PHYSIOLOGY REVIEW EXAM QUESTIONS

1. The uptake of a novel drug by hepatocytes occurs down an electrochemical gradient. Uptake is
independent of other solutes, and the rate of uptake is saturated at high extracellular drug
concentrations. Which membrane transport process is most likely to account for all these characteristics
of drug uptake?
A. Antiport with Cl-
B. Cotransport with Na+
C. Facilitated diffusion
D. Primary active transport

Answer: (C) Facilitated diffusion

Facilitated diffusion only occurs passively down the solute electrochemical gradient; it occurs via
uniporters, with no dependence on other solutes and is saturable.

2. Homeostasis relies on feedback to achieve its aims. “Negative” feedback refers to which situation
below? The body’s response:
A. travels from the effector to the integrating center via the afferent pathway.
B. opposes the stressful stimulus.
C. is to decrease the set point.
D. enhances the stressful stimulus.

Answer is B: “Negative” refers to the opposing nature of the response.

3. Organelles that neutralize drugs and toxins are

A. Nuclei
B. Mitochondria
C. Lysosomes
D. Peroxisomes

Answer: D. Peroxisomes contain oxidases capable of combining oxygen with hydrogen ions derived from
different intracellular chemicals to form hydrogen peroxide (H2O2), a highly oxidizing substance used in
association with catalase, another oxidase enzyme present in large quantities in peroxisomes. These
enzymes oxidize and neutralize many drugs and toxins that might otherwise be poisonous to the cell.

4. A group of medical students is experimenting with a peak flow meter in the respiratory physiology
laboratory. Two students decide to compete to see which of them can blow the hardest into the device.
Which of the following muscles is most effective at producing a maximal expiratory effort such as this?
A. Diaphragm
B. External intercostal muscles
C. Internal intercostal muscles
D. Rectus abdominis
Answer: D. Rectus abdominis
The abdominal muscles are the most powerful expiratory muscles; the internal intercostal muscles are
weak expiratory muscles. The diaphragm is the primary inspiratory muscle, supported by the external
intercostal muscles; the sternocleidomastoid is an accessory muscle of inspiration.

5. Refer to the graph below:

Assuming a respiratory rate of 12 breaths/min, calculate the minute ventilation.

A. 1 l/min
B. 4 l/min
C. 5 l/min
D. 6 l/min

Answer: D. Minute ventilation is VT × respiratory rate. VT from the graph is 500ml. Therefore, minute
ventilation = 500 × 12 = 6 l/min.

6. Which of the following is the site of highest airway resistance?

A. Trachea
B. Largest bronchi
C. Medium-sized bronchi
D. Smallest bronchi

Answer: C. The medium-sized bronchi actually constitute the site of highest resistance along the
bronchial tree. Although the small radii of the alveoli might predict that they would have the highest
resistance, they do not because of their parallel arrangement. In fact, early changes in resistance in the
small airways may be “silent” and go undetected because of their small overall contribution to
resistance.

7. A 50 -year-old man with a persistent cough and difficulty breathing is referred by his family physician
for pulmonary function tests. The test results show that the forced vital capacity (FVC), forced expired
volume in 1 s (FEV1), and functional residual capacity (PRC) are all significantly below normal. Which of
the following diagnosis is consistent with these pulmonary function test results?
A. Asthma
B. Chronic bronchitis
C. Emphysema
D. Pulmonary fibrosis
Answer: D. FVC and FEV1 are expected to be reduced in all these conditions. The coexistence of low FRC
indicates reduced resting lung volume and is consistent with the low static lung compliance found in
patients with pulmonary fibrosis.

8. The factor responsible for the left shift of Hb-O2 dissociation curve is:
A. Increase in 2,3-DPG in RBC
B. Fall in temperature
C. Fall in pH
D. Increase level of CO2 blood

Answer: B. Fall in temperature

9. In the transport of CO2 from the tissues to the lungs, which of the following occurs in venous blood?
A. Conversion of CO2 and H2O to H+ and HCO3− in the red blood cells (RBCs)
B. Buffering of H+ by oxyhemoglobin
C. Shifting of HCO3− into the RBCs from plasma in exchange for Cl−
D. Binding of HCO3− to hemoglobin

Answer: A. CO2 generated in the tissues is hydrated to form H+ and HCO3− in red blood cells (RBCs). H+
is buffered inside the RBCs by deoxyhemoglobin, which acidifies the RBCs. HCO3− leaves the RBCs in
exchange for Cl− and is carried to the lungs in the plasma. A small amount of CO2 (not HCO3−) binds
directly to hemoglobin (carbaminohemoglobin).

