UNIVERSITY OF RUHUNA FACULTY OF MEDICINE

Second Examination for Medical Degrees

PHYSIOLOGY- Paper 1
April 2019 Time : Two hours and thirty minutes

TRUE/FALSE TYPE MCQs ( QUESTIONS 1-15) – Mark whether each response is true or false

1) Haemoglobin concentration of the same blood sample was measured 15 times using an
automated instrument. The instrument gave exactly the same reading with each
measurement. Which of the following can be stated regarding this instrument?
a. it has a very high accuracy
b. it has a very high precision
c. it does not need to be calibrated
d. there is no bias in it
e. there is no systematic error it

2) In a healthy volunteer, venous drainage from the right upper limb was obstructed for five
minutes by applying a tourniquet around the mid upper arm.
a. Amount of water in his right hand towards the end of the five minute period is higher than
at the beginning of the obstruction.
b. Towards the end of the five minute period, nail bed capillaries in his right arm have a lower
than normal hydrostatic pressure in the venular end.
c. After releasing the tourniquet, more than usual amount of interstitial fluid will enter into
the venular end of capillaries in the right hand.
d. After releasing the tourniquet, more than the usual amount of lymph would drain from the
right arm.
e. Colloid osmotic pressure of the capillary blood in the hand would gradually decrease during
the period of obstruction.

3) End diastolic volume,

a. is reduced in pericardial effusion
b. does not change significantly when heart rate increases from 70/min to 150/min
c. of right ventricle is higher during inspiration than during expiration
d. of right ventricle is reduced when a person stands up from lying down position
e. is reduced in diastolic dysfunction
4) Cardiovascular changes that occur during moderately severe isometric exercise include
a. an increase in the systolic blood pressure
b. an increase in the diastolic blood pressure
c. a decrease in total peripheral resistance
d. an increase in the coronary arterial blood flow
e. an increase in the AV nodal delay
5) Carbon monoxide
a. binds to haemoglobin with higher affinity compared to oxygen
b. poisoning leads to hyperventilation
c decreases the release of O
d. poisoning is treated with hyperbolic oxygen
e. poisoning leads to Cherry-red colored blood
6) In tension pneumothorax of the side
a. intrapleural pressure of the left side is equal to the atmospheric pressure
b. the left lung fails to expand properly.
c. more than the normal amount of air enters into the lung
d. the pulmonary deflation receptors are activated
e. hyper resonance is present over the left side of the chest.
7) Gastric mucosa is not damaged by acid and pepsin due to the
a. presence of mucin
b. production of bicarbonate by the stomach
c. inactivation of pepsin in the gastric lumen
d. dilution of gastric contents by food
e. presence of trefoil peptides

8) True or false regarding defecation?

a. most of the time, the rectum is empty
b. colonic contents enter the rectum due to mass movements
c. defecation reflex is stronger when it is initiated voluntarily than when it is initiated
spontaneously
d. parasympathetic nerves do not play a role in defecation
e. during defecation reflex, myenteric plexus sends inhibitory signals to the internal anal
sphincter
9) Red cell/s
a. lifespan is shorter in haemolytic anaemia
b. diameter is larger than the diameter of an average capillary
c. contain O antigen in a person with O positive blood group
d. formation occurs in the marrow of all skeletal bones of a newborn
e. recipient are mixed With donor's serum in direct testing
10) Mechanisms that can aggravate heart failure in renal disease include
a. hypertension secondary to chronic renal failure
b. reduced intravascular volume in nephrotic syndrome
c. reduced urinary concentrating ability in Chronic renal failure
d. reduced renal blood flow in renal artery Stenosis
e. anaemia secondary to chronic renal failure
11) Features of cretinism include
a. umbilical hernia
b. large tongue
c. maintenance of infantile body proportions
d. excessive sweating
e. normal intelligence

