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GUYTONAND HALLThe world’s foremostmedical physiology resourcesGuyton and Hall Textbook of MedicalPhysiology, 13th EditionJohn E. Hall, PhD978-1-4557-7005-2Unlike other physiology textbooks, this clear andcomprehensive guide has a consistent, single-authorvoice and focuses on the content most relevant to clinicaland pre-clinical students. The detailed but lucid text iscomplemented by didactic illustrations that summarizekey concepts in physiology and pathophysiology.Pocket Companion to Guytonand Hall Textbook of MedicalPhysiology, 13th EditionJohn E. Hall, PhD978-1-4557-7006-9All of the essential information youneed from the world’s foremost medicalphysiology textbook – right in your pocket!Reflecting the structure and content ofthe larger text, it helps you recall andeasily review the most essential,need-to-know concepts in physiology.Guyton and Hall PhysiologyReview, 3rd EditionJohn E. Hall, PhD978-1-4557-7007-6Prepare for class exams as well as thephysiology portion of the USMLE Step 1.This review book features more than1,000 board-style questions and answers,allowing you to test your knowledge ofthe most essential, need-to-knowconcepts in physiology!ORDER TODAY! elsevierhealth.com
NOTE TO INSTRUCTORS:Contact your Elsevier Sales Representative for teachingresources, including slides and image banks, for Guytonand Hall Textbook of Medical Physiology, 13e, or requestthese supporting materials at:http://evolve.elsevier.com/Hall13
THIRD EDITIONGuyton and HallPhysiology ReviewJohn E. Hall, PhDArthur C. Guyton Professor and ChairDepartment of Physiology and BiophysicsDirector of the Mississippi Centerfor Obesity ResearchUniversity of Mississippi Medical CenterJackson, Mississippi
1600 John F. Kennedy Blvd.Ste 1800Philadelphia, PA 19103-2899GUYTON AND HALL PHYSIOLOGY REVIEW, THIRD EDITION ISBN: 978-1-4557-7007-6Copyright 2016 by Elsevier, Inc. All rights reserved.No part of this publication may be reproduced or transmitted in any form or by any means, electronic ormechanical, including photocopying, recording, or any information storage and retrieval system, withoutpermission in writing from the publisher. Details on how to seek permission, further information about thePublisher’s permissions policies and our arrangements with organizations such as the Copyright ClearanceCenter and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.This book and the individual contributions contained in it are protected under copyright by the Publisher(other than as may be noted herein).NoticesKnowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment maybecome necessary.Practitioners and researchers must always rely on their own experience and knowledge in evaluatingand using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including partiesfor whom they have a professional responsibility.With respect to any drug or pharmaceutical products identified, readers are advised to check the mostcurrent information provided (i) on procedures featured or (ii) by the manufacturer of each product to beadministered, to verify the recommended dose or formula, the method and duration of administration,and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individualpatient, and to take all appropriate safety precautions.To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability,negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideascontained in the material herein.Previous editions copyrighted 2011, 2006 by Saunders, an imprint of Elsevier, Inc.ISBN: 978-1-4557-7007-6Senior Content Strategist: Elyse O’GradyContent Development Specialist: Lauren BoylePublishing Services Manager: Patricia TannianSenior Project Manager: Carrie StetzDesign Direction: Julia DummittPrinted in the United States of AmericaLast digit is the print number: 9 87 65 4 321
ContributorsThomas H. Adair, PhDThomas E. Lohmeier, PhDProfessor of Physiology and BiophysicsUniversity of Mississippi Medical CenterJackson, MississippiProfessor Emeritus of Physiology and BiophysicsUniversity of Mississippi Medical CenterJackson, MississippiJoey P. Granger, PhDR. Davis Manning Jr, PhDBilly S. Guyton Distinguished ProfessorProfessor of Physiology and MedicineDirector of the Cardiovascular-Renal Research CenterDean of the School of Graduate Studies in the HealthSciencesUniversity of Mississippi Medical CenterJackson, MississippiProfessor Emeritus of Physiology and BiophysicsUniversity of Mississippi Medical CenterJackson, MississippiUnits II, IX, X, XI, XII, and XIIIUnit IVJohn E. Hall, PhDArthur C. Guyton Professor and ChairDepartment of Physiology and BiophysicsDirector of the Mississippi Center for Obesity ResearchUniversity of Mississippi Medical CenterJackson, MississippiUnits I, V, and XIIIRobert L. Hester, PhDProfessor of Physiology and BiophysicsDirector of the Computer Services, Electronics, andInstrumentations CoreUniversity of Mississippi Medical CenterJackson, MississippiUnit XIVUnits III and IVJane F. Reckelhoff, PhDBilly S. Guyton Distinguished ProfessorProfessor of Physiology and BiophysicsDirector of the Women’s Health Research CenterDirector of Research DevelopmentUniversity of Mississippi Medical CenterJackson, MississippiUnit XIVJames G. Wilson, MDProfessor of Physiology and BiophysicsUniversity of Mississippi Medical CenterJackson, MississippiUnit VIUnits VII, VIII, and XVv
