO2)
B)CO2)less)soluble)than)O2)
C)CO2)less)soluble)than)N2)
D)N2O)is)less)soluble)than)O2)
E)N2O)is)less)soluble)than)N2)
F)O2)is)less)soluble)than)N2)
CM21)Renumbered)as)a)version)of)CM05) )
CM22)In)a)patient)with)pulmonary)
obstruction)addition)of)helium)to)the)
inspired)mixture:)
A)Density)is)not)altered)
B)Flammability)of)mixture)is)increased)
C)Viscosity)is)minimally)altered)
D)Rotameter)would)not)need)to)be)
recalibrated)
E)Decreased)O2)transfer)
F)Solubility)of)oxygen)is)decreased)
CM23)For)washout)curve)described)by)??)
y=y0.e%kT/?)
A)After)2)time)constants)13.5%)remains)
B)50%)of)substance)remaining)after)1)
time)constant)
C)After)6)times)constants)y)=)e)
D)After)2)half)lives)90%)has)been)
removed)
E)After)1)half)life)37%)remains)
CM24)Hagen%Poiseuille)relationship:)
A)??)laminar)flow)
B)??)turbulent)flow)
C)?)
B)
Ostwald)solubility)coefficient)%)the)volume)of)gas)which)dissolves)in)1)unit)
volume)of)the)liquid)at)ambient)temperature)&)pressure.))
Bunsen)solubility)coefficient)%)volume)of)gas)corrected)for)STP)which)
dissolves)in)1)unit)volume)of)liquid)at)temp)concerned)at)1)atm)pressure.)
For)BLOOD)
Blood:gas)solubility)coefficients)%)N20)>)CO2)>)02)>)N2))
0.46)>)0.06)>)0.03)>)0.015)
A)
)
For)PLASMA)
Water:gas)solubility)coefficients)%)CO2)>)N2O)>)02)>)N2)))%%%)))
0.57)>)0.38)>)0.024)>)0.012)
)
[Taken)from)black)bank)answers])
C)
Helium)is)an)inert)gas,)it)does)not)support)combustion.)
It)has)a)lower)density)so)velocity)will)be)higher)in)turbulent)flow)and)WOB)
is)lessened.))
Viscosity)air)STP)0.0001695)Poise)
Viscosity)helium)STP)0.001863)
Viscosity)nitrogen)STP)0.0001657)
Rotamer)need)to)be)adjusted)for)specific)substance)%)density)is)important)
A)
Half)life:)time)taken)for)negative)exponential)process)to)reach)half)initial)
value)
Time)constant:)time)take)to)reach)0)at)initial)rate)of)process,)by)63%)for)
each)time)constant)
In)theory,)process)continues)indefinitely)
)
One)time)constant)equals:))
)
• 0.37)of)original)amount)or)63%)excreted)
• t1/2)/)ln)2)
• t1/2)/)0.693)
• Vd)/)Cl)
• compliance*resistance))
)
Figures)for)a)negative)exponential)process,)interms)of)time)constants:))
• After)1)time)constant,)37%)is)left)and)63%)been)removed))
• After)2)time)constants,)13%)is)left)and)87%)been)removed))
• After)3)time)constants,)5%)is)left)and)95%)has)been)removed))
After)4)time)constants,)2%)is)left)and)98%)has)been)removed)
A)
Describes)laminar)flow)
4
Q)=)P.Pi.r /8nl)
126"
CM25)Pulmonary)artery)catheter)can)be)
used)for:)
A)PCWP)>)LAP)
B)Applying)Fick’s)principle,)can)be)used)
to)measure)cardiac)output)
C/D/E?)
CM26)An)apparatus)whereby)an)external)
voltage)is)applied)to)a)silver/silver)
chloride)anode)and)a)platinum)cathode)
would)be)used)to)measure)
A)Oxygen)content)
B)Oxygen)partial)pressure)
C)Carbon)dioxide)content)
D)Carbon)dioxide)partial)pressure)
E)pH)
CM27)For)laminar)flow)
A)Decreased)by)increased)pressure)
B)Influenced)by)viscosity)
C)Influenced)by)density)
D)Proportional)to)length)to)4th)power)
E?)
CM28)Carbon)dioxide)dissolved)in)blood)
follow)which)law?)
A)Charles)law)
B)Avogadro’s)law)
C)Henry’s)law)
D)Dalton’s)law)
E)Boyles)law)
CM29)Electroencephalogram)(EEG):)
A)Reticular)activating)system)
B)Limbic)system)
C)Thalamus)
D)Cortex)
B)
Continuous)monitoring)of:)
K. Pulmonary)artery)pressures)
L. Mixed)venous)O2)saturation)(specialized)only))
M. temperature)
Intermittent)monitoring)of:)
% Pulmonary)artery)occlusion)pressure)(wedge))
% cardiac)output)(usually)thermodilution))
% mixed)venous)blood)sample)for)gas)analysis)
)
PCWP)correlates)with)LA)pressure.)Provided)mitral)valve)is)not)stenosed,)
correlates)closely)with)LVEDP.)Used)as)an)index)of)LV)preload)
[Brandis)p275])
B)
This)is)describing)a)clark’s)electrode.)
