In a normal heart
a) The right coronary artery lies in the atrioventricular groove
b) The coronary sinus lies in the anterior atrioventricular groove
c) The venae cordis minimae drain directly into the cardiac cavities
d) There is increased forward flow through the coronary arteries during ventricular systole
e) The blood supply to the interventricular septum arises from the anterior descending branch of the left coronary artery.
Concerning the foetal circulation
a) It is possible for vena caval blood to each the aorta without going through the left ventricle or left atrium
b) The pO2 in the descending aorta is less than in the ductus arteriosus
c) The foramen ovale closes at birth because of increased left atrial pressure
d) At birth flow in the ductus arteriosus reverses because of decreased pulmonary resistance
e) Umbilical arterial blood has a higher PO2 than umbilical venous blood
The following are produced in the hypothalamus
a) Prolactin
b) T.R.F
c) T.S.H
d) Vasopressin
e) A.C.T.H
Insulin and growth hormone have directly opposing effects on
a) Fat catabolism
b) Glucose utilisation
c) Fat anabolism
d) Protein anabolism
e) Glycogen production
The following influence aldosterone secretion
a) Surgical stress
b) Total sodium intake
c) Renal ischaemia
d) Angiotensin
e) Plasma potassium concentration
Parathormone
a) Increases plasma calcium concentration
b) Increases bone resorption of calcium
c) Increases urinary phosphate loss
d) Is a polypeptide
e) Causes phosphaturia
Carotid body receptors
a) Have a higher blood flow gm for gm than the brain
b) Have baroreceptors activity
c) Respond to changes in oxygen content of the blood
d) Respond to changes in pH
e) Are not affected by carotid endarterectomy
Concerning liver blood flow
a) Portal venous pressure is less than 20 mmHg.
b) 50% is from the hepatic artery
c) Total flow is 1.5 1/min
d) The liver derives most of its oxygen needs from the portal supply
e) The oxygen saturation of portal blood is 95%
Sodium concentration is less than 50mmol in
a) Oedema fluid
b) Interstitial fluid
c) Interstitial fluid
d) A 24 Hr urine sample
e) Cerebrospinal fluid
Cardiac output is increased during:-
a) Stimulation of sympathetic cardiac nerves
b) Tension pneumothorax
c) Acclimatization to high altitude
d) Hypovolaemic shock
e) Stimulation of the sinus nerve
Pulmonary vascular resistance:
a) Is increased in hypoxia
b) Is decreased by a low pH
c) Can be measured using a flow-directed balloon catheter
d) Is increased by isoprenaline
e) Is decreased by 5-HT
One or more prostaglandins:
a) Are peptides found in prostatic secretions
b) Dilate the bronchi
c) Stimulate uterine contractions
d) Raise the intracranial pressure
e) Affect platelet function
In the control of body temperature:
a) Shivering is a spinal reflex
b) Energy from brown fat is released via beta adrenergic receptors
c) Brain amines play and important role
d) PGEI may cause pyrexia
e) Control is independent of higher centres
In the control of respiration:
a) Hypoxic drive originates in the peripheral chemoreceptors
b) There is no significant hypoxic drive in a normal subject breathing air at sea level.
c) The response of CO2 is linear over the normal range
d) The increased drive in exercise is due to incomplete oxygen equilibration in the pulmonary capillaries
e) The gasping respiration of shock is a baroreceptor reflex
Gas content of blood:
a) The normal venous PO2 is approximately 5.2 kPa (40 mmHg)
b) The normal venous oxygen saturation is 75%
c) At sea level and breathing air, 0.6 ml oxygen are dissolved in 100 ml blood containing 15 gm haemoglobin/d1
d) Nitrogen is only carried in arterial blood in the dissolved form
e) At a PO2 of 5.2 kPa (40 mmHg) and at sea level, 47 ml CO2 are combined with haemoglobin at a concentration of 15 gm/dl
The effect of Hypercarbia upon the oxyhaemoglobin dissociation curve is :
a) To shift the curve to the left
b) To reduce the affinity fo haemoglobin for oxygen
c) Also temperature dependent
d) Masked by decreases in 2,3-DPG
e) Enhanced in anaemia
Regarding the ECG
a) The t wave represents ventricular depolarisation
b) The standard ECG is recorded at 50mm/sec.
