P H Y S I O L O G Y:

-Cellular Physiology (1-15)

-Hematopoiesis & Hemostasis(16-20)
-Immunology (21-30)
-Renal Physiology (31-50)

GROUP
MX-3
 Question 1-10:
Cellular Physiology

PGI Mary Claire R. Losorata

 Question 1-10:
Cellular Physiology

PGI Mary Claire R. Losorata

Question Difficulty Level: AVERAGE
#1
A 20-year-old man reports blood in his urine 2 weeks after he had a sore throat. He
has uremia and blood pressure of 160/100mmHg with peripheral edema, suggestive
of volume expansion secondary to salt and water retention. Which of the following
is the approximate extracellular fluid volume of a normal individual?

A. 5% of body weight
B. 10% of body weight
C. 20% of body weight
D. 40% of body weight
E. 60% of body weight
Question Difficulty Level: AVERAGE
#1
A 20-year-old man reports blood in his urine 2 weeks after he had a sore throat. he
has uremia and blood pressure of 160/100mmHg with peripheral edema, suggestive
of volume expansion secondary to salt and water retention. Which of the following
is the approximate extracellular fluid volume of a normal individual?

A. 5% of body weight
B. 10% of body weight
C. 20% of body weight
D. 40% of body weight
E. 60% of body weight
In an average 70-kilogram adult man, the total body water is about
60% of the body weight, or about
42 liters.

About 28 of the 42 liters of fluid in the body are inside the trillions
of cells and is collectively called the intracellular fluid. Thus, the
intracellular fluid constitutes about 40% of the total body weight
in an “average” person.

All the fluids outside the cells are collectively called the
extracellular fluid. Together these fluids account for about 20 % of
the body weight, or about 14 liters in a 70-kilogram man.

- Guyton 14th ed Chap 25 Pg 306-307

Rationale
Question Difficulty Level: MOST DIFFICULT
#2
What are the factors affecting net rate of diffusion of molecules and ions across cell
membrane?

I. Concentration Difference
II. Electrical Potential Difference
III. Pressure Difference
IV. Selective Permeability of Plasma membrane

A. I and III
B. I, II, III
C. IV only
D. All of the above
Question Difficulty Level: MOST DIFFICULT
#2
What are the factors affecting net rate of diffusion of molecules and ions across
cell membrane?

I. Concentration Difference
II. Electrical Potential Difference
III. Pressure Difference
IV. Selective Permeability of Plasma membrane

A. I and III
B. I, II, III
C. IV only
D. All of the above
Selective Permeability is a characteristic or property of plasma membrane as a requisite barrier which is
dictated by its unique structure and chemical composition. It is impermeable to large molecules and
charged ions but is permeable to certain ions and molecules like O2, CO2, ammonia and water.

If the cell wishes to use such substance, therefore, it must be able to accumulate against concentration
gradient. a simple pore in a membrane cannot concentrate anything. The membrane must be endowed
with special machinery that uses metabolic energy to drive the uphill movement of these substances.

Boron and Boulpaep 3rd ed,

Rationale Chapter 2, Page 8-9
Factors affecting net rate of diffusion

1. Concentration Difference

- rate of net diffusion into the cell is proportional to the

concentration on the outside minus the concentration on
the inside.

2. Electrical Potential Difference

3. Pressure Difference

- Guyton 14th ed Chap 4 Pg 56-57

Rationale
Factors affecting net rate of diffusion

1. Concentration Difference
2. Electrical Potential Difference

- electrical charges of the ions cause them to move

through the membrane

3. Pressure Difference

- Guyton 14th ed Chap 4 Pg 56-57

Rationale
Factors affecting net rate of diffusion

1. Concentration Difference
2. Electrical Potential Difference
3. Pressure Difference

- higher pressure on one side of a membrane than on the

other side means that the sum of all the forces of the molecules
striking the channels on that side of the membrane is greater
than on the other side. Causing movement from area of greater
pressure to area of lower pressure.

- Guyton 14th ed Chap 4 Pg 56-57

Rationale
Question Difficulty Level: DIFFICULT
#3
Every muscle in the body is composed of a mixture of so-called Fast and Slow
muscle fibers. The following are characteristics of a Slow muscle fiber.
I - Fibers are smaller
II - Fibers are innervated by smaller nerve fibers
III - Fibers have more extensive blood vessel system
IV - Fibers contain large amount of myosin
V - Fibers have fewer mitochondria

A. I and II
B. I, II, III
C. I, II, IV
D. I, II, III, IV
E. All of the Above
Question Difficulty Level: DIFFICULT
#3
Every muscle in the body is composed of a mixture of so-called Fast and Slow
muscle fibers. The following are characteristics of a Slow muscle fiber.
I - Fibers are smaller
II - Fibers are innervated by smaller nerve fibers
III - Fibers have more extensive blood vessel system
IV - Fibers contain large amount of myoglobulin
V - Fibers have fewer mitochondria

A. I and II
B. I, II, III
C. I, II, IV
D. I, II, III, IV
E. All of the Above
 Slow Muscle Fibers
Type 1 or Red Muscle
• Smaller Fibers
• Innervated by smaller nerve fibers.
• Have a more extensive blood vessel
system and more capillaries to supply
extra amounts of oxygen
• Greatly increased numbers of
mitochondria to support high levels of
oxidative metabolism
• Contain large amounts of myoglobin. The •
myoglobin gives the slow muscle a reddish
appearance and hence the name red
muscle.
Rationale
Fast Muscle Fibers
Type 2 or White Muscle
• Fibers are large for great strength of
contraction.
• An extensive sarcoplasmic reticulum is
present for rapid release of calcium ions to
initiate contraction.
• Large amounts of glycolytic enzymes are present
for rapid release of energy by the glycolytic
process.
Have a less extensive blood supply than do
slow fibers because oxidative metabolism is of
secondary importance.
• Have fewer mitochondria than do slow fibers,
also because oxidative metabolism is
secondary.A deficit of red myoglobin in fast
muscle gives it the name white muscle.
- Guyton 14th ed Chap 6 Pg 88
Question Difficulty Level: VERY DIFFICULT
#4
Excitation-contraction coupling in skeletal muscle involves all of the following events
EXCEPT one. Which one is this EXCEPTION?

A) Binding of Ca++ to calmodulin

B) Conformational change in dihydropyridine receptor
C) Depolarization of the transverse tubule (T tubule) membrane
D) Increased Na+ conductance in end-plate membrane
Question Difficulty Level: VERY DIFFICULT
#4
Excitation-contraction coupling in skeletal muscle involves all of the following events
EXCEPT one. Which one is this EXCEPTION?

A) Binding of Ca++ to calmodulin

B) Conformational change in dihydropyridine receptor
C) Depolarization of the transverse tubule (T tubule) membrane
D) Increased Na+ conductance in end-plate membrane
Question Difficulty Level: VERY DIFFICULT
#4
Excitation-contraction coupling in skeletal muscle involves all of the following events
EXCEPT one. Which one is this EXCEPTION?

A) Binding of Ca++ to calmodulin --> EC of Smooth Muscle

B) Conformational change in dihydropyridine receptor
EC of C) Depolarization of the transverse tubule (T tubule) membrane
Skeletal
muscle D) Increased Na+ conductance in end-plate membrane
 - USMLE Step 1 2019

Rationale Ganongs
23rd edition
Rationale
Question Difficulty Level: VERY EASY
#5
A Diagram of a Nerve Action Potential (for Questions 5 and 6)

What process is responsible for the change

in membrane potential that occurs between
point 1 and point 3?

A.Movement of Na+ into the cell

B.Movement of Na+ out of the cell
C.Movement of K+ into the cell
D.Movement of K+ out of the cell
Question Difficulty Level: VERY EASY
#5
A Diagram of a Nerve Action Potential (for Questions 5 and 6)

What process is responsible for the change

in membrane potential that occurs between
point 1 and point 3?

A. Movement of Na+ into the cell

B. Movement of Na+ out of the cell
C. Movement of K+ into the cell
D. Movement of K+ out of the cell
Nerve Action Potential

Resting stage is the resting membrane

potential before the action potential begins. The membrane is said
to be “polarized” during this stage because of the −70 millivolts
negative membrane potential that is present.

