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Guyton & Hall Physiology Review Second Edition John E. Hall, PhD Arthur C. Guyton, Professor and Chair, Associate Vice Chancellor for Research, Department of Physiology and Biophysics, University of Mississippi
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Guyton & Hall Physiology Review Second Edition John E. Hall, PhD Arthur C. Guyton, Professor and Chair, Associate Vice Chancellor for Research, Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi Saunders Copyright 1600 John F. Kennedy Blvd., Ste Philadelphia, PA GUYTON & HALL PHYSIOLOGY REVIEW, SECOND EDITION ISBN: Copyright 2011, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. ISBN: Acquisitions Editor: William R. Schmitt Developmental Editors: Christine Abshire Publishing Services Manager: Patricia Tannian Senior Project Manager: Sarah Wunderly Design Direction: Louis Forgione Printed in China Last digit is the print number: Contributors Thomas H. Adair, PhD, Professor of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, Unit II, Unit XII, and Unit XIII David J. Dzielak, PhD, Professor of Surgery, Professor of Health Sciences, Associate Professor of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, Unit IX, Unit X, andunit XI Joey P. Granger, PhD, Billy Guyton Professor of Physiology and Biophysics and Medicine, Dean of the School of Graduate Studies, University of Mississippi Medical Center, Jackson, Mississippi, Unit IV John E. Hall, PhD, Arthur C. Guyton Professor and Chair, Associate Vice Chancellor for Research, Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, Unit I, Unit V, andunit XIII Robert L. Hester, PhD, Professor of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, Unit VI, Unit VII, andunit VIII Thomas E. Lohmeier, PhD, Professor of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, Unit XIV R. Davis Manning, PhD, Professor of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, Unit III, Unit IV, andunit XV David B. Young, PhD, Professor Emeritus of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, Unit XIV Preface Self-assessment is an important component of effective learning, especially when studying a subject as complex as medical physiology. The Guyton & Hall Physiology Review is designed to provide a comprehensive review of medical physiology through multiple-choice questions and explanations of the answers. Medical students preparing for the United States Medical Licensure Examinations (USMLE) will also find this book useful, since test questions have been constructed according to the USMLE format. The questions and answers in this review are based on Guyton and Hall s Textbook of Medical Physiology, twelfth edition (TMP 12). More than 1000 questions and answers are provided, and each answer is referenced to the Textbook of Medical Physiology to facilitate a more complete understanding of the topic and self-assessment of your knowledge. Illustrations are used to reinforce basic concepts. Some of the questions incorporate information from multiple chapters in the Textbook of Medical Physiology to test your ability to apply and integrate the principles necessary for the mastery of medical physiology. An effective way to use the review is to allow an average of 1 minute for each question in a given unit, approximating the time limit for a question in the USMLE examination. As you proceed, indicate your answer next to each question. After finishing the questions and answers, spend as much time as necessary to verify your answers and to carefully read the explanations provided. Read the additional material referred to in the Textbook of Medical Physiology, especially for questions where incorrect answers were chosen. Guyton & Hall Physiology Review should not be used as a substitute for the comprehensive information contained in the Textbook of Medical Physiology. It is intended mainly as a means of assessing your knowledge of physiology and of strengthening your ability to apply and integrate this knowledge. We have attempted to make this review as accurate as possible, and we hope that it will be a valuable tool for your study of physiology. We invite you to send us your critiques, suggestions for improvement, and notifications of any errors. I am grateful to each of the contributors for their careful work on this book. I also wish to express my thanks to William Schmitt, Rebecca Gruliow, Christine Abshire, and the rest of the Elsevier staff for their editorial and production excellence. I am especially indebted to the late Dr. Arthur C. Guyton, who wrote the first eight editions of the Textbook of Medical Physiology, beginning nearly 50 years ago. I had the privilege of working with him on the ninth and tenth editions and have attempted in the last two editions to continue his practice of accurately presenting the complex principles of physiology in language that is easy for students to read and understand. John E. Hall, PhD, Jackson, Mississippi Table of Contents Copyright Contributors Preface Unit 1: The cell and general physiology Unit 2: Membrane physiology, nerve, and muscle Unit 3: The heart Unit 4: The circulation Unit 5: The body fluids and kidneys Unit 6: Blood cells, immunity, and blood coagulation Unit 7: Respiration Unit 8: Aviation, space, and deep-sea diving physiology Unit 9: The nervous system: a. general principles and sensory physiology Unit 10: The nervous system: b. the special senses Unit 11: The nervous system: c. motor and integrative neurophysiology Unit 12: Gastrointestinal physiology Unit 13: Metabolism and temperature regulation Unit 14: Endocrinology and reproduction Unit 15: Sports physiology UNIT I The cell and general physiology 1. The term glycocalyx refers to A) the negatively charged carbohydrate chains that protrude into the cytosol from glycolipids and integral glycoproteins B) the negatively charged carbohydrate layer on the outer cell surface C) the