12) In an adult male, disturbance to the hypothalamo pituitary portal system would
clinically significant effects due to the reduction of
a. TSH
b. ACTH
c. GH
d. FSH
e. Prolactin
13) The following would be considered abnormal in seminal fluid analysis report.
a. seminal fluid volume of 2.5 mL
b. sperm count of 1 million/mL
c. presence of 50% sperms with abnormal morphology
d. presence of 60% progressively motile sperms
e. presence of fructose in the seminal fluid
14) Nerve conduction velocity
a. is directly proportional to proximal latency
b. of pain fibers are faster than that of motor fibers
c. of a sensory nerve can be recorded both orthodromicaily and antidromically
d. is used in classification of sensory nerves
e. is reduced in demyelination

15) The type of gait and the disorder are correctly matched.
a. festinant gait - tabes dorsalis
b. high stepping gait - common peroneal nerve palsy
c. Stamping gait - loss of sensation from the feet
d. waddling gait - paralysis of gluteus medius
e. broad-based gait - damage to the internal capsule
 SINGLE BEST RESPONSE QUESTIONS (QUESTIONS 16-45)

Select the best response and mark it on the answer sheet (Only one response per question).

16) A 6 month-old child with vomiting for two days was bought to the emergency department
in unconscious state. Following blood investigation were obtained (Normal ranges are given
within brackets)
Serum Na+ 151mmoI/L (135-150), serum K+ 3.4 mmol/L (3.5-5.0), serum glucose 70mmol/L
(70-90), arterial pH 7.30 (7.35-7.45) serum urea 45mmol/dL (7-20).
Which one of the above measurements indicates
that has developed severe dehydration that has affected his tissue metabolism?
a. serum Na +
b. serum K+
c. serum glucose
d. arterial pH
e. serum urea
17) Mid diastolic murmur and ejection systolic murmur were detected in a 4 years old child
during routine clinical examination. There was a fixed split of the second heart sound.
What is the most likely diagnosis?
a. ASD
b. VSD
c. PDA
d. Fallot’s tetralogy
e. Congenital aortic stenosis
18) A patient with a transplanted heart shows an increase in the heart rate when he exercises.
What is the explanation for this increase in heart rate?
a. psychic stimuli
b. an increase in the circulating catecholamines
c. a reduction in the total peripheral resistance
d. a reduction in the activity of the dorsal vagal nucleus.
e. an increase in venous return during deep inspiration.
19) Which one of the following statements best describes the Monro-Kellie doctrine?
a. The cerebral blood flow remains relatively constant over the blood pressure range of 65-140
mmHg.
b. The local blood flow to different parts of the brain varies with local brain activity despite
having a constant cerebral blood flow.
c. The blood brain barrier helps to keep the composition of cerebrospinal fluid relatively
constant despite changes of the composition of arterial blood.
d. The volume occupied by the blood, cerebrospinal fluid and the brain inside the craniu m
remains constant.
e. The central chemoreceptors located in the medulla help to keep the blood flow to the
medulla relatively constant.
20) Amount of tissue fluid in a muscle is increased during muscular exercise. Which Of the
following contributes least to this increase in the amount of tissue fluids?
a. increase in the surface area available for filtration in the capillary bed
b. accumulation of osmotically active particles in the intestitium
c. accumulation of vasodilatory metabolites
d. alteration in lymphatic drainage from the muscle
e. increase in the right atrial pressure

21) Transpulmonary pressure varies with the phase of respiration and the site of lung.
Which one of the following statements describe the site and phase of respiration with the
highest transpulmonary pressure?
a. apex of the lung at the end of normal inspiration
b. apex of the lung at the end of normal expiration
c. apex of the lung at the end of deep inspiration
d. base of the lung at the end of deep inspiration
e. base of the lung at the end of normal expiration

22) Pulmonary emphysema shows a restrictive pattern of the lung disease. What is the
reason for this restrictive pattern?