Resting Stage

Rationale - Guyton 13th ed, Chap 5 Page 65

Nerve Action Potential

Caused by opening of the Na+ channels. When the Na+ channels

open, Na+ moves into the cell down its electrochemical gradient,
driving the membrane potential toward the Na+ equilibrium
potential

on ti
The normal “polarized” state of –70 millivolts is immediately

lariza
neutralized by the inflowing positively charged sodium ions,
with the potential rising rapidly in the positive direction.This
Depo process is called depolarization.

Rationale - Guyton 13th ed, Chap 5 Page 65

Nerve Action Potential

Overshoot
Overshoot is the brief portion at the peak of action
potential when the membrane potential is
POSITIVE (lies above 0 millivolts)

great excess of positive Na+ ions moving to the

inside causes the membrane potential to actually
overshoot beyond the zero level and to become
somewhat positive

Rationale
Nerve Action Potential

Repol
The sodium channels begin to close, and the potassium channels
open to a greater degree than normal.

a
rizati
Then, rapid diffusion of potassium ions to the exterior re-
establishes the normal negative resting membrane potential, which

on
is called repolarization of the membrane.

Rationale - Guyton 13th ed, Chap 5 Page 65

Nerve Action Potential

Hyperpolarizing afterpotential (undershoot)

K+ conductance remains high for some time after closure of Na+
channels. Thus, bringing membrane potential very close to K+
equilibrium potential

Undershoot

Rationale - Guyton 13th ed, Chap 5 Page 65

Question Difficulty Level: AVERAGE
#6
A Diagram of a Nerve Action Potential (for Questions 5 and 6)

What process is responsible for the change

in membrane potential that occurs between
point 3 and point 5?

A.Movement of Na+ into the cell

B.Movement of Na+ out of the cell
C.Movement of K+ into the cell
D.Movement of K+ out of the cell
Question Difficulty Level: AVERAGE
#6
A Diagram of a Nerve Action Potential (for Questions 5 and 6)

What process is responsible for the change

in membrane potential that occurs between
point 3 and point 5?

A.Movement of Na+ into the cell

B.Movement of Na+ out of the cell
C.Movement of K+ into the cell
D.Movement of K+ out of the cell
Question Difficulty Level: EASY
#7
Simple diffusion and facilitated diffusion share which of the following
characteristics?

A) Can be blocked by specific inhibitors

B) Do not require adenosine triphosphate (ATP)
C) Require transport protein
D) Saturation kinetics
E) Transport solute against concentration gradientat
Question Difficulty Level: EASY
#7
Simple diffusion and facilitated diffusion share which of the following
characteristics?

A) Can be blocked by specific inhibitors

B) Do not require adenosine triphosphate (ATP)
C) Require transport protein
D) Saturation kinetics
E) Transport solute against concentration gradient
Question Difficulty Level: EASY
#7
Simple diffusion and facilitated diffusion share which of the following
characteristics?

A) Can be blocked by specific inhibitors --> (Not Applicable)

B) Do not require adenosine triphosphate (ATP)
C) Require transport protein -->(Only Facilitated Diffusion)
D) Saturation kinetics --> (Only Facilitated Diffusion)
E) Transport solute against concentration gradient --> (Neither)
In contrast to primary and secondary active transport, neither facilitated diffusion nor simple
diffusion requires additional energy and, therefore, can work in the absence of ATP.

Only facilitated diffusion displays saturation kinetics and involves a carrier protein.

By definition, neither simple nor facilitated diffusion can move molecules from low to high
concentration.

The concept of specific inhibitors is not applicable to simple diffusion that occurs through a
lipid bilayer without the aid of protein.

- Guyton 14th ed Chapter 4 Pg 52

Rationale
Question Difficulty Level: EASY
#8
Cytoskeleton is a network of fibrillar proteins organized into filaments or tubules.
These filaments are categorized into 3 types. What type of filament is found in
Centrioles and mitotic spindles during Cell division.

A.Microfilaments
B.Intermediate filaments
C.Microtubules
D.Cytokeratins
Question Difficulty Level: EASY
#8
Cytoskeleton is a network of fibrillar proteins organized into filaments or tubules.
These filaments are categorized into 3 types. What type of filament is found in
Centrioles and mitotic spindles during Cell division.

A.Microfilaments
B.Intermediate filaments
C.Microtubules
D.Cytokeratins
Question Difficulty Level: EASY
#8
Cytoskeleton is a network of fibrillar proteins organized into filaments or tubules.
These filaments are categorized into 3 types. What type of filament is found in
Centrioles and mitotic spindles during Cell division.

A.Microfilaments --> muscle contraction

B.Intermediate filaments --> maintain cell structure
C.Microtubules
D.Cytokeratins--> intermediate filament
 - USMLE Step 1 2019 pg 48

Both the centrioles and the mitotic spindle of the mitosing cell are composed of stiff microtubules.

- Guyton 13th ed. Page 17

Rationale
Question Difficulty Level: AVERAGE
#9
Which of the following will not shorten during muscle contraction?

A. Z Disk
B. A Band
C. I Band
D. H Zone
Question Difficulty Level: AVERAGE
#9
Which of the following will not shorten during muscle contraction?

A. Z Disk
B. A Band
C. I Band
D. H Zone
 A band = composed of overlapping Thick and thin filaments
AkA. Dark bands
it is the entire length of the thick filament or myosin

I band = composed ONLY of Thin filaments

AkA. Light bands

Z Disc = is the attachment site of Thin Filaments

is a boundary between sarcomeres

H zone= is the region of sarcomere where Thick filaments

do not overlap with think filaments
AKA. Bare Zone

Rationale
 HIZ Shrinks

Rationale A band is Always same length

Question Difficulty Level: VERY EASY
#10
Which of the following is a an inhibitory neurotransmitter in the central nervous
system (CNS)?

A. Norepinephrine
B. Glutamate
C. GABA
D. Serotonin
E. Histamine
Question Difficulty Level: VERY EASY
#10
Which of the following is a an inhibitory neurotransmitter in the central nervous
system (CNS)?

A. Norepinephrine
Inhibitory Excitatory
B. Glutamate Neurotransmitters Neurotransmitters
C. GABA
D. Serotonin GABA
Norepinephrine
Glycine Glutamate
E. Histamine Nitric Oxide
Serotonin
Histamine

- BRS 7th Ed Chapter 1 Pg

37-39
 GABA (ƴ-aminobutyric acid)
- is an inhibitory neurotransmitter
Inhibitory - synthesized from Glutamate by glutamate decarboxylase
Neurotransmitters
- it has 2 types of receptors:
• GABAa Receptor
- increases Cl- conductance and
GABA - is site of action of Benzodiazepine and Barbiturates
Glycine • GABAB Receptor
Nitric Oxide
- increases K+ conductance

Glycine
- is an inhibitory neurotransmitter found primarily in Spinal cord
and Brain stem
- increases Cl- conductance

Nitric Oxide
- is a short-acting inhibitory transmitter in GI, Blood Vessels and CNS
- is synthesized in presynaptic nerve terminals where NO synthase
converts Arginine to Citrulline and NO

Rationale - BRS 7th Ed Chapter 1 Pg 37-39

 Norepinephrine
- is the primary transmitter released from postganglionic
Excitatory sympathetic neurons
Neurotransmitters
- removed by reuptake or metabolized by MAO and COMT

Norepinephrine
Glutamate Glutamate
Serotonin - is the most prevalent excitatory neurotransmitter in the brain
Histamine
Serotonin
- is present in high concentrations in Brainstem
- is formed from tryptophan
- is converted to melatonin in Pineal gland

Histamine
- is formed from Histidine
- is present in the neurons of Hypothalamus

Rationale - BRS 7th Ed Chapter 1 Pg 37-39

Question # Difficulty Level: Average
11
Which characteristic or component is shared by skeletal muscle and smooth
muscle?

A. Thick and thin filaments arranged in sarcomeres

B. Troponin
C. Elevation of intracellular [Ca2+] for excitation–contraction coupling
D. Spontaneous depolarization of the membrane potential
E. High degree of electrical coupling between cells
Question # Difficulty Level: Average
11
Which characteristic or component is shared by skeletal muscle and smooth
muscle?

