Download PGI PG 2020 May Physio Solved Question Paper

1.Allofthesearecorrectofrenalphysiology
except:
a)SodiumabsorptionoccursinDCT
b)Potassiumisbothsecretedandabsorbedintubules
c)GlucoseisreabsorbedinDCT

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d)All
e)None
CorrectAnswer-C
Ans.Ci.e.GlucoseisreabsorbedinDCT
RENALHANDLINGOFSUBSTANCE

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InPCT:
60-70%offilteredwaterreabsorbedpassively.
Coupledmainlytosodiumreabsorption.
Glucose&aminoacidsAbsorbedcompletely(100%).
Maximum(90%)bicarbonateabsorption.

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InDCT:
Principal(P)cellsreabsorbsodium&waterfromlumen
&secretepotassiumintolumen.
Intercalated(I)cellsreabsorbpotassium&secrete
hydrogenintolumen.

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Sodiumreabsorptionapproximately7%filteredNa2+reabsorbed.
InHenleloop:
Thindescendingsegment-
Waterreabsorption:Highlypermeabletowater.
Reabsorptionofsolutes:Impermeabletosolutes(Na2+,Cl-&

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urea).

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Minimalureasecreted.
Inthinascendinglimb:
NaCl-reabsorptionoccurs-DuetohighNaCl-permeability.
Lesspermeabletowater.

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Thickascendinglimb:
Sodium,Potassium&Chloridereabsorption:
TransportsoneNa2+,oneK+,&twoCl-.
Activesodiumabsorptionoccurs.
30%filteredNa2+reabsorbed.

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Waterreabsorption:Totallyimpermeabletowater.

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2.Bloodbrainbarrierisabsentin?
a)Adenohypophysis
b)Neurohypophysis
c)Hypothalamus

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d)Thalamus
e)None
CorrectAnswer-B
Ans.is'b'i.e.,Neurohypophysis
Bloodbrainbarriersexistbothatthechoroidplexusandatthetissue

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capillarymembranesinessentiallyallareasofthebrainparenchyma
exceptinsomeareosofthehypothalamus,pinealgland,adarca
posttema,wheresubstancesdiffusewithgreatereaseintothetissue
spaces.
FourareasthatareoutsideofBBBare(l)theposteriorpituitary

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(neurohypophysis)andtheadjacentventralpartofthemedian
eminenceofthehypothalamus,(2)theareapostrema,(3)the
organumvasculosumofthelaminaterminalis(OVLT,supraoptic
crest),and(4)thesubfornicalorgan(SFO).
Referredtocollectivelyasthecircumventricularorgans

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3.TrueregardingHbA2is/are?
a)Ithasmorecapacitytocarryoxygen
b)ConcentrationismorethanHbA
c)LevelisincreasedinThalasemia
d)Consistsof2alphaand2betachains

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e)Noneoftheabove
CorrectAnswer-B
Ans.is'c'i.e.,LevelisincreasedinThalassemia
Ref:Ganong23d/ep.523-525https://www.aafp.org/alp/2009/08
15/p339.html

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"Thehemoglobinelectrophoresiswithbetathalassemiatraitusually
hasreducedorabsentHbA,elevatedlevelsofHbA2.andincreased
HbF.
However,anormalconcentrationofHbA2doesnotruleoutbeta
thalassemiatrait.especiallyiftherewascoexistentirondeficiency,

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whichcanlowerHbA2levelsintothenormalrange."
"HemoglobinA2maybeincreasedinbetathalassemiaorinpeople
whoareheterozygousforthebetathalassemiagene.

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4.TRUEstatement(s)regarding"loopof
Henley"inkidneyis/are?

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a)AscendinglimbactivelyabsorbsNa
b)AscendinglimbactivelyabsorbsCl
c)Ascendinglimbsecreteswaterinlumen
d)Descendinglimbsecreteswater
e)DescendinglimbreceiveshyperosmolarfluidfromPCT

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CorrectAnswer-A:B
Ans.is'a'i.e.,AscendinglimbactivelyabsorbsNa+&'b'i.e.
AscendinglimbactivelyabsorbsCl-
Ref:Ganong25th/eP.680-691;Essentialsofmedicalphysiologyp.
271

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LOOPOFHENLE
TheloopofHenlehasathindescending,athinascendinganda
thickascendingsegments.
REABSORPTIONINTHINASCENDINGLIMB:
NaCl-reabsorptionoccurs-

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DuetohighNaCl-permeability.
Lesspermeabletowater.
Tubularfluidisiso-osmotic.
REABSORPTIONINTHICKASCENDINGLIMB:
Sodium,Potassium&Chloridereabsorption:

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By"Secondaryactivetransport"-
ThroughNa2+-K+-2Cl--carriertransporter.
TransportsoneNa2+,oneK+,&twoCl-.
Activesodiumabsorptionoccurs.

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30%filteredNa2+reabsorbed.

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Waterreabsorption:
Totallyimpermeabletowater.
Ascendingsegmentalsoreferred"Diluting"segment:
Duetosodium&soluteabsorptionwithoutwater.
Resultingintubularfluiddilution.

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Tubularfluidishypotonic.

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5.Iodineistransportedtothethyroidgland
by?
a)Activetransport
b)Diffusion

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c)Passivetransport
d)Pinocytosis
e)None
CorrectAnswer-A
Ans.is'a'i.e.,Activetransport[Ref:Ganongjs24th/ep.3411]

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Iodineuptakeforthyroidhormonesynthesis:
Iodineuptakemediatedbythyroidfollicularcellsfromtheblood
plasmaisthefirststepforthesynthesisofthyroidhormones.
Thisingestediodineisboundtoserumproteins,especiallyto
albumins.

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Therestoftheiodinewhichremainsunlinkedandfreein
bloodstream,isremovedfromthebodythroughurine.
Basolateralmembraneofthyroidcells(follicularcells)haveactive
transportsystemforiodineuptake-Na+:I-symporter(NlS)
(Secondaryactivetransport).

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ThistrappingstimulatedbyTSH,

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6.Antioxidanteffectsareshownby?
a)VitaminC
b)VitaminE
c)Selenium

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d)Zinc
e)VitaminB
CorrectAnswer-A:B:C:D
Ans.is'a'i.e.,VitaminC,'b'i.e.VitaminE,'c'i.e.,Selenium&'d',
Zinc

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RefHarper's30th/ep.565;Robbins'sth/ep.66-67,http://
www.rroij.coml
Naturallyoccurringantioxidants:
Alkaloidsandrelatedcompounds
Aminoacidsandpeptidederivatives:-cysteine,tryptophan,

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melatonin,andtryptamine
Vitamins:-Betacarotene,VitaminA,VitaminC,VitaminE
(tocopherol)
Minerals:-selenium,zinc
Enzymes:-catalase,superoxidedismutase(SOD),andglutathione

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peroxidase
Flavonoids&Isoflavonoids:Chalconesandcatechins
Carnosine
Clorogenic&melanicacids
Curcuminandderivatives

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Ergothioneine
Freephenolicacids
Hydroquinonesandquinones

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Lignans
Lipoicacid

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Lycopene
Tetrapyrroles
Uricacidandotherourines

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7.Rightcombinationofsensoryreceptorand
sensationcarriedbythemincludes?

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a)Krouse'sbulb-pressure
b)Paciniancorpuscels-vibration
c)Meissner'scorpuscles-pressure
d)Ruffini'sendorgans-pressure
e)Merkel'sdisc-coldtemperature

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CorrectAnswer-B:D
Ans.is'b'i.e.,Paciniancorpuscles-vibration&'d'i.e.Ruffini's
endorganspressure
[Ref:Guyton12th/ep.560tableG6.1);Principlesofmedical
physiologyp.647,648

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Tactile(Touch)receptor:
Whetheratactilereceptorsensespressureorvibrationdependson
whetherreceptorisfastlyadaptingorslowlyadapting.
Touch,pressure,&vibrationaredifferentformsofsamesensation.
Pressureisfeltwhenforceappliedonskinissufficienttoreachdeep

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receptors.
Touchisfeltwhenforceisinsufficienttoreachdeepreceptors.
Hence,detectedbysuperficialreceptors(Merkel'sdisc&Meissner's
corpuscle).
Vibrationsarerhythmicvariationsinpressure.

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I.e.Rhymicvariationsofforcethatreachesdeepreceptors.
Divisions:
2a.Slowlyadapting:
Examplesinclude,"Oneeachfromsuperficial&deepcutaneous

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receptors"

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Ruffini'sendorgan-
Meanttodetectsustainedpressure.
Uselessforvibrations.
Merkel'sdisk-
Detecttwo-pointdiscrimination.

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2b.Rapidlyadapting:
Examples,
"Oneeachfromsuperficial&deepcutaneousreceptors"
Paciniancorpuscle-
Stopsdischargeinresponsetosustainedpressure.

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Usefultodetectvibrations-I.e.,whenpressurefluctuatesrapidly.
Meissner'scorpuscle-
Detectsurfacetexture.
Hence,HighertherateofreceptoradaptationGreateris
detectablevibrationfrequency.

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3.Basedontypeoftactilesensationsdetected:
3a.Superficialsensations:
Generallytouch
ByMeissner'scorpuscle(detectsurfacetexturei.e.roughor
smooth)

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ByMerkel'sdisc(detecttwo-pointdiscrimination).
3b.Deepsensations:
Pressure(Deeptouch)-DetectedbyRufiniorgan.
Vibrations-DetectedbyPaciniancorpuscle.
SUMMARY:

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1.Superficialcutaneousreceptors:
Detecttouch(Superficialsensation)
Merkel'sdisk-Slowlyadapting&detecttwo-point
discrimination.
Meissner'scorpuscle-Rapidlyadapting&detectsurface

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texture.
2.Deepcutaneousreceptors:
Detectdeeptouch,pressure,&Vibration.
Ruffini'sendorgan-Slowlyadapting&detectsustained
pressure/deeptouch.

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Paciniancorpuscle-Rapidlyadapting&detect

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vibrations(usefulonlywhenpressurefluctuatesrapidly.i.e.during
vibrations).
Highertherateofadaptationofreceptor,thegreatervibration
frequencyitcandetect.

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8.TRUEregardinghypoxemiais/are?
a)Decreaseinventilation
b)Decreaseindeliveryofoxygentotissues
c)Inadequateutilizationofoxygenbytissuesdespitenormal
deliveryofoxygen

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d)Decreasedoxygenpressureinblood
e)Alloftheabove
CorrectAnswer-A:D
Ansis'a'i.e.,Decreaseinventilation&'d'i.e.Decreasedoxygen
pressureinblood.

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[Ref:Ganong25th/ep.647624/ep.649;Principlesofmedical
physiologyp.354,355;
https://www.ncbi.nlm.nih.gov/pmc/articles/PMc52341994]
Optionb&carerelatedwithhypoxia,nothypoxemia.
Hypoxemiaandhypoxia:

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Thetermhypoxiaandhypoxemiaarenotsynonymous.
Hypoxemiaisdefinedasadecreaseinthepartialpressureof
oxygeninthebloodwhereashypoxiaisdefinedb!reducedlevelof
tissueoxygenation.
Hypoxiacanbeduetoeitherdefectivedeliveryordefective

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utilizationofoxygenbythetissues.
Causesofhypoxemia
Theinspiredairhasreducedoxygencontent(e.g.,athighaltitudeor
duetoothercauses).
Insufficientgasexchangeiscausedbyalveolarhypoventilation.