a. increased airway resistance

b. reduced lung compliance
c. decreased intrapleural pressure
d. increased intra-alveolar pressure
e. decreased transpuimonary pressure

23) Although tissue hypoxia occurs in carbon monoxide poisoning there is remarkable
absence of stimulation of respiration in this condition. What is the best explanation for this?

a. carbon monoxide impairs the function of peripheral chemoreceptors

b. carbon monoxide impairs the function of central chemoreceptors
c. carbon monoxide impairs the function of the respiratory center
d. respiratory muscle paralysis
e. PaO2 is normal in carbon monoxide poisoning
24) Following were the investigation findings of a 25-year old female patient with a
respiratory rate of 30 per minute. Reference ranges are given within brackets.
PaO2 - 103 mmHg (80-120 mmHg)
PaCO2 - 3O mmHg (38-42mmHg)
pH - 7.48 (7.35-7.45)
Select most likely reason for the high respiration rate seen in this patient.
a. Stimulation of respiration due to high altitude
b. lung fibrosis
c. compensation for disturbance in acid-base balance
d. stimulation of chemoreceptors by CO2
e. Hysterical hyperventilation
25) Which one of the following during examination of the respiratory system explain the
principle 'sound is conducted better in solid medium than in the air medium?

a. absence of breath sounds in obstructed airway

b. stony dullness in pleural effusion
c. bronchial breathing in pneumonia
d. fine basal crepts in pulmonary oedema
e. wheezing sounds (rhonchi) in bronchial asthma
26) A 40 year-old male who had partial gastrectomy complained of fainting after meals. Late
dumping syndrome was suspected. Which one of the following features is most useful in
diagnosing this condition?
a. onset of fainting 15 minutes after a meal
b. tachycardia
c. low PCV
d. low blood glucose
e. low blood pressure
27) Absorption of which one of the following nutrients is mostly affected if the gastric
secretion is completely blocked?
a. fat
b. protein
c iron
d. cobalamin
e. calcium
28) Select the substance which would always show a lower concentration in the blood leaving
the liver than the blood coming to it via the portal vein in a healthy person.

a. glucose
b. direct bilirubin
c. indirect bilirubin
d. vitamin B12
e. vitamin D

29) A five year-old boy developed excessive bleeding after one of his teeth fell out. Bleeding
episode was managed and investigations were started for a bleeding disorder. There was a
family history of excessive bleeding in one of his maternal uncles. This child's bleeding time
and prothrombin time were normal but the APTT was prolonged. Factor VIll assay was done
which was also normal.
What is the most likely diagnosis?
a. von-Willibrand disease
b. Haemophilia A
c. Haemophilia B
d. Cirrhosis of the liver
e. Protein C deficiency
30) Strongest evidence favuoring primary proliferative polycythemia (polycythemia vera ) is
a. high red cell count
b. JAK 2 positivity
c. PCV more than 50%
d. high Haemoglobin
e. low ESR
31) Foetal haemoglobin(Hb) has greater affinity for O2 than adult Hb. What is the reason for
this?
a. affinity for 2,3- BPG is greater in adult Hb than in foetal Hb
b. partial pressure of CO2 in foetal blood is higher that of adult blood.
c. there is a higher concentration of Hb in foetus than in adults.
d. foetus lives in a relatively higher temperature than the mother
e. foetal Hb has higher P50 than adult Hb

32) The concentration of a substance increases along the length of PCT of the nephron. What
is the most likely substance?
a. glucose
b. amino acids
c. sodium
d. bicarbonate
e. inulin

33) Water deprivation test was performed on a patient with polyuria. Which one of following
observations is the strongest evidence for diagnosing compulsive water drinking?
a. osmolality of 500 mosmol/L in the early morning urine sample
b. serum osmolality reaching the value of 300 mosmol/L during the test
c. reduction of body weight by 3% during the test
d. urine osmolality starting to increase only after 4 hours of starting the test
e. gradual reduction of urine volume during the test

