Faculty of Medicine – Al Kasr Al Ainy

PHYSIOLOGY 2023/104
Module 104 Cardiopulmonary System Final May/June 2024
MARK SCHEME
Maximum Mark: 120

Published by Aya Mohsen

This mark scheme is published as an aid to undergraduates, to indicate the requirements of

the examination. It shows the basis on which Examiners were instructed to award marks. It
does not indicate the details of the discussions that took place at an Examiners’ meeting
before marking began, which would have considered the acceptability of alternative answers.

Mark schemes should be read in conjunction with the question paper and the Principal Examiner
Report for Teachers.

Al Kasr Al Ainy will not enter into discussions about these mark schemes.

Al Kasr Al Ainy is publishing the mark schemes for the May/June 2024 finals for Year 1
Medicine.

This document consists of 18 printed

pages.

[Turn over]
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Generic Marking Principles

These general marking principles must be applied by all examiners when marking candidate answers. They should be applied
alongside the specific content of the mark scheme or generic level descriptors for a question. Each question paper and mark
scheme will also comply with these marking principles.

GENERIC MARKING PRINCIPLE 1:

Marks must be awarded in line with:

 the specific content of the mark scheme or the generic level descriptors for the question
 the specific skills defined in the mark scheme or in the generic level descriptors for the question
 the standard of response required by a candidate as exemplified by the standardisation scripts.

GENERIC MARKING PRINCIPLE 2:

Marks awarded are always whole marks (not half marks, or other fractions).

GENERIC MARKING PRINCIPLE 3:

Marks must be awarded positively:

 marks are awarded for correct/valid answers, as defined in the mark scheme. However, credit is given for valid answers
which go beyond the scope of the syllabus and mark scheme, referring to your Team Leader as appropriate
 marks are awarded when candidates clearly demonstrate what they know and can do
 marks are not deducted for errors
 marks are not deducted for omissions
 answers should only be judged on the quality of spelling, punctuation and grammar when these features are
specifically assessed by the question as indicated by the mark scheme. The meaning, however, should be
unambiguous.
GENERIC MARKING PRINCIPLE 4:

Rules must be applied consistently, e.g. in situations where candidates have not followed instructions or in the
application of generic level descriptors.

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GENERIC MARKING PRINCIPLE 5:

Marks should be awarded using the full range of marks defined in the mark scheme for the question (however; the use of the
full mark range may be limited according to the quality of the candidate responses seen).

GENERIC MARKING PRINCIPLE 6:

Marks awarded are based solely on the requirements as defined in the mark scheme. Marks should not be awarded with
grade thresholds or grade descriptors in mind.

Science-Specific Marking Principles

1 Examiners should consider the context and scientific use of any keywords when awarding marks. Although keywords may
be present, marks should not be awarded if the keywords are used incorrectly.

2 The examiner should not choose between contradictory statements given in the same question part, and credit should
not be awarded for any correct statement that is contradicted within the same question part. Wrong science that is
irrelevant to the question should be ignored.
3 Although spellings do not have to be correct, spellings of syllabus terms must allow for clear and unambiguous
separation from other syllabus terms with which they may be confused (e.g. ethane / ethene, glucagon / glycogen,
refraction / reflection).
4 The error carried forward (ecf) principle should be applied, where appropriate. If an incorrect answer is subsequently
used in a scientifically correct way, the candidate should be awarded these subsequent marking points. Further guidance
will be included in the mark scheme where necessary and any exceptions to this general principle will be noted.

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5 ‘List rule’ guidance

For questions that require n responses (e.g. State two reasons …):

 The response should be read as continuous prose, even when numbered answer spaces are provided.
 Any response marked ignore in the mark scheme should not count towards n.
 Incorrect responses should not be awarded credit but will still count towards n.
 Read the entire response to check for any responses that contradict those that would otherwise be credited.
Credit should not be awarded for any responses that are contradicted within the rest of the response. Where two
responses contradict one another, this should be treated as a single incorrect response.
 Non-contradictory responses after the first n responses may be ignored even if they include incorrect science.

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6 Calculation specific guidance

Correct answers to calculations should be given full credit even if there is no working or incorrect working, unless the
question states ‘show your working’.