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9.AccordingtoWHO,normalsemenfindings
are?
a)Volume-1.5ml
b)Concentration-15million/ml
c)Progressivemotility->40%

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d)Normalmorphology->10%
e)Ph-<6.3
CorrectAnswer-A:B
Ans.is'a'i.e.,Volume-1.5ml&'b'i.e.Concentration-15
million/mlhttps://www.institutobernabeu.com/foro/en/2014/02/17/semen-

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quality-parameters-according-to-the-world-health-organisation-who/
TheWorldHealthOrganisation(WHO)haspublishedseveral
editionsofthe"ManualfortheExaminationofHumanSemenand
Sperm-CervicalMucusInteraction",thelastonein2010.
Theconceptof"LowerReferenceLimit(LRL)wasestablishedinthe

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lastmanualoftheWHO.
Therearemanyparametersobtainedthroughaspermiogram,the
mostfrequentlystudiedare:
Volume:Thenormalvolumeofanejaculatesampleafter3/5daysof
sexualabstinenceis1.5mlapproximately.Lowervolumesmight

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suggesthypospermia.
Color:Spermisusuallyopalescentwhite,slightlyyellow.Whenthe
colorisaltered,itisrecommendedtostudypossiblecauses.
pH:ValueshouldbegreaterthanT.l.Lowervaluesmightbeasign
ofazoospermia(lackofspermatozoa)orchronicinflammatory

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processes.

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Spermconcentration:Normalvaluesarearound15millionperml
eiaculatedor39millionpercompletesemensample.Whenthese
valuesareloweritcouldindicateOligozoospermia.
Motility:Thepercentageofmotilespermatozoaandprogressively

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motileisanalyzed.Theprogressivemotilityvalueshouldbeover
32%,onthecontraryitmightindicateAstenozoospermia.
Vitality:Thepercentageofvitalspermatozoamustbeover58%.
LowervaluescouldindicateAstenozoospermia.
Morphology:Theremightbe4%ormorenormalspermatozoaina

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usualspermiogram.Lowerpercentagescouldindicate
teratozoospermia.

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10.Normalvalueofhydrogenionsinhuman
fluidsis?
a)35meq/L

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b)40meq/L
c)45meq/L
d)50meq/L
e)Noneoftheabove
CorrectAnswer-E

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Ansis'e'i.e.,Noneoftheabove
Thenormalhydrogenionconcentrationofbloodandotherbody
fluidsisquitelow<0.0001mEq/L)comparedwiththebodyfluid
concentrationsofotherelectrolytes.
Becauseitissolow,hydrogenionconcentrationismeasuredinpH

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units,calculatedasthenegativelogarithmoftheconcentrationin
milliequivalentsperliter.
NormalpHrangesfrom7.35to7.45forarterialbloodandfrom7
.31to7.41forvenousblood.

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11.

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Whichofthefollowingplaymost
importantroleinmemory:
a)Synapticnetwork
b)Electricconductionnetwork
c)Conductivitycircuit

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d)Conductivitynetwork
e)None
CorrectAnswer-A
Ans:a.SynapticNet.
[Ref:Ganong25th/283-88;Guyton12th/67;AKJain6th/1039-40]

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Synapticnetworkssinglebestanswer"Long-termmemoryinvolves
changesinthestructureofneuronsincludinggrowthofnew
processesandsynapses.
So,totheextentthatyourememberanythingaboutthismaterialon
memorytomorrow,ornextweek,ornextyear,itwillbebecause

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structuralchangesinsynapsesarebeginninginyourbrains.

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12.CyanidepoisoningblockKinflux&Na
efflux.ButATPreversethiseffect.Sotrue
statement(s)relatedtomechanismof
actionofcyanideis/are:

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a)Kinflux&NaeffluxisregulatedbyNa-KATPaseenzyme
b)Kinflux&NaeffluxisregulatedbyNa-Kpump
c)ATPprovideenergyforthischannel
d)Na-KATPasechannelisATPindependent
e)None

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CorrectAnswer-A:B:C
Ans:a.Kinflux&NaEffluxIsRegulatedByNa-K-ATpase
Enzymeb.Kinflux&NaEffluxIsRegulatedByNa-Kpumpc.
ATPprovidesenergyforthischannel.
[Ref:Reddy32nd/595;Katzung13th/1010;Guyton12th/357;AK

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Jain6th/459;Harrison19th/262e-7]
Cyanide:
Directlypoisonsthelaststepinthemitochondrialelectrontransport
chain,cytochromea3,whichresultsinashutdownofcellularenergy
production.

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Thispoisoningresultsfromcyanidehighaffinityforcertainmetals,
notablyCoandFe+++.Cytochromea3containsFe+++,towhich
CN-binds.
CyanidePoisoning:
Itinhibitstheactionofcytochromeoxidase,carbonicanhydrase&

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probablyofotherenzymesystem.
Itblocksthefinalstepofoxidativephosphorylation&preventsthe

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formationofATP&itsuseasanenergysource.

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13.TrueaboutCarbonmonoxidepoisoning:
a)COhas100timesmoreaffinitythan02forHb

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b)Causerightsideshiftingof02dissociationcurve
c)Oxygen-haemoglobinsaturationcurvebecomeshyperbolic
shape
d)PulseoximetrycanaccuratelydetectlevelofCO
e)10-15%levelofCOnormallymayoccurinhealthynonsmoker

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CorrectAnswer-C
Ans:c.Orygen-haemoglobinsaturationsaturationCurve
BecomesHyperbolicShape
[RefGanong25th/650-51;Guyton12th/352;AKJain6th/431;
httpst/pedclerk.bsd.uchicago.edu/page/(www.nebi.Nlm.nih.

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gov)
Carbon-monoxide-poisoning:
Carbonmonoxideshiftstheoxygen-haemoglobinsaturationcurveto
theleftandchangesittoamorehyperbolicshape.
Lessoxygenisavailableforthetissues.

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plasmalevelofcarboxyhemoglobinisnormallyquitelow.
Atbaseline,levelsupto3percent,naybeseeninnonsmokers,
whilesmokersmayhavelevelsupto10-15%percent.
LeftshiftofO2-Hbdissociationcurveoccurin-COpoisoningHbF,
myoglobinebdecreaseinbodytemperature.

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COhasabout240timestheaffinityofO2forHb;thismeansthatCO
willcombinewiththesameamountofHbas02whentheCOpartial
pressureis240timeslower.

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14.Deadspaceisincreasedin:
a)Positivepressureventilation

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b)Extensionofneck
c)Anticholinergicdrug
d)Endotrachealtubeintubation
e)Emphysema
CorrectAnswer-A:B:C:E

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Ans:a.Positivepressureventilationb.Extensionofneckc.
AntiCholinergicdruge.Emphysema
RefAjayYadav5th/4-5;Ganong25th/632-33;Guyton323;AKlain
6th/421
AnatomicalDeadSpaceIncreasedin:

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OIdage
Neckextension
jawprotrusion
Bronchodilators
Increasinglungvolume(moreininspiration)

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Atropine(causebronchodilation)
Anaesthesiamask,circuits
Intermittentpositivepressureventilation(IppV)&positiveend
expiratorypressure(PEEP)
AlveolarDeadSpaceincreasedby:

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Lungpathologiesaffectingdiffusionatcapillarymembranelike
interstitiallungdisease,pulmonaryembolism,pulmonaryedema&
ARDS
Generalanaesthesia
IPPV

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PEEP
HYPotension

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15.Whichofthefollowingistrueabout
cardiacinnervation:
a)T1-T5issympatheticsupply

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b)Inferior&superiorcervicalganglianotinvolveininnervation
c)Parasympatheticsupplyisfromvagusnerve
d)Greatcardiacnervearisefromsuperiorcervicalganglia
e)InferiorcervicalgangliagivesoffInferiorcardiacnerve
CorrectAnswer-A:E

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Ans:a.T1-T5issympathetice.Inferiorcervicalgangliagives
offinferiorcardiacnerve
[Ref:BDC6th/Vol.I267;Grayb40th/982;Guyton12th/178;AKlain
6th/324]
CardiacInnervation

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Thecervicalgangliaareparavertebralgangliaofthesympathetic
nervoussystem.
Thecervicalganglionhasthreeparavertebralganglia.
Superiorcervicalganglion(largest)-adjacenttoC2&C3
Middlecervicalganglion(thesmallest)-adjacenttoC6;target:

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heart,neck.
Inferiorcervicalganglion.Theinferiorganglionmaybefusedwith
thefirstthoracicgangliontoformasinglestructure,thestellate
ganglionadjacenttoC7.
Themiddlecardiacnerve(greatcardiacnerve),thelargestofthe

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threecardiacnerves,arisesfromthemiddlecervicalganglion.
Nervesemergingfromchemicalsympatheticgangliacontributeto
thecardiacplexus.

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SymPatheticsupply:T1toT5spinalsegments.
SympatheticpreganglionicfibrespassintothesymPathetictrunkto

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superionmiddle&inferiorcardiacganglion
Sympatheticpostganglionicfibrespassesviasuperiormiddle&
inferiorcardiacsympatheticnerves
Parasympatheticsupplytoheartisviatwovagusnerveswiththeir
cellbodieslocatedinthemedullainthenucleusambiguus.

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16.Trueaboutcortisollevelinbloodplasma:
a)Morningconcentrationis17-18nmol/d1
b)Morningconcentrationis5-23pg/dL
c)Eveningconcentrationisalmosthalfofmorningconcentration
d)Eveningconcentrationis5-23i.ig/dL

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e)None
CorrectAnswer-B:C
Ans:b.Morningconcentrationis5-23microg/dLc.Evening
concentrationisalmostHalfOfMorningConcentration
Eveningconcentrationisalmosthalfofmorningconcentration(a/c

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belowreferencevalues).
Cortisolconcentrationat8.00aminmorning5-20mcg/dL(140-550
nmol/L).

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17.Saccadicceyemovementiscontrolledby:
a)Parietallobe

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b)Prefrontallobe
c)Temporallobe
d)Frontalcortex
e)Occipitallobe
CorrectAnswer-D

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Ans:d.Frontalcortex
[RefGanong25th/189,195-96;Guyton12tlt/786;AKJain1115-16]
Normallysaccadicmovementsarevoluntarybutcanbearousedby
peripheralvisualorauditorystimulibystimulationoffrontaleye
fields(area8).

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Thusthesemovementsareprogrammedinthefrontalcortex.
Thebilateralfrontaleyefieldsinthispartofthecortexareconcerned
withthecontrolofsaccades,andanareajustanteriortothesefields
isconcernedwithvergenceandthenearresponse.

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18.TrueaboutnormalECG:

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a)NormalPRintervalis0.12-0.20s
b)PRinternalcorrespondenceinitiationofPwavetoinitiationofR
wave
c)QTinternalcorrespondenceinitiationofQwavetoinitiationofT
wave

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d)NormalQRSinterval<0.12s
e)NormalQTcinterval
CorrectAnswer-A:D
Ans:a.NormalPRintervalis0.12-0.20sd.NormalQRSinterval
[Ref:Ganong25th/524;Guyton12th/179-80;ECGmadeEasyby

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Hamptot4th/6-71]
ThePRintervalismeasuredfromthebeginningofPwavetothe
beginningofQRScomplex.
AQTcintervallongerthan0.45sislikelytobeabnormal.
NormalQRSintervaldurationisnogreaterthan0.12s.

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QTintervalisameasureofthetimebetweenthestartoftheQwave
andtheendoftheTwaveintheheart'selectricalcycle.