10. CO2 is primarily transported in the arterial blood as:

A. Dissolved CO2
B. Carbonic acid
C. Carbaminohemoglobin
D. Bicarbonate

Answer: D. About 68–70% CO2 transported as HCO3– form.

11. Diffusion of gas in respiratory membrane:

A. Directly proportional to thickness of respiratory
B. No lipid - water solubility
C. Inversely proportional to pressure gradient
D. Inversely proportional to molecular weight of the gas

Answer: D. Inversely proportional to molecular weight of the gas (Recall Ficks law of diffusion)

12. Oxygen carrying capacity of blood is largely determined by:

A. Hb level
B. Amount of CO2 in blood
C. Acidosis
D. Plasma concentration
Answer: A. 99% of arterial oxygen is carried by Hemoglobin, only 1% in the form of
dissolve oxygen.

13. With regard to lung ventilation, what does “dead space” refer to?
A. air in the conducting zone of the bronchial tree
B. air remaining in the alveoli after an exhalation at maximal effort.
C. air between the parietal and visceral pleura
D. the difference between the volume of a maximum inhalation and the tidal volume.

Answer: A. Dead space refers to air that is inhaled into the airways but does not reach the alveoli, hence
is exhaled again without participating in gas exchange.

14. A 9-ycar-old boy decided to find out for how long he could continue to breathe into and out of a
paper bag. After approximately 2 minutes, his friends noticed that he was breathing very rapidly so they
forced him to stop the experiment. What change in arterial blood gas composition was the most potent
stimulus for this boy's hyperventilation?
A. Decreased PCO2
B. Decreased PO2
C. Decreased pH
D. Increased PCO2

Answer: D. Breathing into and out of a paper bag will result in accumulation of CO2 and depletion of 02
in the bag. The same changes will, therefore, be reflected in alveolar air and in arterial blood.
Accumulation of CO2 will also result in a decrease in the blood pH. However, in normal subjects, the
most potent drive to breathe is the arterial Pco2 , acting through central chemoreceptors.

15. Filtration pressure in glomeruli of the kidney:

A. 10 mm of Hg
B. 6 mm of Hg
C. 15 mm of Hg
D. 2.0 mm of Hg

Answer: A. Net filtration pressure is 10 mm Hg (average pressure in glomerular capillary).

Note: According to Ganong’s Physiology: “The net filtration pressure (PUF) is 15 mm Hg at the afferent
end of the glomerular capillaries, but it falls to zero.” But here the question is not about afferent end; it’s
the average pressure. So, better answer is 10 mm Hg. If question mention afferent arterioles level; go for
15 mm Hg.

16. Glomerular filtration rate is increased when:

A. Plasma oncotic pressure is increased
B. Glomerular hydrostatic pressure is decreased
C. Tubular hydrostatic pressure
D. Increased renal blood flow
Answer: D. Increase blood flow to the capillary, increases glomerular hydrostatic pressure.

17. Several hormones regulate the tubular reabsorption of water and electrolytes at different sites in the
nephron. Which of the following combination is correct?
A. Angiotensin in distal tubule
B. Aldosterone in collecting ducts
C. ADH in proximal tubule
D. ANP in loop of Henle

Answer: b. Aldosterone in collecting ducts

18. A 54-year-old woman received. a life-saving kidney transplant 6 months ago and had been well until
the p8$1 few days. She now reports severe fatigue and dizziness upon standing. Urinalysis is positive for
glucose, and there is excessive excretion of HC03- and phosphate. In which segment of the nephron is
function most likely to be abnormal?
A. Proximal tubule
B. Loop of Henle
C. Distal tubule
D. Collecting duct

Answer: A. The patient has a condition called acquired Fanconi syndrome. The presence of high levels of
glucose, HCO, -, and phosphate together in the urine suggest proximal tubule dysfunction because this is
their main site of reabsorption.