c) Q-T interval is inversely related to heart rate.
d) S-T elevation occurs in pericarditis and is convex upward.
e) Information regarding muscle mass may be obtained
In the cardiac cycle
a) Atrial contraction is more important at slow, than at fast heart rates.
c) The first heart sound is caused by an abrupt rise in intraventricular pressure and closure of the A-V valves.
d) The fourth heart sound occurs on atrial contraction with flow through the A-V valves.
e) PCWP normally equates with LAP.
f) The apex beat lies in the 5th ICS in the MCL
In the working myocardium
a) Resting membrane potential is – 60v.
b) There is an increase in Na permeability during phase 0
c) Ca2+ enters the cell during phase 2.
d) ATP is bound and split by myosin ATPase.
e) No oxygen debt is incurred.
The following are correct?
a) (H+) =40 nmoml/litre if bicarbonate = 18 and PCO2= 40 mm---
b) pH=log(H+)
c) The pK of bicarbonate is 5.1
d) pH=pK +log (HC03-)
H2C03
e) Ph is directly proportional to the concentration of hydrogen ions
With acute exposure to Fi02 of 10% you would expect
a) Respiratory alkalosis
b) An increase in cardiac output
c) Alkaline urine
d) Increased arterial PCO2
e) Pulmonary vasoconstriction
Concerning compliance
a) Lung compliance is les than total compliance
b) Dynamic compliance is less in a paralysed patient
c) In IPPV tidal volume depends only on compliance
d) Compliance is directly proportional to V/Q ratio
e) Compliance in a 5 year old is double than that of a 20 year old.
The following can be determined from the volume pressure curve
a) Work of breathing
b) FRC
c) Compliance
d) Static Compliance
e) Dynamic Compliance
Breathing in the lateral position
a) Ventilation is greater in the upper lung
b) PO2 is greater in the lower lung
c) V/Q ratio in the lower lung is increased
d) Perfusion is greater in the upper lobe.
e) V/Q is about 1 near right pulmonary artery
Closing volume
a) Is 10% of a fit young persons vital capacity
b) Varies with extremes of age
c) Increases with supine position
d) Increases with obesity
e) By law is more than closing capacity
The coronary circulation
a) 90% of venous blood passes through the coronary sinus into the RA
b) Left coronary flow is greatest mid systole
c) Auto-regulation occurs between the mean pressure of 40 and 220 mmHg.
d) ADP is largely responsible for auto-regulation
e) Isoflurane is the least potent of the inhalation agents in reducing myocardial contractility.
f) Myocardial oxygenation increases via increasing oxygen extraction.
With myocardial contraction
a) Energy of contraction is inversely proportional to muscle fibre length.
c) Increased diastolic filling increases stroke volume
d) VEDP is used as a measure of EDV
e) LV performance curves plot LVSW v LEVDP
f) An LVEDP of 12 cmH20 could be normal
Regarding Cardiac Output.
a) 10% supplies the coronary circulation at rest
b) CO=BP*PVR
c) Stroke volume is more important than HR in increasing CO in a young healthy adult.
d) Using a thermistor tipped PAFC, CO is equivalent to the area under the cooling curve.
e) Inotropes and vasodilators may increase CO.
The neuromuscular junction.
a) The pre-post junctional gap is 100-200 A.
b) Ach is released a quanta, proportional to the third power of the calcium concentration.
c) Pre-junctional receptors control Ach synthesis
d) MEPPs are propagated
e) Aminoglycosides are channel blockers.