For questions in which the number of significant figures required is not stated, credit should be awarded for correct
answers when rounded by the examiner to the number of significant figures given in the mark scheme. This may not
apply to measured values.

For answers given in standard form (e.g. a  10n) in which the convention of restricting the value of the coefficient (a) to
a value between 1 and 10 is not followed, credit may still be awarded if the answer can be converted to the answer
given in the mark scheme.

Unless a separate mark is given for a unit, a missing or incorrect unit will normally mean that the final calculation
mark is not awarded. Exceptions to this general principle will be noted in the mark scheme.
7 Guidance for chemical equations

Multiples / fractions of coefficients used in chemical equations are acceptable unless stated otherwise in the

mark scheme. State symbols given in an equation should be ignored unless asked for in the question or stated

otherwise in the mark scheme.

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Examples of how to apply the list rule
State three reasons… [3]

A 1 Correct  F 1 Correct 
2 Correct  (4 responses) 2 Correct 
2 2
3 Wrong  3 Correct 
CON (of (discount
3) 3)

B 1 Correct, Correct ,  G 1 Correct 

(4 responses) 2 Correct  (5 responses) 2 Correct 
3 Wrong ignore 3 3 Correct  3
Correct ignor
CON (of e
4) ignor
e
C 1 Correct  H 1 Correct 
(4 responses) 2 Correct, Wrong ,  (4 responses) 2 Correct 
2 2
3 Correct ignore 3 CON (of (discount
2) 2)
Correct 
D 1 Correct  I 1 Correct 
(4 responses) 2 Correct, CON (of , (discount (4 responses) 2 Correct 
2) 2) 2 2
3 Correct  3 Correct 
CON (of (discount
2) 2)

E 1 Correct 
(4 responses) 2 Correct  3
3 Correct, Wrong 

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Mark scheme abbreviations
; separates marking points
/ alternative answers for the same point
A accept (for answers correctly cued by the question, or by extra guidance)
R reject
I ignore
() the word / phrase in brackets is not required, but sets the
context AW alternative wording (where responses vary more than
usual) underline actual word given must be used by candidate
(grammatical variants
accepted)
max indicates the maximum number of marks that can be given
ora or reverse argument
mp marking point (with relevant number)
ecf error carried forward
AVP alternative valid point

This was originally an A2 Paper 4 Bio pdf

The heading of the question in the ms is based on business mark schemes
Live laugh Business OL, easiest subject ever
Subject zay el sokar fl shay
Nefsy azaker

‫ِبْس ِم اللِه ٱلَّر ْح ٰمِن ٱلَّر ِح يِم‬

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Question Answer Marks

1(a) Define Automaticity and Rhythmicity of the heart. 2

Automaticity: ability of the heart to initiate its own contraction independent of external stimuli.
Rhythmicity: ability of the heart to beat regularly.

1(b) Outline the cause of Automaticity and Rhythmicity. 3

1 due to, presence of pacemaker cells ;
2 generates spontaneous ;
3 and regular action potentials ;

1(c) State the rate of Pacemaker cells. 3

1 SAN → 90-150/min ;
2 AVN → 60/min ;
3 Purkinje → 20-40/min ;

Question Answer Marks

2(a) Explain the Pacemaker potential Phase 4 (Pre-potential). 11

1 at -60 mv ;
2 Opening of funny Na channels/HCN, regulated by intracellular cAMP ;
3 causes inward Na current ;
4 Activation of Na-Ca exchanger ;
5 due to spontaneous release of Ca ;
6 from SR of SAN ;
7 moves 1 Ca out for 3 Na in, so net influx of one positive charge ;
8 causes inward Na current;
9 at -50 mv ;
10 Opening of transient/T-type Ca channels ;
11 causes inward Ca current, causes depolarization to -40 mv ;

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Question Answer Marks

2(b) Explain the Pacemaker potential Phase 0 (Depolarization). 7

1 at -40 mv (firing level threshold) ;
2 Closure of funny channels ;
3 and transient/T-type Ca channels ;
4 Opening of long lasting/L-type Ca channels ;
5 causes inward Ca current ;
6 cause slow depolarization, “slow response action potential’;
7 Gradual opening of delayed rectifying potassium channels ;