19. Which of the following occurs in type A intercalated cells of the collecting tubules?
A. Secretion of H+, reabsorption of HCO3, and reabsorption of K+
B. Secretion of K+, reabsorption of Na+, and reabsorption of HCO3
C. Reabsorption of H+, secretion of HCO3 , and secretion of K+
D. Reabsorption of H+, secretion of HCO3 , and reabsorption of K+

Answer: A. Type A intercalated cells of the collecting tubules secrete H+ by a hydrogen-ATPase

transporter and by a hydrogen-potassium-ATPase transporter. They also reabsorb HCO3 and K+

20. Which of the following causes hyperkalemia?

A. Exercise
B. Alkalosis
C. Insulin injection
D. Decreased serum osmolarity

Answer: A. Exercise causes a shift of K+ from cells into blood. The result is hyperkalemia. Hyposmolarity,
insulin, β-agonists, and alkalosis cause a shift of K+ from blood into cells. The result is hypokalemia.
21. A 63-year-old hospitalized woman becomes oliguric and confused. A blood sample is drawn to
measure her glucose concentration, which is found to be 35 mg/dL. An IV access is obtained and an
ampule of 50% dextrose is given followed by a continuous infusion of 10% dextrose. Most of the glucose
that is filtered through the glomerulus undergoes reabsorption in which of the following areas of the
nephron?
A. Proximal tubule
B. Descending limb of the loop of Henle
C. Ascending limb of the loop of Henle
D. Distal tubule
E. Collecting duct

Answer: A. Glucose is reabsorbed along with Na+ in the early portion of the proximal tubule via a
secondary active transport process. Normally, essentially all filtered glucose is reabsorbed. In diabetes
mellitus, hyperglycemia results in a tubular filtration load that exceeds and glycosuria ensues. The renal
threshold for glucose is the plasma level at which glucose first appears in the urine. The predicted renal
threshold is approximately 300 mg/dL, that is, the transport maximum (Tmax) for glucose of 375 mg/min
divided by the GFR (normally ~125 mL/min). However, the actual renal threshold is only approximately
200 mg/dL because the Tmax for glucose is not identical in all tubules.

22. Substrate which is both secreted and filtered:

A. Uric acid
B. Glucose
C. Urea
D. Na+

Answer: Urate (uric acid): Freely filterable. Almost all the filtered urate is reabsorbed early in the PCT;
however, further on in the proximal tubule, urate undergoes active tubular secretion. Then, in the
straight portion, some of the urate is once again reabsorbed. The total rate of tubular reabsorption is
normally much greater than the rate of tubular secretion,
so the mass of urate excreted per unit time is only a small fraction of the mass filtered.
Urea: Absorbed from medullary collecting duct by facilitated diffusion and diffuse back into thin
ascending limb of loop of Henle. So, it is not active secretion but passive diffusion of urea.

23. Which one of the following substances, actively transported by the tubular cells, has the highest
Tubular Transport Maximum?
A. Plasma protein
B. Hemoglobin
C. Glucose
D. Sodium

Answer: C. Tm for Glucose = 375 mg/dL, plasma proteins = 30 mg/min. Na+ = does not have Tm.

24. Which of the following would you expect to find in a patient who has chronic diabetic ketoacidosis?
A. Decreased renal HCO3 excretion, increased NH4 + excretion, increased plasma anion gap
B. Increased respiration rate, decreased arterial PCO2, decreased plasma anion gap
C. Increased NH4 + excretion, increased plasma anion gap, increased urine pH
D. Increased renal production HCO3, increased NH4 + excretion, decreased plasma anion gap

Answer: A. Diabetic ketoacidosis results in a metabolic acidosis that is characterized by a decrease in

plasma bicarbonate concentration, increased anion gap (due to the addition of unmeasured anions to
the extracellular fluid along with the ketoacids), and a renal compensatory response that includes
increased secretion of NH4 +. There is also an increased
respiratory rate with a reduction in arterial PCO2, as well as decreased urine pH and decreased renal
HCO3 excretion.