Beta receptor stimulation of he heart
a) Is predominantly beta 2.
b) Increases myocardial contractility
c) Increases refractory period
d) Increases intracellular Ca2+
e) Increases A-V conduction velocity
Nervous regulation of the heart
a) Sympathetic nerve arise from T2 and T3
b) Parasympathetic stimulation leads to a fall in CO
c) Baroreceptor stimulation increases sympathetic tome
d) Heart rate increase by 20/min for each deg C rise in core temp.
e) Sympathetic stimulation increases the slope of end systolic pressure volume relationship
The oxy-haemoglobin dissociation curve.
a)Is left shifted by a fall in pH
b) Position is defined by the P50 (normally 40mmHg)
c) Is produced from the allosteric interaction of molecular oxygen on he Hb molecule
d) Is right shifted by an increase in temperature
e) Is influenced by the Rapoport-Luebering shunt
The tension of 02/CO2 in blood may be determined by
a) Haldane method
b) Van-Slyke method
c) Polarography
d) Gas chromatography
e) Tonometry
Oxygen
a) 1G combines with 23ml 02
b) 1 molecule so Hb combines with four fo molecular 02
c) is responsible for the Paul-Bert effect
d) May be used in the treatment of pneumatosis coli
e) Is a product fo photosynthesis
Pulmonary blood volume
a) Is normally 20% of TBV
b) 250ml. Blood is within pulmonary capillaries in an adult
c) Acts as a reservoir
d) Decreases in inspiration
e) Increases with mitral stenosis
Parathyroid hormone
a) Raises plasma ionised calcium concentration
b) Increases osteoclast activity
c) Increases the reabsorption of phosphate
d) Decreases production of 1, 25 DiOH CC.
e) Increases Alkaline Phosphatase
Creative Kinase (CPK)
a) Is found in heart muscle, kidney and skeletal muscle.
b) Increases in hypothyroidism
c) Reduces in alcoholism
d) Increases with parturition
e) May increase post CVA.
Iron
a) Total body iron is 150mmol (8g).
b) 70% is in the RBC.
c) Is essential for oxidative phosphorylation
d) Is stored in he reticuloendothelial system
e) Parenteral therapy may easily lead to iron overload.
Compensatory mechanisms for a primary acidosis include:-
a) Hyperventilation
b) Increased urine pH
c) Elevated CSF bicarbonate
d) Decreased carbonic anhydrase activity within the renal tubular cells
e) Bicarbonate excretion to control urine pH.
Nerve conduction
a) At the height of the action potential the membrane potential approaches the equilibrium potential balancing the ions on the tow sides of the membrane
b) The duration of the refractory period limits transmission frequency
c) Is fastest in myelinated fibres
d) Saltatory conduction involves sodium and chloride permeability alone.
e) Speed is always directly proportional to the thickness of the nerve fibres
Potassium balance:
a) Is acutely regulated by changes in concentration across cell membranes
b) Plasma levels are acutely elevated by an alpha adrenergic affect
c) Hyperkalaemia decreases glucagon secretion
d) Intracellular alkalosis decreases serum potassium
e) 90% of the total body potassium is intracellular
The following statements are true of the oxyhaemoglobin dissociation curve:
a) The p50 is approximately 3.6 kPa (27 mmHg)
b) The curve moves to the right if there is Hypercarbia
c) The curve moves to the left if there is acidaemia
d) The p50 is decreased by a raised PaCO2
e) The steepest part of the curve is below the normal venous point.
The following changes occur in acclimatization at altitude;
a) The kidneys excrete an acid urine
b) The red bone marrow is suppressed
c) Cardiac output increases
d) The haemoglobin concentration rises
e) The shape of chest wall changes to favour pump handle movement
The following are true for jugular venous pressure tracings:-
a) The ‘a’ wave is due to atrial systole
b) The summit of the ‘v’ wave marks the beginning of ventricular systole
c) The ‘a-v’ interval is a guide to the conduction time of the bundle of His
d) The ‘c’ wave is due to bulging of the artio-ventricular valves into the atrium
e) The ‘v’ wave is due to filling of the atrium with the atrio-ventricular valves closed.
