1.

What is the oxygen-carrying capacity of a 16-year-old boy with hemoglobin of

14g/dl?

•16

•22

✓18

•14
The correct answer is 18.

O2 content = (O2 bound to hemoglobin) + (O2 solubilized in plasma) = (1.34 × Hb ×

SaO2) + (0.003 × PaO2).

SaO2 = percent saturation of arterial blood with O2.

Solubility constant of O2 = 0.003

PaO2 = partial pressure of O2 in arterial blood.

Normally 1 g Hb can bind 1.34 mL O2;

The average Hb amount in the blood is 15 g/dL.

O2 binding (carrying) capacity ≈ 20 mL O2/dL of blood.

With ↓ Hb there ↓ is O2 content of arterial blood, but no O2 saturation and Pao2

change.

O2 delivery to tissues = cardiac output × O2 content of blood.

According to the given question,

Normally 1 gm of Hemoglobin Binds to 1.34 ml of O2

Given Hb=14g/dl,

So O2 binding capacity =1.34*14= 18.76

Hence closest is 18

Oxygen-hemoglobin dissociation curve

2.

A 25-year-old patient with a respiratory volume of 500 mL. The intrapleural pressure
measured -4 before inspiration and -8 at the end of inspiration. The pulmonary
compliance of the patient will be

•150 ml/cm H20

•50 ml/cm H2O

✓125 ml/cm H2O

•62.5 ml/cm H2O

The pulmonary compliance is 125 ml/cm of H20.

Compliance = Change in lung volume / Change in pressure

Compliance = 500/4

Compliance= 125 mL/cm H20

Compliance

Compliance is the tendency of the lung tissue to regain its

original position after an applied force has been removed.

It is a Change in lung volume for a change in pressure (ΔV/ΔP). Inversely

proportional to wall stiffness and increased by surfactant.

Increase in Lung Compliance Decrease in Lung Compliance

Emphysema Fibrosis
Aging Pneumonia
Exercise Pulmonary edema
↑ Surfactant Atelectasis
Pregnancy Pleural effusion
Anesthesia Chest wall deformities

Compliance of the lung and chest wall is measured as the slope of the PTR curve, or,
as a change in lung volume per unit change in airway pressure

Elastic Recoil

Tendency for lungs to collapse inward and chest wall to spring outward.

At FRC, airway and alveolar pressures equal atmospheric pressure (PB; called zero),
and intrapleural pressure is negative (preventing atelectasis). The inward pull of the
lung is balanced by the outward pull of the chest wall. System pressure is
atmospheric. Pulmonary vascular resistance (PVR) is at a minimum
The relation between the recoil of the lungs and the recoil of the chest can be
measured through a spirometer and a curve of airway pressure plotted against
volume is the pressure-volume curve of the total respiratory system (PTR).

Lung inflation follows a different pressure-volume curve than lung deflation due to
the need to overcome surface tension forces in inflation.

3.

What is a function of the Golgi tendon organ?

✓Sense changes in muscle tension

•Sense changes in position of the muscle

•Sense changes in muscle direction

•Sense changes in length of the muscle

The correct answer is A it senses changes in muscle tension.

The Golgi tendon reflex ( Inverse stretch reflex ) is the opposite of the muscle stretch
reflex.

The protective mechanism to prevent

tearing of the muscle or avulsion of the tendon from its attachments to the
bone, The lengthening reaction takes place (When The tension in a contracted
muscle is significantly elevated, the inhibitory effect from the Golgi tendon organ
leads to instantaneous relaxation of the entire muscle)
4.

What is the Reflex responsible for tachycardia during right atrial distension?