25. A patient has the following laboratory values: arterial pH = 7.13, plasma HCO3 = 15meq/L, plasma
chloride concentration = 118 mEq/l, arterial PCO2 = 28 mm Hg, and plasma Na+ concentration = 141
mEq/l.
What is the most likely cause of his acidosis?
A. Salicylic acid poisoning
B. Diabetes mellitus
C. Diarrhea
D. Emphysema

Answer: C. The patient has a lower than normal pH and is therefore acidotic. Because the plasma
bicarbonate concentration is also lower than normal, the patient has metabolic acidosis with respiratory
compensation (i.e., is lower than normal). The plasma anion gap (Na+ - Cl - HCO3 = 10meq/L) is in the
normal range, suggesting that the metabolic acidosis is not caused by excess nonvolatile acids such as
salicylic acid or ketoacids caused by diabetes mellitus. Therefore, the most likely cause of the metabolic
acidosis is diarrhea, which would cause a loss of HCO3 in the feces and would be associated with a
normal anion gap and a hyperchloremic (increased chloride concentration) metabolic acidosis.

26. Capacitation of sperms takes place in the:

A. Seminiferous tubules
B. Epididymis
C. Vas deference
D. Uterus

Answer: D. Capacitation starts in cervix and ends at the level of isthmus of fallopian tube.

27. Positive feedback action of estrogen for inducing luteinizing hormone surge is associated with which
of the following steroid hormone ratios in peripheral circulation?
A. High estrogen: low progesterone
B. Low estrogen: high progesterone
C. Low estrogen: low progesterone
D. High estrogen: high progesterone
Answer: A. High estrogen should be present at least for two days for positive feedback effect. When
circulating estrogen was increased about 300% for 24 h, only negative feedback was seen; but when it
was increased about 300% for 48 h or more, LH surge is seen. When circulating levels of progesterone
were high, the positive feedback effect of estrogen was inhibited. In primates, there is evidence that
both the negative and the positive feedback effects of estrogen are exerted in the mediobasal
hypothalamus.

28. Which of the following inhibits the secretion of growth hormone by the anterior pituitary?
A. Sleep
B. Stress
C. Puberty
D. Somatomedins

Answer: D. Growth hormone is secreted in pulsatile fashion, with a large burst occurring during deep
sleep (sleep stage 3 or 4). Growth hormone secretion is increased by sleep, stress, puberty, starvation,
and hypoglycemia. Somatomedins are generated when growth hormone acts on its target tissues; they
inhibit growth hormone secretion by the anterior pituitary, both directly and indirectly (by stimulating
somatostatin release).

29. In an individual with a thyroid hormone producing adenoma, one might expect which of the
following?
A. ↑ T4, ↓ T3, ↓ TRH, ↓ TSH
B. ↑ T4, ↑ T3, ↓ TRH, ↓ TSH
C. ↑ T4, ↑ T3, ↑ TRH, ↓ TSH
D. ↑ T4, ↑ T3, ↓ TRH, ↑ TSH

Answer: B. A thyroid hormone–producing adenoma causes an increase in thyroid hormones. Thus, one
would expect an increase in both circulating T4 and T3 caused by the adenoma. The increased T4 and T3
feeds back to inhibit the production and release of TRH from the hypothalamus and TSH from the
anterior pituitary to halt further production of the thyroid hormones. However, the adenoma does not
respond to normal feedback regulation, and thus T3 and T4 remain high.

30. Which of the following is true about thyroid hormones?

A. Thyroid peroxidases are used for formation T1 and T2 from T3 and T4
B. Thyroglobulin protein is needed for organification of iodine
C. T1/2 of T3 is more than T4
D. T4 is more protein bound to TBG than T3

Answer: D. T4 is more protein bound to TBG than T3

31. Destruction of zona glomerulosa will deplete:

A. Aldosterone
B. Cortisol
C. Testosterone
D. Catecholamines

Answer: A. Aldosterone is synthesized in the zona glomerulosa

32. Which step in steroid hormone biosynthesis, if inhibited, blocks the production of all androgenic
compounds but does not block the production of glucocorticoids?
A. Cholesterol → pregnenolone
B. Progesterone → 11-deoxycorticosterone
C. 17-Hydroxypregnenolone → dehydroepiandrosterone
D. Testosterone → estradiol

Answer: C. The conversion of 17-hydroxypregnenolone to dehydroepiandrosterone (as well as the

conversion of 17-hydroxyprogesterone to androstenedione) is catalyzed by 17,20-lyase. If this process is
inhibited, synthesis of androgens is stopped.