These)metals)are)in)a)solution)of)electrolyte)(eg)KCl).)A)voltage)of)0.6V)is)
applied)between)the)electrodes)&)the)current)flow)is)measured.)
%
O2)+)4e)+)2H2O)→)4OH )
More)O2)tension)gives)more)electron)uptake)gives)more)current)
B)
From)Hagen%Pouseille:)
)
)
C)
Charles)law)V1T1=V2T2)
23,)
Avogadrows)6.02)x)10 equal)volumes)of)gases)at)STP)contain)equal)
number)of)molecules)
Henry:)when)system)in)equilibrium:)amount)of)gas)dissolved)=)k)x)PPgas)
above)solution)
Daltons:)each)gas)exerts)pressure)that)it)would)if)it)occupied)the)volume)
alone)
Boyles)V1P1)=)V2P2)
[Brandis)p284,)Davis)&)Kenny)chapter4])
D)
16)electrodes)placed)on)head)to)pick)up)characteristic)potentials)from)
nerve)tracts,)brainstem)and)cerebrum.)
Measures)voltage)difference)between)different)parts)of)the)cortex.)
[Davis)&)Kenny)p291])
127"
CM30)Which)of)the)following)
utilises/does)not)utilise)change)in)
electrical)resistance?)
A)“something)about)wire”)
B)Strain)gauge)
C)Katharometer)
D)Bourdon)gauge)
E)Thermocouple)
CM31)Surface)tension:)
no)other)details)%)renumber)to)RE51)
CM32)Which)combination)of)pulmonary)
artery)catheter)values)is)consistent)with)
cardiogenic)shock?)
A)High)PCWP,)low)CI,)high)SVR)
B)Low)EF,)high)PCWP,)low)MAP)
C)High)EF,)low)PCWP,)low)MAP)
...)
CM32b)Features)of)cardiogenic)shock)%)
CO,)PCWP,)peripheral)vessels:)
A)decrease)increase)constriction)
B)decrease)decrease)constriction)
C)increase)increase)dilation)
D)decrease)increase)dilation)
E)increase)decrease)dilation)
CM33)When)estimating)LVEDV)from)
PCWP,)all)of)the)follow)are)assumptions)
except:)
A)Normal)mitral)valve)
B)Normal)LV)compliance)
C)Normal)airway)pressures)
D)Normal)LV)systolic)function)
D)%)does)NOT)
All)others)DO)
Wire:)as)stretched)becomes)longer)&)thinner)&)therefore)resistance)
increases)
Strain)gauge:)based)on)wire)stretch,)used)in)pressure)transducer)
Katharometer:)measures)that)changes)in)thermal)conductivity)of)the)gas)
by)the)change)in)the)electrical)resistance)of)a)heated)wire)placed)in)the)gas)
flow.))
Bourdon)gauge:)this)is)a)device)for)measuring)pressure,)and)is)attached)to)
a)sensing)element)containing)a)small)tube)of)mercury)or)volatile)fluid.)
Variation)in)temp)causes)a)volume)or)pressure)change)in)the)fluid)&)this)is)
recorded)on)the)Bourdon)gauge)
Thermocouple:)2)metal)strips)with)junctions)convert)thermal)potential)
difference)to)electrical)
[Davis)&)Kenny,)various])
)
A)
Low)output)state)
CO)or)CI)drops)
PCWP)likely)increase)due)to)low)output)
EF)likely)fall)
SVR)may)try)to)increase)to)compensate,)which)will)try)to)maintain)MAP)
A)
)
as)above)
D)
PCWP)correlates)with)LA)pressure.)Provided)mitral)valve)is)not)stenosed,)
correlates)closely)with)LVEDP.)Used)as)an)index)of)LV)preload)
[Brandis)p275]))
PCWP)underestimates)LVEDV)if)LV)noncompliant)
PCWP)overestimates)LVEDV)is)increased)PEEP)
Systolic)function)less)important)
[MCQ)website])
128"
CM34)The)attenuation)of)ultrasound)is) B)
NOT)affected)by:) Ultrasonic)attenuation)is)the)loss)in)energy,)expressed)as)the)change)in)
A)Frequency) intensity,)as)the)energy)travels)through)a)medium.)