✓Bainbridge reflex

•Bezold-Jarisch reflex

•J reflex

•Cushing reflex
Bainbridge Reflex is responsible for tachycardia during right atrial distension

The stretch receptors of the atria elicit their reflex called the Bainbridge reflex

Bainbridge Reflex Pathway

Atria Dilation
↓
Stretch Receptors in Atria Activated
↓
Afferent Signals through Vagus Nerves
↓
Medulla of Brain
↓
Efferent Signals through Vagal and Sympathetic Nerves
↓
Increased Heart Rate and Strength of Contraction
↓
Prevention of Blood Damming

Bezold—Jarisch Reflex:

Activation of Chemosensitive Vagal C Fibers in Cardiopulmonary Region

↓
Profound Bradycardia (Significantly Decreased Heart Rate)
↓
Hypotension (Decreased Blood Pressure)
↓
Brief Period of Apnea (Temporary Cessation of Breathing)
↓
Followed by Rapid Shallow Breathing

Cushing Reflex:

Increased Intracranial Pressure

↓
Compromised Blood Supply to RVLM Neurons
↓
Local Hypoxia and Hypercapnia (Low Oxygen and High Carbon Dioxide levels)
↓
Increased Neuronal Discharges
5.

During the regulation of ___________ Feedforward control system is employed.

✓Temperature

•Blood pressure

•pH

•Blood volume
Feed forward control system is used during the regulation of temperature

The control system in the body when no stimulus is required but still, the system
predicts and makes corrective changes it
is called Feedforward/Adaptive Control.

Temperature control - Thermoregulatory responses are started by the

hypothalamus before the changes in environmental temperature have succeeded in
changing the body's core body temperature
The cephalic phase of gastric secretion- Just
thinking about food increases gastric acid production

Examples

Feedforward Regulation Feedback Regulation

Salivation response to food
Shivering in response to cold
temperature
Release of insulin before a meal
Activation of the immune system to
foreign antigens
Pupil constriction in bright light
conditions
Muscle activation prior to lifting heavy
objects
Activation of the "fight or flight"
response to a perceived threat
Release of adrenaline in response to
stress or danger
Control of breathing rate based on carbon
dioxide levels
Heart rate adjustment in response to
changes in blood pressure
Sweating in response to increased body
temperature
Release of digestive enzymes in response
to food in the stomach
Regulation of blood sugar levels by insulin
and glucagon
Body temperature regulation through
thermoregulatory mechanisms
Regulation of water balance through thirst
sensation
Control of blood pH through respiratory and
renal mechanisms
 Feedforward Regulation
Increased production of red blood cells
at high altitudes
Vasoconstriction and piloerection in
response to cold temperatures
Feedback Regulation
Control of blood calcium levels by
parathyroid hormone and calcitonin
Regulation of body temperature through
vasodilation and vasoconstriction

6.

All cellular junctions are present in a cardiac muscle except.

✕Fascia adherens

✓Zonula occludens

•Macula adherens

•Gap junctions
Zonula occludens is also called a tight junction. It is absent in cardiac
muscle

Cardiac muscle cells are connected by Fascia adherens ( analog of zonula

adherens), Gap junctions, and Macula adherens.

Cardiac muscle fibers are made up of many separate cells connected in series and
parallel to one another. The areas where the end of one muscle fiber connects to
another are called intercalated discs.

At each intercalated disc, the plasma membrane fuses with one another forming a
gap junction that provides low-resistance bridges for the spread of excitation from
one fiber to another permitting the cardiac muscle to function as a syncytium.

Tight junctions (zonula occludens) A –prevents paracellular movement of

solutes; composed of claudins and occludins.

Adherens junction (belt desmosome, zonula adherens) B –forms “belt”

connecting actin cytoskeletons of adjacent cells with cadherins (Ca2+ - dependent
adhesion proteins). Loss of E-cadherin promotes metastasis.
Desmosome (spot desmosome, macula adherens) C –structural support via
intermediate filament
interactions. Autoantibodies to desmoglein

3 +/– desmoglein 1 → pemphigus vulgaris.

Gap junction D – channel proteins called

connexons permit electrical and chemical
communication between cells.

