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MCQs and EMQs in HUMAN PHYSIOLOGY 6th edition This page intentionally left blank MCQs and EMQs in HUMAN PHYSIOLOGY with answers and explanatory comments 6th edition Ian C Roddie CBE, DSc, MD, FRCPI Emeritus Professor of Physiology, The Queen's University of Belfast; former Head of Medical Education, National Guard King Khalid Hospital, Jeddah, Saudi Arabia William FM Wallace BSc, MD, FRCP, FRCA, FCARCSI, FRCSEd Emeritus Professor of Applied Physiology, The Queen’s University of Belfast; former Consultant in Physiology, Belfast City Hospital, Belfast, N. Ireland A member of the Hodder Headline Group LONDON First published in Great Britain in 1971 Second edition 1977 Third edition 1984 Fourth edition 1994 Fifth edition 1997 This sixth edition published in 2004 by Arnold, a member of the Hodder Headline Group, 338 Euston Road, London NW1 3BH http://www.arnoldpublishers.com Distributed in the United States of America by Oxford University Press Inc., 198 Madison Avenue, New York, NY10016 Oxford is a registered trademark of Oxford University Press © 2004 Ian C. Roddie and William F.M. Wallace All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronically or mechanically, including photocopying, recording or any information storage or retrieval system, without either prior permission in writing from the publisher or a licence permitting restricted copying. In the United Kingdom such licences are issued by the Copyright Licensing Agency: 90 Tottenham Court Road, London W1T 4LP. Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. For these reasons the reader is strongly urged to consult the drug companies’ printed instructions before administering any of the drugs recommended in this book. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN 0 340 811919 1 2 3 4 5 6 7 8 9 10 Commissioning Editor: Georgina Bentliff Project Editor: Heather Smith Production Controller: Jane Lawrence Cover Design: Amina Dudhia Index: Dr Laurence Errington Typeset in 9pt Rotis Serif by Servis Filmsetting Ltd, Manchester Printed and bound in Malta What do you think about this book? Or any other Arnold title? Please send your comments to [email protected] CONTENTS Preface vi How to use the book vii 1 Body fluids MCQs 1-57 1 EMQs 58-67 21 2 CardiovascuIar system MCQs 68-126 33 EMQs 127-138 53 3 Respiratory system MCQs 139-187 63 EMQs 188-194 79 4 Alimentary system MCQs 195-249 87 EMQs 250-260 107 5 Neuromuscular system MCQs 261-330 115 EMQs 331-340 139 6 Special senses MCQs 341-384 149 EMQs 385-394 163 7 Urinary system MCQs 395-434 171 EMQs 435-444 185 8 Endocrine system MCQs 445-501 193 EMQs 502-512 211 9 Reproductive system MCQs 513-567 219 EMQs 568-576 237 l0. General questions MCQs 577-639 245 EMQs 640-649 265 11 Sport and exercise physiology MCQs 650-686 273 EMQs 687-691 287 12 Interpretative questions MCQs 692-708 291 EMQs 709-714 325 Index 337 PREFACE This book has now reached its sixth edition since it was first published over 30 years ago. Our aim to base the questions on generally accepted aspects of physiology most relevant to clinical practice seems to have been fulfilled – medical, dental and other health care students and doctors in specialty training in countries around the world have told us of the book’s relevance and usefulness. Wehave tried to cover most of the concepts and knowledge typically asked for in physiology examinations and to concentrate on the core knowledge that is essential to pass them. We believe that students who score consistently well in these questions know enough to face most examinations in physiology with confidence. By concentrating on the area where yes/no answers can be given to questions with reasonable certainty, we have had to exclude areas where knowledge is as yet conjectural and speculative. We have tried to avoid excessive detail in the way of facts and figures; those which are included are of value in medical practice. Both conventional and SI units are generally quoted. Comments on the answers are given on the reverse of each question. We hope that, with the comments, the book will provide a compact revision tutor, encouraging understanding rather than rote learning. For most questions the common five-branch MCQ format has been used. The stem and a single branch constitute a statement to be judged True or False by the reader. Care has been taken that the statements in any question are not mutually exclusive, so five independent decisions are required to answer each question. This system has the advantage of simplicity and brevity over most other forms of multiple-choice question. In this edition, a further opportu- nity has been taken to prune and edit questions for greater compactness, clarity and precision and to bring in new areas of knowledge which have emerged since the last edition went to press. We have alsotended to expand the comments in an effort to increase the clarity of our explanations