SCHOOL OF NURSING

PGY 2040; HUMAN PHYSIOLOGY)

8th May, 2023.

BSc NURSING PROGRAMMES

Time allowed: 2 HOURS

READ INSTRUCTIONS CAREFULLY

1. Write your computer number on the question Paper and the answer booklet.
2. Follow instructions carefully pertaining to each section. There three sections.
3. You will be expelled from the Exam room if found cheating.
4. Please write as clearly as possible as POOR handwriting cannot be marked.

EXAMINER: DR MOSTIE MOONGA.

TOTAL MARKS: 100

MCQS

SECTION A (15 Marks)

Questions 1 – 15. Select the one that is the best in each case. Each question carries 1 mark.

1. Proteins that are secreted by cells are generally:

(a) Not synthesized on membrane-bound ribosome.

(b) Initially synthesized with a signal peptide or leader sequence at their C terminal.

(c) “Packaged” in the Golgi apparatus.

(d) Moved across the cell membrane by endocytosis.

(e) Secreted in a form that is larger than the form present in endoplasmic reticulum.

2. The resting membrane potential is maintained by:

(a) Activity of H+ Ca++ ATPase

(b) Hydrolysed K+ channels

(c) Hydrolysed Na+ channels

(d) Hydrolysed Ca++ channels

(e) Activity of Na+K+ ATPase

3. Inactivation of the sodium-potassium pump will cause

(a) An increase in the intracellular volume

(b) An increase in the intracellular potassium concentration

(c) Hyperpolarization of the membrane potential

(d) An increase in the excitability of nerve cells

(e) An increase in the flow of sodium out of the cell

4. At the postsynaptic membrane the EPSP is:

(a) Produced by ACh, giving rise to an increased permeability first to Na+ and then after a
delay to K+.

(b) Produced by ACh, causing an increased permeability to Na+ and K+ simultaneously

(c) Caused by a permeability increase to all ions except Na+.

(d) Brought about by the splitting of ACh

(e) Produced by ACh, giving rise initially to an increased K+ permeability and then after a
delay to Na+.

5. Which structure is present in smooth muscle and lacking in skeletal muscle?

(a) Junctions between muscle cells

(b) Overlapping thick and thin filaments

(c) A cytoskeleton

(d) A sarcoplasmic reticulum

(e) Neuromuscular junctions (end plates).

6. Genesis of resting membrane potential is mainly because of:

(a) K+ permeability is equal to Na+ permeability

(b) K+ permeability is more than Na+ permeability

(c) K+ permeability is less than Na+ permeability

(d) None of the above

(e) All of the above.

7. Autophagic vacuoles are nothing but:

(a) Mitochondria

(b) Endoplasmic reticulum

(c) Lysosomes

(d) Nucleus

(e) Nucleolus

8. Secondary active transport requires energy:

(a) Directly

(b) Indirectly

(c) Releases energy only

(d) Does not require energy

(e) None of the above.

9. In which one of the following transport processes is the substance moving down its
electrochemical gradient?

a. Sodium out of nerve cells

b. Calcium into the sarcoplasmic reticulum

c. Hydrogen into the lumen of the distal nephron

d. Glucose into adipose tissue

e. Potassium into striated muscle cells.

10. Excitation-contraction coupling in smooth muscle is initiated when calcium binds to

a. Myosin light chains

b. Calmodulin

c. Troponin

d. Tropomyosin

e. Protein kinase A.

11. The rate of diffusion of a particle across a membrane will increase if

a. The area of the membrane decreases

b. The thickness of the membrane increases

c. The size of the particle increases

d. The concentration gradient of the particle decreases

e. The lipid solubility of the particle increases.

12. Nicotinic receptors are responsible for

a. Producing the skeletal muscle end-plate potential

b. Decreasing the rate of phase-4 depolarization at the SA node

c. Increasing the force of stomach contractions

d. Delaying the emptying of liquids from the stomach

e. Decreasing the excitability of sympathetic postganglionic neurons.

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13. Which of the following words or phrases is most closely associated with an end-plate
potential at the neuromuscular junction?

a. “All-or-none response”

b. Depolarization

c. Hyperpolarization

d. Action potential

e. Electrically excitable gates

14. During the process of excitation-contraction coupling in skeletal muscle, calcium is released
from the sarcoplasmic reticulum by;

a. Inositol triphosphate (IP3)

b. Protein kinase A

c. An increase in intracellular calcium concentration

d. Membrane depolarization

e. An increase in intracellular sodium concentration.