Hemidesmosome E –connects keratin in basal

cells to underlying basement membrane. Autoantibodies → bullous pemphigoid.
(Hemidesmosomes are down “bullow.”)

Integrins–membrane proteins that maintain integrity of basolateral membrane by

binding to collagen, laminin, and fibronectin in basement membrane.

7.

The difference in trajectory between expiratory loop and the inspiratory loop in the
curve is due to:

•Difference in airway resistance during inspiration and expiration

✓Difference in concentration of surfactant during inspiration and expiration

•Inspiration is active and expiration is passive

•Difference in alveolar pressure during inspiration and expiration

Difference in trajectory between the expiratory loop and the inspiratory loop in the
curve is due to difference in concentration of surfactant during inspiration and
expiration

The difference between inflation and the deflation curves is called hysteresis.

It exists because greater transpulmonary pressure is required to open a previously

closed airway due to a deficit of surfactant at the air-water interface than to keep an
open airway from closing as it has abundant surfactant.

Application of Law of Laplace in alveoli–alveoli

have ↑ tendency to collapse on expiration as radius ↓

Surfactant

Surfactant is secreted by Type II pneumocytes

from lamellar bodies

Surfactant ↓ alveolar surface tension, ↓ alveolar collapse, ↓ lung recoil, and ↑

compliance.

It is composed of multiple lecithins, mainly dipalmitoylphosphatidylcholine

(DPPC). Synthesis begins ~20 weeks of gestation and achieves mature levels ~35
weeks of gestation. Glucocorticoids are important for fetal surfactant synthesis
and lung development.

Hence Steriods may be given for preterm babies for lung maturation

Collapsing pressure = 2 (surface tension)/radius

8.

The Efferent arteriolar constriction causes all except

✓Decreases oncotic pressure in glomerular capillaries

•Increases hydrostatic pressure in glomerular capillaries

•Decreases renal blood flow

•Decrease in GFR
Efferent arteriolar constriction increases oncotic pressure in glomerular
capillaries.

Efferent arteriolar constriction can both decrease and increase GFR depending on
the severity of resistance.

Efferent arteriolar constriction causes increased glomerular hydrostatic

pressure and slightly increased GFR.

Renal Blood Flow

Severe efferent arteriolar constriction

↓
Significant reduction in renal blood flow
↓
Increase in plasma protein concentration
↓
Increase in glomerular colloid oncotic pressure
↓
Net force for filtration decreases
↓
Resulting in decreased GFR

GFR - Glomerular Filtration Rate

RFP - Effective renal plasma flow
FF - Filtration Fraction
9.

Absolute refractory period is due _____________ .

•Closure of active gates of sodium channel

✓Closure of inactive gates of sodium channel

•Closure of potassium channels

✕Opening of calcium channels

The absolute refractory period is due to the closure of the inactive sodium channel
gates

Voltage-gated sodium channels can either be closed, open, or inactive. They have an
activation gate and an inactivation gate.

The stimulus is given, the activation gate of

the sodium channels opens, and sodium flows into the cell causing the membrane
potential to become more positive.

After 0.5 to 1 millisecond, the inactivation gate automatically closes and no extra
stimulus can excite the nerves even though the stimulus is strong it is called the
absolute refractory period

Changes in membrane potential and relative membrane

permeability to Na+ and K+ during an action potential.

Absolute Refractory Period Relative Refractory Period

Neuron requires a stronger-than-normal
Neuron is unresponsive to stimuli.
stimulus to generate an action potential.
 Absolute Refractory Period
Sodium (Na+) channels are
inactivated.
Neuron unable to generate an
action potential regardless of
stimulus strength.
Short duration (around 1 ms).
Prevents backward propagation of
action potentials.
Relative Refractory Period
Sodium (Na+) channels have recovered from
inactivation, but potassium (K+) channels may
still be open or recovering.
Neuron can generate an action potential, but it
requires a higher stimulus strength than during
the resting state.
Relatively longer duration (tens to hundreds of
ms).
Allows backward propagation under certain
conditions.