layer of anions aligned on the cytosolic surface of the plasma membrane D) the large glycogen stores found in fast muscles E) a mechanism of cell cell attachment 2. Messenger RNA (mrna) A) carries the genetic code to the cytoplasm B) carries activated amino acids to the ribosomes C) is single-stranded RNA molecules of 21 to 23 nucleotides that can regulate gene transcription D) forms ribosomes 3. Which of the following statements is true for both pinocytosis and phagocytosis? A) Involves the recruitment of actin filaments B) Occurs spontaneously and non-selectively C) Endocytotic vesicles fuse with ribosomes that release hydrolases into the vesicles D) Is only observed in macrophages and neutrophils E) Does not require ATP 4. In comparing two types of cells from the same person, the variation in the proteins expressed by each cell type reflects A) differences in the DNA contained in the nucleus of each cell B) differences in the numbers of specific genes in their genomes C) cell-specific expression and repression of specific genes D) differences in the number of chromosomes in each cell E) the age of the cells 5. Micro RNAs (mirnas) A) are formed in the cytoplasm and repress translation or promote degradation of mrna before it can be translated B) are formed in the nucleus and then processed in the cytoplasma by the dicer enzyme C) are short (21 to 23 nucleotides) double-stranded RNA fragments that regulate gene expression D) repress gene transcription Questions 6 8 A) Nucleolus B) Nucleus C) Agranular endoplasmic reticulum D) Granular endoplasmic reticulum E) Golgi apparatus F) Endosomes G) Peroxisomes H) Lysosomes I) Cytosol J) Cytoskeleton K) Glycocalyx L) Microtubules For each of the scenarios described below, identify the most likely subcellular site listed above for the deficient or mutant protein. 6. Studies completed on a 5-year-old boy show an accumulation of cholesteryl esters and triglycerides in his liver, spleen, and intestines and calcification of both adrenal glands. Additional studies indicate the cause to be a deficiency in acid lipase A activity. 7. The abnormal cleavage of mannose residues during the post-translational processing of glycoproteins results in the development of a lupus-like autoimmune disease in mice. The abnormal cleavage is due to a mutation of the enzyme α-mannosidase II. 8. The observation that abnormal cleavage of mannose residues from glycoproteins causes an autoimmune disease in mice supports the role of this structure in the normal immune response. Questions 9 11 A) Nucleolus B) Nucleus C) Agranular endoplasmic reticulum D) Granular endoplasmic reticulum E) Golgi apparatus F) Endosomes G) Peroxisomes H) Lysosomes I) Cytosol J) Cytoskeleton K) Glycocalyx L) Microtubules Match the cellular location for each of the steps involved in the synthesis and packaging of a secreted protein listed below with a term listed above. 9. Initiation of translation 10. Protein condensation and packaging 11. Gene transcription 12. Redundancy or degeneration of the genetic code occurs during which of the following steps of protein synthesis? A) DNA replication B) Transcription C) Post-transcriptional modification D) Translation E) Protein glycosylation 13. Which of the following does not play a direct role in the process of transcription? A) Helicase B) RNA polymerase C) Chain-terminating sequence D) Activated RNA molecules E) Promoter sequence 14. Which of the following proteins is most likely to be the product of a proto-oncogene? A) Growth factor receptor B) Cytoskeletal protein C) Na + channel D) Ca ++ -ATPase E) Myosin light chain 15. Which of the following events does not occur during the process of mitosis? A) Condensation of the chromosomes B) Replication of the genome C) Fragmentation of the nuclear envelope D) Alignment of the chromatids along the equatorial plate E) Separation of the chromatids into two sets of 46 daughter chromosomes 16. Which of the following characteristics of a biological membrane is most influenced by its cholesterol content? A) Thickness B) Ion permeability C) Fluidity D) Glycosylation E) Hydrophobicity 17. The appearance of which of the following distinguishes eukaryotic cells from lower units of life? A) DNA B) RNA C) Membranes D) Protein E) Nucleus 18. Assume that excess blood is transfused into a patient whose arterial baroreceptors are nonfunctional and blood pressure increases from 100 to 150 mm Hg. Then, assume that the same volume is blood is infused into the same patient under conditions where his arterial baroreceptors are functioning normally and blood pressure increases from 100 to 125 mm Hg. What is the approximate feedback gain of the arterial baroreceptors in this patient when they are functioning normally? A) 1.0 B) 2.0 C) 0.0 D) +1.0 E) +2.0 Answers 1.B) The cell glycocalyx is the loose negatively charged carbohydrate coat on the outside of the surface of the cell membrane. The membrane carbohydrates usually occur in combination with proteins or lipids in the form of glycoproteins or glycolipids, and the glyco portion of these molecules almost invariably protrudes to the outside of the cell. TMP A) mrna molecules are long, single RNA strands that are suspended in the cytoplasm, and are composed of several hundred to several thousand RNA nucleotides in unpaired strands. The mrna carries the genetic code to the cytoplasm for controlling the type of protein formed. The transfer RNA (trna) transports activated amino acids to the ribosomes. Ribosomal RNA, along with about 75 different proteins, forms ribosomes. MicroRNAs are single-stranded RNA molecules of 21 to 23 nucleotides that regulate gene transcription and translation. TMP A) Both pinocytosis and phagocytosis involve movement of the plasma membrane. Pinocytosis involves invagination of the cell membrane whereas phagocytosis involves evagination. Both events require the recruitment of actin and other cytoskeleton elements. Phagocytosis