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19.Whichofthefollowingis/aretrueabout
SIADH:

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a)Desmopressinisusedfortreatment
b)Vasopressinlevelisinappropriatelyhigh
c)Plasmaosmolalityishigherthanurineosmolality
d)TedOsmolalityofurine
e)TedOsmolalityofplasma

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CorrectAnswer-B:D
Ans:b.VasopressinlevelisinappropriatelyHighd.Ted
Osmolalityofurine
[RefHarrison19th/2280;Ganong25th/698;AKJain6th/673-74]
Desmopressinisveryusefulinthemanagementofdiabetes

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insipidus.
SyndromeofInappropriateAntidiureticHormone
Thesyndromeof"inappropriate'hypersecretionofantidiuretic
hormone(SIADH)occurswhenvasopressinisinappropriatelyhigh
relativetoserumosmolality.

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Vasopressinisresponsiblenotonlyfordilutionalhyponatremia
(serumsodium<135mmol/L)butalsoforlossofsaltintheurine
whenwaterretentionissufficienttoexpandtheECFvolume,
reducingaldosteronesecretion
Features:

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Hyposmolality
Increasedurineosmolality
Urineosmolalitybecomeshigherthanplasmaosmolality
UrinaryNa+exceeds20mEq/L

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20.Whichofthefollowingfeature(s)is/are

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suggestiveofnehogrnicDIincomparison
tocentralDI:
a)Desmopressinnasalsprayrestoreurineoutputtonormallevel
b)Basalvasopressinlevel>1pg/ml
c)NormalposteriorpituitarybrightspotisnotvisibleonMRIscan

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d)Changeinwaterlossduringfluiddeprivationtest
e)None
CorrectAnswer-B
Ans:b.Basalvasopressinlevel>1pg/ml
[RefGanong25th/698;Guyton12th/488-89;AKJain6th/674]

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FailuretoProduceADH:"Central"DiabetesInsipidus.
Thetreatmentforcentraldiabetesinsipidusisadministrationofa
syntheticanalogofADH,desmopressin,whichactsselectivelyon
V2receptorstoincreasewaterpermeabilityinthelatedistaland
collectingtubules.

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Desmopressincanbegivenbyinjection,asanasalspray,ororally,
anditrapidlyrestoresurineoutputtowardnormal.
ThepolyuriaanilpolydipsiaofnephrogenicDIarenotaffectedby
treatment*ithstandarddosesofDDAVP.

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21.Truestateinent(s)aboutOlfactorysystem

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:
a)Olfactorymucosacoverupper1/3ofnasalcavity
b)Olfactorypathwaypassesviathalamustoorbitofrontalcortex
c)Adaptationtoodourdeveloponlyafter1-2minutes
d)OlfactoryreceptorsactviacAMP

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e)Rateofolfactorynerveimpulseschangeapproximatelyin
proportiontothelogarithmofstimulusstrength
CorrectAnswer-A:B:D:E
Ans.(A)Olfactorymucosacoverupper1/3ofnasalcavity
(B)Olfactorypathwaypassesviathalamustoorbitofrontal

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cortex(D)OlfactoryreceptorsactviacAMP(E)Rateofolfactory
nerveimpulseschangeapproximatelyinproportiontothe
logarithmofstimulusstrength
Rateofolfactorynerveimpulseschangeapproximatelyinproportion
tothelogarithmoFstimulusstrength.

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Theolfactoryreceptorsadaptabout5O%inthefirstsecondorso
afterstlmulatlan.Thereafter,theyadaptverylittleandveryslowly.
Adaptation:Itdevelopswithinsecondsonminutes,dependingon
thenatureofthesubstance.
Weber-FechnerLawstatesthatthesubjectivesensation(ofodor,

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soundorlightintensity)isproportionaltothelogarithmof!the
stimulusintensity''
ThereceptorintheolfactorymucousmembranearecoupledtoG-
proteins.
Olfactoryregions:theUpper1/3oflateralwalls(uptosuperior

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concha),correspondingpartofthenasalseptumandtheroofofthe
nasalcavityfromtheolfactoryregion'Here,mucousmembraneIs
palerincolor

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22.Vomitingcentre(s)involvedinpost-
operativevomiting

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a)Areapostrema
b)Chemoreceptortriggerzone(CTZ)
c)Reticularformationlocatedinmedulla
d)Nucleustractussolitarius
e)Basalganglia

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CorrectAnswer-A:B:D
Ans.A,AreapostremaB,Chemoreceptortriggerzone(CTZ)&
D,Nucleustractussolitarius
PostoperativeNauseaandVomiting(PONV):
PONVisdefinedasanynausea,retching,orvomitingoccurring

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duringthefirst24-48haftersurgeryinpatients.
Accordingtoourcurrentmodel,thebrainstructuresinvolvedinthe
pathophysiologyofvomitingaredistributedthroughoutthemedulla
oblongataofthebrainstem,notcentralized,lnananatomically
defined'vomitingcentre'.

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Suchstructuresincludethechemoreceptortriggerzone(cRTZ),
Locatedatthecaudalendofthefourthventricleinthearea
postrema,andthenucleustractussolitarius(NTS),locatedin
theareapostremaandlowerpons.
PONVcanbetriggeredbyseveralperioperativestimuli,including

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opioids,volatileanaesthetics,anxiety,adversedrugreactions,and
motion.

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23.Trueaboutspecialanatomyand
Physiologyoflung:
a)Surfactantpreventcollapseofsmallalveoliintolargerone

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b)Largeralveolihasmoretendencytocollapsethansmaller
alveoliinabsenceofsurfactant
c)Surfactantdecreasechanceofcollapse
d)Surfactantincreasessurfacetension
e)Withsurfactant,largealveolitendtobecomesmallerand

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smalleronestendtobecomelarger
CorrectAnswer-A:C:E
Ans.(A)Surfactantpreventcollapseofsmallalveoliintolarger
one(C)Surfactantdecreasechanceofcollapse(E)With
surfactant,largealveolitendtobecomesmallerandsmaller

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onestendtobecomelarger
Upperregionalveolihavelargervolumes.
Alreadyfilledwithairandarelesscompliantcomparedtothoseto
dependentregions
LowsurFacetensionalveoliaresmall-duetothepresenceinthe

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fluidliningthealveoliofsurfactant,alipidsurface-tension-lowering
agent.
Surfactantdeficiencyisanimportantcauseofinfantrespiratory
distresssyndrome(IRDS,alsoknownashyalinemembrane
disease.

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Surfacetensioninthelungsoftheseinfantsishigher,andthe
alveoliarecollapsedlnmatryareas(atelectasis).

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24.Allaretrueaboutacromegalyexcept:
a)IncreasedIGF-1levels
b)Excessivegrowthoccursbeforefusionoftheepiphysesofthe

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longbones
c)Somatostatinanaloguescanbeused
d)Growthhormonelevelsincreased
e)Transsphenoidalsurgicalresectionisthepreferredprimary
treatmentforpituitaryadenoma

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CorrectAnswer-B
Ans.B.Excessivegrowthoccursbeforefusionofthe
epiphysesofthelongbones
Inacromegaly,IGF-IlevelsareinvariablyhighandreflectaLog-
LinearrelationshipwithclrculatlngGHconcentrations.

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Foracromegaly,somatostatinanaloguesandGHreceptor
antagonistsareindicated
Age-matchedserumIGF-Ilevelsareelevatedinacromegaly.
Somatostatinanaloguesareusedasadjuvanttreatmentfor
preoperativeshrinkageoflargeinvasivemacroadenomas.

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Transsphenoidalsurgicalresectionbyanexperienced.surgeonis
thepreferredprimarytreatment.
Tumorsofthesomatotrophsoftheanteriorpituitary(pituitary
adenomas)secretelargeamountsofgrowthhormone,leadingto
glgantbmlnchlUrenandacromegalyinadults.

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Hypersecretionofgrowthhormoneisaccompaniedby
hypersecretionofprolactinin20-40%ofpatientswithacromegaly.

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25.Truestatement(S)is/are:
a)Vasopressinincreaseonlywaterreabsorption,notsolute
reabsorption

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b)AldosteroneincreaseNa+reabsorptionfromtubules
c)GlomerularfiltrateofPCThassimilarosmolarityasofplasma
d)UrineishyperosmolarinearlyDCT
e)Generallyurineosmolarityequalstoplasmaosmolarity
CorrectAnswer-A:B:C

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Ans(A)Vasopressinincreaseonlywaterreabsorption,not
solutereabsorption(B)AldosteroneincreaseNa+reabsorption
fromtubules(C)GlomerularfiltrateofPCThassimilar
osmolarityasofplasma
Antidiuretichormone(ADH,Vasopressin)increasespermeabilityof

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distaltubules(mildaction)andcollectingducts(mainly)to
water)increaseswaterreabsorption.
Aldosteronecausesretentlonofsodlumtromthekidneyand
increasedurinaryexcretionofpotassium;ithaslittleeffectonwater
excretion.

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PCT:Theosmolalityoffluidstntubuleisunchangedatapprox.
3(X)mosmie,isotonicityismaintained.
ThetubularfluidenteringtheDCTisalwayshypotonictoplasma.
ThefluidinthedescendinglimboftheloopofHenlebecomes
hypertonicaswatermovesoutofthetubuleintothehypertonic

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interstitium.
Intheascendinglimbltbecomesmoredilutebecauseofthe
movementofNa+andCl-outofthetubularlumen,and.whenfluid
reachesthetopoftheascendinglt.

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AdrenalmineralocorticoidssuchasaLDosteroneincreasedtubular

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reabsorptionofNa+inassociationwithsecretionofK+andH+and
alsoNa+reabsorptionwithCl-.

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26.Rapidlyadaptingreceptor(s)is/are:
a)Painreceptor
b)Paciniancorpuscles

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c)Musclespindle
d)Golgitendonorgans
e)Meissnercorpuscles
CorrectAnswer-B:D:E
Ans.(B)Paciniancorpuscles(D)Golgitendonorgans

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(E)Meissnercorpuscles
Rapidlyadapting:Rapidlyadaptingmechanoreceptorsinclude
Meissnercorpuscleend-organs,Paciniancorpuscleend-organs,
hairfolliclesreceptorsandsomefreenerveendings.
Merkel'sdiscsandMelssner'scorpusclesaretactilereceptors.

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Theyarerapidlyadaptingreceptors.
Paciniancorpuscles:Theyrespondtodeformationcausedbyfirm
pressureandarequietlyadapting.

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27.Whichofthefollowingis/aretrueabout
normallevel:

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a)TotalCalcium:8.5-10.5mg/dL
b)Sodium:135-145mmol/L
c)Potassium:3.5-5.1mmol/L
d)Creatinine:0.6-2.6mg/dL
e)TSHlevel:0.1-3.1mIU/L

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CorrectAnswer-A:B:C
Ans.(A)TotalCalcium:8.5-10.5mg/dL(B)Sodium:135-145
mmol/L(C)Potassium:3.5-5.1mmol/L
Davidson22ed/1308,HarrisonL9rh/2762,2763,
TSH-.2-4.5mU/L

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Calcium(total):8.5-10.5mg/dL
Potassium-3.5-5.0meq/L
Sodium-136-146meq/L
Serumcreatinine-0.6-1.6mg/dl

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28.TrueaboutActionPotentialinskeletal

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musclefibersandnervefibres:
a)Skeletalmusclefibresconductionvelocityis1/4ofthick
myelinatednervefiber
b)Actionpotentialofbothqualitativelysimilar
c)Restingmembranepotentialalmostsame

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d)Durationofactionpotentialsameinboth
e)Actionpotentialofbothquantitivelysimilar
CorrectAnswer-B:C
Ans.(B)Actionpotentialofbothqualitativelysimilar
(C)Restingmembranepotentialalmostsame

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MuscleActionPotential-ComparisonwithNerveActionPotential
GuytonIlth/89
Restingmembranepotential:about-80to-90millivoltstoskeletal
fibers-thesameaslnlargemyelinatednervefibers.
Durationofactionpotential1to5millisecondstnskeletalmuscle

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aboutfivetimesaslongasinlargemyelinatedfibers..
Velocityofconduction:3to5m/sec-about1/13ththevelocityof
conductioninlargemyelinatedteraefibersthatexciteskeletal
muscle.