Event Description and Cause

Neurons have a negatively charged resting state, typically
Resting Membrane
around -70 mV, maintained by the activity of ion channels,
Potential
particularly the sodium-potassium pump.
A stimulus triggers the opening of ion channels, allowing an
Depolarization influx of sodium ions (Na+), leading to a change in
membrane potential towards a more positive value.
If the depolarization reaches a critical level (around -55
Threshold
mV), the threshold is reached, initiating an action potential.
Rapid depolarization occurs as voltage-gated sodium
Action Potential channels open, causing a massive influx of sodium ions
(Na+), resulting in a rapid increase in membrane potential.
Voltage-gated potassium channels open, allowing
potassium ions (K+) to leave the neuron, restoring the
Repolarization
negative charge inside the neuron and returning the
membrane potential.
In some neurons, the repolarization phase leads to a brief
Hyperpolarization
period of increased negativity, known as hyperpolarization,
(optional)
caused by slow closing of potassium channels.
Following an action potential, there is a refractory period
Refractory Period during which the neuron is temporarily unable to generate
another action potential.
10.

A, B, and C are three permeable ions. A=-50 and B=-30. At RMP if there is no net
electrogenic transfer, what is the value of C?

✕-80

✓+80

•-20

•+20

If the electrogenic transfer at Resting Membrane Potential is Zero

A+ B + C = 0
A = -50 and B = -30
-50+(-30)+C=0
C=+80

11.

Slow waves are generated by

✓Interstitial cells of Cajal

•Myenteric neurons

•Parasympathetic neurons

•Smooth muscle cells

Interstitial cells of Cajal are the pacemaker cells of the GIT that initiate the basic
electrical rhythm. These are stellate mesenchymal pacemaker cells with smooth
muscle-like features.

In the stomach and the small intestine, these cells are located in the circular smooth
muscle layer near the myenteric plexus.

In the colon, they are at the submucosal border of the circular muscle layer.

The slow waves usually rarely cause muscle contraction in most parts of the
gastrointestinal tract, except perhaps in the stomach

Instead, they mainly excite the appearance of intermittent spike potentials, and the
spike potentials in turn actually excite the muscle contraction.

Type of Wave Origin

Pacemaker cells (Interstitial cells of Cajal) in the smooth
Slow Wave
muscle layer of the intestine
Sequential contraction and relaxation of circular and
Peristaltic Wave
longitudinal muscle layers
Alternating contraction and relaxation of adjacent
Segmental Wave
segments of circular muscles
Migrating Motor Complex Coordinated contractions initiated in the stomach and
(MMC) propagating through the small intestine
Contraction and relaxation of haustral sacs in the large
Haustral Wave
intestine
Mass Movement Powerful, coordinated contraction of the colon
12.

What is the amount of is glucose excreted if the patient has a blood glucose level of
200 mg/dL and a GFR of 90 ml/min ( transport maximum of the patient is as shown
below)

✓30 mg/min

•40 mg/min

✕50 mg/min

•80 mg/min
The Correct Answer is 30mg/ml solution

Filtered load = GFR × Px.

Excretion rate = V × Ux.

Reabsorption rate = filtered – excreted.

Secretion rate = excreted – filtered.

FeNa = fractional excretion of sodium.

FeNa = Na+ excreted/ Na+ filtered

= V × UNa / GFR × PNa
= PCr × UNa / UCr × PNa

1: Total filtered glucose

GFR 90 ml/min
Plasma glucose concentration
= 200 mg/dL
= 2 mg/ml (1 dL=100 ml).

Total filtered glucose

= GFR x Plasma glucose concentration.

= 90 ml/min x 2 mg/ml
= 180 mg/min.