is not spontaneous and is selective, being triggered by specific receptor-ligand interactions. TMP C) The variation in proteins expressed by each cell reflects cell-specific expression and repression of specific genes. Each cell contains the same DNA in the nucleus and the same number of genes. So differentiation results not from differences in the genes but from selective repression and /or activation of different gene promoters. TMP A) MicroRNAs (mirna) are formed in the cytoplasm from pre-mirnas and processed by the enzyme dicer that ultimately assembles RNA-induced silencing complex (RISC), which then generates mirnas. The mirnas regulate gene expression by binding to the complementary region of the RNA and repressing translation or promoting degradation of mrna before it can be translated by the ribosome. TMP H) Acid lipases, along with other acid hydrolases, are localized to lysosomes. Fusion of endocytotic and autolytic vesicles with lysosomes initiates the intracellular process that allows cells to digest cellular debris and particles ingested from the extracellular milieu, including bacteria. In the normal acidic environment of the lysosome, acid lipases use hydrogen to convert lipids into fatty acids and glycerol. Other acid lipases include a variety of nucleases, proteases, and polysaccharide-hydrolyzing enzymes. TMP E) Membrane proteins are glycosylated during their synthesis in the lumen of the rough endoplasmic reticulum. Most post-translational modification of the oligosaccharide chains, however, occurs during the transport of the protein through the layers of the Golgi apparatus matrix, where enzymes such as α- mannosidase II are localized. TMP K) The oligosaccharide chains that are added to glycoproteins on the luminal side of the rough endoplasmic reticulum, and subsequently modified during their transport through the Golgi apparatus, are attached to the extracellular surface of the cell. This negatively charged layer of carbohydrate moieties is collectively called the glycocalyx. It participates in cell cell interactions, cell ligand interactions, and the immune response. TMP12 14; see also Chapter 34 9.I) Initiation of translation, whether of a cytosolic protein, a membrane-bound protein, or a secreted protein, occurs in the cytosol and involves a common pool of ribosomes. Only after the appearance of the N-terminus of the polypeptide is it identified as a protein destined for secretion. At this point, the ribosome attaches to the cytosolic surface of the rough endoplasmic reticulum. Translation continues, and the new polypeptide is extruded into the matrix of the endoplasmic reticulum. TMP E) Secreted proteins are condensed, sorted, and packaged into secretory vesicles in the terminal portions of the Golgi apparatus, also known as the trans-golgi network. It is here that proteins destined for secretion are separated from those destined for intracellular compartments or cellular membranes. TMP12 15 11.B) All transcription events occur in the nucleus, regardless of the final destination of the protein product. The resulting messenger RNA molecule is transported through the nuclear pores in the nuclear membrane and translated into either the cytosol or the lumen of the rough endoplasmic reticulum. TMP D) During both replication and transcription, the new nucleic acid molecule is an exact complement of the parent DNA molecule. This is a result of predictable, specific, one-to-one base pairing. During the process of translation, however, each amino acid in the new polypeptide is encoded by a codon, a series of three consecutive nucleotides. Whereas each codon encodes a specific amino acid, most amino acids can be encoded for by multiple codons. Redundancy results because 60 codons encode a mere 20 amino acids. TMP A) Helicase is one of the many proteins involved in the process of DNA replication. It does not play a role in transcription. RNA polymerase binds to the promoter sequence and facilitates the addition of activated RNA molecules to the growing RNA molecule until the polymerase reaches the chainterminating sequence on the template DNA molecule. TMP A) An oncogene is a gene that is either abnormally activated or mutated in such a way that its product causes uncontrolled cell growth. A proto-oncogene is simply the normal version of an oncogene. By definition, proto-oncogenes are divided into several families of proteins, all of which participate in the control of cell growth. These families include, but are not limited to, growth factors and their receptors, protein kinases, transcription factors, and proteins that regulate cell proliferation. TMP B) DNA replication occurs during the S phase of the cell cycle and precedes mitosis. Condensation of the chromosomes occurs during the prophase of mitosis. Fragmentation of the nuclear envelope occurs during the prometaphase of mitosis. The chromatids align at the equatorial plate during metaphase and separate into two complete sets of daughter chromosomes during anaphase. TMP C) The cholesterol content of a membrane determines the packing density of phospholipids. The higher the cholesterol content, the more fluid the membrane and the greater the lateral mobility of membrane components, including proteins and phospholipid molecules themselves. To a lesser extent, cholesterol content also affects the leakiness of a membrane to water-soluble molecules. TMP E) Nucleic acids and proteins, together, constitute the fundamental replicable unit of life, exemplified by viruses. Membranes and even organelles appear in prokaryotic cells, but only eukaryotic cells possess a nucleus. TMP A) The feedback gain of the control system is calculated as the amount of correction divided by the remaining error of the system. In this example, blood pressure increased from 100 to 150 mm Hg when the baroreceptors were not functioning. When the barore
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