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29.Comprehensionpreservedinwhichofthe

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follwingaphasia
a)Broca'saphasia
b)Conductionaphasia
c)Wernicke'saphasia
d)Gobalaphasia

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e)Anomicaphasia
CorrectAnswer-A:B:E
Ans.A,Broca'saphasiaB,Conductionaphasia&E,Anomic
aphasia
Repetition

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Comprehension ofSpoken Naming
Fluency
Language
Preserved
Wernicke's

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Impaired
Impaired
Impaired or
increased
Preserved

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Broca's
(except
Impaired
Impaired Decreased
grammar)

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Global
Impaired
Impaired
Impaired Decreased
Conduction

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Preserved
Impaired
Impaired Preserved
Nonfluent
Preserved

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Preserved Impaired Impaired
(motor)transcortical
Fluent(sensory)
Impaired
Preserved Impaired Preserved

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transcortical
No

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No
Isolation
Impaired

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Echolalia Impaired purposeful
speech
Preserved
exceptfor
Anomic

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Preserved
Preserved Impaired word-
finding
pauses
Impairedonlyfor

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Pureword
spoken
Impaired
Preserved Preserved
deafness

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language
Impairedonlyfor
Purealexia
Preserved Preserved Preserved
reading

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30.Tissueelevationofwhichofthefollowing
causevasoconstriction:
a)Na+
b)K+
c)Mg

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d)Ca2+
e)H+
CorrectAnswer-D
Ans.D.Ca2+
VascularControlbylonsandOtherChemicalFactorsGuyton

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12th(SAE)/269
Anincreaseincalciumionconcentrationcausesvasoconstriction.
Anincreaseinpotassiumionconcentration,.withinthephysiological
range,causesvasodilation.
Anincreaseinmagnesiumionconcentrationcausespowerful

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vasodilation.
Anincreaseinhydrogenionconcentration(decreaseinpH)causes
dilationofthearterioles.
Anionsthathavesignificanteffectsonbloodvesselsareacetateand
citrate.AnIncreaseincarbondioxideconcentrationcausesmoderate

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vasodilationinmosttissuesbutmarkedvasodilationinthebrain.

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31.Whichofthefollowingstatement(s)is/are
truechangesattimeofovulation:
a)GnRHleveldecreases
b)Gonadotropinhormonesurge

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c)hCGsurge
d)1`Prostaglandins
e)Activationofproteolyticenzymes
CorrectAnswer-B:D:E
Ans.B,GonadotropinhormonesurgeD,1`Prostaglandins&

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E,Activationofproteolyticenzymes
Ovulation:
ThemidcycleLHsurgeisresponsibleforadramaticincreasein
localconcentrationsofprostaglandinsandproteolyticenzymesin
thefollicularwall.

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Thesesubstancesprogressivelyweakenthefollicularwalland
ultimatelyallowaperforationtoform.
Ifpregnancydoesoccur,placentalhCGwillmimicLHactionand
continuallystimulatethecorpusluteumtosecreteprogesterone.
FeedbackEffects:

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At36-48hbeforeovulation,theestrogenfeedbackeffectbecomes
positive,andthisinitiatestheburstofLHsecretion(LHsurge)that
producesovulation.
Ovulationoccursabout9afterLHpeak-FSHsecretionalsopeaks,
despiteasmallriseininhibin,probablybecauseof.thestrong

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stimulationofgonadotropesbyGnRH.
Duringthelutealphase,thesecretionofLHandFSHislowbecause

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oftheelevatedlevelsofestrogen,progesterone,andinhibin.

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32.Whichofthefollowingstatementsaretrue
regardingdiffusionofgasinlung-

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a)Diffusionofgasisperfusionlimited
b)CO,diffuses20timesfasterthan02
c)PO2gradientislowbetweenalveoli&bloodvesselincaseof
restrictivelungdisease
d)Diffusionofgasisdecreasedinemphysema

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e)Diffusioncapacityof0,is25
CorrectAnswer-A:B:D:E
Ans.(A)Diffusionofgasisperfusionlimited(B)CO,diffuses20
timesfasterthan02(D)Diffusionofgasisdecreasedin
emphysema(E)Diffusioncapacityof0,is25

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Ref:Textbookofrespiratoryphysiology3rded/p913
Flow-limit(Perfusion-limited)Vsdiffusion-limitedtransport:
DiffusionofO2,CO2,N2Oacrosstherespiratorymembraneareall
flow(perfusion)limited.
COtransferisdiffusion-limited-Sincecarbonmonoxide(CO)is

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takenupbyhemoglobinanditbindssoavidlywithHb.
DiffusionCapacityOfO2-2O-25ml/min/mmHg.
DiffusionCapacityOfCO2-400ml/min/mmHg
CO2diffuses15-20timesfasterthanO2
Diffusionofgasinemphysema:

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EmphysemaCausesthickeningofrespiratorymembrane
Causingreduceddiffusiontogases.

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33.Whichofthefollowingaboutrenin
angiotensinsystemaretrue-
a)Reninisproducedbymodifiedsmoothmusclesofglomerular

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capillary
b)Maculadensacellsarepartofthispathway
c)Angiotensinogenisconvertedtoangiotensinbythispathway
d)Angiotensinconvertingenzymeispresentinlungcapillary
endothelialcell

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e)Angiotensin-IIisdecapeptide
CorrectAnswer-A:B:C:D
Ans.(A)Reninisproducedbymodifiedsmoothmusclesof
glomerularcapillary(B)Maculadensacellsarepartofthis
pathway(C)Angiotensinogenisconvertedtoangiotensinby

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thispathway(D)Angiotensinconvertingenzymeispresentin
lungcapillaryendothelialcell
Ref:Principlesofmedicalphysiologyp.417Ganong25th/ep.
672-700
Juxtaglomerularapparatus:

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ThejuxtaglomerularaPParatusislocatedattheangleoftheafferent
andefferentarterioles,whereitcomesincontactwiththedistal
tubules.
Itcomprisesthemaculadensa,juxtaglomerular(JGcells),andthe
laciscells.

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Juxtaglomerular(granular)cellsaremodifiedsmoothmusclecellsin
thescalamediaoftheterminalpartoftheafferentarterioles.
Theycontainlargegranulesandsecreterenin.

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Laciscells(extraglomerularmesangialcells)thatarelocatedinthe
angularspacebetweenthejunctionofafferentandefferent

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arterioles&alsocontainsomerenin.
Thepartofthedistaltubulewhichcomesincontactwiththeafferent
arterioleismadeofaspecializedepitheliumcalledthemacula
densa.
RENIN-ANGIOTENSINSYSTEM:

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Reninisaproteaseenzymewhichissecretedbyjuxtaglomerular
(jG)cellsofafferentarterioles.
Mostpowerfulstimulusforreninreleaseisreducedrenalperfusion
pressure
Loweredpressurestimulatereninrelease.

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IncreasedNaClindistaltubulesissensedbymaculadensaandthe
signalistransmittedtoJGcells.
ThisresultsindecreasedReninrelease.
OppositeoccurswhendecreasedNaClisdeliveredindistaltubule,
i.e.,increasedreninrelease.

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Adenosineisprobablythemediatorofsignal.
JGcellsareinnervatedbysympatheticfibers.Theyreleasereninin
responsetosympatheticdischarge,andbycirculating
catecholamines.
ThereninreleasedfromthejGcellsentersthecirculationandacts

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onanalpha2-globulin.
Angiotensinogen(secretedbythelivertoconvertitintoa
decapeptide,angiotensinIbysplittingLeucine-Valinebondof
angiotensinogen.
Theenzymeangiotensinconvertingenzyme(ACE)thenactson

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angiotensinIandconvertitintoanoctapeptide,angiotensinII,by
splittingphenylalanine-histidinebondofangiotensinII.
ACEisfoundonthesurfaceofcapillaryendotheliumoflung,
thereforeangiotensinIIisformedonlungcapillaryendothelium.
AngiotensinIIisdegradedintoangiotensinIIIbysplitting

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asparagine-argininebondbyaminopeptidase.

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34.Trueaboutrenaltubularsystemare?
a)AscendingloopofHenleactivelypumpsChlorideoutoftubule
b)AscendingloopofHenleactivelypumpsCarbonateoutof
tubule

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c)DescendingloopofHenleispermeabletowater
d)AscendingloopofHenleisimpermeabletowater
e)DescendingloopofHenlereceiveshypotonicsolution
CorrectAnswer-A:C:D
Ans.(A)AscendingloopofHenleactivelypumpsChlorideout

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oftubule(C)DescendingloopofHenleispermeabletowater
(D)AscendingloopofHenleisimpermeabletowater
Ref:Ganong25th/ep.680-682
Thindescendingsegment(limb):
Highlypermeabletowater.

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Waterabsorptionisobligatoryandoccursthroughaquaporin-1water
channel.
Relativelyimpermeabletosolutes(sodium,chlorideandurea).
Therefore,onlywaterisreabsorbedfromthethindescendingHenle
hypertonicfluid.

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Noactivesecretionorreabsorption.
Thinascendingsegment(Limb):
LesspermeabletowaterbutisverymuchpermeabletoNacl.
Thickascendingsegment(limb):
Totallyimpermeabletowater.

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Hypotonictoplasma.
Hence,Dilutingsegment.
30%offilteredNa-isreabsorbedinascendinglimb(60%,

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reabsorbedinproximaltubule).

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35.Truestatementaboutnervemuscle

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physiologyis?
a)ActionpotentialtraversesalongTtubules
b)Contractionismainlybecauseofextracellularcalcium
c)Rynadinereceptorssensetheactionpotiential
d)actinpullsthemyosin

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e)ATPbindstomyosin
CorrectAnswer-A:C:E
Ans.(A)ActionpotentialtraversesalongTtubules
(C)Rynadinereceptorssensetheactionpotiential(E)ATP
bindstomyosin

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Excitationcontractioncoupling:
SkeletalmusclefiberisinnervatedbyA-alphaneuron.
Carriestheimpulse(actionpotential)toneuromuscularjunction
wherereleaseofacetylcholinefrompresynapticvesicleoccurs.
Events:

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EachsarcomerehasT-tubules.
T-tubuledepolarizes,conformationalchangesoccurin
dihydropyridineReceptors(DHPR)ofT-tubules.
LeadstoaninteractionbetweenDHPRandRyanodinereceptors
(RyR)intheterminalcisternsofsarcoplasmicreticulum.

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DHPR-RyRinteractionleadstoreleaseofCa+ionsfromthe
terminalcisternsintothecytoplasm(sarcoplasm).
DiffusionofCa+intosarcoplasmcausesmuscleContraction.
Molecularevents:
Cross-bridgecycle:

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Cross-bridgingofmyosinwithactinproducesbending(flexion)of
myosinheadproduces"Powerstroke"slidingofactinonmyosin
andmusclecontraction.