33. Which neurotransmitters are released by the cells of the adrenal medulla in response to stress?
A. Dopamine and serotonin
B. Acetylcholine and GABA
C. Adrenaline (epinephrine) and noradrenaline (norepinephrine)
D. Glutamate and glycine

Answer: C. Adrenaline (epinephrine) and noradrenaline (norepinephrine)

34. Which of the following can cause hypocalcemia?

A. Thyroxine
B. Calcitonin
C. Parathyroid hormone
D. Cholecalciferol

Answer: B. The Ca2+ lowering hormone has been named calcitonin, which inhibits osteoclast.

35. Which of the following would you expect to find in a patient whose diet has been low in calcium for 8
weeks?
A. Increased phosphate levels
B. Raised calcitonin levels
C. Increased parathyroid hormone secretion
D. Activation of 24–25 dihydroxycholecalciferol

Answer: C. Circulating ionized calcium acts directly on the parathyroid glands in a negative feedback
fashion to regulate the secretion of PTH. Low calcium diet leads to hypocalcemia, which stimulates PTH
release. PTH causes hypophosphatemia. In presence of hypocalcemia, serum calcitonin level decreases
and active form of vit. D increases with decrease in inactive form of vit. D3(24,25 dihydrocholecalciferol).

36. After a meal rich in carbohydrate, insulin secretion is stimulated by:

A. CCK
B. Serotonin
C. VIP
D. GLP-1

Answer: D. The insulin secretory response of incretins, called the incretin effect,
accounts for at least 50% of the total insulin secreted after oral glucose. There are two incretins, known
as glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1), that are
responsible for the above functions.

37. Glucose transporter involved in insulin stimulated glucose transport is:

A. GLUT-1
B. GLUT-2
C. GLUT-3
D. GLUT-4

Answer: D

38. Which of the following pancreatic secretions has a receptor with four subunits, two of which have
tyrosine kinase activity?
A. Insulin
B. Glucagon
C. Somatostatin
D. Pancreatic lipase

Answer: A. The insulin receptor in target tissues is a tetramer. The two β subunits have tyrosine kinase
activity and autophosphorylate the receptor when stimulated by insulin.

39. A 30-year-old woman is breastfeeding her infant. During suckling, which hormonal response is
expected in the woman?
A. Increased secretion of ADH from the supraoptic nuclei
B. Increased secretion of ADH from the paraventricular nuclei
C. Increased secretion of oxytocin from the paraventricular nuclei
D. Decreased secretion of neurophysin

Answer: C. During suckling, stimulation of receptors on the nipples increases neural input to both the
supraoptic and paraventricular nuclei. Activation of these nuclei leads to the release of oxytocin and
neurophysin from secretion granules in the posterior pituitary gland. Suckling does not stimulate the
secretion of appreciable amounts of ADH.

40. ADH regulate which of the following aquaporin?

A. 1
B. 2
C. 3
D. 4

Answer: B. ADH inserted aquaporin 2 on luminal membrane of collecting duct epithelium cell.
Aquaporin 3 & 4 are constitutively present on basolateral membrane of collecting duct cell but are not
regulated by ADH.

41. All of the following hormones have receptors on the plasma membrane of target tissues EXCEPT:
A. Thyrotropin
B. Glucagons
C. Estradiol
D. Epinephrine

Answer: C. Estradiol

42. Hypothalamus controls the hormone secretion of:

A. Anterior hypophysis
B. Posterior hypophysis
C. Kidney
D. Pineal gland

Answer: A. Hypothalamus controls anterior pituitary hormones. Posterior pituitary

hormones synthesized in hypothalamus.

