MCQs And EMQs In Human Physiology - Unbound

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moc.topsgo.bldaolnwodsqcmlaciwww.med

otogsplb.daolnowdsqcmlaciwww.medMCQs and EMQs inHUMANPHYSIOLOGY6th edition

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potsgolb.danlowodsqcmicaldem.wwwMCQs and EMQs inHUMANPHYSIOLOGYwith answers andexplanatory comments6th editionIan C Roddie CBE, DSc, MD, FRCPIEmeritus Professor of Physiology, The Queen's University of Belfast; formerHead of Medical Education, National Guard King Khalid Hospital, Jeddah,Saudi ArabiaWilliam FM Wallace BSc, MD, FRCP, FRCA, FCARCSI, FRCSEdEmeritus Professor of Applied Physiology, The Queen’s University of Belfast;former Consultant in Physiology, Belfast City Hospital, Belfast, N. IrelandA member of the Hodder Headline GroupLONDON

otogsplb.daolncqsdowlmacidem.wwwFirst published in Great Britain in 1971Second edition 1977Third edition 1984Fourth edition 1994Fifth edition 1997This sixth edition published in 2004 byArnold, a member of the Hodder Headline Group,338 Euston Road, London NW1 3BHhttp://www.arnoldpublishers.comDistributed in the United States of America byOxford University Press Inc.,198 Madison Avenue, New York, NY10016Oxford is a registered trademark of Oxford University Press 2004 Ian C. Roddie and William F.M. WallaceAll rights reserved. No part of this publication may be reproduced ortransmitted in any form or by any means, electronically or mechanically,including photocopying, recording or any information storage or retrievalsystem, without either prior permission in writing from the publisher or alicence permitting restricted copying. In the United Kingdom such licencesare issued by the Copyright Licensing Agency: 90 Tottenham Court Road,London W1T 4LP.Whilst the advice and information in this book are believed to be true andaccurate at the date of going to press, neither the author[s] nor the publishercan accept any legal responsibility or liability for any errors or omissionsthat may be made. In particular (but without limiting the generality of thepreceding disclaimer) every effort has been made to check drug dosages;however it is still possible that errors have been missed. Furthermore,dosage schedules are constantly being revised and new side-effectsrecognized. For these reasons the reader is strongly urged to consult thedrug companies’ printed instructions before administering any of the drugsrecommended in this book.British Library Cataloguing in Publication DataA catalogue record for this book is available from the British LibraryLibrary of Congress Cataloging-in-Publication DataA catalog record for this book is available from the Library of CongressISBN 0 340 8119191 2 3 4 5 6 7 8 9 10Commissioning Editor: Georgina BentliffProject Editor: Heather SmithProduction Controller: Jane LawrenceCover Design: Amina DudhiaIndex: Dr Laurence ErringtonTypeset in 9pt Rotis Serif by Servis Filmsetting Ltd, ManchesterPrinted and bound in MaltaWhat do you think about this book? Or any other Arnold title?Please send your comments to feedback.arnold@hodder.co.uk

ceHow to use the book1 Body MCQsEMQs692-708709-7142913252 CardiovascuIar system3 Respiratory system4 Alimentary system5 Neuromuscular system6 Special senses7 Urinary system8 Endocrine system9 Reproductive systeml0. General questions11 Sport and exercise physiology12 Interpretative questionsIndex337

otogsplb.daolncqsdowlmacidem.wwwPREFACEThis book has now reached its sixth edition since it was first published over 30 years ago. Ouraim to base the questions on generally accepted aspects of physiology most relevant to clinical practice seems to have been fulfilled – medical, dental and other health care students anddoctors in specialty training in countries around the world have told us of the book’s relevanceand usefulness.We have tried to cover most of the concepts and knowledge typically asked for in physiology examinations and to concentrate on the core knowledge that is essential to pass them. Webelieve that students who score consistently well in these questions know enough to face mostexaminations in physiology with confidence. By concentrating on the area where yes/noanswers can be given to questions with reasonable certainty, we have had to exclude areaswhere knowledge is as yet conjectural and speculative. We have tried to avoid excessive detailin the way of facts and figures; those which are included are of value in medical practice. Bothconventional and SI units are generally quoted. Comments on the answers are given on thereverse of each question. We hope that, with the comments, the book will provide a compactrevision tutor, encouraging understanding rather than rote learning.For most questions the common five-branch MCQ format has been used. The stem and asingle branch constitute a statement to be judged True or False by the reader. Care has beentaken that the statements in any question are not mutually exclusive, so five independent decisions are required to answer each question. This system has the advantage of simplicity andbrevity over most other forms of multiple-choice question. In this edition, a further opportunity has been taken to prune and edit questions for greater compactness, clarity and precisionand to bring in new areas of knowledge which have emerged since the last edition went topress. We have also tended to expand the comments in an effort to increase the clarity of ourexplanations and so add to the educational value of the self-assessment exercise.The book is divided into sections, each section containing questions related to one of themain physiological systems of the body. They cover both basic and applied aspects of the subject. The applied questions are designed so that the answers may be deduced mainly by makinguse of basic physiological knowledge and should provide a link with clinical practice. There isalso a section on sports and exercise physiology and one containing ‘Interpretative’ questionsto provide practice in the interpretation of data, diagrams and figures. A new feature in thisedition is the addition of a number of Extended Matching Questions (EMQs) for each section ofthe book. EMQs are an alternative form of multiple-choice question where answers have to beselected from lists of options. They are becoming increasingly popular in undergraduate andpostgraduate examinations.We thank colleagues for suggesting questions and all who commented on previous editions.We continue to welcome such comments.ICRWFMWSeptember 2003