A. Thick and thin filaments arranged in sarcomeres

B. Troponin
C. Elevation of intracellular [Ca2+] for excitation–contraction coupling
D. Spontaneous depolarization of the membrane potential
E. High degree of electrical coupling between cells
Skeletal muscle Smooth muscle

Rationale
Question # Difficulty Level: Difficult
12
At the muscle end plate, acetylcholine causes the opening of:

A. Na+. channels and depolarization toward the Na+ equilibrium potential

B. K+ channels and depolarization toward the K+ equilibrium potential
C. Ca2+ channels and depolarization toward the Ca2+ equilibrium potential
D. Na+ and K+ channels and depolarization to a value halfway between the Na +
and K+ equilibrium potentials
Question # Difficulty Level: Difficult
12
At the muscle end plate, acetylcholine causes the opening of:

A. Na+. channels and depolarization toward the Na+ equilibrium potential

B. K+ channels and depolarization toward the K+ equilibrium potential
C. Ca2+ channels and depolarization toward the Ca2+ equilibrium potential
D. Na+ and K+ channels and depolarization to a value halfway between
the Na+ and K+ equilibrium potentials
Rationale
Question # Difficulty Level: Average
13
Which of the following temporal sequences is correct for
excitation–contraction coupling in skeletal muscle?
A. Increased intracellular Ca2+; action potential in the muscle membrane; cross-
bridge formation
B. Action potential in the muscle membrane; depolarization of the T tubules;
release of Ca2+2+ from the SR
C. Action potential in the muscle membrane; splitting of adenosine
triphosphate (ATP); binding of Ca2+ to troponin C
D. Release of Ca2+ from the SR; depolarization of the T tubules; binding of
Ca2+ to troponin C
Question #
13 Difficulty Level: Average

Which of the following temporal sequences is correct for

excitation–contraction coupling in skeletal muscle?
A. Increased intracellular Ca2+; action potential in the muscle membrane; cross-
bridge formation
B. Action potential in the muscle membrane; depolarization of the T
tubules; release of Ca2+2+ from the SR
C. Action potential in the muscle membrane; splitting of adenosine
triphosphate (ATP); binding of Ca2+ to troponin C
D. Release of Ca2+ from the SR; depolarization of the T tubules; binding of
Ca2+ to troponin C
Rationale
Question #
14 Difficulty Level: Difficult

In contraction of gastrointestinal smooth muscle, which of the following

events occurs after binding of Ca2+ to calmodulin?
2+

A. Depolarization of the sarcolemmal membrane

B. Ca2+2+-induced Ca2+2+ release
C. Increased myosin-light-chain kinase
D. Increased intracellular Ca2+2+ concentration
E. Opening of ligand-gated Ca2+2+ channels
Question #
14 Difficulty Level: Difficult

In contraction of gastrointestinal smooth muscle, which of the following

events occurs after binding of Ca2+ to calmodulin?
2+

A. Depolarization of the sarcolemmal membrane

B. Ca2+2+-induced Ca2+2+ release
C. Increased myosin-light-chain kinase
D. Increased intracellular Ca2+2+ concentration
E. Opening of ligand-gated Ca2+2+ channels
Rationale
Question #
15 Difficulty Level: Difficult

Which of the following is true regarding smooth muscle?

A. The force of smooth muscle contraction is highly dependent on calcium

released from the sarcoplasmic reticulum.
B. Removal of potassium from the intracellular fluid facilitates smooth
muscle relaxation.
C. The maximum force of contraction of smooth muscle is greater than that
of skeletal muscle.
D. Myosin phosphatase determines the time required for contraction of
smooth muscle.
Question #
15 Difficulty Level: Difficult

Which of the following is true regarding smooth muscle?

A. The force of smooth muscle contraction is highly dependent on calcium

released from the sarcoplasmic reticulum.
B. Removal of potassium from the intracellular fluid facilitates smooth
muscle relaxation.
C. The maximum force of contraction of smooth muscle is greater than
that of skeletal muscle.
D. Myosin phosphatase determines the time required for contraction of
smooth muscle.
Rationale
Rationale
Question #16-25:
Immunology
PGI Maryanne Waga
Question Difficulty Level: Difficult
#16
  Innate component(s) of immunity is/are
I. Bone marrow cells
II.  Lymphatic cells
III. NK cells

A.  I & III

B.  I &II
C.  I, II & III
D.  II & III

     
 GENERAL PROCESS:
(NON-SPECIFIC)
>Phagocytosis
>Destruction through enzymes
>resistance of skin to invasions by
organisms
>Presence of certain chemicals in the
blood and cells that attach to foreign
organisms or toxins that destroy them
-Rapidly: Minutes- hours

-No memory response

ability to develop extremely

powerful and HIGHLY SPECIFIC
IMMUNITY against individual
invading agents
-develops over longer
periods

-memory response is faster

and more robust

Rationale
 MACROPHAGE

USMLE 2020, page 96,99

Rationale G u y t o n & H a l l : Te x t b o o k o f M e d i c a l P h y s i o l o g y 1 4 e d ,
page 450
Question Difficulty Level: Easy
#17
Which is not true for T lymphocytes?
A.    Differentiate and mature in the thymus
B.    Establish residence in the Para cortex area of the
lymph node
C.   Provide the helper factor for B cell activation
D.   Differentiate into plasma cells
 GENERAL PROCESS:
(NON-SPECIFIC)
>Phagocytosis
>Destruction through enzymes
>resistance of skin to invasions by
organisms
>Presence of certain chemicals in the
blood and cells that attach to foreign
organisms or toxins that destroy them
-Rapidly: Minutes- hours

-No memory response

ability to develop extremely

powerful and HIGHLY SPECIFIC
IMMUNITY against individual
invading agents
-develops over longer
B Lymphocytes
periods

-memory response is faster

and more robust

T Lymphocytes

Rationale
 B.    Establish residence in the Para cortex area of the
lymph node

A. Differentiate and mature in the thymus

Rationale USMLE 2020, page 96

 C.   Provide the helper factor for B cell
IL-2
activation

IL-4,5,6

G u y t o n & H a l l : Te x t b o o k o f M e d i c a l P h y s i o l o g y , 1 4 t h e d ,

Rationale p a g e 460, 462,466,467

Ga n o n g ’s Rev i ew o f Med ica l Ph y s io l o g y, 2 6 t h ed , p a g e7 7
Question Difficulty Level: Difficult
#18
Characteristics of Humoral immunity include the following:

A.    The body develops circulating antibodies which are globin molecules
in the blood that are capable of attacking the invading agent
B.    Achieved through the formation of large numbers of activated
lymphocytes designed to destroy foreign agent
C.   T lymphocytes produce  immunoglobulins
D.   All of these
 GENERAL PROCESS:
(NON-SPECIFIC)
>Phagocytosis
>Destruction through enzymes
>resistance of skin to invasions by
organisms
>Presence of certain chemicals in the
blood and cells that attach to foreign
organisms or toxins that destroy them
-Rapidly: Minutes- hours

-No memory response

ability to develop extremely

powerful and HIGHLY SPECIFIC
IMMUNITY against individual
invading agents
-develops over longer
periods

-memory response is faster

and more robust

Rationale
 B Lymphocytes

ability to develop extremely

powerful and HIGHLY SPECIFIC
IMMUNITY against individual
invading agents
-develops over longer T Lymphocytes
periods

-memory response is faster

and more robust

Rationale
 Guyton & Hall: Textbook of Medical Physiology , 14ed, page
Rationale 460
Question Difficulty Level: Difficult
#18
Characteristics of Humoral immunity include the following:

A.    The body develops circulating antibodies which are globin

molecules in the blood that are capable of attacking the invading agent
B.    Achieved through the formation of large numbers of activated
lymphocytes designed to destroy foreign agent
C.   T lymphocytes produce  immunoglobulins
D.   All of these
The humoral immunity is also known as the B cell immunity
because B lymphocytes produce the antibodies. The body
develops circulating antibodies which are globin molecules in
the blood plasma capable of attacking the invading antigen

B. Is pertaining to cell mediated Immunity

C. B Cells/ Lymphocytes are responsible with the production of

immunoglobulins

Rationale Guyton & Hall: Textbook of Medical Physiology , 14ed, page 459-462
 A. CORRECT

A.    The body develops

circulating antibodies which are
globin molecules in the blood
that are capable of attacking the
invading agent

Rationale Guyton & Hall: Textbook of Medical Physiology , 14ed, page 459-462
 B. WRONG!