2: Transport maximum:

Transport maximum is 150 mg/min.

3: Excretion:
Excretion = Total filtered glucose - Transport Maximum
= 180-150 mg/min
= 30 mg/min

Glucose at a normal plasma level (range 60–120 mg/dL) is completely reabsorbed in

proximal convoluted tubule (PCT) by Na+/glucose cotransport.

In adults, at plasma glucose of ∼ 200 mg/dL, glucosuria begins (threshold). At a rate

of
∼ 375 mg/min, all transporters are fully saturated (Tm - Transport Maximum ).

Normal pregnancy is associated with ↑ GFR. With ↑ filtration of all substances,

including glucose, the glucose threshold occurs at lower plasma glucose
concentrations → glucosuria at normal plasma glucose levels.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors (eg, -flozin drugs) result in

glucosuria at plasma concentrations
< 200 mg/dL.

Glucosuria is an important clinical clue to diabetes mellitus.

Splay phenomenon—Tm for glucose is reached gradually rather than sharply due to
the heterogeneity of nephrons (ie, different Tm points); represented by the portion
of the titration curve between threshold and Tm
13.

Which of the following given below can be responsible for the Bezold-Jarisch reflex?

•Histamine

✓Serotonin

•Angiotensin

•Prostaglandin
Ans is B

Activation of chemosensitive vagal C fibers in the cardiopulmonary region (eg,

juxtacapillary region of alveoli, ventricles, atria, great veins, and pulmonary artery)
causes profound bradycardia, hypotension, and a brief period of apnea followed by
rapid shallow breathing. This response pattern is called the Bezold–Jarisch reflex
And it can be elicited by a variety of substances including
capsaicin, serotonin, phenylbiguanide, and veratridine.

Bezold—Jarisch Reflex:

Activation of Chemosensitive Vagal C Fibers in Cardiopulmonary Region

↓
Profound Bradycardia (Significantly Decreased Heart Rate)
↓
Hypotension (Decreased Blood Pressure)
↓
Brief Period of Apnea (Temporary Cessation of Breathing)
↓
Followed by Rapid Shallow Breathing

14.

The fourth heart sound is caused by

•Vibrations in the ventricular wall during systole

•Closure of aortic and pulmonary valves

✓Ventricular filling

•Closure of mitral and tricuspid valves

The fourth heart sound is caused by Ventricular Filling

Heart
Description of the Cause
Sounds

Closure of the mitral and tricuspid valves at the beginning of

systole (contraction phase of the heart).
S1
Indicates the start of ventricular contraction and the ejection of
blood from the heart.

Closure of aortic and pulmonary valves close at the beginning of

diastole (relaxation phase of the heart).
S2 Loudest at left upper sternal border.
Signifies the end of ventricular contraction and the closure of the
major arteries leaving the heart.

Occurs during the early

S3
rapid
ventricular filling phase.
Heart
Description of the Cause
Sounds
Best heard at apex with patient in left lateral decubitus position
Associated
with ↑ filling
pressures
(eg, MR, AR,
HF,
thyrotoxicosis)
and more
common in
dilated
ventricles
(but can be
normal in
children,
young adults,
athletes, and
pregnancy).
Turbulence
caused by
blood
from LA
mixing
with ↑
ESV.

Often called an "S4 gallop" or

“atrial kick”
Occurs when the atria contract forcefully against a stiff ventricle
during late diastole.
S4
Best heard at apex with patient in left lateral decubitus position.
High atrial pressure. Associated with ventricular noncompliance
(eg, hypertrophy). Considered abnormal if palpable. Common in
older adults.
15.

On JVP "a" wave represents

•Atrial filling

✓Atrial contraction

•Ventricular relaxation

•Ventricular filling
"a" wave corresponds to atrial contraction

JVP Wave
Description
Component

Atrial contraction.
Prominent upward deflection in the JVP
a wave waveform(cannon a wave)
Absent in atrial fibrillation
.