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36.Trueaboutcoppermetabolismisare?
a)Intestinalabsorptionoccursinduodenum

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b)95%bondtoalbuminintheserum
c)Ceruloplosmincontains6atomsofcopper
d)FailuretoSynthesizeceruloplasmincauseswilson'sdisease
e)Copperexcretionmainlyoccursinurine
CorrectAnswer-A:C:D

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Ans.(A)Intestinalabsorptionoccursinduodenum
(C)Ceruloplosmincontains6atomsofcopper(D)Failureto
Synthesizeceruloplasmincauseswilson'sdisease
Ref:Dineshpuri3ed/p.412
Copperprimarilyfunctionsasacomponentofmetalloenzymesor

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proteinsthatparticipateinredoxreactions.
Adulthumanbodycontains50-100mgofcopperofwhichlargest
amountarepresentinmuscles(30-50mg),bones(10-20mg),and
liver(10-15mg).
Absorption:

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Intestinalabsorptionofcopperoccursmainlyfromduodenum.
SignificanceofCeruloplasmin:
Fromportalcirculation,copperistransportedtoliver,bindto
albumin,withinhepatocytescopperisincorporatedinto
apoceruloplasmintoformceruloplasmin.

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Ceruloplasmincontains6-8atomsofcopper.
Failuretosynthesizeceruloplasminisimplicatedinpathogenesisof
wilsondisease.
Transportandexcretion
Plasmaconcentrationofcopperis100-200mg/dl,about95%of

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whichisboundtoceruloplasmin,
Excretionofcoppermainlyoccursinbile.

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37.Trueaboutgasequation-
a)Gasconstantis0-9
b)PV=constant

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c)PV=nRT
d)Diffusionisdirectlyrelatedtomolecularweightofgas
e)Oxygenhasmorediffusioncoefficient
CorrectAnswer-C
Ans.C.PV=nRT

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Gasequation:
Theidealgaslawisquantitativeexpressionoftheforegoing
principles:PV=nRT.
WherePisthepressure,Visthevolume,nisthenumberofgram
moleculesofthegas,RisthegasconstantandTistheabsolute

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temperature.
ValueofRis0.082(R=0.082),whentheunitsemployedare
atmosphere,litresandcentigrade.
Therateofinfusion(D)isdirectlyproportionaltothepressure
gradient(LP)andgasdiffusesfromhigherpressureareastolower

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pressureareas.
Partialpressuregradient(gaspressuredifference)isthebasicfactor
whichpromotediffusionofagas.
Rateofdiffusionisdirectlyproportionaltootherfactorsalso,viz.(i)
Surfaceareaofrespiratorymembrane(A);and(ii)Solubilityofgas

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concerned(S).
Therateofdiffusionisinverselyproportionalto(i)Thethicknessof
therespiratorymembrane(d);and(ii)Molecularweightofthegas
(MW).

---

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38.TrueaboutProstaglandins-

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a)Derivedfromlipooxygenasepathway
b)FirstproductisPGG2
c)PGE2causesvasoconstriction
d)PGF2acausesbronchoconstriction
e)PG12causesfallinBP

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CorrectAnswer-B:D:E
Ans.(B)FirstproductisPGG2(D)PGF2acauses
bronchoconstriction(E)PG12causesfallinBP
Prostaglandins(PG)synthesis:
Prostaglandins(PGs),thromboxanes(TXs),prostacyclin(PGI)and

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leukotrienesarecollectivelycalledeicosanoids.
Thesesarederivativesofprostanoicacid.
Theseeicosanoidsarederivedfrom5,8,11,14eicosatetraenoic
acid(arachidonicacid),thefattyacidreleasedfrommembranelipids
bytheactionofphospholipase-A2.

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39.Whichis/arefeature(s)ofprostaglandins-
a)20carbonatomcompound
b)10carbonatomcompound
c)Cyclopentanering
d)-OHgroupat156position

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e)Transdoublebondat10thposition
CorrectAnswer-A:C:D
Ans.(A)20carbonatomcompound(C)Cyclopentanering(D)-
OHgroupat156position
(Ref:HarperjP/ep.239-40;Lippincott6h/ep.213-15;Vasudevan

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5th/ep.167;Shinde7/ep.64-65;Satyanarayan4th/ep.664)
Prostaglandinsare20carboncompounds,containinga
cyclopentanering.Theyhavehydrox(OH)groupatposition-15and
trans-doublebondatposition-13.

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40.

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Whichofthefollowingis/areeffectof
increased2,3-DPGonoxygen-hemoglobin
dissociationcurve?
a)edaffinityofheamoglobintooxygen
b)edaffinityofhaemoglobintooxygen

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c)Leftshiftofoxygen-hemoglobindissociationcurve
d)Rightshiftofoxygen-hemoglobindissociationcurve
e)Nochangeinoxygen-hemoglobindissociationcurve
CorrectAnswer-B:D
Ans.(B)edaffinityofhaemoglobintooxygen(D)Rightshift

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ofoxygen-hemoglobindissociationcurve
[Ref:Ganong25th/ep.610-41;Guyton's12'h/ep.j56-57;AKlain
6'h/ep.430]
Oxygen-hemoglobindissociationcurveis2,3DPGinRBC.
DPGisanoptionalby-productoftheglycolyticpathway.

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DPGbindswithdeoxygenatedhemoglobinbutnotwithoxygenated
hemoglobin.
RaisedDPGconcentrationreleasesoxygenfromoxyhemoglobinby
shiftingthefollowingreversiblereactiontotheright.
Mechanism:

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OnemoleculeofDPGbindswithonemoleofdeoxyhemoglobin.
HenceanincreaseinDPGconcentrationshiftstheoxygen-
hemoglobindissociationcurvetotheright.
Thus2,3DPGcausesdelivery(unloading)ofO,tothetissues.
Fetalhemoglobinhasconsiderablylessaffinityfor2,3-DPGthan

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doesadulthemoglobinthereforefetalhemoglobinhasagreater

---

affinityforoxygenthanadulthemoglobin.
Inhumanblood,theaffinityoffetalhemoglobinfor2,3-DPGisonly
about4O%thatofadulthemoglobin.
Thismakesfetalhemoglobinbehaveasif2,3-DPGlevelsarelow.

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41.Oxygenconsumptionbytheheartis
determinedby?
a)Intramyocardialtension
b)Contractilestateofthemyocardium
c)Initiallengthofthemyocardialmusclefiber

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d)Heartrate
e)Basaloxygenconsumptionofmyocardium
CorrectAnswer-A:B:C:D:E
Ans.(A)Intramyocardialtension(B)Contractilestateofthe
myocardium(C)Initiallengthofthemyocardialmusclefiber

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(D)Heartrate(E)Basaloxygenconsumptionofmyocardium
[Ref:Ganong25th/ep.550;Guyton's12th/ep.216-17]
Myocardialoxygendemand-Factorsinfluencing:
Thebasalmetabolismofthehearttissuenormallyaccountsof25%
ofmyocardialoxygendemandinrestingindividuals.

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Myocytescontraction(cardiaccontraction)istheprimaryfactor
determiningmyocardialoxygenconsumptionabovethebasalleyek
andcardiaccontractionaccountsfor75%ofmyocardialoxygen
consumption.
Myocardialwalltension,

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Heartrate(Chronotropy),
Inotropicstate(contractility).
Myocardialwalltensionisdirectlyproportionaltointraventricular
pressure(P)andventricularradius(R)'andinverselyproportionalto
myocardialwallthickness(myocardialmass).

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Intraventricularpressure(intracavitarypressure)isdeterminedby

---

aorticpressure(i.e.,afterload)andventricularradiusisdetermined
byenddiastolicventricularvolume(i.e.,Preload).

---

42.Insulincausesintracellularshiftofwhich
ofthefollowingion?

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a)Na+
b)K+
c)Chloride
d)Calcium
e)Bicarbonate

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CorrectAnswer-B
Ans.B.K+
[Ref:Ganong25th/ep.433-34;Guyton's12'h/ep.613;AKlain
6,h/ep.748]
InsulinlowersserumK+concentrationi.e.,causeshypokalemia.

--- Content provided by FirstRanker.com ---

ThehypokalemicactionofinsulinisduetostimulationofK+intake
bythecellsmainlyinmuscleandadiposetissue.
InsulinincreasestheactivityofNa+-K+ATPaseincellmembrane,
sothatmoreK+ispumpedintocells.

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43.Hypothalmkpituitaryaxis(HPA)controls

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allexcept-
a)Thyroid
b)Parathyroid
c)Pancreas
d)Testis

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e)Adrenals
CorrectAnswer-B:C
Ans.(B)Parathyroid(C)Pancreas
[Ref:Ganong25'h/ep.308-14;Harrison'sp.401e-2]
Almostallsecretionbythepituitaryiscontrolledbyeitherhormonal

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ornervoussignalsfromthehypothalamus.
Secretionfromtheposteriorpituitaryiscontrolledbynettesignals
thatoriginateinthehypothalamusandterminateintheposterior
pituitary.
Secretionbyanteriorpituitaryiscontrolledbyhormonescalled

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hypothalamicreleasingandhypothalamicinhibitoryhormones(or
factors)secretedwithinthehypothalamusandthenconductedtothe
anteriorpituitarythroughhypothalamichypophysealportalvessels.

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44.Truestatementaboutmalereproductive
physiology-

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a)SertolicellssecreteMiillerianinhibitingsubstance(MIS)
b)Inhibinisreleasedbysertolicell
c)Primaryspermatocyteisdiploid
d)LHandFSHaresteroidalinnature
e)Inhibinstimulatesfollicle-stimulatinghormone(FSH)

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CorrectAnswer-A:B:C
Ans.(A)SertolicellssecreteMiillerianinhibitingsubstance
(MIS)(B)Inhibinisreleasedbysertolicell(C)Primary
spermatocyteisdiploid
HormonesoftheTestes:

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Thehormone-secretingcellsinthetestesaretheleydigcellsand
sertolicells.
LeydigcellshavereceptorsforLHandsecretealltheandrogens,
i.e.,testosterone(majorandrogen),dihydrotestosterone(DHT),
androstenedioneanddehydroepiandrosterone(DHEA).

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Allofthemhave19carbonatoms.
SertolicellsareunderthecontrolofFSH,i,e.,havereceptorsfor
FSH.WhenstimulatedbyFSH,thesecellssecrete
androgenbindingprotein(ABP),inhibinand,MlS(mullerianinhibiting
substance).Sertolicellsalsocontainaromatase;

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theenzymethatconvertsandrogenstoestrogens.
Besidethesehormonalfunction,junctionbetweenadjacentsertoli
cellsformsblood-testisbarrierwhichdoesnotallowharmful
substancestoentertheareawherespermatogenesisisgoingon.

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Sertolicellakohaverec4,torsforandrogens(testosterone)which

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stimulatesspermatogenesis.
Hormonalcontroloftesticularfunction.
LHistropicforleydigcellsandthesecretionoftestosteroneisunder
thecontrolofLH.
FSHistropicforsertolicelland,stimulatessertolicellstosecrete

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inhibinandandrogenbindingprotein(ABP).
Primaryspermatocyteisdiploid.

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45.Erythropoietinis/areproducedby-
a)Juxtaglomerularcells
b)Interstitialcellsoftheperitubularcapillarybedofthekidneys

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c)ParsrectaofPCT
d)Maculadensa
e)Mesangialcell
CorrectAnswer-B
Ans.B.Interstitialcellsoftheperitubularcapillarybedofthe

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kidneys
[Ref:Ganong25e/ep.706;Guyton's12e/ep.461;AKlain6e/ep.
68]
Erythropoietinisaglycoproteinhormonewhichstimulateerythrocyte
production.

