Physio-1.

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1. A 69-year-old female complains of bilateral visual difficulty that has

progressed over the last year. She appeared depressed and very worried for
her vision. Funduscopic examination reveals small yellow retinal lesions
clustered in the macula.

Which of the following would you expect most on visual field examination?

A. Homonymous hemianopsia
B. Binasal hemianopsia

C. Bitemporal hemianopsia

D. Arcuate cotomas

E. Central scotomas

2. A 55 year-old male patient is being evaluated for hypoventilation. He is obese

and suffering from hypertension for many years. He is asked to take several
deep breaths in rapid succession, and the following physiologic information is
obtained:

Which of the following locations is the most likely site of this patient's disease?
A. Nasopharynx
B. Brainstem
C. Pericardial space
D. Peripheral nerves
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E. Neuromuscular junction

3. A 53-year-old obese woman presents to the emergency room with severe

epigastric pain that started after a heavy meal. She attended birthday party
where they had a barbeque and drank a lot of beers. She has had several
milder episodes before related to fatty food consumption. Physical
examination reveals marked tenderness in the right subcostal area.
Which of the following hormones most likely provoked the current attack in this
patient?

A. Secretin
B. Cholecystokinin
C. Gastrin
D. Vasoactive intestinal peptide (VIP)
E. Motilin
F. Somatostatin

4. A 53-year-old Asian female comes to your office with a 5-month history of

amenorrhea. She took oral contraceptive pills for 8 years but discontinued
them 5 months ago. Her past medical history is no contributary. She is asking
why she does not have her menstrual cycles anymore. You explain that
menopause is the most likely explanation of her amenorrhea. Which of the
following is the best test to confirm your suspicion?
A. Serum luteinizing hormone level
B. Serum estrone level
C. Serum prolactin level
D. Serum follicle-stimulating hormone level
E. Urinary 17-ketosteroids

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5. A 42-year-old Caucasian female comes to the physician complaining of

difficulty sleeping. She says that his new job as a manager is very stressful
and requires frequent travel. During the past 6 months, she has made
numerous trips between the United States and Italy. She experiences
difficulty sleeping and daytime sleepiness for several days after these trips,
but her sleep then improves significantly.
Which of the following hypothalamic nuclei is most likely responsible for this
delayed improvement in her symptoms?

A. Anterior
B. Lateral
C. Posterior
D. Suprachiasmatic
E. Supraoptic
F. Ventromedial.

6. A 30-year-old Afro-American female experiences disorientation, heart

raising, tremulousness and excessive sweating, all of which quickly become
better after drinking some honey dissolved in water. She has had type 1
diabetes mellitus for 5 years and her insulin regimen has been stable for the
last seven months. Which of the following most likely precipitated this
patient's symptoms?

A. Respiratory infection
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B. Moderate to severe pain

C. Exercise
D. Weight gain
E. Sleep deprivation

7. A 54-year-old male experiences severe back pain due to metastatic

carcinoma. He has 20 years of one pack history of smoking daily. Low-dose
morphine is injected into the epidural space that produces long-lasting
analgesia. Which of the following is the most likely direct postsynaptic action
of the drug on the spinal level in this patient?

A. Blocking voltage-dependent sodium flow

B. Increasing potassium efflux out of the cells
C. Increasing chloride influx into the cells
D. Increasing calcium inflow into the cells
E. Activating Na/Ca exchange mechanisms

8. In the Mount Sinai Hospital in New York group of physiologists started

research related to osmolarity and body fluids. The body fluid
volume/osmolarity changes in a 27-year-old hospitalized male patient are
shown on the slide below (solid line - normal; dotted line - patient).

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Which of the following is the most likely cause of his condition?

A. Acute gastrointestinal hemorrhage

B. Psychogenic polydipsia
C. Diabetes insipidus
D. Adrenal insufficiency
E. Hypertonic saline infusion

9. A 27-year-old female is brought to the emergency room with weakness and

confusion. She has experienced polyuria, polydipsia and increased appetite
for several months. Her breath has a fruity odor. She is deficient in a
substance that normally:

A. Increases glucagon secretion

B. Decreases glucagon secretion
C. Facilitates the action of glucagon
D. Increases renal glucose production
E. Increases the renal threshold for glucose reabsorption

10. A 32-year-old man comes to the physician because he and his wife have
been unable to conceive for the last 3 years. They have no offspring.
Infertility evaluation is begun, and laboratory studies show a low sperm
count. Futher evaluation elucidates a rare genetic abnormality that leads to

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permanently inactive FSH receptors. Which of the following substances is

most likely decreased in this patient?
A. FSH
B. LH
C. lnhibin B
D. Testosterone
E. DHEA

11. A 27-year-old female comes to the physician because he and her husband
have been unable to conceive for the last 3 years. They have no offspring. A
patient is treated with a gonadotropin-releasing hormone (GnRH) agonist.
The blood level of the drug is demonstrated by the graph below.