The following cause vasodilation of the peripheral arterial blood vessels:
a) Thromboxane A2
b) Endothelin
c) Adenosine diphosphae (ADP)
d) Nitric oxide (NO)
e) Prostacylin
In decompression sickness:
a) Bubbles of carbon dioxide form in the tissues
b) Joint pain is typical feature
c) Symptoms typically begin 48 h after returning to atmospheric pressure
d) The condition is commoner in smokers
e) Recompression should be rapid.
The following are physiological effects of hyperventilation.
a) Increased pulmonary artery pressure
b) Peripheral arteriolar vasodilation
c) A shift to the left in the oxygen dissociation curve
d) Fall in plasma potassium concentration
e) Alakalosis
Saltatory conduction:-
a) Occurs only in myelinated nerve fibres
b) Is conduction of an action potential between schwann cell nuclei
c) Is slowed as temperature falls
d) Is faster in nerve fibres of larger diameter
e) Occasionally occurs in un-myelinated nerve fibres
The carotid sinus:
a) Is located at the origin of the internal carotid artery
b) Contains receptors that are sensitive to blood pH
c) Is innervated by the glossopharyngeal nerve
d) Causes peripheral vasodilation when stimulated
e) Becomes hypersensitive, particularly in young women.
Adult haemoglobin:-
a) Contains four molecules of globin
b) Combines with carbon dioxide
c) Combines with carbon monoxide at the same site on the haemoglobin molecule as oxygen
d) Carries molecular rather than ionic oxygen
e) Production is increased by direct action of hypoxia on the bone marrow
The QRS complex on he electrocardiogram:-
a) Is caused by ventricular myocardial repolarisation
b) Will normally contain a Q-wave up to half the height of the R-wave
c) Corresponds with the phase of isovolumetric contraction
d) Is shortened in tricyclic poisoning
e) May be used to assess rotation of the heart along its longitudinal axis
Growth hormone and insulin has opposite effect in:-
a) Carbohydrate uptake by muscle
b) Anabolism of fat
c) Catabolism of fat
d) Protein synthesis
e) Amino acid uptake
The following hormones are produced by the hypothalamus:
a) Corticotrophin releasing factor
b) Prolactin
c) ADH
d) TSH
e) Growth hormone
Reduced FRC
a) In the obese
b) Assuming an upright posture
c) Following anaesthesia
d) Is more pronounced after upper abdominal than peripheral surgery
e) Increased gaseous induction time
A decrease in arterial oxygen tension would occur with :-
a) Old age
b) Breathing 1% carbon monoxide
c) Anaemia
d) Pregnancy
e) High attitude
A marked increase in ventilation would be caused by:-
a) Breathing air containing 0.3% carbon monoxide
b) Deceasing CSF pH
c) A rise in the blood pH to 7.45
d) With an increase of arterial carbon dioxide above 10 Kpa
e) Administration of Doxapram
In the explosive phase of a cough
a) Intrapleural pressure may rise to 50 mmHg
b) There is a decrease in cerebral perfusion pressure
c) There is a narrowing of the airways
d) There is contraction of the diaphragm
e) There is closure of glottis
Intrapleural pressure
a) Can be measured with an oesophageal balloon
b) Is related to diffusion of O2 into the Intrapleural space
c) Becomes increasingly negative with increasing lung volumes
d) Equals atmospheric pressure at FRC
e) Is more negative at the apices because of the weight of the lungs
Calcitonin
a) Is produced in parathyroid glands
b) Is simulated by calcitonin releasing factors
c) Inhibits bone resorption
d) Decreases plasma calcium
e) Influences metabolic rate
With 24 hour starvation there is
a) An increase in Lipolysis
b) Respiratory quotient increase
c) An increase in Glucocorticoids
d) Hypoglycemia
e) Dehydration