15. The resting potential of a nerve membrane is primarily dependent on the concentration
gradient of

a. Potassium

b. Sodium

c. Calcium

d. Chloride

e. Bicarbonate

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SECTION B (30 marks)
There 15 questions, In questions 16 – 30 write down “T” or “F” if the statement is True or False
respectively against a, b, c, d corresponding the statement. Each question in this section carries
two marks. ¼ will be deducted from each wrong answer.
16. About the Golgi apparatus the following are true;
a. T Process and sorts out lipids
b. TIs a system of membranous sacs
c. F Site for protein synthesis and modification
d. T Has two sides the cis and trans

17. The Mitochondria,

a. T Is the power house of the cell
b. T Is inherited from the mother
c. T Is essential for life
d. T Contains its own DNA
18. Lysosomes,
a. F Lacks degradative enzymes
b. F Is only found in animals
c. T Function as recycling Centre
d. T Contain enzymes capable of digesting proteins, polysaccharides, nucleic acid.

19. Concerning the plasma membrane the following are true;

a. F It is impermeable barrier
b. T Contains transporter proteins
c. T Has proteins that work as receptors for drugs
d. T Is a lipid bilayer with proteins embedded in it.
20. Attachment of the myosin heads to actin filament is possible:

(a) F After an increasing of K+ concentration in the sarcoplasm

(b) T After Ca2+-trponin interaction
(c) F After tropomyosin settles into the groove between actin chain
(d) T After an incoming of A.P. into the cell

21. Skeletal muscle can be stimulated to produce tetanus by:

(a) T Repeated stimulation directly to the muscle

(b) T Giving a volley of stimuli at high enough frequency so that each stimulus
arrives at the contractory phase of the previous stimulus
(c) T Applying a stimulus high enough to activate all the muscle fibers within the
muscle
(d) T Inhibiting the enzyme cholinesterase
22. Smooth muscle:

(a) F Does not contain motor end plate and sarcomere

(b) F Can’t be tetanized
(c) T Contracts according to the “all or none” principle
(d) T Has variable length-tension curve.

23. Concerning sodium potassium ATPase pump activity:

(a) F The pump is active only in one direction

(b) T The activity of the pump is the same in difference tissues
(c) T The pump regulates Na+ and K+ concentration between ECF and ICF
(d) T There are other pumps in the cells

24. The osmolality of fluids:

(a) F Intracellular fluid is hypertonic to plasma

(b) T Na+ exerts approximately 80% of the total plasma Osmolality
(c) T Plasma proteins exerts approximately 10% out of total blood osmolality
(d) F The osmolality is affected by the volume of solutes and the temperature

25. The intracellular fluid compartment:

(a) F Has a higher concentration of Na+ than K+

(b) F Is approximately equal to that of the extracellular fluid in the newborn
(c) T Has a higher concentration of Ca2+ than the extracellular fluid

(d) T Has a higher concentration of HCO3- than the extracellular fluid

26. The smooth endoplasmic reticulum;

a. T Is a site for lipid biosynthesis
b. F Is a site for metabolism of drugs
c. T Is a site for protein synthesis
d. T Are important site in biosynthesis of steroid hormones

27. Regarding the resting membrane potential (RMP):

(a) T The RMPs are produced by small quantities of the total ions which are shifted
through the membrane
(b) F The RMP has a very high permeability to sodium ions
(c) F Is mainly depends on the transmembrane gradient of Na+ ions
(d) T RMP has a very low permeability to Na+ ions

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28. The multi-unit type of smooth muscle:

(a) T Is present in most blood vessels

(b) T The excitation arises mainly from autonomic nerves
(c) F Have absolute and relative refractory period
29. In smooth muscle:

(a) T There is no troponin

(b) T Calmodulin functions like troponin
(c) F Calmodulin replaces tropomyosin

(d) F Contraction is independent of calcium

30. The synaptic delay:

(a) T Refers to the slowing of rate transmission attributed to be at the synapse.

(b) T Is a feature of all synapses.
(c) F May be shortened in all synapses.

(d) F Can react to hormones like estrogens, vasopressin and progesterone

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SECTION C (55 marks)

Has two parts, Part A and Part B.

Part A Long essays has 7 questions choose 4 only.