B)Velocity) Attenuation)(dB))=)afx)
C)The)number)of)interfaces) a)=)attenuation)coefficity)(dependent)on)the)type)of)tissue))
D)Wavelength) f)=)ultrasonic)frequency)
E)Type)of)tissue) x)=)thickness)of)the)material)
)
Velocity)won’t)affect)attenuation,)just)how)fast)the)US)beam)moves)
through.)The)greater)the)tissue)density,)the)faster)the)US)moves)through.)
E.g.)air)330)m/s,)blood)1540)m/s,)bone)4080)m/s.)Ref)Miller.)
)
Causes)of)ultrasound)attenuation)are)
% scattering)
% absorption)
% reflection)
CM35)Which)is)the)derived)SI)unit)for) E)
pressure)measurement?) )
A)mmHg) Pascal)=)Newton/m2)
B)cmH20) A)torr)is)a)non%SI)unit)of)pressure)
C)atm)
D)torr)
E)pascal)

CM36)Which)of)the)following)is)NOT)a) E)
base)SI)unit?) SI)Base)Units:)
A)Metre) Length)))))))))))))))))))))))))meter))))))))m)
B)ampere) Mass))))))))))))))))))))))))))))kilogram))kg)
C)Candela) Time))))))))))))))))))))))))))))second))))))s)
D)kelvin) Electical)current))))))))))ampere))))))A)
E)Newton) Temperature)))))))))))))))))kelvin)))))))K)
Amount)of)substance)))mole)))))))))mol)
Luminous)intensity))))))candela)))))cd)
)
Newton)=)kg/m2)
Pascal)=)Newton/m2)
[http://physics.nist.gov/cuu/Units/units.html])

CM37)Which)is)true)regarding)the)clark)
electrode?)
A)Has)a)Ag/AgCl)cathode)and)a)platinum)
anode)
B)Can)measure)pO2)in)both)gas)and)
blood)sample)
C)Uses)a)0.6)amp)polarising)current)
D)Is)accurate)despite)changing)temp)
E)Is)calibrated)using)a)special)electrical)
device)
B)
Platinum)cathode)and)Ag/AgCl)anode.)
Voltage)of)0.6V)is)applied)between)the)electrodes)&)the)current)flow)is)
measured.)
O2)tension)varies)with)temperature.)
Calibrated)using)known)standardised)gas)mixtures.))
[Davis)&)Kenny)p204])

129"
CM38)Regarding)Raman)scattering:)
A)The)wavelength)remains)unchanged)
B)It)is)a)form)of)mass)spectroscopy)
C)?..)the)emitted)photon)has)the)same)
wavelength)
D)Only)occurs)with)?monoatomic)
molecule)%)OR%)can)only)be)used)to)
measure)one)gas)at)a)time)
E)Can)be)used)to)measure)the)
concentration)of)a)gas)
CM39)Jul10)ECG)R)wave)in)V1)compared)
to)V5)
A.)Bigger)than)
B.)Smaller)than)
C.)Proportional)to)
D.)Not)related)
)
CM40)[Feb12])Henry's)law)states:)
A.)The)amount)of)gas)dissolved)
is)directly)proportional)to)the)
partial)pressure)of)the)gases)
above)it.)
B.)?)
C.)?)
D.)?)
E.)?)
)
E)
The)Raman)effect)describes)the)partial)transfer)of)energy)between)
radiation)(eg)from)a)laser))and)a)molecule.)The)energy)transfer)affects)the)
energy)of)vibration)associated)with)bonds)between)atoms)in)the)molecule,)
so)absorption)of)radiation)at)a)particular)wavelength)is)associated)with)a)
specific)type)of)bond)between)atoms)in)the)molecule.)Energy)of)radiation)
∝)frequency)of)radiation,)∴)transfer)of)energy)result)in)a)change)in)the)
wavelength)of)the)radiation.)The)decrease)in)the)wavelength)of)the)
radiation)is)characteristic)of)an)individual)type)of)molecule,)so)the)Raman)
effect)can)be)used)to)measure)the)partial)pressures)of)a)range)of)gases)in)
anaesthesia.)
This)differs)from)mass)spectroscopy)which)bombards)molecules)with)
electrons,)some)of)which)become)charged)&)are)then)accelerated)out)of)
the)sample)chamber)into)a)magnetic)field)and)are)deflected)based)on)their)
masses.))
It)requires)more)than)one)atom)but)they)can)be)the)same)or)different)sort)
of)atoms.)
If)more)than)one)volatile)agent)is)present)in)the)Raman)chamber)at)the)
same)time,)can)still)measure)these.)
Both)the)type)and)concentration)of)a)specific)gas)can)be)identified.)
[Davis)&)Kenny,)224%6,)Stoelting)&)Millier)online)Basics)of)anaesthesia])
B)
)
130"
131"