The following are true:-
a) Fats are predominantly absorbed in the ileum
b) Vit K is absorbed in the stomach
c) Bile salts are absorbed in the duodenum
d) Iron is absorbed in the terminal ileum
e) Water is predominantly absorbed in the rectum
Human erythrocytes:-
a) Contain more potassium ions than calcium ions
b) Are formed from megakaryocytes in bone marrow
c) Contain carbonic anhydrase
d) Have a life of between 110 and 130 days
e) Have average diameter of 10-12 microns (micrometers)
The following substances are necessary for normal erythropoiesis:-
a) Ascorbic acid
b) Folic acid
c) Vitamin E
d) Iron
e) B12
Increase in 2.3 diphosphoglyceric acid (2,3, D.P.G.) concentration in red blood cell influences:-
a) The oxygen consumption of the cells
b) The life of stored red blood cells
c) The oxyhaerroglobin blood dissociation
d) The rate of carbonic acid formation by red cells
e) The pH of the plasma
In a normal adult the differential white cell count includes:-
a) Neutrophis 65 to 70 percent
b) Lymphocytes 20 to 25 percent
c) Monocytes 5 to 8 percent
d) Eosinophis 0 to 4 percent
e) Basophil 0 to 1 percent
Compared with intracellular fluid, the extracellular fluid contains a greater concentration of :-
a) Sodium ions
b) Magnesium ions
c) Protein
d) Hydrogen ions
e) Bicarbonate ions
Antidiuresis for 12 or more hours leads to
a) Retention of sodium
b) Decrease in plasma corisol
c) Increased renal excretion of nitrogen
d) Increased renal excretion of potassium
e) Decrease in plasma osmolality
Straining during defecation cause an immediate:-
a) Rise in the aortic blood pressure
b) Rise in the central venous pressure
c) Increase in arterial PCO
d) Fall in the intracranial pressure
e) Increase in the intraocular pressure
The following secretions of the stomach are essential
a) HCI
b) Persin
c) Renin
d) Intrinsic factor
e) Gastrin
The effects of an increase in efferent vagal activity include:-
a) Slowing of the heart rate
b) Increased contractility of atria
c) Decreased chronotropism
d) Slowing of conduction between ventricles
e) Bronchospasm
Hypoxaemia stimulates respiration by an action on:-
a) The carotid sinus
b) Central pH
c) Central respiratory neurones
d) The carotd and aortic bodies
e) Central chemoreceptors in the hypothalamus
The alveolar carbon dioxide tension:
a) Is normally 36-44 mm Hg
b) Is normally 3-6 mm Hg below the arterial tension
c) Influences the alveolar oxygen tension during air breathing
d) Increases during pregnancy
e) Roughly doubles when alveolar ventilation is halved.
Surfactant:-
a) Increase surface tension in the alveoli
b) Can be detected in normal amniotic fluid at term
c) Prevents collapse of alveoli at low lung volume
d) May be deficient in premature infants
e) Maintains the normal permeability of the alveolo-capillary membrane
A healthy person exposed to an acute reduction in the partial pressure of oxygen to 50 mm Hg in the inspired air will:-
a) Develop respiratory alkalosis
b) Secrete more acid urine
c) Have increased pulmonary vasoconstriction
d) Have an increased cardiac output
e) Have a reduction in the oxygen carrying capacity of his blood.
Reabsorption of glucose in the kidneys:-
a) Occurs in the distal convoluted tubule
b) Is directly controlled by the plasma glucose level.
c) Is directly controlled by insulin secretion
d) Is inhibited by phloridzin
e) Does not require adenosine triphosphate
The mass of gas dissolved in a liquid at constant ambient temperature depends upon the:-
a) Temperature of the liquid
b) Partial pressure of the gas
c) Diffusion coefficient
d) Solubility of the gas in the liquid
e) Critical temperature of the gas.