otogsplb.daolnowdsqcmlaciwww.medHOW TO USE THIS BOOK1. A stimulus to fill gaps in your knowledgeThis book is intended as a revision tutor and should help you to revise your physiology in preparation for examinations. It is particularly aimed at helping you to identify areas where yourknowledge and understanding need to be improved. The statements in this book are presentedso that you can commit yourself in written opinion and can then confirm correct informationand identify errors. The comments should reinforce your knowledge when you are correct andindicate why you were mistaken if your answer is wrong.2. Scoring your answers – multiple choice questionsABCAnswer, say, 20 questions (100 decisions), aiming to complete them in about 50 minutes.In our experience of this type of question (one point tested in each Part), it is best for candidates to answer virtually all questions.Score your answers by giving 1 for a correct response, 1 for an incorrect response and0 for any omitted. It is suggested that this approach is in line with professional life whenmany true/false decisions must be taken – send the patient to hospital? Begin a certaintreatment? Carry out surgery urgently? The penalties for a wrong decision can be considerable!As a very approximate guide, the following scale would apply to candidates who have notspent time memorizing particular ellentoutstanding3. Scoring your answers – extended matching questionsFor these questions it is usual not to subtract marks for wrong answers, since the chance ofrandomly getting the correct answer is much less than for multiple-choice questions, where itis 50%. The same stratification of results (above) can then be applied.4. Range of optionsPlease note for the MCQs that all, some, or none of the branches in each question may be true.Also, for the EMQs a given option may be used more than once, or not at all.

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otogsplb.daolnowdsqcmlaciww1w.medBODY FLUIDS1MCQs1. Extracellular fluid in adults differs from intracellular fluid in that itsA.B.C.D.E.Volume is greater.Tonicity is lower.Anions are mainly inorganic.Sodium:potassium molar ratio is higher.pH is lower.2. Blood group antigens (agglutinogens) areA.B.C.D.E.Carried on the haemoglobin molecule.Beta globulins.Equally immunogenic.Not present in fetal blood.Inherited as recessive Mendelian characteristics.3. Total body water, expressed as a percentage of body weightA.B.C.D.E.Can be measured with an indicator dilution technique using deuterium oxide.Is smaller on average in women than in men.Rises following injection of posterior pituitary extracts.Falls during starvation.Is less than 80 per cent in young adults.4. Breakdown of erythrocytes in the bodyA.B.C.D.E.Occurs when they are 6–8 weeks old.Takes place in the reticulo-endothelial system.Yields iron, most of which is excreted in the urine.Yields bilirubin which is carried by plasma protein to the liver.Is required for the synthesis of bile salts.5. A person with group A bloodA.B.C.D.E.Has anti-B antibody in the plasma.May have the genotype AB.May have a parent with group O blood.May have children with group A or group O blood only.Whose partner is also A can only have children of groups A or O.6. Blood platelets assist in arresting bleeding byA.B.C.D.E.Releasing factors promoting blood clotting.Adhering together to form plugs when exposed to collagen.Liberating high concentrations of calcium.Releasing factors causing vasoconstriction.Inhibiting fibrinolysis by blocking the conversion of plasminogen to plasmin.7. Plasma bilirubinA.B.C.D.E.Is a steroid pigment.Is converted to biliverdin in the liver.Does not normally cross cerebral capillary walls.Is freely filtered in the renal glomerulus.Is sensitive to light.MCQQuestions 1–7