1. Clearly explain the mechanism of action potential (10 marks).

ANSWER
Step 1; Application of stimulus a stimulus can be mechanical, chemical, light, sound etc.
Step 2; Depolarization, due to influx of sodium ion s via (NA VGC) into the excitable cell
Step 3; Repolarization, due to efflux of Potassium VIA (K VGC) out of the excitable cells.
This make the cell become more negative
Step 4; Hyperpolarization, due to delayed closure of K+ channels. Hence more and more
K+ leaves the cell causing a decrease in membrane potential beyond the resting
Membrane potential
Step 5; resting membrane potential and no stimulus has been applied
2. Clearly explain and illustrate how body water is distributed in 70kg health human body?(10
marks)

1. 60% OF 70KG = 42L

2. Intracellular fluid is amount of fluid present inside the cells.
3. Extracellular fluid is the amount of fluid present outside the cells.
4. Intravascular fluid is fluid found in the vessels.
5. Transcellular fluid is fluid found synovial joints,CSF, pericardial and plural spaces

3. Ms Stevens, a 25 year old librarian, who arrives at the Emergency Department in LMMUTH
complaining of difficulty in breathing and fatigue of skeletal muscles. On examination, vital
signs were Temperature 36.8 degrees Celsius, pulse rate 78 b/min, respiration rate 20 b/min
and BP 118/76 mmHg. The Consultant in that department requested you to answer the
following;
a) Define a synapse and mention two types of synapses (3 marks).
a) Synapse; junction/connection between two excitable cells that is used in the
transmission of electrical impulses from one excitable cell to the other. Two types;
Chemical synapse and Electrical synapse
b) Explain the mechanism happening at the NMJ (7 marks).
 1, Action potential travels towards presynaptic terminal.
• 2, Depolarization of the presynaptic terminal opens Ca2+ channels, and Ca2+ flows
into the terminal.
• 3, Acetylcholine (ACh) is extruded into the synapse by exocytosis.
• 4, ACh binds to its receptor on the motor end plate.
• 5, Channels for Na+ and K+ are opened in the motor end plate.
• 6, Depolarization of the motor end plate causes action potentials to be generated in
the adjacent muscle tissue.
• 7, ACh is degraded to choline and acetate by acetyl cholinesterase (AChE); choline
is taken back into the presynaptic terminal on an Na+-choline cotransporter.
4. Define and give specific examples: (a) Facilitated diffusion (b) Filtration (c) Secondary
Active transport (d) Electrogenic pump and (e) Pinocytosis (10 marks).
(a) Facilitated diffusion; a form of diffusion but requires carrier protein e.g Glucose
Transporters, Na+-Glucose transporter etc
(b) Filtration; a form of diffusion but involves large quantities of substances moving from
high pressure to low pressure, e.g. Glomerular filtration, filtration at capillary beds
(c) Secondary Active transport; A form of active transport different from diffusion. It
recquires transportation of substance from Low to high concentrated are using energy
indirectly. it is dependent on the active transport system
(d) Electrogenic pump: it creates an electrical potential across the cell membrane e.g Na-K
pump
(e) Pinocytosis: “Cell drinking”; movement of extracellular fluid into a cell by infolding of
plasma membrane to form a vesicle e.g Solutes in extracellular fluid.
5. Describe step by step the physiology of cardiac muscle contraction?

6. Explain step by step contraction of smooth muscles such as those of the uterus. What do
you understand by the word, “Atony of the uterus?” (10marks).
7. Describe the physiology of the smooth endoplasmic reticulum. Discuss the source of energy for
muscle contraction. (10 marks).

Source of energy for smooth muscle contraction is ATP which comes from glycolysis of
carbohydrates, breakdown of proteins and fats.

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Part B short essays has 4 questions choose 3 only. Each question carries 5 marks.
1. Describe how myasthenia Gravis comes about and state its clinical features? (5 marks)

2. Lambart- Eaton syndrome is another neuromuscular disease that has symptoms of muscle
weakness and fatigue. How is this different from myasthenia Gravis? (5marks).
3. Give reasons why repetitive motor neuron stimulation improves muscle strength in patients
with Lambart Eaton syndrome but has no therapeutic effect in patients with myasthenia
gravis.(5marks)

4. Using your description of neuromuscular transmission, explain why severe muscle

weakness (e.g. ocular, jaw) occurs in myasthenia Gravis.(5marks)
5. Describe how Lambart Eaton syndrome come about and state its clinical features. (marks)
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