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PrefaceThe main goal of this book is the same as in previous editions: to provide students a tool for assessing their masteryof physiology as presented in Guyton and Hall Textbook ofMedical Physiology.Self-assessment is an important component of effectivelearning, especially when studying a subject as complex asmedical physiology. Guyton & Hall Physiology Review isdesigned to provide a comprehensive review of medical physiology through multiple-choice questions and explanationsof the answers. Medical students preparing for the UnitedStates Medical Licensure Examinations (USMLE) will alsofind this book useful because most of the test questions havebeen constructed according to the USMLE format.The questions and answers in this review are based onGuyton and Hall Textbook of Medical Physiology, 13thEdition (TMP 13). More than 1000 questions and answersare provided, and each answer is referenced to the Textbookof Medical Physiology to facilitate a more complete understanding of the topic. Illustrations are used to reinforcebasic concepts. Some of the questions incorporate information from multiple chapters to test your ability to apply andintegrate the principles necessary for mastery of medicalphysiology.An effective way to use this book is to allow an average of 1 minute for each question in a unit, approximatingthe time limit for a question in the USMLE examination.As you proceed, indicate your answer next to each question. After finishing the questions and answers, verify youranswers and carefully read the explanations provided. Readthe additional material referred to in the Textbook of Medical Physiology, especially for questions for which incorrectanswers were chosen.Guyton and Hall Physiology Review should not be usedas a substitute for the comprehensive information contained in the Textbook of Medical Physiology. It is intendedmainly as a means of assessing your knowledge of physiology and strengthening your ability to apply and integratethis knowledge.We have attempted to make this review as accurate aspossible, and we hope that it will be a valuable tool for yourstudy of physiology. We invite you to send us your critiques, suggestions for improvement, and notifications ofany errors.I am grateful to each of the contributors for their careful work on this book. I also wish to express my thanksto Lauren Boyle, Rebecca Gruliow, Elyse O’Grady, CarrieStetz, and the rest of the Elsevier staff for their editorialand production excellence.John E. Hallvii
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ContentsUNIT I Introduction to Physiology: The Cell and General Physiology Answers 15UNIT II Membrane Physiology, Nerve, and Muscle Answers 919UNIT III The Heart Answers 2737UNIT IV The Circulation Answers 4561UNIT V The Body Fluids and Kidneys Answers 7591UNIT VI Blood Cells, Immunity, and Blood Coagulation Answers 105111UNIT VII Respiration 117Answers 131UNIT VIII Aviation, Space, and Deep-Sea Diving Physiology Answers 141143UNIT IX The Nervous System: A. General Principles and SensoryPhysiology 145Answers 151UNIT X The Nervous System: B. The Special Senses Answers 157165UNIT XI The Nervous System: C. Motor and Integrative Neurophysiology Answers 173185ix
ContentsUNIT XII Gastrointestinal Physiology Answers 193203UNIT XIII Metabolism and Temperature Regulation Answers 213219UNIT XIV Endocrinology and Reproduction Answers 225241UNIT XV Sports Physiology Answers x253255
Guyton and HallPhysiology Review