Which of the following is the most likely indication for drugs in this patient?

A. Infertility
B. Precocious puberty
C. Prostate cancer
D. Endometriosis.
E. Dysfunctional uterine bleeding

12. A 33-year-old female is being evaluated for painful muscle cramps. On

physical examination, light tapping on the chin elicits masseter muscle
spasms. She has a serum sodium level of 140 mEq/dL, potassium level of 4.2
mEq/dL, and calcium level of 7.1 mg/dl. Which of the following components
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of her past medical history is most likely contributing to his current

condition?
A. Metastatic bone cancer
B. Thyroid surgery
C. Multivitamin overdose
D. Chlorthalidone treatment
E. Overt hypothyroidism

13. In the Mount Sinai Hospital in New York group of geneticist started research
about synthesis of neurophysin. An individual with a point mutation affecting
the gene responsible for neurophysin synthesis is most likely to suffer from:
A. Short stature
B. Hyperpigmentation
C. Diabetes insipidus
D. Hypothyroidism
E. Infertility

14. A 55-year-old female is diagnosed with diabetes mellitus during a routine

check-up. She has a history of hypertension for which takes bet blocker and
diuretic. Her urine is negative for glucose and ketones, however. Treatment
with which of the following agents would increase the C-peptide level in this
patient's blood?
A. Acarbose
B. Glyburide
C. Metformin
D. Rosiglitazone
E. Enalapril
F. Low-calorie diet

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15. A 33-year-old female is referred to a neurologist because of recent-onset

diplopia and ataxia few weeks ago. She has not experienced nothing similar
before. However, about 8 months ago, she had numbness and paresthesia
involving her left leg that have since resolved. After a throughout
neurological examination which confirms her presenting complaints, the
physician orders an MRI of the brain, which shows several areas of T2
hyperintensity consistent with axonal demyelination. A diagnosis of multiple
sclerosis is done. Which of the following neuronal properties is most likely to
decrease as a direct result of demyelination?
A. Threshold
B. Temporal summation
C. Spatial summation
D. Length constant
E. Time constant

16. A 23-year-old man undergoes an Airman medical examination because he

applied to join Army. During testicular examination, he is found to have only
1 testis in his scrotum. Further evaluation reveals an elevated serum FSH
level and a normal serum LH level. Production of which of the following
substances is likely to be impaired in this patient?

A. Testosterone
B. Dihydrotestosterone
C. DHEA
D. lnhibin B
E. Cortisol

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17. A 53-year-old Japanese female undergoes total gastrectomy after an

invasive gastric adenocarcinoma was diagnosed by endoscopy. You advise
her that she should receive lifelong supplementation of which of the
following?
A. Gastric enzymes
B. Hydrochloric acid
C. Medium-chain triglycerides
D. Fat-soluble vitamin
E. Water-soluble vitamin

18. A 37-year-old female comes to the physician because she has not been
feeling like herself lately. She has had fatigue and is anxious that her weight
increased even though she feels as though she is eating less for some period
of time. Furthermore, she requests to be referred to a dermatologist, as she
says that she has always had "nice" skin, but recently become dry. She has
also observed that her hair has been thinning recently, and hopes the
dermatologist can do something about that that as well. The patient is an
actor, thus the symptoms regarding her physical appearance are particularly
important to her. Laboratory evaluation reveals high serum TSH, low T3, and
low T4 levels. Supplementing T3 to this patient would most likely result in
which of the following?

TSH T3 Reverse T3 T4

A. No change Increase Increase Decrease

B. No change Increase Decrease Decrease

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C. Decrease Increase Increase Decrease

D. Decrease Increase Decrease Decrease

E. Decrease Increase Decrease Increase

19.In the Mount Sinai Hospital in New York group of physiologist started
research project related to calories intake in nutrition. A 42-year-old obese
participant was accepted in the study. They evaluate his food intake. The
participant is 5'7" tall and weighs 260 lbs. He consumes 3,000 calories per
day, with 30% coming from proteins. How much protein does this patient
consume per day?
A. 130
B. 160
C. 180
D. 225
E. 250

20.A 30-year-old Caucasian female comes to the physician complaining of

dizziness and mild confusion over the last two weeks. She has a past medical
history of seizures beginning in childhood and was recently started on
carbamazepine by her physician. Ordered laboratory studies show a low
serum sodium level. This patient's condition is caused by an inadequate
response to a specific hormone, and proteins known as neurophysins are
involved in the production of this hormone. Which of the following sites
depicted below secretes neurophysin into the circulation?

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

21. In the Mount Sinai Hospital in New York group of physiologists started
research about membrane potential of neuron. They are studying recordings
of the membrane potential from a giant squid axon. A portion of their
recordings is shown on the slide below.