Cell mediated Immunity

B.    Achieved through

the formation of large
numbers of activated
lymphocytes designed
to destroy foreign agent

Rationale Guyton & Hall: Textbook of Medical Physiology , 14ed, page 459-462
 C. WRONG!

C.   T lymphocytes produce 
immunoglobulins

ANTIBODIES= IMMUNOGLOBULINS

Rationale Guyton & Hall: Textbook of Medical Physiology , 14ed, page 459-462
Question Difficulty Level: Average
#19
Which of the following is incorrectly matched?

A.    IgM- 1ST antibody class typically released by plasma cells

B.    IgD- binds to mast cells and basophils and causes histamine release
C.   IgG- able to activate complement
D.   IgA- found in saliva and tears
Rationale USMLE 2020, page 105
Question Difficulty Level: Easy
#20
Which component of the complement system promotes
opsonization?
A.    C3a
B.    C3b
C.   C4a
D.   C4b
E.    C5a
 Complement system:
MAIN FUNCTION
01 Enhance (complement) the actions of
antibodies and phagocytic cells in neutralizing
and destroying pathogens, removing damaged
cells from the body and promote inflammation

COMPLEMENT
02 -collective term that describes a system of about 20
proteins, many of which are enzyme precursors
-Principal actors in this system are 11 proteins
designated C1 through C9, B, and D
present normally: plasma proteins in the blood, the
proteins that leak out of the capillaries into the tissue
spaces.
CLASSICAL PATHWAY
03 The enzyme precursors are normally inactive but
can be activated

G u y t o n & H a l l : Te x t b o o k o f M e d i c a l P h y s i o l o g y
, 14ed, page 465 C3b-O (Opsonization)

Rationale
C5a- chemoTAXIs
(think of TAXI along C5 highway)
Question Difficulty Level: Very Easy
#21Which of the following statement/s is/are true?
A.    Neutrophils are typically one of the first WBCs to arrive at the
site of infection
B.    Macrophages contain lysosomes which contain digestive
enzymes
C.   Eosinophils help defend against parasitic infections
D.   Natural killer cells attack and kill virus infected cells
E.    All of the above
A.    Neutrophils are typically one of the first WBCs to arrive at
the site of infection
B.    Macrophages contain lysosomes which contain digestive
enzymes
Both neutrophils and macrophages contain an abundance of
lysosomes filled with proteolytic enzymes especially geared for
digesting bacteria and other foreign protein matter. The lysosomes of
macrophages (but not of neutrophils) also contain large amounts of
lipases, which digest the thick lipid membranes possessed by some
bacteria, such as the tuberculosis bacillus. p452
C.   Eosinophils help defend against parasitic
infections
Eosinophils, however, are often produced in large numbers in D. Natural killer cells attack and kill virus infected cells
people with parasitic infections, and they migrate into
tissues diseased by parasites. Although most parasites are
too large to be phagocytized by eosinophils or any other
phagocytic cells, eosinophils attach themselves to the
parasites by way of special surface molecules and release
substances that kill many of the parasites
Robbins and Cotran: Pathologic Basis of Disease, 9 th Ed, p.71

Rationale
USMLE 2020, page 101
Guyton & Hall: Textbook of Medical Physiology , 14ed, page 452,456
Question Difficulty Level: Easy
#22An unknown red cell solution that agglutinates with the addition of
antisera A and antisera B has the following phenotype.

A.    Blood type O

B.    Blood type A
C.   Blood type B
D.   Blood type AB
An unknown red cell solution that agglutinates with the addition of
antisera A and antisera B has the following phenotype.

A.    Blood type O

B.    Blood type A
C.   Blood type B
D.   Blood type AB

Rationale Guyton & Hall: Textbook of Medical Physiology , 14 th ed, page 471-
473
Question Difficulty Level: Average
#23 TRUE of Delayed type hypersensitivity
A.  Antigen sensitization of primary contact
B.  Increased immunoglobulin production
C.  Occurs within minutes to hours
D.  Tissue injury mediated by helper T cells
Rationale Robbins and Cotran: Pathologic Basis of Disease, 9th Ed, p.205,207
Rationale USMLE 2020 page 112-113
Rationale USMLE 2020 page 112-113
Question Difficulty Level: Easy
#24
The least common of granulocytes but very important in immediate
hypersensitivity reactions because it releases Histamine.

A. Basophil
B. Eosinophil
C. Neutrophil
D. NK cells
E. Lymphocytes
Question Difficulty Level: Easy
#24
The least common of granulocytes but very important in immediate
hypersensitivity reactions because it releases Histamine.

A. Basophil
B. Eosinophil
C. Neutrophil
D. NK cells
E. Lymphocytes
Question Difficulty Level: Easy
#24
The least common of granulocytes but very important in immediate
hypersensitivity reactions because it releases Histamine.

A. Basophil
B. Eosinophil
C. Neutrophil
D. NK cells
E. Lymphocytes
 Guyton & Hall: Textbook of Medical Physiology , 14 th ed, page 449
Rationale
Question Difficulty Level: Easy
#25 
Vaccination makes use of live or attenuated infectious agents to most
likely give rise to:

A. Innate Immunity
B. Active Immunity
C. Adaptive Immunity
D. Passive Immunity
Rationale
Rationale USMLE 2020, page 110-111
 Question #26-30
Hematopoiesis, Hemostasis
PGI Shelley Pantinople
Question #
26 Difficulty Level: Difficult

Bone marrow starts to form blood cells at what age?

A. 3rd week of fetal development

B. 4th week of fetal development
C. 3rd month of fetal development
D. 4th month of fetal development
E. At birth
Question #
26 Difficulty Level: Difficult

Bone marrow starts to form blood cells at what age?

A. 3rd week of fetal development

B. 4th week of fetal development
C. 3rd month of fetal development
D. 4th month of fetal development
E. At birth
Rationale
Rationale
Question #
27 Difficulty Level: Difficult

What is the last nucleated stage found in erythropoiesis?

A. Basophilic erythroblast
B. Polychromatophilic erythroblast
C. Orthochromatic erythroblast
D. Reticulocyte
Question #
27 Difficulty Level: Difficult

What is the last nucleated stage found in erythropoiesis?

A. Basophilic erythroblast
B. Polychromatophilic erythroblast
C. Orthochromatic erythroblast
D. Reticulocyte
 Filled with hemoglobin
Nucleus condenses to small size, then
absorbed or extruded
ER reabsorbed
Basophilic material disappears

Rationale
Question #
28 Difficulty Level: Average

True of intrinsic pathway for initiating clotting:

A. begins with a traumatized vascular wall

B. begins with extravascular tissues that come into contact with blood
C. begins with trauma to the blood
D. B&C
E. all of the above
Question #
28 Difficulty Level: Average

True of intrinsic pathway for initiating clotting:

A. begins with a traumatized vascular wall

B. begins with extravascular tissues that come into contact with blood
C. begins with trauma to the blood
D. B&C
E. all of the above
Rationale
Question #
29 Difficulty Level: Difficult

What is the clotting factor IV?

A. Labile factor
B. Conversion factor
C. Calcium
D. Hageman factor
E. Magnesium
Question #
29 Difficulty Level: Difficult

What is the clotting factor IV?

A. Labile factor
B. Conversion factor
C. Calcium
D. Hageman factor
E. Magnesium
Rationale
Question #
30 Difficulty Level: Difficult

Which of the following is true?

A. Fibrin-stabilizing factor causes non-covalent bonds between fibrin

monomer molecules and cross-linkages between fibrin fibers
B. Thrombin causes polymerization of fibrinogen molecules into fibrin fibers
C. Once a blood clot has started to develop, it causes a negative feedback to
lessen clotting.
D. The rate limiting factor in causing blood coagulation is the conversion of
fibrinogen to fibrin.
Question #
30 Difficulty Level: Difficult

Which of the following is true?

A. Fibrin-stabilizing factor causes non-covalent bonds between fibrin

monomer molecules and cross-linkages between fibrin fibers
B. Thrombin causes polymerization of fibrinogen molecules into fibrin
fibers
C. Once a blood clot has started to develop, it causes a negative feedback to
lessen clotting.
D. The rate limiting factor in causing blood coagulation is the conversion of
fibrinogen to fibrin.
Rationale
 Question #31-40:
Renal and Acid Base
Physiology
PGI Vanessa Gail Lumacang
Question #31 Difficulty Level: DIFFICULT

Renin is a component of the RAA system which the body uses to control blood
pressure. Which of the following will lead to an increase in the circulating levels of
renin in the blood?