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UNITIIntroduction to Physiology: The Cell andGeneral Physiology1. Which statement about microRNAs (miRNAs) is correct?A) miRNAs are formed in the cytoplasm and represstranslation or promote degradation of messengerRNA (mRNA) before it can be translatedB) miRNAs are formed in the nucleus and then processed in the cytoplasm by the dicer enzymeC) miRNAs are short (21 to 23 nucleotide) doublestranded RNA fragments that regulate gene expressionD) miRNAs repress gene transcription2. Compared with the intracellular fluid, the extracellular fluid has sodium ion concentration,potassium ion concentration,chloride ion concentration, and phosphateion concentration.A) Lower, lower, lower, lowerB) Lower, higher, lower, lowerC) Lower, higher, higher, lowerD) Higher, lower, higher, lowerE) Higher, higher, lower, higherF) Higher, higher, higher, higher3. In comparing two types of cells from the same person,the variation in the proteins expressed by each cell typereflects which of the following?A) Differences in the DNA contained in the nucleus ofeach cellB) Differences in the numbers of specific genes intheir genomesC) Cell-specific expression and repression of specificgenesD) Differences in the number of chromosomes in eachcellE) The age of the cells4. Which statement about telomeres is incorrect?A) Telomeres are repetitive nucleotide sequences atthe end of a chromatidB) Telomeres serve as protective caps that prevent thechromosome from deterioration during cell divisionC) Telomeres are gradually consumed during repeatedcell divisionsD) In cancer cells, telomerase activity is usually reduced compared with normal cells5. Which of the following events does not occur duringthe process of mitosis?A) Condensation of the chromosomesB) Replication of the genomeC) Fragmentation of the nuclear envelopeD) Alignment of the chromatids along the equatorialplateE) Separation of the chromatids into two sets of 46“daughter” chromosomes6. The term “glycocalyx” refers to what?A) The negatively charged carbohydrate chains thatprotrude into the cytosol from glycolipids and integral glycoproteinsB) The negatively charged carbohydrate layer on theouter cell surfaceC) The layer of anions aligned on the cytosolic surfaceof the plasma membraneD) The large glycogen stores found in “fast” musclesE) A mechanism of cell–cell attachment7. Which statement is incorrect?A) The term “homeostasis” describes the maintenanceof nearly constant conditions in the bodyB) In most diseases, homeostatic mechanisms are nolonger operating in the bodyC) The body’s compensatory mechanisms often leadto deviations from the normal range in some of thebody’s functionsD) Disease is generally considered to be a state of disrupted homeostasisQuestions 8–10A) NucleolusB) NucleusC) Agranular endoplasmic reticulumD) Granular endoplasmic reticulumE) Golgi apparatusF) EndosomesG) PeroxisomesH) LysosomesI) CytosolJ) CytoskeletonK) GlycocalyxL) Microtubules1
Unit I Introduction to Physiology: The Cell and General PhysiologyFor each of the scenarios described below, identify themost likely subcellular site listed above for the deficient ormutant protein.8. The abnormal cleavage of mannose residues during thepost-translational processing of glycoproteins resultsin the development of a lupus-like autoimmune diseasein mice. The abnormal cleavage is due to a mutation ofthe enzyme α-mannosidase II.9. The observation that abnormal cleavage of mannoseresidues from glycoproteins causes an autoimmunedisease in mice supports the role of this structure inthe normal immune response.10. Studies completed on a 5-year-old boy show an accumulation of cholesteryl esters and triglycerides in hisliver, spleen, and intestines and calcification of bothadrenal glands. Additional studies indicate the cause tobe a deficiency in acid lipase A activity.Questions 11–13A) NucleolusB) NucleusC) Agranular endoplasmic reticulumD) Granular endoplasmic reticulumE) Golgi apparatusF) EndosomesG) PeroxisomesH) LysosomesI) CytosolJ) CytoskeletonK) GlycocalyxL) MicrotubulesMatch the cellular location for each of the steps involvedin the synthesis and packaging of a secreted protein listedbelow with the correct term from the list above.11. Protein condensation and packaging12. Initiation of translation13. Gene transcription14. Worn-out organelles are transferred to lysosomes bywhich of the following?A) AutophagosomesB) Granular endoplasmic reticulumC) Agranular endoplasmic reticulumD) Golgi apparatusE) Mitochondria215. Which of the following is not a major function of theendoplasmic reticulum (ER)?A) Synthesis of lipidsB) Synthesis of proteinsC) Providing enzymes that control glycogen breakdownD) Providing enzymes that detoxify substances thatcould damage the cellE) Secretion of proteins synthesized in the cell16. Which of the following does not play a direct role in theprocess of transcription?A) HelicaseB) RNA polymeraseC) Chain-terminating sequenceD) “Activated” RNA moleculesE) Promoter sequence17. Which statement is true for both pinocytosis andphagocytosis?A) Involves the recruitment of actin filamentsB) Occurs spontaneously and nonselectivelyC) Endocytotic vesicles fuse with ribosomes that release hydrolases into the