2(c) Explain the Pacemaker potential Phase 3 (Repolarization). 8

1 Opening of delayed rectifying potassium channels ;
2 cause outward K current ;
3 Closure of long lasting/L-type Ca channels ;
4 to stop inward Ca currents ;
5 Repolarization to -60 mv ;
6 causes gradual inactivation of K channels ;
7 and activation of funny channels and Na-Ca exchanger ;
8 to initiate phase 4;

2(d) (Part 1) State how Autonomic activity affects rate of SA nodal discharge / chronotrophy / heart 8
rate / rhythmicity.
Sympathetic (positive chronotropy) ;
1 increases rate of SA node discharge, so increases HR ;
2 tachycardia ;
3 sympathetic nerve releases norepinephrine ;
4 bind β1 receptors at SAN to increase c-AMP ;
5 increases funny current ;
6 causes earlier start of Diastolic depolarization, (phase 3 does not reach -60 mv) ;
7 and increases slope of phase 4 ;
8 so reaches threshold for phase 0 in shorter time ;

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Question Answer Marks

2(e) (Part 2) State how Autonomic activity affects rate of SA nodal discharge / chronotrophy / heart 11
rate / rhythmicity.
Parasympathetic (negative chronotropy) ;
1 decreases rate of SA node discharge, so decreases HR ;
2 bradycardia ;
3 vagal nerve releases acetylcholine ;
4 bind muscarinic at SAN to decrease c-AMP ;
5 decreases funny current ;
6 causes delayed start of Diastolic depolarization, (phase 3 reaches more than -60 mv) ;
7 and decreases slope of phase 4 ;
8 so reaches threshold for phase 0 in longer time ;
+
9 Acetylcholine activates special K channels (KAch) ;
10 increases K efflux to oppose the funny current ;
11 decreases slope of phase 4 ;

Question Answer Marks

4(a) Factors affecting rate of SA nodal discharge / chronotrophy / heart rate / rhythmicity. 13
1 Autonomic activity ;
2 Sympathetic increases HR/tachycardia, Parasympathetic decreases HR/bradycardia ;
3 Catecholamines ;
4 from adrenal medulla ;
5 increase HR/tachycardia ;
6 Body Temperature ;
7 every 1 degree increases HR by 10 beats/min causing tachycardia ;
8 Extracellular K level ;
9 hypokalemia, decreases K conductance of SAN, so increases slope of phase 4 so increases
HR/tachycardia ;
10 hyperkalemia, increases K conductance of SAN, so decreases slope of phase 4 so decreases
HR/bradycardia ;
11 Ca channel blockers ;
12 inactivates long-lasting/L-type Ca channels ;
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13 causes decreases HR/bradycardia ;

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Question Answer Marks

4(b) Give an account on conduction of action potentials within the heart. 25

1 direct electric conduction from cell to cell via gap junctions at intercalated discs ;
2 cardiac muscles act as a functional physiological syncytium ;

the velocity of conduction depends on

3 number of gap junction ;
4 amplitude and speed of upstroke of AP ;

rate of conduction depends on

5 Sympathetic nerve releases norepinephrine ;
6 Bind β1 receptors ;
7 ↑ionic conductance → faster upstroke of AP → ↑ velocity ;
8 Parasympathetic nerve→ release acetylcholine ;
9 Bind Muscarinic receptors ;
10 ↓ionic conductance → slower upstroke of AP → ↓velocity ;
11 Digitalis→ stimulating parasympathetic →↓ velocity ;

Pathway
12 via pacemaker cells ;
13 SA node ;
14 in right atrium ;
15 conducted through, atrial myocytes (0.5 m/sec) ;
16 or, 3 Internodal bundles (1 m/sec) ;
17 AV node (0.05 m/sec) ;
18 at lower posterior atrial septum ;
19 the only pathway between atria & ventricles ;
20 slow conduction, due to, few gap junctions and slow upstroke ;
21 Allow ventricular filling & Protect ventricles from abnormal high rhythm ;
22 bundle of his and branches on each side of ventricular septum (2 m/sec.) ;
23 purkinje fibers have rapid conduction (4 m/sec) ;
24 allows coordinated contraction ;
25 ventricular myocytes (0.5 m/sec) ;

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Question Answer Marks

5(a) Explain the Cardiac Myocyte Action potential Phase 4 (RMP). 16

1 -90 mv ;
2 determined by concentration gradient, permeability and pumps ;