The membrane is most permeable to potassium ions at which of the following

points?
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A. A
B. B
C. C
D. D
E. E

22. In the Mount Sinai Hospital in New York group of physiologists started
research about glucose transporters. They studies glucose transporters that
facilitate glucose diffusion in various tissues. The following graph plots the
number of glucose transporters found on the cell surface of two types of
cells (circles versus squares) against insulin concentration. Respectively,
which cell types do the circles and square most likely represent?

A. Adipocytes and skeletal muscle cells

B. Hepatocytes and cortical pyramidal cells
C. Hepatocytes and renal tubular cells
D. Skeletal muscle cells and renal tubular cells
E. Pancreatic beta cells and intestinal epithelial cells

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23. In the Mount Sinai Hospital in New York group of physiologists started
research about glycose transport in adipose cells. One of their experiments
reveals that, in the presence of insulin, 0-glucose transport across the plasma
membrane of adipocytes is more rapid than L-glucose transport.
Which of the following transport processes best describes the mechanism for
glucose entry into adipocytes?

A. Simple diffusion
B. Receptor-mediated endocytosis
C. Carrier-mediated transport
D. Primary active transport
E. Co-transport

24.In the Mount Sinai Hospital in New York group of physiologists started
research about the effects of cortisol on vascular reactivity. The scientists
find that administration of cortisol alone does not elicit a vascular response.
Following this, the researchers conduct an experiment on
hypophysectomized animals to measure vascular reactivity to an infusion of
norepinephrine. Vascular reactivity is then measured again in these animals
after pretreating them with cortisol. The following curves describethefindings
of the experiment. Which of the following best describe the effect of cortisol
in this experiment?

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A. Tachyphylaxis
B. Permissive
C. Synergistic
D. Additive
E. Metabolic

25.In the Mount Sinai Hospital in New York group of physiologists started
research about GIT function. In an animal experiment, the pancreatic duct is
cannulated, and different secretory stimuli are applied to the gland. The
following tracings are received by measuring pancreatic fluid constituents:

x k-----

Time
Secretin

Substance 'X' is most likely which of the following?

A. Sodium
B. Chloride

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C. Trypsinogen
D. Bicarbonate
E. Phosphate

26. In the Mount Sinai Hospital in New York group of neurophysiologists started
research about physiology of pain. They conduct an experiment on animal
and various endogenous compounds are measured in the spinal fluid after
application of painful stimuli. One of the compounds that increase as a result
of the experiment is a pentapeptide with a strong affinity to delta- and mu-
receptors. Which of the following substances is most likely to have a
common molecular origin with the pentapeptide described above?

A. Prolactin
B. TSH
C. ACTH
D. Growth hormone
E. Vasopressin
F. Somatomedin C

27. A 37-year-old Caucasian female, immigrant from Russia comes to your office
with a significantly enlarged thyroid gland. Serum TSH and T4 and T3 levels
are normal. You suspect that iodine deficiency may have contributed to
woman's enlarged thyroid gland. Which of the following best describes the
function of thyroid peroxidase in this patient?

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A. Iodide uptake
B. Thyroglobulin synthesis
C. Thyroglobulin iodination
D. lodotyrosine deiodination
E. Thyronine secretion

28. A 29-year-old Afro-American female is treated because she couldn’t

conceive for two years. She receives a short course of menotropins followed
by a single injection of human chorionic gonadotropin (hCG). hCG is used to
simulate which of the following physiologic events?
A. Estrogen surge
B. Follicle-stimulating hormone surge
C. Progesterone surge
D. Luteinizing hormone surge
E. Prolactin surge

29. In the Mount Sinai Hospital in New York group of physiologists started
research about physiology of GIT hormones. They measure the bicarbonate
content of duodenal aspirates and plot these values as a function of the
blood level of hormone A (see the graph below).

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The hormone studied by the scientists is most likely one produced in the:

A. Pancreas
B. Duodenum
C. Stomach
D. Liver
E. Kidneys

30.In the Mount Sinai Hospital in New York group of neurophysiologists started
research about physiology of pain. They perform experiment in which they
do gastric function monitoring in healthy subjects volunteers before, during
and after a meal shows an initial rise, peak, and then decline in gastric acid
production. Which of the following helps most to down-regulate gastric
secretion after a meal?
A. Basal secretion
B. Cephalic phase
C. Gastrin release
D. Intestinal influences
E. Receptive relaxation
F. Postprandial alkaline tide.

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31. In the Mount Sinai Hospital in New York group of physiologists started
research about differed ways of transport across cell membranes. They found
that many drugs and toxins act by inhibiting substance flow across cell
membranes. Which of the following inhibits primary active transport?
A. Tetrodotoxin
B. Verapamil
C. Omeprazole
D. Lidocaine
E. Dofetilide

32. A 37-year-old Asian woman who underwent an uncomplicated

cholecystectomy two month ago eats a small meal containing mostly
triglycerides and a small amount of complex carbohydrates. In this female,
most of the dietary lipids would be absorbed in the:
A. Stomach
B. Duodenum
C. Jejunum
D. Ileum
E. Colon

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