vesiclesD) Is only observed in macrophages and neutrophilsE) Does not require ATP18. Which of the following proteins is most likely to be theproduct of a proto-oncogene?A) Growth factor receptorB) Cytoskeletal proteinC) Na channelD) Ca -ATPaseE) Myosin light chain19. Which statement is incorrect?A) Proto-oncogenes are normal genes that code forproteins that control cell growthB) Proto-oncogenes are normal genes that code forproteins that control cell divisionC) Inactivation of anti-oncogenes protects against thedevelopment of cancerD) Several different simultaneously activated oncogenes are often required to cause cancer20. Which statement about feedback control systems is incorrect?A) Most control systems of the body act by negativefeedbackB) Positive feedback usually promotes stability in asystemC) Generation of nerve actions potentials involvespositive feedbackD) Feed-forward control is important in regulatingmuscle activity
Unit I Introduction to Physiology: The Cell and General Physiology22. Which of the following cell organelles is responsible forproducing adenosine triphosphate (ATP), the energycurrency of the cell?A) Endoplasmic reticulumB) MitochondriaC) LysosomesD) Golgi apparatusE) PeroxisomesF) Ribosomes23. Which statement about mRNA is correct?A) mRNA carries the genetic code to the cytoplasmB) mRNA carries activated amino acids to the ribosomesC) mRNA is composed of single-stranded RNA molecules of 21 to 23 nucleotides that can regulate genetranscriptionD) mRNA forms ribosomes24. “Redundancy” or “degeneration” of the genetic codeoccurs during which step of protein synthesis?A) DNA replicationB) TranscriptionC) Post-transcriptional modificationD) TranslationE) Protein glycosylation3U nit I21. Assume that excess blood is transfused into a patientwhose arterial baroreceptors are nonfunctional andwhose blood pressure increases from 100 to 150 mmHg. Then, assume that the same volume of blood is infused into the same patient under conditions in whichhis arterial baroreceptors are functioning normallyand blood pressure increases from 100 to 125 mm Hg.What is the approximate feedback “gain” of the arterialbaroreceptors in this patient when they are functioningnormally?A) 1.0B) 2.0C) 0.0D) 1.0E) 2.0
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ANSWERS5. B ) DNA replication occurs during the S phase of thecell cycle and precedes mitosis. Condensation of thechromosomes occurs during the prophase of mitosis.Fragmentation of the nuclear envelope occurs duringthe prometaphase of mitosis. The chromatids align atthe equatorial plate during metaphase and separateinto two complete sets of daughter chromosomes during anaphase.TMP13 p. 372. D ) The extracellular fluid has relatively high concentrations of sodium and chloride ions but lower concentrations of potassium and phosphate compared withthe intracellular fluid.TMP13 pp. 3-46. B ) The cell “glycocalyx” is the loose negatively chargedcarbohydrate coat on the outside of the surface of thecell membrane. The membrane carbohydrates usually occur in combination with proteins or lipids in theform of glycoproteins or glycolipids, and the “glyco”portion of these molecules almost invariably protrudesto the outside of the cell.TMP13 p. 143. C ) The variation in proteins expressed by each cell reflects cell-specific expression and repression of specificgenes. Each cell contains the same DNA in the nucleusand the same number of genes, and thus differentiationresults not from differences in the genes but from selectiverepression and/or activation of different gene promoters.TMP13 p. 414. D ) Telomeres are repetitive nucleotide sequences, located at the end of a chromatid, that serve as protectivecaps to prevent the chromosome from deteriorationduring cell division, but they are gradually consumedduring cell divisions (see figure below). In cancer cells,the enzyme telomerase is activated (not inhibited) andadds bases to the ends of the telomeres so that manymore generation
of physiology as presented in Guyton and Hall Textbook of Medical Physiology. Self-assessment is an important component of effective learning, especially when studying a subject as complex as medical physiology. Guyton & Hall Physiology Review is designed to provide a comprehensive review of medical phys -
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Ann Sutherland Harris, Professor of Italian Baroque Art Henry Clay Frick Department of the History of Art and Architecture . I am profoundly grateful to my doctoral committee (Ann Sutherland Harris, David Wilkins, Anne Weis, Kathleen Christian, Francesca Savoia and Dennis Looney) for having faith in me, for offering direction when needed, and for their ample doses of .