Causes of RMP
3 efflux of K via inward rectifying potassium channels, (conducts inward current in, hyperpolarization) ;
4 influx of Na and Ca with low permeability ;
5 Na-K ATPase pumps 3 Na+ out for 2 K in ;

Maintenance of ionic concentrations:

6 During RMP ;
7 there is a, continuous leak of K to outside ;
8 equilibrium of K is -94 mv ;
9 there is a, continuous little leak of Na to inside ;
10 equilibrium of Na is +61 mv ;
11 During action potential ;
12 more Na & Ca in, and more K out ;
13 Na-K ATPase, pumps 3 Na out for 2 K in ;
14 Ca ATPase, pumps Ca out ;
15 Na-Ca exchanger, 3 Na for 1 Ca ;
16 operates in both directions, depending on concentration gradient ;
5(b) Explain the Cardiac Myocyte Action potential Phase 0 (Depolarization). 6
1 firing level is -65 mv
2 rapid upstroke from -90 to +20mv ;
3 due to, inactivation of IRK ;
4 so less K conductance ;
5 due to, opening of voltage gated Na channels ;
6 so inward Na, fast response for a very short period ;

5(c) Explain the Cardiac Myocyte Action potential Phase 1 (Rapid Small Repolarization). 3
1 closure of voltage gated Na channels ;
2 opening of special transient outward K channels ;
3 opening of Cl channels ;

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Question Answer Marks

5(d) Explain the Cardiac Myocyte Action potential Phase 2 (Plateau). 7

1 lasts 200 msec ;
2 around 0 mv, it is a balance between ;
3 outward positive via, DRK channels ;
4 K conductance is less than resting value, at phase 4 ;
5 inward positive via, long lasting/L-type Ca channels ;
6 and, increased activity of Na-Ca exchanger, during late phase 2 ;
7 moves 1 Ca out for 3 Na in ;
5(e) Explain the Cardiac Myocyte Action potential Phase 3 (Rapid Late Repolarization). 6
1 closure of, long-lasting/L-type Ca channels and ;
2 ↓ activity of Na-Ca exchanger ;
3 delayed rectifier K channels → causes outward K ;
4 as membrane potential approaches RMP ;
5 closure of DRK ;
6 ↑activity of inwardly rectifying K channels, to reach -90 mV ;

Question Answer Marks

6(a)(i) Relationship between Action potential &mechanical response. 2

1 contraction occurs at the start of depolarization and reaches its maximum at end of plateau ;
2 relaxation occurs at the first half of repolarization ;

6(a)(ii) Excitability changes during action potential.

1 Absolute refractory period (ARP) ;
2 no response to any stimulus because of, inactivation of Na channels ;
3 Relative refractory period (RRP) ;
4 respond to suprathreshold stimulus ;
5 Supernormal period ;
6 responds to weaker stimulus, causing arrhythmias ;
7 prevents tetanic contractions, by occupying all of systole and early diastole ;

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Question Answer Marks

6(a)(iii) Effect of ischemia on electrical activity of the heart. 3

1 causes accumulation of K in ECF ;
2 due to opening of KATP channels, and inhibition of Na-K ATPase pump ;
3 causes membrane depolarization ;
4 decreases number of active Na channels ;
5 decreases slope of phase 0 & increases intracellular Ca ;
6 decreases conduction velocity ;

6(b) Mechanical Properties (Excitation contraction coupling). 7

1 membrane depolarization ;
2 open L-type Ca channels, causing Ca entry ;
3 open ryanodine sensitive-calcium channel on SR ;
4 “Calcium- induced Calcium release” ;
5 Ca binds to Troponin-C causing contraction ;
6 relaxation via removal of calcium from cytoplasm via ;
7 SERCA → actively reuptake Ca ;
8 Na-Ca exchanger and Ca pump to move Ca out ;
9 the force of cardiac contraction depends on Ca ;

Question Answer Marks

9(a) Regulation of Myocyte Relaxation (lusitropy). 6

1 sympathetic/catecholamines, binds to β1 receptors
2 ↑ c-AMP → activates protein kinase
3 ↑ activation of SERCA, decreases binding of Troponin to Ca
4 ischemia → ↓activity of Ca pump →↑ intracellular Ca→ inhibits relaxation.
5 sympathetic causes strong contraction and rapid relaxation
6 myocardial ischemia causes weak contraction and poor relaxation.