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Inadults,about85%oferythropoietincomesfromthekidney
(interstitialcellsinperitubularcapillarybed)and15%fromliver
(Perivenoushepatocytes).Smallamountisalsoproducedinbrain;
anduterusandoviduct.

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46.Trueaboutcarotidsinus-

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a)Chemoreceptor
b)Presentinearlypartofinternalcarotidartery
c)Hasglomuscells
d)Baroreceptor
e)Suppliedbyglossopharyngealnerve

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CorrectAnswer-B:D:E
Ans.(B)Presentinearlypartofinternalcarotidartery
(D)Baroreceptor(E)Suppliedbyglossopharyngealnerve
[Ref:Ganong25th/ep.658;Guyton'sl2h/ep.251-52;AKlain6th/ep.
j27-29;Gray,s4p/ep.447]

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Carotidsinusisalittlebulgeattherootofinternalcarotidartery,
Isatypeofabaroreceptor.
Itisinnervatedbythesinusnerve,abranchofglossopharyngeal(IX
cranial)nerve.

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47.Stresshyperglycemiaoccursduetoall

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except-
a)IncreasedlevelofACTH
b)Increasedlevelofcortisol
c)Decreasedlevelofnorepinephrine
d)Insulinresistance

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e)Increasedlevelofepinephrine
CorrectAnswer-C
Ans.C.Decreasedlevelofnorepinephrine
[Ref:Ganong25th/ep.364;Guytan's12'h/ep-598-556;Schwartz
th/ep.17-2a;AKlain6'h/ep.606;Bailey6Love2Ch/ep.4'9;

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CSDT1l'h/ep.103-05]
StressHyperglycemia:
Suppressionofinsulinsecretioncoupledwithincreasedsecretionof
glucagon,growthhormone,glucocorticoids(cortisol),and
catecholamines(epinephrine,

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norepinephrine)leadstohyperglycemia.

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48.Parasympatheticnervestimulationresults
in:
a)Sphincterclosureofgallbladder
b)Increasedperistalsis

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c)DecreasedGITmotility
d)Detrusormusclerelaxation
e)Gallbladdermusculaturecontraction
CorrectAnswer-B:E
Ans.(B)Increasedperistalsis(E)Gallbladdermusculature

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contraction
[RefGanong25th/257-60,24th/265;Katzung13th110-111]
Parasympatheticnervesaremotortomusculatureofthegallbladder
&bileduct,butinhibitorytothesphincter.
SympatheticnervesfromT7-9arevasomotor&motortosphincters.

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Thecranialoutflowoftheparasympatheticdivisionsuppliesthe
visceralstructuresintheheadviaoculomotor,facial,and
glossopharyngealnerves,andthoseinthethoraxandupper
abdomenviathevagusnerves.
Pupil-Constricted(Miosis)

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Ciliarymuscle-Constricted(nearvision)
Glands(Nasal,Lacrimal,Parotid,SubmandibulalGastricPancreatic)
-Stimulationofcopioussecretion(containingmanyenzymesfor
enzyme-secretingglands)
Sweatglands-Sweatingonpalmsofhands

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Bronchialmuscle-Contraction
Gallbladderandbileducts-Contracted

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LUmen-Increasedperistalsisandtone
Detrusor-Contracted
Trigone-Relaxed

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49.Trueaboutmusclespindle:
a)GroupIafibercontainsensoryafferent
b)Nuclearbag&nuclearchainfiberspresentinintrafusalmuscle
fiber
c)MotorsupplybyAafiber

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d)Motorsupplybyyfiber
e)Secondaryendingisstimulatedbynuclearbagfiber
CorrectAnswer-A:B:D
Ans.(A)GroupIafibercontainsensoryafferent(B)Nuclear
bag&nuclearchainfiberspresentinintrafusalmusclefiber

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(D)Motorsupplybyyfiber
[Ref.A.K.Jain6th/873-76;Guyton12th/770-73]
MUSCLESPINDLES
Are"Stretchreceptor"locatedwithinamuscle.
Yetfound,interminglingwithmusclefibers.

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'Intrafusalfibers'-Specializedmusclefibersseenwithin
spindle
(Note:-Fususreferstospindle).
Nuclearbagfibers:
Usually,2perspindle.

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Nuclearbagfiber1-
WithlowlevelofmyosinATPaseactivity.
Nuclearbagfiber2-
WithhighlevelofmyosinATPaseactivity.
Nuclearchainfibers

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Arethinner&shorter.
Fourormorefibersperspindle(morethannuclearbagfibers)

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Sensory/afferentinnervation:
Twoafferentfibertypesoriginateintrafusally,
Annulospiral/primaryendings:

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Foundwoundaroundcentralregionofbothnuclearbag&nuclear
chainfiber.
Are"A"/"Ia"fibers.
Flower-spray/secondaryendings:
Innervateperipheralparts/endsofnuclearchainfiber.

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Are"A"/"II"fibers.
2.Motor/efferentinnervation:
Innervatesperipheralpartsofbothnuclearbag&nuclearchain
fibers.
Mainlyby"A"type/"-motorneurons"/"Fusimotorneuron"/"Small

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motornervesystemofLeksellefferents".
Becauseoftheircharacteristicsmallersize.

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50.Hyperbaricoxygentherapyis/areusedin:
a)Radiationinducedproctitis
b)Tensionpneumothorax

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c)Bleomycininducedlungdamage
d)Gasaangrene
e)Carbonmono-oxidepoisoning
CorrectAnswer-A:D:E
Ans.(A)Radiationinducedproctitis(D)Gasaangrene

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(E)Carbonmono-oxidepoisoning
[RefManipalsurgeryp.176;A.K.Jainp.461]
HyperbaricOxygenTherapy-Indication:
Anaemichypoxiaespeciallyduetocarbonmono-oxidepoisoningor
severebloodloss)

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Stagnanthypoxia
Histotoxichypoxia(Radiationinducedtissueinjury&gasgangrene)
COpoisoning.
Infection(gasgangrene).
Cancertherapytopotentiatercdiathcrapy

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Arterialinsufficiency
Decompressionsickness&airembolism
Contraindication-
Untreatedpneumothorax
Duringtreatmentwithdrugslike-Bleomycin(bleomycin-induced

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lung
injury),Doxorubicin(Adriamycin),cisplatin,Disulfiram.

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51.Peripheralcyanosisis/areassociated
with:
a)SLE

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b)TAPVC
c)Atrialseptaldefect
d)Methemoglobinemia
e)Cardiogenicshock
CorrectAnswer-E

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Ans.E.Cardiogenicshock
[Ref:PJM20th/16-19;Ganong25th/642.]
Peripheralcyanosis:
Causedbyslowingofbloodflowandincreasedextractionofoxygen
fromnormallysaturatedblood.

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Resultsfromvasoconstrictionordecreasedperipheralbloodflow,
reducedcardiacoutputorvascularocclusion.
Characterizedbycyanosisofskinaloneandsparingofmucous
membranes
Causes:

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Vasculorocclusion
Arterialobstruction
Venousobstruction
Reducedcardiacoutput
Coldexposure

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Redistributionofbloodflowfromtheextremities

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52.Bloodinfoetusis/areformedby:
a)Liver
b)Lymphnodes
c)Spleen

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d)Bonemarrow
e)Yolksac
CorrectAnswer-A:B:C:D:E
Ans.(A)Liver(B)Lymphnodes(C)Spleen(D)Bonemarrow
(E)Yolksac

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Bloodformationoccurlater(5wk)throughoutembryonic
mesenchyme,thenliver,spleen/thymus,bonemarrowlymphnode
(ref:embryoIogy.mrd.unsw.au).
FormationofbloodincludeformationofRBC,WBC&platelet.
Bloodproductionstartsfrom3rdweekofintrauterinelife.

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3rdweekto3rdmonth(intravascularphase)-Erythropoiesisoccurs
inthemesodermofyolksac
B/w3rdto5thmonthofintrauterinelife,erythropoiesisoccur
principallyintheliver(tosomeextentinthespleen).
5thmonthonwards(myeloidphase)=Erythropoiesisoccursinred

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bonemarrow(allmarrowisredbonemarrowatthisstage)

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53.Importantbuffersystemoperatingin
blood:
a)Proteinsystembuffer
b)Phosphatebuffer

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c)Carbonicacid-Bicarbonatesystembuffer
d)Hemoglobinsystembuffer
e)None
CorrectAnswer-A:C:D
Ans.(A)Proteinsystembuffer(C)Carbonicacid-Bicarbonate

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systembuffer(D)Hemoglobinsystembuffer
[RefA.K.Jain6th/559-60,55;Ganong25th/643-44]
Acidandbaseshiftsinthebloodarelargelycontrolledbythreemain
buffersinblood:(1)proteins,(2)hemoglobin(3)thecarbonicacid-
bicarbonatesystem

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Morethan90%ofblood'scapacitytobuffercarbonicacidis
attributedtothehaemoglobinbuffersystem.
Carbonicacid-bicarbonatesystemisoneofthemosteffectivebuffer
systemsinthebody.
Inplasma,phosphateconcentrationistoolowforthissystemtobea

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quantitativelyimportantbuffetbutitisimportantintracellularly.

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54.Pepsinogen,theinactiveformofpepsin,
issecretedby:
a)InterstitialcellofCajal
b)Chiefcell

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c)Panethcell
d)Gobletcell
e)ZymogenCells
CorrectAnswer-B:E
Ans.(B)Chiefcell(E)ZymogenCells

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[RefGanong25th/456,24th/457-59]
Thegastricmucosacontainsmanydeepglands.
Inthepyloricandcardiacregions,theglandssecretemucus.
Bodyofthestomach,includingthefundus,theglandscontain
parietal(oxyntic)cells,whichsecretehydrochloricacidandintrinsic

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factor,andchief(zymogen,peptic)cellssecretingpepsinogen.

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55.TypeIIBmusclefibersaredifferentfrom
typeIfiberwithhaving:
a)Smalldiameter
b)CalciumreWleasebysarcoplasmicreticulumislow

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c)Fastfatigable
d)Colorpink
e)Fasteracting
CorrectAnswer-C:E
Ans.(C)Fastfatigable(E)Fasteracting

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[RefGanong25th/108,24th/107t23rd/103]
ClassificationErlanger Lloyd&
Characteristics Function
&Gasser
Hunt

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offibers
Diameter-13-
20
Myelination
Proprioception-

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-Heavily
Duetofiberthickness
myelinated&
Motorsupplyto
Aalpha

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I
thick
skeletalmuscle
Conduction-
(extrafusalto

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70-120
musclespindle)
(maximum
velocity)
Diameter-4-13

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Myelination-
Touch
Abeta
II
Present

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Kinesthesia

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Conduction-
Pressure
25-70
-No

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comparable
ent
Diameter-3-6
Diameter- Myelination-
Motorsupplyto

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3-6
Slightly
intrafusalmuscle
Agamma
Myelination myelinated

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fibers(Muscle
-Slightly
Conduction-
spindles)
myelinated 15-30

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Conduction
-15-30ity-
Pain-
Diameter-1-5 "Fast/Epicritic/First"
Myelination-

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pain.
Some
Sincefibersare
Adelta
III

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myelination
relativelyfast
Conduction-5- Temperature
30
Pressure

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Touch
Diameter-1-3
Myelination-
Preganglionic
-No

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Some
autonomicfibers
Bfiber
comparable myelination
(bothsympathetic&

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entity-
Conduction-3- parasympathetic)
14
Pain-
Diameter-0.2- Slowpain

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1.0
("Protopathic
Myelination-
/Secondpain)
Cfiber

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IV
Unmyelinated Temperature
Conduction-
Pressure
0.2-2

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Postganglionic
(minimum)
autonomicfibers.