34) Parathyroid hormone (PTH) increases the calcium reabsorption from the renal tubule.
Despite this increase in calcium reabsorption, urinary calcium excretion is increased in
primary
hyperparathyroidism.
What is the best explanation for this observation?
a. actions of physiological and pathological levels of PTH are different
b. renal functions are altered in primary hyperparathyroidism
c. in primary hyperparathyroidism, a large amount of Ca ++ is filtered due to hypercalcaemia
d. primary hyperparathyroidism produces a polyuria due to nephrogenic diabetes insipidus
e. There is a parallel increase in Ca ++ secretion by the renal tubular cells.

35)A 50 year-old patient with type I diabetes mellitus who was taking insulin for the last 25
years started to develop recurrent episodes of hyperglycemia while on his usual insulin dose.
He never missed his meals during these episodes. On examination was having pallor and
oedema.
Which of the following investigations will show an abnormality that would suggest the cause
for hypoglycaemia in this patient?
a. C peptide level
b. HbA1C level
c. serum creatinine
d. autonomic function tests
e. haemoglobin concentration of blood

36) Investigation findings of a patient with secondary hypertension are given below.
Low serum K+, elevated total body Na+, elevated plasma renin activity, normal amount of
urinary metanephrine excretion, undetectable level of midnight cortisol.
What is the most likely diagnosis?
a. Cushing syndrome
b. primary hyperaldosteronism
c. phaeochromocytoma
d. hyperthyroidism
e. renal artery stenosis

37) Endocrine disorders can secondary hypertension. Which hormone can cause
hypertension in hormone deficiency as well as in hormone excess?
a. thyroxin
b. PTH
c. cortisol
d. adrenaline
e. growth hormone

38) There are many tests available for the diagnosis of adrenocortical hormonal disorders.
Out of them, which one of the following is the best test to differentiate adrenocortical
hormone
excess due to a pituitary adenoma from an adrenocortical adenoma?
a. perimetry
b. serum cortisol level
c. overnight dexamethasone suppression test
d. low dose dexamethasone suppression test
a. high dose dexamethasone suppression test
39) Some drugs are used in postpartum period to promote lactation. What is the most likely
group of drugs used in this situation?
a. dopamine receptor blockers
b. dopamine agonists
c. oestrogens
d. oxytocin analogues
e. levodopa

40) Following disorders lead to abnormalities of sexual maturation and function. Which one
of them have male internal genitalia together with female external genitalia?
a. Klinefelter syndrome
b. Turner syndrome
c. congenital 5- alpha reductase deficiency
d. congenital adrenal hyperplasia
e. Kallman syndrome

41) Hot flushes are seen in postmenopausal women. Which one of the following has a
relationship with hot flushes?
a. very high FSH levels
b. low oestrogen levels
c. LH surges
d. low progesterone levels
e. postmenopausal osteoporosis

42) Husband of a newly married couple who left for an overseas scholarship six months ago
returned for a three day visit to see his wife. They have decided not to have children until
husband returns home permanently in another one year’s time.
What is the best contraceptive method they can use during the short visit?
a. condoms
b. coitus interruptus
c. cervical mucus method
d. insertion of an intrauterine device immediately
e. use ‘morning after pill' daily for three days
43) Which one of the following features of pain is indicative of a superficial pain?
a. precise localization
b. slow onset
c. association with nausea
d. association with sweating
e. contraction of muscles around the painful area
44) CSF examination of a patient revealed that there were few red cells along with larger
number
of neutrophils. What is the most likely diagnosis?
a. subarachnoid haemorrhage
b. viral meningitis
c. bacterial meningitis
d. traumatic puncture
e. tuberculous meningitis
45) Which of the following would contribute least to the heat loss during a 400-meter running
event?
a. heat loss through the evaporation of sweat
b. heat loss through the respiratory system
c. conduction
d. radiation
e. convection