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Question Answer Marks

7(a) Regulation of Contractility (inotropic state) of cardiac myocytes. 4

1 Positive inotropic mechanisms
2 Sympathetic (norepinephrine) or catecholamines → ✓ bind β1 receptors →↑c-AMP→ ✓ Activates Protein
Kinase → phosphorylates a. L-type Ca++ channel b. calcium release channel on SR
3 Glucagon hormone →↑c-AMP
4 for production of, acetylcholine / ACh ;
5 for, making / moving, vesicles ; A exocytosis
6 ↑ ECF Ca++ →↑Ca++ entry.
7 Drugs: • Digitalis→ inhibits Na+ -K + ATPase →↑ Na+ . Na+ -Ca++ exchanger move 3Na+ out for 1Ca++
in. →↑Ca++ inside myocytes. • Xanthine (caffeine)→ inhibit breakdown of c-AMP→↑c-AMP conc.

7(b) X – agree, because Na+ influx leads to depolarisation ; 3

Y – disagree, because Cl– influx leads to hyperpolarisation / description

or
disagree, because no Na+ influx so no depolarisation ;

X and Y – agree, because Na+ (influx) is balanced by Cl– (influx) / AW ;

7(c) any two from: 2

1 decrease in transmission speed ;

2 ref. to shorter local circuits ;
3 no / less, saltatory conduction / described ;

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Question Answer Marks

8(a) any four from: 4

1 both photosystem I and photosystem II involved ; A both photosystems

2 photoactivation of chlorophyll occurs ;
3 photolysis of water occurs / description ;
4 oxygen production / oxygen-evolving complex involved ;
5 electrons emitted by photosystem I used to reduce NADP
or
NADP is the final electron acceptor ;
6 photosystem I receives electrons from photosystem II
or
photosystem II receives electrons from photolysis (of water) ;
7 ETC / electron transport chain, sets up proton gradient
or
chemiosmosis / ATP produced ;

8(b) GP used to make, amino acids / fatty acids / lipids ; 2

TP used to make, hexose / starch / cellulose / amino acids / glycerol / lipids ;

8(c)(i) 3.10  1.55 3.10  1.50 2

15 or 15 ;

0.10 / 0.11 ;

8(c)(ii) any three from: 3

1 temperature now not limiting

or
carbon dioxide concentration now limiting ;
2 closure of stomata ;
3 lack of water / AW ;
4 denaturation of enzymes
or
active site no longer complementary to substrate / no ESCs form ;
5 AVP ; e.g. ref. to optimum temperature / photorespiration occurs

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Question Answer Marks

8(c)(iii) similar shape but below high intensity curve ; 1

Question Answer Marks

9(a) any four from: 4

7 (drink of water causes) increase in blood water potential / AW ;

8 detected by, osmoreceptors / hypothalamus ;
9 causes decrease in release of ADH (into blood in first hour) ;
10 less water reabsorbed (from collecting ducts) ;
11 (so) decrease in blood water potential / blood water potential returns to set point ;
12 causes increase in release of ADH ;
13 negative feedback ;

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Question Answer Marks

9(b) any four from: 4

nervous system endocrine system

1 communicatio action potential / impulse and hormone ;

n
2 nature of electrical (and chemical) and chemical ;
communicati
on
3 mode of neurone and blood ;
transmissi
on
4 response muscle and target, organs / tissue / cells ;
destinati
on
5 transmissi fast(er) and slow(er) ;
on speed

6 location specific / localised and (can be) widespread ;

of effect

7 response fast(er) and slow(er) ;

speed

8 duration short-lived / temporary and can be long-lasting / permanent

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Question Answer Marks

10(a) 1 dye / paint / clipping fur / collar / electronic chip ; 4

2 death / birth / reproduction ;
3 Lincoln ;
4 repeated / replicated ;

10(b) any four from: 4

1 idea of negative impact on, the environment / ecosystems / habitat / food webs / food chain ;
2 decreases biodiversity ;
3 large / fast, increase in number ;
4 competition for (named) resources ;
5 ref. to new disease ;
6 may be toxic
or
few animals able to eat it ;
7 attracts pollinators (away from native species) ;

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