A. Decreased renal sympathetic activity

B. Increased blood pressure
C. Decreased NaCl delivery to macula densa
D. All of the above
E. None of the above
Question #31 Difficulty Level: DIFFICULT

Renin is a component of the RAAS system which the body uses to control blood
pressure. Which of the following will lead to an increase in the circulating levels of
renin in the blood?

A. Decreased renal sympathetic activity

B. Increased blood pressure
C. Decreased NaCl delivery to macula densa
D. All of the above
E. None of the above
A. Decreased renal sympathetic activity
B. Increased blood pressure
C. Decreased NaCl delivery to macula densa
D. All of the above
E. None of the above

Rationale USMLE 2020, Section III, page 588

Rationale USMLE 2020, Section III, page 588
Rationale USMLE 2020, Section III, page 588
Rationale USMLE 2020, Section III, page 588
Question #32 Difficulty Level: DIFFICULT

Which statement regarding urine formation is correct?

A. The glomerular capillaries have much higher rate of filtration than most capillaries
because of a high glomerular oncotic pressure
B. Endothelial cells of the glomerular capillary membrane are richly endowed with
fixed negative charges that hinder passage of plasma proteins
C. Tubular secretion is quantitatively important than tubular reabsorption in the
formation of urine
D. Most substances in the plasma, except for proteins and sugars, are freely filtered
E. None of the above
Question #32 Difficulty Level: DIFFICULT

Which statement regarding urine formation is correct?

A. The glomerular capillaries have much higher rate of filtration than most capillaries
because of a high glomerular oncotic pressure
B. Endothelial cells of the glomerular capillary membrane are richly endowed
with fixed negative charges that hinder passage of plasma proteins
C. Tubular secretion is quantitatively important than tubular reabsorption in the
formation of urine
D. Most substances in the plasma, except for proteins and sugars, are freely filtered
E. None of the above
A. The glomerular capillaries have a much higher rate of filtration than most
other capillaries because of a high glomerular hydrostatic pressure and a
large capillary filtration coefficient (Kf).
C. Tubular reabsorption is quantitatively more important than tubular secretion
in the formation of urine.
D. Most substances in the plasma, except for proteins, are freely filtered, so their
concentration in the glomerular filtrate in the Bowman’s capsule is almost
the same as in the plasma.

Guyton Physiology, 14th ed., Ch 26, pages 323,

Rationale 329, 330
Filterability of 1.0 means that the substance is filtered as freely as water
whereas, filterability of 0.75 means that the substance only 75% as rapidly as
water.

Rationale Guyton Physiology, 14th ed., Ch 27, page 332

Question #33 Difficulty Level: AVERAGE

SIADH will cause what type of fluid imbalance?

A. Isoosmotic volume expansion

B. Hyperosmotic volume expansion
C. Hypoosmotic volume expansion
D. Isoosmotic volume contraction
E. Hyperosmotic volume contraction
Question #33 Difficulty Level: AVERAGE

SIADH will cause what type of fluid imbalance?

A. Isoosmotic volume expansion

B. Hyperosmotic volume expansion
C. Hypoosmotic volume expansion
D. Isoosmotic volume contraction
E. Hyperosmotic volume contraction
Rationale Guyton Physiology, 14th ed., Ch 25, page 314
Question #34 Difficulty Level: AVERAGE

This characteristic feature is NOT associated with the glomerulus:

A. Composed of anastomosing network of capillaries

B. Has a low hydrostatic pressure
C. Capillaries are covered by the epithelial cells
D. Fluid filtered flows into the Bowman’s capsule
E. None of the above
Question #34 Difficulty Level: AVERAGE

This characteristic feature is NOT associated with the glomerulus:

A. Composed of anastomosing network of capillaries

B. Has a low hydrostatic pressure
C. Capillaries are covered by the epithelial cells
D. Fluid filtered flows into the Bowman’s capsule
E. None of the above
The glomerulus contains a network of
branching and anastomosing glomerular
capillaries that compared with other
capillaries have high hydrostatic pressure.
The glomerular capillaries are covered
with epithelial cells.

Guyton Physiology, 14th ed., Ch 26, pages 323,

Rationale 329, 330
 Fluid filtered from the glomerular
capillaries flows into Bowman’s capsule
and then into the proximal tubule.

Guyton Physiology, 14th ed., Ch 26, pages 323,

Rationale 329, 330
Question #35 Difficulty Level: DIFFICULT

During diabetic ketoacidosis, hydrogen ions actively secreted by the proximal

tubule are associated with which physiologic process?

A. Excretion of ammonium ions

B. Reabsorption of bicarbonate
C. Reabsorption of potassium ions
D. Reabsorption of phosphate ions
E. All of the above
Question #35 Difficulty Level: DIFFICULT

During diabetic ketoacidosis, hydrogen ions actively secreted by the proximal

tubule are associated with which physiologic process?

A. Excretion of ammonium ions

B. Reabsorption of bicarbonate
C. Reabsorption of potassium ions
D. Reabsorption of phosphate ions
E. All of the above
Rationale Guyton Physiology, 14th ed., Ch 31, page 411
Rationale Guyton Physiology, 14th ed., Ch 31, pages 415
A. Excretion of ammonium ions
B. Reabsorption of bicarbonate
C. Reabsorption of potassium
ions
D. Reabsorption of phosphate
ions
E. All of the above

Rationale BRS Physiology, 7th ed., page 336

Hyperkalemia inhibits NH3
synthesis which produces a
decrease in H+ excretion as
NH4+.

Rationale BRS Physiology, 7th ed., page 335

A. Excretion of ammonium ions
B. Reabsorption of bicarbonate
C. Reabsorption of potassium
ions
D. Reabsorption of phosphate
ions
E. All of the above

Rationale Guyton Physiology, 14th ed., Ch 30, pages 384

A. Excretion of ammonium ions
B. Reabsorption of bicarbonate
C. Reabsorption of potassium
ions
D. Reabsorption of phosphate
ions
E. All of the above

Rationale Osmosis Video

A. Excretion of ammonium ions
B. Reabsorption of bicarbonate
C. Reabsorption of potassium
ions
D. Reabsorption of phosphate
ions
E. All of the above

Rationale Osmosis Video

A. Excretion of ammonium ions
B. Reabsorption of bicarbonate
C. Reabsorption of potassium
ions
D. Reabsorption of phosphate
ions
E. All of the above

Rationale Guyton Physiology, 14th ed., Ch 30, pages 384

Question #36 Difficulty Level: DIFFICULT

Which of the following will decrease the secretion of K+ in the distal tubule?

A. High potassium diet

B. Metabolic alkalosis
C. Thiazide diuretic
D. Hypoaldosteronism
E. Treatment with beta agonist
Question #36 Difficulty Level: DIFFICULT

Which of the following will decrease the secretion of K+ in the distal tubule?

A. High potassium diet

B. Metabolic alkalosis
C. Thiazide diuretic
D. Hypoaldosteronism
E. Treatment with beta agonist
Rationale Guyton Physiology, 14th ed., Ch 30, pages 384
Rationale Osmosis Video
Rationale Osmosis Video
Rationale Osmosis Video
Rationale Osmosis Video
A. High potassium diet
B. Metabolic alkalosis
C. Thiazide diuretic
D. Hypoaldosteronism
E. Treatment with
beta agonist

Rationale Guyton Physiology, 14th ed., Ch 30, pages 388

A. High potassium diet
B. Metabolic alkalosis
C. Thiazide diuretic
D. Hypoaldosteronism
E. Treatment with
beta agonist

Rationale Osmosis Video

 A. High potassium diet
B. Metabolic alkalosis
C. Thiazide diuretic
D. Hypoaldosteronism
E. Treatment with
beta agonist

MECHANISM OF ACTION:
Inhibit Na-Cl symporter

Rationale Dr. Mike and Dr. Matt YouTube Video

A. High potassium diet
B. Metabolic alkalosis
C. Thiazide diuretic
D. Hypoaldosteronism
E. Treatment with
beta agonist

Rationale Dr. Mike and Dr. Matt YouTube Video

A. High potassium diet
B. Metabolic alkalosis
C. Thiazide diuretic
D. Hypoaldosteronism
E. Treatment with
beta agonist

Rationale Dr. Mike and Dr. Matt YouTube Video

A. High potassium diet
B. Metabolic alkalosis
C. Thiazide diuretic
D. Hypoaldosteronism
E. Treatment with
beta agonist

Rationale Dr. Mike and Dr. Matt YouTube Video

A. High potassium diet
B. Metabolic alkalosis
C. Thiazide diuretic
D. Hypoaldosteronism
E. Treatment with
beta agonist

Rationale Dr. Mike and Dr. Matt YouTube Video

A. High potassium diet
B. Metabolic alkalosis
C. Thiazide diuretic
D. Hypoaldosteronism
E. Treatment with
beta agonist

Rationale Osmosis Video

A. High potassium diet
B. Metabolic alkalosis
C. Thiazide diuretic
D. Hypoaldosteronism
E. Treatment with
beta agonist

Rationale Osmosis Video

Question #37 Difficulty Level: AVERAGE

Angiotensin II plays an essential role in regulation of renal circulation. Its action on

the efferent arteriole will result in which of the following changes?