otogsplb.daolncqsdowlmacidem.www2Body fluids – seCells contain half to two-thirds of the total body fluid.It is the same; if it were lower, osmosis would draw water into the cells.Mainly Cl and HCO3 ; inside, the main anions are protein and organic phosphates.Around 30:1; the intracellular ratio is about 1:10.Intracellular pH is lower due to cellular metabolism.FalseFalseFalseFalseFalseThey are part of the red cell membrane.They are glycoproteins.A, B and D antigens are more immunogenic than the others.Fetal blood may elicit immune responses if it enters the maternal circulation.They are Mendelian dominants.TrueTrueTrueFalseTrueD2O (heavy water) exchanges with water in all body fluid compartments.Women carry relatively more fat than men and fat has a low water content.ADH in the extracts inhibits water excretion by the kidneys.It rises as fat stores are metabolized to provide energy.70 per cent, the percentage in the lean body mass, is about the maximum per centpossible.FalseTrueFalseTrueFalseThe normal erythrocyte lifespan is 16–18 weeks.The RES removes effete RBCs from the circulation.Most of the iron is retained for further use.The protein makes the bilirubin relatively water-soluble.Bile salts are synthesized from sterols in the liver.TrueFalseTrueFalseTrueThis appears about the time of birth.This would make them blood group AB.They could inherit an A gene from the other parent to give genotype AO.B or AB are possible depending on the partner’s genes.In this case, neither parent has the B gene.TrueTrueFalseTrueFalsee.g. Thromboplastin, part of the intrinsic pathway.Vascular leaks are sealed by such platelet plugs.High Ca2 levels are not needed for haemostasis; normal levels are adequate.e.g. Serotonin (5-hydroxytryptamine).Serotonin from platelets can release vascular plasminogen activators.FalseFalseTrueFalseTrueIt is a porphyrin pigment derived from haem.Bilirubin is derived from biliverdin formed from haem, not the other way about.The ‘blood–brain barrier’ normally prevents bilirubin entering brain tissue.The bilirubin–protein complex is too large to pass the glomerular filter.Light converts bilirubin to lumirubin which is excreted more rapidly; phototherapy may be used in the treatment of haemolytic jaundice in .C.D.E.6.A.B.C.D.E.7.A.B.C.D.E.

otogsplb.daolnowdsqcmlaciwww.medBody fluids – questions3Questions 8–13A. Originate from precursor cells in lymph nodes.B. Can increase in number when their parent cells are stimulated by factors released fromactivated lymphocytes.C. Unlike granulocytes, do not migrate across capillary walls.D. Can transform into large multinucleated cells in certain chronic infections.E. Manufacture immunoglobulin M.9. ErythrocytesA.B.C.D.E.Are responsible for the major part of blood viscosity.Contain the enzyme carbonic anhydrase.Metabolize glucose to produce CO2 and H2O.Swell to bursting point when suspended in 0.9 per cent (150 mmol/litre) saline.Have rigid walls.10. Human plasma albuminA.B.C.D.E.Contributes more to plasma colloid osmotic pressure than globulin.Filters freely at the renal glomerulus.Is negatively charged at the normal pH of blood.Carries carbon dioxide in blood.Lacks the essential amino acids.11. Neutrophil granulocytesA.B.C.D.E.Are the most common leukocyte in normal blood.Contain proteolytic enzymes.Have a lifespan in the circulation of 3–4 weeks.Contain actin and myosin microfilaments.Are present in high concentration in pus.12. Bleeding from a small cut in the skinA.B.C.D.E.Is normally diminished by local vascular spasm.Ceases within about five minutes in normal people.Is prolonged in severe factor VIII (antihaemophilic globulin) deficiency.Is greater from warm skin than from cold skin.Is reduced if the affected limb is elevated.13. AntibodiesA. Are protein molecules.B. Are absent from the blood in early fetal life.C. Are produced at a greater rate after a first, than after a second, exposure to an antigensix weeks later.D. Circulating as free immunoglobulins are produced by B lymphocytes.E. With a 1 in 8 titre are more concentrated than ones with a 1 in 4 titre.MCQ8. Monocytes