and so add to the educational value of the self-assessment exercise. The book is divided into sections, each section containing questions related to one of the main physiological systems of the body. They cover both basic and applied aspects of the sub- ject. The applied questions are designed so that the answers may be deduced mainly by making use of basic physiological knowledge and should provide a link with clinical practice. There is also a section on sports and exercise physiology and one containing ‘Interpretative’ questions to provide practice in the interpretation of data, diagrams and figures. A new feature in this edition is the addition of a number of Extended Matching Questions(EMQs) for each section of the book. EMQs are an alternative form of multiple-choice question where answers have to be selected from lists of options. They are becoming increasingly popular in undergraduate and postgraduate examinations. Wethank colleagues for suggesting questions and all who commented on previous editions. Wecontinue to welcome such comments. ICR WFMW September 2003 HOW TO USE THIS BOOK 1. A stimulus to fill gaps in your knowledge This book is intended as a revision tutor and should help you to revise your physiology in prep- aration for examinations. It is particularly aimed at helping you to identify areas where your knowledge and understanding need to be improved. The statements in this book are presented so that you can commit yourself in written opinion and can then confirm correct information and identify errors. The comments should reinforce your knowledge when you are correct and indicate why you were mistaken if your answer is wrong. 2. Scoring your answers – multiple choice questions A Answer, say, 20 questions (100 decisions), aiming to complete them in about 50 minutes. In our experience of this type of question (one point tested in each Part), it is best for candidates to answer virtually all questions. B Score your answers by giving (cid:2)1 for a correct response, (cid:3)1 for an incorrect response and 0 for any omitted. It is suggested that this approach is in line with professional life when many true/false decisions must be taken – send the patient to hospital? Begin a certain treatment? Carry out surgery urgently? The penalties for a wrong decision can be consid- erable! C As a very approximate guide, the following scale would apply to candidates who have not spent time memorizing particular questions: 50–60 fair 60–70 good 70–90 excellent 90–100 outstanding 3. Scoring your answers – extended matching questions For these questions it is usual not to subtract marks for wrong answers, since the chance of randomly getting the correct answer is much less than for multiple-choice questions, where it is 50%. The same stratification of results (above) can then be applied. 4. Range of options Please note for the MCQs that all, some, or none of the branches in each question may be true. Also, for the EMQs a given option may be used more than once, or not at all. This page intentionally left blank 1 BODY FLUIDS 1 MCQs M Questions 1–7 C Q 1. Extracellular fluid in adults differs from intracellular fluid in that its A. Volume is greater. B. Tonicity is lower. C. Anions are mainly inorganic. D. Sodium:potassium molar ratio is higher. E. pH is lower. 2. Blood group antigens (agglutinogens) are A. Carried on the haemoglobin molecule. B. Beta globulins. C. Equally immunogenic. D. Not present in fetal blood. E. Inherited as recessive Mendelian characteristics. 3. Total body water, expressed as a percentage of body weight A. Can be measured with an indicator dilution technique using deuterium oxide. B. Is smaller on average in women than in men. C. Rises following injection of posterior pituitary extracts. D. Falls during starvation. E. Is less than 80 per cent in young adults. 4. Breakdown of erythrocytes in the body A. Occurs when they are 6–8 weeks old. B. Takes place in the reticulo-endothelial system. C. Yields iron, most of which is excreted in the urine. D. Yields bilirubin which is carried by plasma protein to the liver. E. Is required for the synthesis of bile salts. 5. A person with group A blood A. Has anti-B antibody in the plasma. B. May have the genotype AB. C. May have a parent with group O blood. D. May have children with group A or group O blood only. E. Whose partner is also A can only have children of groups A or O. 6. Blood platelets assist in arresting bleeding by A. Releasing factors promoting blood clotting. B. Adhering together to form plugs when exposed to collagen. C. Liberating high concentrations of calcium. D. Releasing factors causing vasoconstriction. E. Inhibiting ﬁbrinolysis by blocking the conversion of plasminogen to plasmin. 7. Plasma bilirubin A. Is a steroid pigment. B. Is converted to biliverdin in the liver. C. Does not normally cross cerebral capillary walls. D. Is freely ﬁltered in the renal glomerulus. E. Is sensitive to light.