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56.Whichofthefollowingistrueabout
myoglobin:

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a)Bind1molofoxygenpermoleofmyoglobin
b)Dissociationcurveisarectangularhyperbola
c)Itscurveliesrightofthehemoglobincurve
d)BindoxygenatlowP02pressure
e)ShowBohreffect

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CorrectAnswer-A:B:D
Ans.(A)Bind1molofoxygenpermoleofmyoglobin
(B)Dissociationcurveisarectangularhyperbola(D)Bind
oxygenatlowP02pressure
RefGanong25th/641-42,24th/643-zt4;Guyton12th/96

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Myoglobin:
Iron-containingpigmentfoundinskeletalmuscle.
Containsonehemegroupwithonepolypeptidechain.
Resembleshemoglobin,butmyoglobinbinds1ratherthan4molof
O2mole.

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Itsdissociationcurveisarectangularhyperbolaratherthana
sigmoidcurve.
?Becauseit'scurveistotheleftofthehemoglobincune,asittakes
upO2fromhemoglobinintheblood.
DoesnotshowBohreffect.

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---

---

57.Vasomotorinputstorostralnuclesusof
ventomedialmedullais/arefrom:
a)Inhibitoryinputfromcaudalventrolateralmedulla
b)Excitatoryinputsfromcerebralcortexviahypothalamus

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c)Inhibitoryinputsfromcerebralcortexviahypothalamus
d)Inhibitoryinputsfrombrainstemreticularformation
e)Inhibitoryinputspainpathway
CorrectAnswer-A:B:C
Ans.(A)Inhibitoryinputfromcaudalventrolateralmedulla

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(B)Excitatoryinputsfromcerebralcortexviahypothalamus
(C)Inhibitoryinputsfromcerebralcortexviahypothalamus
[RefGanong25th/587-89,24th/589-91]
Medullarycontrolofthecardiovascularsystem:
OneofthemajorsourcesofexcitatoryinPuttosympatheticnerves

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controllingthevasculatureisagroupofneuronslocatednearthe
pialsurfaceofthemedullaintheRostralVentrolateralMedulla
(RWM).
Thisregionissometimescalledavasomotorarea
NeurovascularcompressionoftheRVLMhasbeenlinkedtosome

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casesofessentialhypertensioninhumans
TheactivityofRVLMneuronsisdeterminedbymanyfactors
FactorsaffectingtheactivityofRVLM
Excitatoryinputs:
Cortexviohypothalamus,mesencephalicperiaqueductalgray,brain

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stemreticularformation,painpathway,somaticafferent
(somatosympatheticreflex),Carotid&aorticchemoreceptors

---

Inhibitoryinputs:
Cortexvidhypothalamus,caudalventrolateralmedulla,caudal
medullaryraphenuclei,lunginflationafferents;carotid,aortic&

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cardiopulmonarybaroreceptors

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58.ForGrowthhormonetesting,whichofthe
followingstimulatethesecretionsof
Growthhormone:
a)Glucagon

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b)Insulin
c)Cortisol
d)Waterdeprivation
e)Arginine
CorrectAnswer-A:E

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Ans.(A)Glucagon(E)Arginine
[Ref:Ganong25th/328-29,24th/330-32;Guyton12th/555-56;]
GHTesting:
StimulateGrowthHormone:
Decreasedbloodglucose

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Decreasedbloodfreefattyacids
Increasedbloodaminoacids(arginine)
Starvationorfasting
Proteindeficiency
Trauma

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Stress
Excitement
Exercise
Testosterone
Estrogen

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Deepsleep(stagesllandlV)
Growthhormone-releasinghormone

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Ghrelin

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59.Whichofthefollowingarefeatureof
blood-brainbarrier:

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a)Thickbasementmembrane
b)Podocyte
c)Closelyassociatedlayerofastrocyte
d)Tightjunction
e)Decreasedvesiclesinendothelialcells

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CorrectAnswer-A:C:D:E
Ans.(A)Thickbasementmembrane(C)Closelyassociated
layerofastrocyte(D)Tightjunction(E)Decreasedvesiclesin
endothelialcells
Ref;Ganong25th/671,24th/604-06;Guyton12th/816-17

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Blood-brainbarrier(BBB):
Barriersexistbothatthechoroidplexusandatthetissuecapillary
membranesinessentiallyallareasofthebrainparenchymaexcept
insomeareasofthehypothalamus,pinealgland,and.area
postremawheresubstancesdiffusewithgreatereaseintothetissue

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spaces.
Causeofthelowpermeabilityoftheblood-brainbarrieristhe
mannerinwhichtheendothelialcellsofthebraintissuecapillaries
arejoinedtooneanother.
Theyarejoinedbyso-calledtightjunctions.

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Thatis,themembranesoftheadjacentendothelialcellsaretightly
fusedratherthanhavinglargeslit-poresbetweenthem,asisthe
caseformostothercapillariesofthebody.
Glialcellsarederivedfromneuroectoderm(macroglia:astrocytes,

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oligodendrocytes,ependyma)orfrombonemarrow(microglia).

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Glialcells(astrocytes)formalayeraroundbrainbloodvesselsand
maybeimportantinthedevelopmentofthe8BB.
Astrocytesmaybealsoberesponsiblefortransportingionsfromthe
braintotheblood

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60.Whichofthefollowingstatementis/are

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trueregardingFickprincipleof
measurementofcardiacoutput:
a)Cardiacoutputiscalculatedbyamountofoxygenconsumedby
wholebodyperunitmassdividedbyA-VOxygendifference
acrossthelung

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b)Oxygenconcentrationinarteryismeasuredbypassingcatheter
toPulmonaryartery
c)Mixedvenousbloodismeasuredbyinsertingcatheterinto
pulmonaryartery
d)Rateofoxygenabsorptionbythelungsismeasuredby

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spirometry
e)Foroxygencontentofartery,anyarteryofbodycanbechosen
CorrectAnswer-A:C:D:E
Ans,(A)Cardiacoutputiscalculatedbyamountofoxygen
consumedbywholebodyperunitmassdividedbyA-VOxygen

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differenceacrossthelung(C)Mixedvenousbloodismeasured
byinsertingcatheterintopulmonaryartery(D)Rateofoxygen
absorptionbythelungsismeasuredbyspirometry(E)For
oxygencontentofartery,anyarteryofbodycanbechosen
[Ref:Ganong25th/543-44,24th/546-47;A.K.Iain5th/356;Guyton1

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lth/244]
CardiacOutputMeasurement:
Fickprinciplestatesthattheamountofasubstancetakenupbyan
organ(orbythewholebody)perunitoftimeisequaltothearterial
levelofthesubstanceminusthevenouslevel(A-Vdifference)times

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thebloodflow.
Principlecanbeusedtodeterminecardiacoutputbymeasuringthe
amountofO,consumedbythebodyinagivenperiodanddividing
thisvaluebytheA-Vdifferenceacrossthelungs.
InapplyingthisFickprocedureformeasuringcardiacoutputinthe

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humanbeing,mixedvenousbloodisusuallyobtainedthrougha
catheterinsertedupthebrachialveinoftheforearm,throughthe
subclavianvein,downtotherightatrium,and,finally,intotheright
ventricleorpulmonaryartery.
Rateofoxygenabsorptionbythelungsismeasuredbytherateof

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disappearanceoforygenfromtherespiredair,usinganytypeof
oxygenmeter(e.gclosecircuitspirometry)
BecausesystemicarterialbloodhasthesameO2contentinallparts
ofthebody,thearterialO2contentcanbemeasuredinasample
obtainedfromanyconvenientartery.

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61.Feature(s)ofhyperprolactinemiais/areall
except:
a)Amenorrhoea
b)Decreasemilkproduction
c)Galactorrhoea

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d)Hypogonadotropichypogonadism
e)Hypothyroidismmaycausehyperprolactinemia
CorrectAnswer-B
Ans.B.Decreasemilkproduction
[Ref:Ganong25th/331-33,24th/334-35;A.K.Iain5th/695-96;

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Guyton11th/907,918-921,I039-40;CMDT2016/1096-97,06/
1113-14]
Hyperprolactinemia:
Duetoanycausemayresultinhypogonadotropichypogonadism.
HypogonadotropichyPogonadismoftendevelopsinpatientswith

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hyperprolactinemia;itmaybereversedwithtreatmentof
hyperprolactinemia.
Womenmaynoteoligomenorrhoeaoramenorrhoea.
Galactorrhoea,definedasLactationinabsenceofnursing,is
common.

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Prolactindeficiencyinhibitspostpartumlactation.
Primaryhypothyroidismisassociatedwithmildhyperprolactinemia,
probablybecauseofcompensatoryTRHsecretion

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62.Whichofthefollowingis/arePainscale:
a)McGillPainQuestionnaire

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b)Visualanaloguescale
c)ColouredAnalogueScale
d)Alloftheabove
e)Noneoftheabove
CorrectAnswer-D

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Ans.A,McGillPainQuestionnaireB,Visualanaloguescale&
C,ColouredAnalogueScale
ListofPainMeasurementScales:
Wong-BakerFACESPainRatingScale
Visualanalogscale(VAS)

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McGillPainQuestionnaire(MPQ)
NeckPainandDisabilityScale-NPAD
Lequesnealgofunctionalindex.
BehavioralPainScale(BPS)
BriefPainInventory(BPI)

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ClinicalGlobalImpression(CGI)
Critical-CarePainObservationTool(CPOT)
COMFORTscale
FacesPainScale-Revised(FPS-R)

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63.TrueaboutOxytocin:

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a)Secretedfromanteriorpituitary
b)Secretedbyposteriorpituitary
c)Decapeptide
d)Gonadotropinreleasinghormone(GnRH)stimulateitssecretion
e)Causemilkejectionbycontractionofmyoepitheliumofbreast

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CorrectAnswer-B:E
Ans.(B)Secretedbyposteriorpituitary(E)Causemilkejection
bycontractionofmyoepitheliumofbreast
[Ref:Ganong25th/311-13,24th/311-l3;Guytonp918,1040-41,928]
Oxytocin:

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Stimulatespostpartummilkletdowninresponsetosuckling.
Nonapeptide(9aminoacids).
DiffersfromAVPonlyatpositions3and8.
Relativelylittleantidiureticeffectandseemstoactmainlyon
mammaryductstofaci-litatemilkletdownduringnursing.

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Mayhelpinitiateorfacilitatelaborbystimulatingcontractionof
uterinesmoothmuscle,butitisnotclearifthisactionisphysiologic
ornecessaryfornormaldelivery.
Gonadotropin-releasinghormone(GnRH):Itissecretedfrom
hypothalamus&stimulatessecretionofFSH&LH.

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64.Trueabouthormonesensitivelipase:
a)Activityisincreasedbyinsulin
b)Foundintracellular
c)ActivatedbyEpinephrine
d)Locatedinwallbloodcapillaries

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e)None
CorrectAnswer-B:C
Ans.B,Foundintracellular&C,ActivatedbyEpinephrine
[Harper30th/261-62,28th/220]
Hormone-sensitivelipase:

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Hormone-sensitivelipaseisactivatedbyACTH,TSH,glucagon,
epinephrine,norepinephrine,andvasopressinandinhibitedby
insulin,prostaglandinE1,andnicotinicacid
Triacylglycerolundergoeshydrolysisbyahormone-sensitivelipase
toformfreefattyacidsandglycerol.

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Thislipaseisdistinctfromlipoproteinlipase,whichcatalyzes
lipoproteintriacylglycerolhydrolysisbeforeitsuptakeinto
extrahepatictissues.