43. Which of the following represents a physiological action of growth hormone?

A. Increases the breakdown of muscle protein
B. Increases utilization of glucose in muscle
C. Decreases storage of lipids in adipose cells
D. Decreases gene transcription

Answer: C) GH promotes several metabolic changes. These include a net increase in amino acid uptake in
the muscle and liver, a decrease in glucose utilization and storage, and an increase in lipolysis. The net
effect of GH is to decrease glucose and lipid storage in adipose cells.

44. Antidiuretic hormone (ADH) is increased by which of the following?

A. A hyperosmotic extracellular fluid in the hypothalamus
B. A hyperosmotic extracellular fluid in the adenohypophysis
C. A hypoosmotic extracellular fluid in the hypothalamus
D. A hypoosmotic extracellular fluid in the adenohypophysis

Answer: A. Osmoreceptors in, or near, the hypothalamus are important regulators of ADH. Hyperosmotic
extracellular fluid causes the cells of the hypothalamus to shrink and stimulates the release of ADH,
which promotes renal H2O reabsorption to restore the extracellular fluid to
isosmotic.

45. A 39-year-old man with an enlarged head, hands, and feet; osteoarthritic vertebral changes; and
hirsutism presents with a complaint of gynecomastia and lactation. The patient is most likely suffering
from a tumor in which of the following locations?
A. Adrenal cortex
B. Anterior pituitary
C. Breast
D. Hypothalamus

Answer: B. Tumors of the somatotropes of the anterior pituitary gland secrete large
amounts of growth hormone, leading to acromegaly in adults. When the epiphyses have not yet fused to
the long bones, growth is stimulated by excess growth hormone leading to gigantism in children. Once
the epiphyses have closed, linear growth is no longer possible, and growth hormone produces the
pattern of bone and soft-tissue abnormalities typical of acromegaly. Hypersecretion of growth hormone
is accompanied by hypersecretion of prolactin in up to 40% of patients with acromegaly, explaining the
patient’s complaint of lactation. Human growth hormone also has intrinsic lactogenic activity,
contributing to the development of gynecomastia and lactation in this male patient.

46. What RBC enzyme facilitates transport of carbon dioxide (CO2)?

A. Myeloperoxidase
B. Carbonic anhydrase
C. Superoxide dismutase
D. Globin reductase

Answer: B. Carbonic anhydrase catalyzes the reaction of CO2 with water toballow large amounts of CO2
to be transported in blood as soluble bicarbonate ion.

47. When red blood cells break down, the porphyrin portion of hemoglobin is converted by
macrophages to what product(s)?
A. Xanthine
B. Branched-chain amino acids
C. Homocysteine
D. Bilirubin

Answer: D. Macrophages convert the porphyrin portion of hemoglobin to bilirubin.

48. Which phagocytes can extrude digestion products andbcontinue to survive and function for many
months?
A. Neutrophils
B. Basophils
C. Macrophages
D. Eosinophils
Answer: C. Macrophages become activated and enlarged at sites of inflammation and can ingest up to
100 bacteria per macrophage. They can extrude digested material and remain viable and active for many
months. Basophils are not phagocytic, and eosinophils are weak phagocytes. Neutrophils respond rapidly
to infection or inflammation and ingest from 3 to 20 bacteria or other particles before dying.

49. Where does the transmigration of WBCs occur in response to infectious agents?
A. Arterioles
B. Lymphatic ducts
C. Capillaries and venules
D. Inflamed arteries

Answer: C. Transmigration of WBCs occurs through parts of the vasculature that have very thin walls and
minimal vascular smooth muscle layers. This includes capillaries and venules.

50. Patients with human immunodeficiency virus (HIV) exhibit abnormal functioning of which of the
following mechanisms?
A. Antibody production only
B. T cell–mediated cytotoxicity only
C. Degranulation of appropriately stimulated mast cells
D. Both antibody production and T cell–mediated cytotoxicity

Answer: D. Patients with HIV have specific loss of T-helper cells, resulting in a loss of T-cell help for both
antibody production and activation and proliferation of cytotoxic T cells. Assuming that mast cells can be
appropriately stimulated (i.e., bear sufficient residual surfacebound IgE and are exposed to relevant
antigen), their processes for degranulation are intact.