otogsplb.daolncqsdowlmacidem.www4Body fluids – seThey originate from stem cells in bone marrow.Activated T cells release GMCSF (granulocyte/macrophage colony stimulatingfactor) which stimulates monocyte stem cells to proliferate.After 4–6 days in the circulation, monocytes migrate out to become tissue macrophages.The ‘giant cells’ seen in tissues affected by tuberculosis and leprosy.Immunoglobulins are made by ribosomes in d viscosity rises exponentially with the haematocrit.It catalyses the reaction CO2 H2O H HCO3 .Glycolysis generates the energy needed to maintain electrochemical gradientsacross their membranes.This is isotonic with their contents.The walls deform easily to squeeze through capillaries.10.A.TrueB.C.FalseTrueD.E.TrueFalseIts greater mass and lower molecular weight provide more osmotically active particles.Only a small amount is filtered normally and this is reabsorbed by the tubules.Blood pH is well above albumin’s isoelectric point so negative charges (COO )predominate.As carbamino protein (R-NH2 CO2 R-NH COOH).It is a first class protein containing essential and non-essential amino acids.11.A.B.TrueTrueC.D.E.FalseTrueTrueThey comprise 60–70 per cent of circulating leukocytes.Their granules contain such enzymes, which, with toxic oxygen metabolites, cankill and digest the bacteria they engulf.Less than a day.Responsible for their amoeboid motility.Pus consists largely of dead neutrophils.TrueTrueFalseTrueTrueDue to the effects of tissue damage and serotonin on vascular smooth muscle.This is the upper limit of the normal ‘bleeding time’.Factor VIII increases clotting time, not bleeding time.Warmth dilates skin blood vessels.Intravascular pressure is reduced in an elevated limb.A.B.TrueTrueC.FalseD.E.TrueTrueThey are made by ribosomes in plasma cells.Immunological tolerance prevents the fetus forming antibodies to its own proteins.The response to the second exposure is greater since the immune system has beensensitized by the first exposure.T lymphocytes are responsible for cell-mediated immunity.Antibody with a 1 in 8 titre is detected at greater dilution than one with a 1 in 4titre.12.A.B.C.D.E.13.

otogsplb.daolnowdsqcmlaciwww.medBody fluids – questions5Questions 14–19A.B.C.D.E.Are about 1 per cent nucleated.May show an intracellular network pattern if appropriately stained.Are distributed evenly across the blood stream in large blood vessels.Travel at slower velocity in venules than in capillaries.Deform as they pass through the capillaries.15. LymphocytesA.B.C.D.E.Constitute 1–2 per cent of circulating white cells.Are motile.Can transform into plasma cells.Decrease in number following removal of the adult thymus gland.Decrease in number during immunosuppressive drug therapy.16. The specific gravity (relative density) ofA.B.C.D.E.Red cells is less than that of plasma.Plasma is due more to its protein than to its electrolyte content.Plasma decreases as extracellular fluid and electrolytes are lost.Blood is higher on average in women than in men.Urine can fall below 1.000 in a water diuresis17. BloodA. Makes up about 7 per cent of body weight.B. Forms a higher percentage of body weight in fat than in thin people.C. Volume can be calculated by multiplying plasma volume by the haematocrit (expressedas a percentage).D. Volume rises after water is drunk.E. Expresses serum when it clots.18. The cell membranes in skeletal muscleA.B.C.D.E.Are impermeable to fat-soluble substances.Are more permeable to sodium than to potassium ions.Become more permeable to glucose in the presence of insulin.Become less permeable to potassium in the presence of insulin.Show invaginations which connect to a system of intracellular tubules involved in excitation contraction coupling.19. The osmolality ofA.B.C.D.E.A solution determines its freezing point.Intracellular fluid is about twice that of extracellular fluid.1.8 per cent sodium chloride is about twice that of normal plasma.5 per cent dextrose solution is about five times that of 0.9 per cent saline.Plasma is due more to its protein than to its electrolyte content.MCQ14. Circulating red blood cells

otogsplb.daolncqsdowlmacidem.www6Body fluids – rueNucleated red cells are not normally seen in peripheral blood.Reticulocytes, the most immature circulating RBCs, show this pattern whenstained with certain dyes.They form an axial stream away from the vessel wall.The capillary bed has a greater total cross-sectional area than the venular bed.Normal cells, around 7 microns in diameter, become bullet-shaped as they passthrough 5 micron diameter ut 20 per cent of leukocytes are lymphocytes.They migrate by amoeboid movement to areas of chronic inflammation.As plasma cells they manufacture humoral antibodies.The thymus is atrophied and has little function in the adult.Lymphocytes and immune responses are closely linked.A.B.FalseTrueC.FalseD.E.FalseFalseRed cells are

MCQs 261-330 115 EMQs 331-340 139 6 Special senses MCQs 341-384 149 EMQs 385-394 163 7 Urinary system MCQs 395-434 171 EMQs 435-444 185 8 Endocrine system MCQs 445-501 193 EMQs 502-512 211 9 Reproductive system MCQs 513-567 219 EMQs 568-576 237 l0. General questions MCQs 577-639 245 EMQs 640-649 265 11 Sport and exercise physiology MCQs 650-686 .

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