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65.Whichofthefollowingistrueregarding
GLUT-5:

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a)Presentinbrain
b)PresentinAdiposetissue,skeletalmuscle&skin
c)Insulinmediatedtransporter
d)Sodiumindependenttransport
e)PresentinRBC

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CorrectAnswer-D
Ans.(D)Sodiumindependenttransport
[Ref:Ganong25th/435,24th/435;Harper30th/191,28th/171;
LippincottBiochemistry4th/97]
GLUT-5isunusualinthatitistheprimarytransporterforfructose

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(insteadofglucose)inthesmallintestine&thetestes.
Hassodiumindependentfacilitateddiffusionmechanism.

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66.Truestatementrelatingtocomplianceof
lung:
a)Increasedbysurfactant

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b)Decreasedinemphysema
c)Atheightofinspirationcomplianceisless
d)Itcanbemeasuredbymeasuringintrapleuralpressureat
differentlungvolume
e)None

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CorrectAnswer-A:C:D
Ans.(A)Increasedbysurfactant(C)Atheightofinspiration
complianceisless(D)Itcanbemeasuredbymeasuring
intrapleuralpressureatdifferentlungvolume
[Ref:Ganong25th/629-32,24th/629-33;Guytonllth/473-75;A.K.

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Jain5th/437]
Lungcompliance:
Measuredbymeasuringintrapleuralpressureatdifferentlung
volume.
Animportantfactoraffectingthecomplianceofthelungsisthe

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surfacetensionofthefilmoffluidthatlinesthealveoli.
Deficiencyofsurfactant-lesscompliance;moresurfactant-more
compliance.
Compliancedecreaseswiththeinflationofthelungsasmore
pressureisrequiredtodistendthealreadydistendedlung.

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Thecurveisshifteddownwardandtotheright(complianceis
decreased)bypulmonarycongestionandinterstitialpulmonary
fibrosis;pulmonaryfibrosisisaprogressivediseaseofunknown

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causeinwhichthereisstiffeningandscarringofthelung.
Thecurveisshiftedupwardandtotheleft(complianceisincreased)

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inemphysema.

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67.TrueaboutHering-Breuerreflex:
a)Signalinitiatedthroughmechanoreceptorreceptorsoflung
b)SignalinitiatedthroughChemoreceptoroflung
c)SignalinitiatedthroughCarotid&aorticbody

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d)Transmitsignalsthroughthevagusnerve
e)None
CorrectAnswer-A:D
Ans,(A)Signalinitiatedthroughmechanoreceptorreceptorsof
lung(D)Transmitsignalsthroughthevagusnerve

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[Ref:Ganong25th/662,24th/664;Guyton12th/372;A.K.lain5th/461,
463,465]
Hering-BreuerinflationReflex-LunginflationSignalsLimit
Inspiration:
Hering-Breuerinflationreflexisanincreaseinthedurationof

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expirationproducedbysteadylunginflation,andtheHering-Breuer
deflationreflexisadecreaseinthedurationofexpirationproduced
bymarkeddeflationofthelung.
Inhumanbeings,theHering-Breuerreflexprobablyisnotactivated
untilthetidalvolumeincreasestomorethanthreetimesnormal

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(greaterthanabout1.5litersperbreath).
LungInflationSignalsLimitInspiration-TheHerireuerInflation
Reflex:
Stretchreceptorstomechanoreceptorclass.
Stretchreceptors,locatedinthemuscularportionsofthewallsofthe

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bronchiandbronchiolesthroughoutthelungs,transmitsignals
throughthevagiintothedorsalrespiratorygroupofneuronswhen
thelungsbecomeoverstretched.

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68.Trueaboutbloodsupplyofkidney:
a)Flowis600ml/mineachkidney

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b)Itreceivesmorebloodsupplyperunitmassthanthebrain
c)Renalmedullahavemoresupplythanrenalcortex
d)Itisunderdirectsympatheticcontrol
e)None
CorrectAnswer-A:B:D

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Ans.(A)Flowis600ml/mineachkidney(B)Itreceivesmore
bloodsupplyperunitmassthanthebrain(D)Itisunderdirect
sympatheticcontrol
[Ref:Ganong25th/602,674,24th/676-77;Guyton12th/466-67]
Essentiallyallthebloodvesselsofthekidneys,includingtheafferent

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andefferentarterioles,arerichlyinnervatedbysympatheticnerve
fibers.
Bloodflowtothetwokidneysisnormallyabout22percentofthe
cardiacoutput,or1100mlmin
Theouterpartofthekidney,therenalcortex,receivemostofthe

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kidney'sbloodflow.
Bloodflowinrenalmedullaaccountsforonly1to2%ofthetotal
renalflow
Onaper-gram-weightbasis,thekidneysnormallyconsumeoxygen
attwicetherateofthebrainbuthavealmostseventimestheblood

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flowofthebrain.
Inarestingadult,thekidneysreceive1.2-1.3Lofbloodperminute,
orjustunder25%ofthecardiacoutput

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69.AllaretrueaboutBrunner'sglandexcept:
a)Itliesinduodenumonly

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b)Itliesinduodenum&ileum
c)Itsecretesbicarbonaterichfluid
d)ItsecretionsneutralizesacidicpHofstomach
e)Secretesmucusrichfluid
CorrectAnswer-B

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Ans.B.Itliesinduodenum&ileum
[RefGuyton12th/400;A.K.lain5th/202-03]
Brunner'sGland:
Sub-mucousglands&aretortuous,long&penetratethemuscularis
mucosa

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Drainsintothecryptsoflieberkuhn.
Numerousinfirstpartofduodenum(duodenalcaporbulb)meager
belowthecommonopeningofbile&pancreaticducts.
Ingestionoffattyfoodorsecretininjectionproduceslargevolumeof
thickalkalinemucoussecretionwhichprobablyhelpstoprotectthe

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duodenalmucosafromthegastricacid.
Intheduodenumthereareinadditionthesmall,coiledacinotubular
duodenalglands(Brunner'sglands
Functions:
Protectstheduodenalwallfromdigestionbythehighlyacidicgastric

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juiceemptyingfromthestomach.
Mucuscontainsalargeexcessofbicarbonateions,whichaddtothe
bicarbonateionsfrompancreaticsecretionandliverbilein
neutralizingthehydrochloricacidenteringtheduodenumfromthe
stomach"

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70.Oxygenbindingtohemoglobincause
allostericactivation.Thisallosteric
propertyofHbresultsin:
a)Maintainingironinferrousstate(Fe2+)
b)Increaseoxygensupplytotissue

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c)Increasesoxygenbinding
d)Increases2,3-DPGinblood
e)None
CorrectAnswer-B:C
Ans.(B)Increaseoxygensupplytotissue(C)Increasesoxygen

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binding
[RefHarper30th/54-55,29th/S0-51;Ganong2STH/639-4I,
24th/64I-44;Guyton12th/353-56;A.KIain5the/p.57]
Theironinhaemlsinfenousstate(Fe2+)form.
EachFe2+combineloosely&reversiblywithonemoleculeof

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oxygen.
Combinationofhaemwithoxygeniscalledoxygenation&not
oxidation,becauseaftercombinationwithorygen,ironinhaemstay
inFe2+state
OxygenationofHemoglobinTriggersConformationalChanges

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intheApoprotein:
Hemoglobinsbindfourmoleculesof02pertetramer,oneperheme.
AmoleculeofO2bindstoahemoglobintetramermorereadilyif
otherO2moleculesarealreadybound.
Termedcooperativebinding,thisphenomenonpermitshemoglobin

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tomaximizeboththequantityofO2loadedatthePO2ofthelungs

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andthequantityofO2releasedatthePO2oftheperipheraltissues.
TheAllostericPropertiesofHemoglobinsResultfroMTheir
QuaternaryStructures.
Thepropertiesofindividualhemoglobinsareconsequencesoftheir

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quaternaryaswellasoftheirsecondaryandtertiarystructures.
Thequaternarystructureofhemoglobinconfersstrikingadditional
properties,absentfrommonomericmyoglobin,whichadaptsittoits
uniquebiologicalroles.

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71.Calcitriolinchildrenisformedin:

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a)Glomerulus
b)Bowmanncapsule
c)PCT
d)DCT
e)Collectingduct

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CorrectAnswer-C
Ans.(C)PCT
[Ref:Ganong25th/377-78,24th/461Nelson19th/204;A.K.lain
Sth/730:OPGhai8th/112]
Calcitriolisproducedinthecellsoftheproximaltubuleofthe

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nephroninthekidneysbytheactionof25-hydroxyvitaminD31-
alpha-hydroxylase,amitochondrialoxygenaseandanenzyme
whichcatalyzesthehydroxylationof25-hydroxycholecalciferol
(calcifediol).
TheactIVItyoftheenzymeisstimulatedbypTH.

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ThereactionisanimportantcontrolpointinCa2+homeostasis.

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72.Secretionofinsulinisincreasedby:
a)Fattyacid
b)Aminoacid
c)Adrenaline

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d)Acetylcholine
e)Somatostatin
CorrectAnswer-A:B:D
Ans.(A)Fattyacid(B)Aminoacid(D)Acetylcholine
[RefGanong25TH/439,24th/441;Guyton12th/615]

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IncreaseinsulinSecretion:
Increasedbloodglucose
increasedbloodfreefattyacids
Increasedbloodaminoacids
Gastrointestinalhormones(gastrin,cholecystokinin,secretin,gastric

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inhibitorypeptide)
Glucagon,growthhormone,cortisol
Parasympatheticstimulation;acetylcholine
Beta-adrenergicstimulation
Insulinresistance;obesity

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Sulfonylureadrugs(glyburide,tolbutamide)

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73.Trueaboutcarbohydratemetabolism:
a)Itsupplies4kcalspergram
b)Itincreasesinsulinsecretion
c)Storedinliver

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d)Instarvationglycogeninliverisexhaustedonlyafter24-48hr
e)Itprovide80%calorieneedofbody
CorrectAnswer-A:B:C:E
Ans.A,Itsupplies4kcalspergramB,Itincreasesinsulin
secretionC,Storedinliver&E,Itprovide80%calorieneedof

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body
[Ref:Harper30th/176;Park23rd/613;LippincottBiochemistry
6th/329:Ganong25TH/24,24th/441;A.KIain5th/622-29]
Carbohydratemetabolism:
After12to18hoursoffasting,liverglycogenisalmosttotally

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depleted.
Theliverservesasreceiving,manufacturing,storing&distributing
centreforglucose.
Liverglycogenisnearlyexhaustedafter10-18houroffasting.
Provides4k/calspergrams(protein-4;fat-9;dietaryfibre-2)

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Themainsourceofenergyindietsiscarbohydratesare
carbohydratesderivedlargelyfromcereals.
Thesecerealsconstituteabout80%ofourdiet&provides50-80%
ofdailyenergyintake.

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74.Nervevelocityisincreasedby:

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a)Myelination
b)Smalleraxondiameter
c)Decreasedtemperature
d)Increaseinintracellularcalcium
e)Increaseinextracelluarsodium

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CorrectAnswer-A
Ans.A.Myelination
[RefGanong25TH/94,24th/91;Guyton12th/72-7j;A.K'lain5th/147]
Greaterthediameterofagivennervefibre,thegreaterisitsspeed
(becausealargefiberofferslessresistancetohighcurrent.

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Inmyelinatedfibres,thespeedofconductionisapproximately6
timesthefiberdiameter.
Thediameterofmyelinatedfibersrangefrom1-20micro/m,therifore
conductionvelocityvariesfrom6-120mts/sec

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