Atrial relaxation
Descent of the closed tricuspid valve during the
x descent rapid ventricular ejection phase.
Reduced or absent in tricuspid regurgitation and right
HF because pressure gradients are reduced.

RV contraction (closed tricuspid valve

c wave
bulging into the atrium).

↑ RA pressure due to ↑ volume against the closed

tricuspid valve.
v wave
Represents passive atrial filling during ventricular
systole. It is an upward deflection.

RA emptying into RV. Prominent in constrictive

y descent
pericarditis, absent in cardiac tamponade.

x' descent It is a minor downward deflection.

16.

In the 2 vessels shown below, assume the pressure along both the vessels is the
same and both follow linear flow pattern. What will be the amount of blood flow in Y
compared to X

•4

✓8

•16

•32
The question is solved by Poiseuille's law:

The Blood flow in a long narrow tube, the viscosity of the fluid, and the
radius of the tube is expressed mathematically as

Pa -Pb is the pressure difference across the end

Here, the radius is doubled so the flow increases by 2 to the power of 4 = 16.

the length of the vessel is also doubled, so the flow decreases by half = 8

17.

A 15-year-old boy presents with involuntary dancing movements of his right hand
On Investigation he was diagnosed with rheumatic fever. What constitutes the
ganglia involved in the presenting complication?
•Globus pallidus and putamen

•Globus pallidus and lentiform nucleus

•Caudate nucleus and globus pallidus

✓Caudate nucleus and putamen

The given clinical scenario with involuntary dancing movements of hand
suggestive of Sydenham's chorea, a Complications of rheumatic fever

The choreic movements are caused by the destruction of D 2 neurons of the striatum.
The neostriatum consists of the caudate nucleus and putamen.

Rheumatic Fever Clinical Features and Causes

Clinical Features Causes

Infection by Group A beta-hemolytic Streptococcus

bacteria, specifically Streptococcus pyogenes.
Fever
Manifestations include sore throat, tonsillitis, and
pharyngitis.

Autoimmune response triggered by the body's

immune system in response to streptococcal infection.
Joint pain and swelling
(polyarthritis)
Manifestations include pain, swelling, redness, and
limited range of motion in multiple joints.

Autoimmune response targeting the heart valves and

tissues following streptococcal infection.
Carditis (inflammation
of the heart)
Manifestations include murmurs, chest pain, shortness
of breath, fatigue, and signs of heart failure.
 Clinical Features Causes

Formation of immune complexes in the subcutaneous

tissues as a result of streptococcal infection.
Subcutaneous nodules
Manifestations include small, painless, firm nodules
under the skin, usually over bony prominences.

Immunological reaction causing vasodilation and

inflammation in the skin following streptococcal
infection.
Erythema marginatum

Manifestations include pink, non-pruritic, and

expanding rings on the trunk and limbs.

Autoimmune response cause the destruction of D 2

neurons of the striatum in the basal ganglia of the
brain due to streptococcal infection.
Sydenham's chorea
Manifestations include involuntary, purposeless
movements, muscle weakness, and emotional
changes.
18.

Given below is the demonstration of tetanization in the gastrocnemius muscle of a

frog. Identify the tetanising frequency

✓30-35 Hz

•15-20 Hz

•10-15 Hz

•25-20 Hz
Answer is A

Solution

The Scale on the x-axis is 10mm.

The Area under the graph represents muscle contraction
The Paper speed is 1000mm/sec.

The contraction period is a latent period to a maximum force of contraction

including 3 scales = 30 mm.

Hence Contraction period = 30mm = (30/1000) = 30 msec.

Tetanizing frequency = 1/contraction period = 1000/30

=33Hz.
Muscle contraction can be presented by eliciting single
muscle twitches.

TWITCH CONTRACTION

The adding together of individual twitch contractions to

increase the intensity of overall muscle contraction is
Summation.