A. Decreased GFR, no change in RPF, decreased FF

B. Increased GFR, decreased RPF, increased FF
C. Decreased GFR, decreased RPF, no change in FF
D. Decreased GFR, decreased RPF, decreased FF
E. None of the above
Question #37 Difficulty Level: AVERAGE

Angiotensin II plays an essential role in regulation of renal circulation. Its action on

the efferent arteriole will result in which of the following changes?

A. Decreased GFR, no change in RPF, decreased FF

B. Increased GFR, decreased RPF, increased FF
C. Decreased GFR, decreased RPF, no change in FF
D. Decreased GFR, decreased RPF, decreased FF
E. None of the above
Rationale BRS Physiology, 7th ed., Ch 5, page 291
Rationale BRS Physiology, 7th ed., Ch 5, page 290
 Determined by 3 factors:
1. Arterial pressure
2. Afferent arteriolar resistance
3. Efferent arteriolar resistance

Rationale BRS Physiology, 7th ed., Ch 5, page 290

Rationale Guyton Physiology, 14th ed., Ch 27, pages 335
Rationale Guyton Physiology, 14th ed., Ch 27, pages 335
Question #38 Difficulty Level: AVERAGE

The following statements are true regarding the kidneys, except:

A. Left kidney is lower than the right kidney

B. Glomerular capillaries are the only capillaries that lead to arterioles
C. Kidneys produce calcitriol, renin and erythropoietin
D. Peritubular capillaries participate in countercurrent exchange
E. None of the above
Question #38 Difficulty Level: AVERAGE

The following statements are true regarding the kidneys, except:

A. Left kidney is lower than the right kidney

B. Glomerular capillaries are the only capillaries that lead to arterioles
C. Kidneys produce calcitriol, renin and erythropoietin
D. Peritubular capillaries participate in countercurrent exchange
E. None of the above
The right kidney lies slightly lower
than the left because of the large
size of the right lobe of the liver.

Rationale Clinical Anatomy by Snell, Ch 5, page 206

Rationale USMLE 2020, Section III, page 580
Rationale USMLE 2020, Section III, page 589
 Countercurrent exchange is a purely
passive process that helps maintain the
gradient.

Countercurrent multiplication is an active

process that establishes the
corticopapillary osmotic gradient.

Rationale Physiology by Costanzo, 6th ed., Ch 6, page 302

Question #39 Difficulty Level: DIFFICULT

The clearance of this substance is equal to the glomerular filtration rate.

A. Glucose
B. Inulin
C. Creatinine
D. Paraamino hippuric acid (PAH)
Question #39 Difficulty Level: DIFFICULT

The clearance of this substance is equal to the glomerular filtration rate.

A. Glucose
B. Inulin
C. Creatinine
D. Paraamino hippuric acid (PAH)
The following generalizations can be made by comparing the clearance of a
substance with the clearance of inulin, the gold standard for measuring GFR:

1. If the clearance rate of the substance equals that of inulin, the substance is
only filtered and not reabsorbed

2. If the clearance rate is less than of inulin clearance, the substance must have
been reabsorbed by the tubules

Rationale Guyton Physiology, 14th ed., Ch 28, pages 364

3. If the clearance rate of a substance is greater than that of inulin, the substance
must be secreted by the tubules

Rationale Guyton Physiology, 14th ed., Ch 28, pages 364

3. If the clearance rate of a substance is greater than that of inulin, the substance
must be secreted by the tubules

A. Glucose
B. Inulin
C. Creatinine
D. Paraamino hippuric acid
(PAH)

Rationale Guyton Physiology, 14th ed., Ch 28, pages 364

3. If the clearance rate of a substance is greater than that of inulin, the substance
must be secreted by the tubules
Paraamino hippuric acid (PAH) is
A. Glucose filtered and secreted by the renal
B. Inulin tubules. Clearance of PAH is used to
C. Creatinine measure RPF.
D. Paraamino hippuric acid
(PAH)

Rationale BRS Physiology, 7th ed., Ch 5, page 286

Question #40 Difficulty Level: AVERAGE

A 52-year old female came in due to vomiting. ABG result showed: pH 7.46, PaO2
80 mmHg, HCO3 29 mEq/L, paCO2 51 mmHg and O2 sat 95%. This is compatible
with what abnormality?

A. Uncompensated metabolic alkalosis

B. Uncompensated respiratory alkalosis
C. Partially compensated respiratory alkalosis
D. Partially compensated metabolic alkalosis
E. Partially compensated respiratory acidosis
Question #40 Difficulty Level: AVERAGE

A 52-year old female came in due to vomiting. ABG result showed: pH 7.46, PaO2
80 mmHg, HCO3 29 mEq/L, paCO2 51 mmHg and O2 sat 95%. This is compatible
with what abnormality?

A. Uncompensated metabolic alkalosis

B. Uncompensated respiratory alkalosis
C. Partially compensated respiratory alkalosis
D. Partially compensated metabolic alkalosis
E. Partially compensated respiratory acidosis
NORMAL VALUES
pH: 7.35 – 7.45
PaCO2: 35 – 45 mmHg
HCO3: 22 – 26 mEq/L
PaO2: 80 – 100 mmHg
O2 sat: ≥ 95%

Rationale IM Platinum
pH: 7.35 – 7.45
PaCO2: 35 – 45 mmHg
HCO3: 22 – 26 mEq/L
PaO2: 80 – 100 mmHg
O2 sat: ≥ 95%

pH: 7.46
PaCO2: 51 mmHg
HCO3: 29 mmHg
PaO2: 80 mmHg
O2 sat: 95%

Rationale
pH: 7.35 – 7.45
PaCO2: 35 – 45 mmHg
HCO3: 22 – 26 mEq/L
PaO2: 80 – 100 mmHg
O2 sat: ≥ 95%

pH: 7.46 ALKALOTIC

PaCO2: 51 mmHg
HCO3: 29 mmHg
PaO2: 80 mmHg
O2 sat: 95%

Rationale
 pH: 7.46 ALKALOTIC
PaCO2: 51 mmHg
HCO3: 29 mmHg
PaO2: 80 mmHg
O2 sat: 95%

● In respiratory disorders, the pH and PaCO2 change in opposite directions

● In metabolic disorders, the pH and HCO3 change in the same direction

Rationale
 pH: 7.46 ALKALOTIC
PaCO2: 51 mmHg
HCO3: 29 mmHg
PaO2: 80 mmHg
O2 sat: 95%

● In respiratory disorders, the pH and PaCO2 change in opposite directions

● In metabolic disorders, the pH and HCO3 change in the same direction

METABOLIC ALKALOSIS

Rationale
 pH: 7.46 ALKALOTIC
PaCO2: 51 mmHg
HCO3: 29 mmHg
PaO2: 80 mmHg
O2 sat: 95%

● In respiratory disorders, the pH and PaCO2 change in opposite directions

● In metabolic disorders, the pH and HCO3 change in the same direction

METABOLIC ALKALOSIS
COMPENSATED OR UNCOMPENSATED?