The oxygen dissociation curve of blood:-
a) May be constructed by plotting the oxygen content against the oxygen tension
b) Is shifted to the left in the foetus
c) Is shifted to the left with raising the hydrogen ion concentration
d) Is shifted to the right by raising the temperature
e) Is hyperbolic in shape
Peripheral arterial resistance is raised by:-
a) Injection of noradrenaline
b) Increased stroke output
c) Baroreceptor stimulation
d) Hypovolemia
e) Hyperactivity of the juxta-glomerular apparatus
During severe exercise the :-
a) Oxygen saturation of mixed venous blood is 70 percent
b) Heart rate may rise to over 150/min
c) Pulmonary vascular resistance falls
d) Cardiac output may reach 20-30 litres/min
e) Venous pressure rises
Plasma colloid osmotic pressure:-
a) Depends largely on plasma albumin concentration
b) Makes a large contribution to plasma osmolality
c) Is lower than the colloid osmotic pressure of lymph
d) Is affected by the haemoglobin concentration in the red cells
e) Can be raised by intravenous Mannitol
The normal metabolic response to an operation includes:-
a) Antidiuresis for 12 to 24 hours
b) Retention of sodium
c) Decrease in plasma cortisol
d) Increased renal excretion of nitrogen
e) Increased renal excretion of potassium
Pulmonary vascular resistance may be increased by:-
a) Hypoxia
b) Acidawmia
c) Exercise
d) The valsalva manoeuvre
e) Serotonin (5-hydroytryptamine)
Cardiac output:-
a) Is the volume of blood pumped out by either ventricle in one minute
b) Is the product of the heart rate and stroke volume
c) Is under nervous control only
d) May be measured by the Fick principle
e) Falls on assuming the erect posture from the horizontal
The resting membrane potential of a nerve cell:-
a) Is normally about 70 mv internally
b) Is related to the relative concentrations of chloride inside and outside
c) Is little altered by changing the external Na concentration
d) Requires the presence of a sodium pump
e) Is highly dependent on the external concentration of potassium
The following are true:-
a) Fructose is a disaccharide of glucose and galactose
b) Following a meal the blood pyruvate concentration increases.
c) Leucine is a branched chain amino acid.
d) Insulin is required for the production of free fatty acids from stored triglycerides.
e) Uncoupling of oxidative metabolism occurs in brown fat.
The complement system plays an important role in the following:-
a) Mantoux reaction
b) Virus inactivation.
c) Phagocytosis by neutrophils.
d) IgE binding to mast cells.
e) Neutrophil chemotaxis
Calcitonin is:-
a) A peptide hormone
b) Secreted by the parathyroid glands
c) Inhibits osteoblast activity
d) Is secreted following pentagastrin infusion
e) Is functionally antagonised in its action on bone by Parathormone.
Ferritin
a) Is involved in the transfer of iron across the gut wall.
b) Is involved in he tissue storage of iron
c) Is involved in the transfer of iron to the liver
d) Is involved in the transfer of iron to muscles
e) Is destroyed immediately after use.
The following increase on rising from lying down :-
a) Cardiac output
b) Renin secretion
c) Vital capacity
d) Dead space
e) Central venous pressure
Unilateral section of the cervical sympathetic chain causes:-
a) Nasal mucosal hypertrophy on the affected side
b) Enopthalmos on the affected side
c) Mydriasis on the affected side
d) Excessive lacrimation on the affected side
e) Failure of accommodation
Acetylcholine is the neurotransmitter:-
a) At sympathetic preganglionic terminals in the adrenal medulla.
b) At parasympathetic postganglionic terminals in the parotid gland
c) At sympathetic postganglionic terminals in sweat glands
d) At pupillary sympathetic dilator fibres
e) At sympathetic ganglia
The following muscles are important in forced expiration:-
a) External intercostals
b) Internal intercostals
c) Diaphragm
d) Serratus anterior
e) Abdominal muscles
The hepatic blood flow:-
a) Is 1.5 L/min in normal adults
b) 40% comes from the hepatic portal vein
c) The hepatic portal venous pressure is 80 mmHg
d) 70% of the hepatic oxygen supply come from the hepatic artery
e) Is increased by GTN
Myosin
a) Is found only in muscle cells
b) Is composed of tropomyosin and troponin
c) Is linked to actin by cross bridges
d) Is surrounded by sarcoplasmic reticulum
e) Contains an ATPase
In the mechanism of normal clotting
a) Widespread tissue damage produces a substance that interferes with the process
b) Vitamin C is necessary
c) The n