Rationale
Rationale BRS Physiology, 7th ed., Ch 5, page 291
pH: 7.46 ALKALOTIC
PaCO2: 51 mmHg
HCO3: 29 mmHg
PaO2: 80 mmHg
O2 sat: 95%

METABOLIC ALKALOSIS

Rationale
pH: 7.46 ALKALOTIC
PaCO2: 51 mmHg
HCO3: 29 mmHg
PaO2: 80 mmHg
O2 sat: 95%

COMPENSATED
METABOLIC ALKALOSIS

Rationale
 pH: 7.46 ALKALOTIC
PaCO2: 51 mmHg
HCO3: 29 mmHg
PaO2: 80 mmHg
O2 sat: 95%

● If pH is normal, it is fully compensated.

● If pH is abnormal, it is partially compensated.

COMPENSATED
METABOLIC ALKALOSIS

Rationale
 pH: 7.46 ALKALOTIC
PaCO2: 51 mmHg
HCO3: 29 mmHg
PaO2: 80 mmHg
O2 sat: 95%

● If pH is normal, it is fully compensated.

● If pH is abnormal, it is partially compensated.

PARTIALLY COMPENSATED
METABOLIC ALKALOSIS

Rationale
Rationale
Question #41-50:
Renal Physiology
PGI Asela Hariza M. Tominoray
Question Difficulty Level:
#41
 
DIFFICULT

A 69 year old man presents with symptoms of thirst and dizziness, and physical evidence of orthostatic
hypotension and tachycardia, decreased skin turgor, dry mucous membranes, reduced axillary sweating, and
reduced jugular venous pressure. He was recently placed on Angiotensin Converting Enzyme inhibitors for his
Hypertension. Urinalysis reveals a reduction in the fractional excretion of sodium and the presence of acellular
hyaline casts. The internist suspects acute renal failure of pre renal origin associated with increased renin
secretion is an increase in which of the following?

A. Angiotensin II
B. Atrial Natriuretic Peptide (ANP)
C. GFR
D. Mean Blood Pressure
E. Sympathetic Nerve Activity
Question Difficulty Level:
#41
 
DIFFICULT

A 69 year old man presents with symptoms of thirst and dizziness, and physical evidence of orthostatic
hypotension and tachycardia, decreased skin turgor, dry mucous membranes, reduced axillary sweating, and
reduced jugular venous pressure. He was recently placed on Angiotensin Converting Enzyme inhibitors for his
Hypertension. Urinalysis reveals a reduction in the fractional excretion of sodium and the presence of acellular
hyaline casts. The internist suspects acute renal failure of pre renal origin associated with increased renin
secretion is an increase in which of the following?

A. Angiotensin II
B. Atrial Natriuretic Peptide (ANP)
C. GFR
D. Mean Blood Pressure
E. Sympathetic Nerve Activity
E.Sympathetic Nerve Activity
Renin secretion is stimulated by sympathetic nerves innervating the
juxtaglumerular apparatus. Sympathetic nerve activity increases when
baroreceptors sense low blood pressure.

Rationale G u y t o n & H a l l : Te x t b o o k o f M e d i c a l P h y s i o l o g y 1 4 t h
ed. pp.236
 3. Tubuloglumerular
feedback

2. Aldosterone
(ADH)
1.
Renin-Angiotensin Vasoconstrictor
Mechanism

Rationale G u y t o n & H a l l : Te x t b o o k o f M e d i c a l P h y s i o l o g y 1 4 t h
ed. pp . 323-326
 3. Tubuloglumerular
feedback
• Macula densa
- sense changes in NaCl delivery to
the distal tubule. has two (2)
functions:
(1) it decreases resistance to blood
flow in the afferent arterioles, -->
raises glomerular hydrostatic pressure
and helps return GFR toward normal;
(2) it increases renin release
from the juxtaglomerular cells of the
afferent and efferent arterioles

Rationale G u y t o n & H a l l : Te x t b o o k o f M e d i c a l P h y s i o l o g y 1 4 t h
ed.
➢Increasing mean blood pressure (D) decreases sympathetic activity,
thereby decreasing renin secretion.
➢Angiotensin II (A) decreases renin release through a negative feedback
loop by binding AT1 receptors on the juxtaglumerular cells to increase renal
Ca2+ concentration, which inhibits renin secretion.
➢ANP (B) also decreases renin release.
➢Increases in GFR (C) sensed by macula densa leads to secretion of
Adenosine or ATP which contracts the afferent artertiole(tubuloglumerula
feedback) and decreases renin releases. Decreases in GFR leads to an increase
in renin release.

Rationale G u y t o n & H a l l : Te x t b o o k o f M e d i c a l P h y s i o l o g y 1 4 t h
ed.
Question Difficulty Level: EASY
#42
A 63 year old hospitalized woman becomes oliguric and confused. A blood sample is drawn
to measure her glucose concentration, which is found to be 35g/dL. An IV access is obtained
and an ampule of 50% dextrose is given followed by a continuous infusion of 10% dextrose.
Most of the glucoses that is filtered through the glomerulus undergoes reabsorption in which
of the following areas of the nephron?

A. Proximal tubule
B. Descending limb of Loop of Henle
C. Ascending limb of Loop of Henle
D. Distal tubule
E. Collecting duct
Question Difficulty Level: EASY
#42
A 63 year old hospitalized woman becomes oliguric and confused. A blood sample is drawn
to measure her glucose concentration, which is found to be 35g/dL. An IV access is obtained
and an ampule of 50% dextrose is given followed by a continuous infusion of 10% dextrose.
Most of the glucoses that is filtered through the glomerulus undergoes reabsorption in which
of the following areas of the nephron?

A. Proximal tubule
B. Descending limb of Loop of Henle
C. Ascending limb of Loop of Henle
D. Distal tubule
E. Collecting duct
A.Proximal tubule
Glucose is reabsorbed along with Na in the early portion of the proximal
tubule via a secondary active trasnport process. Normally, esentially all the
filtered glucose is reabsorbed.

Rationale G u y t o n & H a l l : Te x t b o o k o f M e d i c a l P h y s i o l o g y 1 4 t h
ed. pp.236
Renal Corpuscle PCT DCT

LOH CD
NEPHRON

Rationale G u y t o n & H a l l : Te x t b o o k o f M e d i c a l P h y s i o l o g y 1 4 t h
ed. pp.236
Rationale
 GLUCOSE
REABSORPTION

Rationale
 HCO3-
REABSORPTION

Rationale
 UREA
REABSORPTION

Rationale
 SECRETED:
METABOLIC BYPRODUCTS
MEDICATIONS

Ammonia

Penicillin

Rationale
Question Difficulty Level: EASY
#43
A trauma patient with multiple rib fracture requires intubation and ventilation.
Mechanical ventilation causes increase in patient’s vasopressin. Which of the
following is the effect of vasopressin in the Kidney?

A. Increased diameter of the renal artery

B. Increase glomerular filtration rate
C. Increased excretion of Na+
D. Increased excretion of water
E. Increased permeability of the collecting ducts to water
Question Difficulty Level: EASY
#43
A trauma patient with multiple rib fracture requires intubation and ventilation.
Mechanical ventilation causes increase in patient’s vasopressin. Which of the
following is the effect of vasopressin in the Kidney?

A. Increased diameter of the renal artery

B. Increase glomerular filtration rate
C. Increased excretion of Na+
D. Increased excretion of water
E. Increased permeability of the collecting ducts to water
E.Increased permeability of the collecting ducts to water

Vasopressin, also called the Antidiuretic Hormone (ADH) which functions

mainly as water retention. It increases the permeability of the collecting ducts
so that water more readily enters the hypertoninc interstitium of the renal
pyramids. Thus, the concentration of solutes in the urine is increased and
urine volume decreases. The overall effect is therefore retention of water in
excess of solute.

Rationale Guyton and Hall 14th ed. pp. 353

Question Difficulty Level:
#44 DIFFICULT

Which of the following has the highest renal clearance?

A.Para-amino Hippuric Acid

B.Inulin
C.Glucose
D.Na+
E.Cl-
Question Difficulty Level:
#44 DIFFICULT

Which of the following has the highest renal clearance?

A.Para-amino Hippuric Acid

B.Inulin
C.Glucose
D.Na+
E.Cl-
A.PAH

Para-amino Hippuric Acid has the greatest clearance of all the substances
because it is both filtered and secreted. Inulin is only filtered The other
substances are filtered and subsequently reabsorbed; therefore, they will have
clearances that are lower than the Inulin clearance.

Rationale BRS 7th ed.

Guyton & Hall 14th ed. pp 363
Question Difficulty Level: AVERAGE
#45
The following are responsible for renal arteriole vasodilation. Except.

A. Angiotensin II
B. Prostaglandin I2
C. Prostaglandin E2
D. Dopamine
E. Bradykinin
Question Difficulty Level: AVERAGE
#45
The following are responsible for renal arteriole vasodilation. Except.

A. Angiotensin II
B. Prostaglandin I2
C. Prostaglandin E2
D. Dopamine
E. Bradykinin
A.Angiotensin II

At low concentrations, Angiotensin II preferentially constricts the Efferent

arterioles, thereby “prtoecting” increasing the GFR. All the other choices are
vasodilators, whihc leads to increase in RBF.

Rationale BRS 7th ed.

Question Difficulty Level:
#46 2ND MOST DIFFICULT

Which of the following is an action of the Parathyroid Hormone(PTH) on the

Renal tubule?

A. Stimulation of the adenylyl cyclase

B. Inhibition of distal tubule K+ secretion
C. Inhibition of distal tubule Ca2+ reabsorption
D. Stimulation of proximal tubule phsphate rabsorption
E. Inhibition of production of 1,25-dihydroxycholecalciferol
Question Difficulty Level:
Difficulty Level:
#46 2ND MOST DIFFICULT

Which of the following is an action of the Parathyroid Hormone(PTH) on the

Renal tubule?

A. Stimulation of the adenylyl cyclase

B. Inhibition of distal tubule K+ secretion
C. Inhibition of distal tubule Ca2+ reabsorption
D. Stimulation of proximal tubule phsphate rabsorption
E. Inhibition of production of 1,25-dihydroxycholecalciferol
Rationale Guyton and Hall Physiology 14th ed. Pp. 390-391
 intestines Kidney bones

Rationale Guyton and Hall Physiology 14th ed. Pp. 390-391

A.Stimulation of the adenylyl cyclase
Parathyroid hormone (PTH) acts on therenal tubule by stimulating adenyl
cyclase and generating cyclic adenosine monophosphate (cAMP). The major
actions of the hormone are inhibition of phosphate reabsorption in the
proximal tubule, stimulation of Ca2+ reabsorption in the distal tubule, and
stimulation of 1,25-dihydroxycholecalciferol production. PTH does not alter
the renal handling of K+.

B. Inhibition of distal tubule K+ secretion

C.Inhibition of distal tubule Ca2+ reabsorption

D.Stimulation of proximal tubule phosphate rabsorption
E. Inhibition of production of 1,25-dihydroxycholecalciferol

Rationale Guyton and Hall Physiology 14th ed. Pp. 390-391

Question Difficulty Level: AVERAGE
#47
A 60-year-old businessman is evaluated by his physician, who determines that his blood
pressure Is significantly elevated at 185/130 mm Hg. Laboratory tests reveal an increase in
plasma renin activity, plasma aldosterone level, and left renal vein renin level. His right
renal vein renin level is decreased. What is the most likely cause of the patient’s
hypertension?

A. Aldosterone-secreting tumor
B. Adrenal adenoma secreting aldosterone and cortisol
C. Pheochromocytoma
D. Left renal artery stenosis
E. Right renal artery stenosis
Question Difficulty Level: AVERAGE
#47
A 60-year-old businessman is evaluated by his physician, who determines that his blood
pressure Is significantly elevated at 185/130 mm Hg. Laboratory tests reveal an increase in
plasma renin activity, plasma aldosterone level, and left renal vein renin level. His right
renal vein renin level is decreased. What is the most likely cause of the patient’s
hypertension?

A. Aldosterone-secreting tumor
B. Adrenal adenoma secreting aldosterone and cortisol
C. Pheochromocytoma
D. Left renal artery stenosis
E. Right renal artery stenosis
D.Left Renal Artery Stenosis
In this patient, hypertension is most likely caused by left renal artery stenosis,
which led to increased renin secretion by the left kidney.

decreased blood flow

Rationale Guyton and Hall 14th ed

D.Left Renal Artery Stenosis
In this patient, hypertension is most likely caused by left renal artery stenosis,
which led to increased renin secretion by the left kidney.

Increased Increased
Increased Na+ Increased
plasma renin secretion of
reabsorption Blood pressure
activity aldosterone

Rationale Guyton and Hall 14th ed

 decreased blood flow
Continuous

Increased pressure

Rationale Guyton and Hall 14th ed

• The right kidney responds to the increase in blood pressure by decreasing its renin
secretion. Right renal artery stenosis (D) causes a similar pattern of results, except that
renin secretion from the right kidney, not the left kidney, is increased.
• Aldosterone-secreting tumorsA and B) cause increased levels of aldosterone, but decreased
plasma renin activity (as a result of decreased renin secretion by both kidneys).
• Pheochromocytoma (C) is associated with increased circulating levels of catecholamines,
which increase blood pressure by their effects on the heart (increased heart rate and
contractility) and blood vessels (vasoconstriction); the increase in blood pressure is sensed
by the kidneys and results in decreased plasma renin activity and aldosterone levels.

Rationale
Question Difficulty Level:
#48 DIFFICULT

The transport maximum of the proximal tubules to glucose is seen at what

level?

A.200 mg/dL
B.250 mg/dL
C.300 mg/dL
D.350 mg/dL
E.375 mg/dL
Question Difficulty Level:
#48 DIFFICULT

The transport maximum of the proximal tubules to glucose is seen at what

level?

A.200 mg/dL
B.250 mg/dL
C.300 mg/dL
D.350 mg/dL
E.375 mg/dL
B.250mg/dL
The renal threshold is at 250 mg/dL while the transport maximum is at 375
mg/dL. The splay is the region in between the threshold and the transport
maximum and is at 250-375 mg/dL

BRS 7th ed.

Rationale
Question Difficulty Level: EASY
#49
The cornerstone in the management of pre-renal acute renal failure is?

A. Antibiotics
B. Investigating for post-renal causes
C. Hydration
D. Ruling out masses impinging on the urinary tract
E. None of the above
Question Difficulty Level: EASY
#49
The cornerstone in the management of pre-renal acute renal failure is?

A. Antibiotics
B. Investigating for post-renal causes
C. Hydration
D. Ruling out masses impinging on the urinary tract
E. None of the above
C.Hydration
Hydration is important in pre-renal ARF as it restores intravascular volume
thus restoring renal blood flow and increasing urine output.

Guyton and Hall 14th ed.

Rationale
Pre-renal AKI
- primarily due to the decreased blood supply to the kidney.
i.e. Severe Hemmorhage, Heart failure

Intra-renal AKI
- within the kidney itself.
- conditions that:
• Injure the Glomerular capillaries (usu. Group A beta Streptococcus)
• Damage the Renal tubular epithelium (severe ischemia, toxins)
• Cause damage to the Renal Interstitium

Guyton and Hall 14th ed.

Rationale
Post-renal AKI
- after the kidney i.e. Ureter, urinary bladder
i.e. Bilateral obstruction othe ureter or renal pelvices by stones or blood clots,
bladder obstruction, obstruction of the Urethra

Guyton and Hall 14th ed.

Rationale
Question Difficulty
Difficulty Level:Level:
#50 DIFFICULT

Which of the following conditions would not have an elevation of the plasma
renin level?

A. Congestive Heart Failure

B. Conn's syndrome
C. Renal artery stenosis
D. Hemorrhagic shock
E. Liver cirrhosis
Question Difficulty
Difficulty Level:Level:
#50 DIFFICULT

Which of the following conditions would not have an elevation of the plasma
renin level?

A. Congestive Heart Failure

B. Conn's syndrome
C. Renal artery stenosis
D. Hemorrhagic shock
E. Liver cirrhosis
C.Conn’s Syndrome
• Conn's syndrome is characterized by the overproduction of the
mineralocorticoid hormone aldosterone by the adrenal glands. This will
produce a negative feedback and thus suppress renin secretion.
• The rest are causes of secondary hyperaldosteronism wherein a
decrease in the intravascular volume would stimulate the RAA axis.

Guyton and Hall 14th ed.

Rationale
FIN