NEET-PG 2012 - Physiology Practice Questions

Q: Which mechanism is primarily responsible for the transport of glucose in renal tubular cells?

Sodium-glucose cotransport. ***Sodium-glucose cotransport*** - Glucose reabsorption in the renal tubules, particularly in the **proximal tubule**, occurs primarily via **secondary active transport** involving **sodium-glucose cotransporters (SGLTs)**. - SGLT proteins use the **sodium concentration gradient** (maintained by the Na+/K+-ATPase on the basolateral membrane) to move glucose against its concentration gradient from the tubular lumen into the cell. *Glucose diffusion* - While passive diffusion may play a minor role, it is insufficient to reabsorb the large amounts of **filtered glucose** - Diffusion would lead to significant **glucose loss in urine**, even at normal blood glucose levels. *Sodium antiport* - Antiport systems move two different ions or molecules in **opposite directions** across a membrane. - While present in renal cells, sodium antiport mechanisms are not the primary means of **glucose reabsorption**; rather, glucose transport is mostly symport. *Facilitated diffusion* - Facilitated diffusion involves carrier proteins (like **GLUT transporters**) that move molecules down their **concentration gradient**. - While GLUT transporters are present on the **basolateral membrane** of tubular cells to move glucose into the interstitium, they are not the primary mechanism for glucose uptake from the tubular lumen, which occurs against a concentration gradient.

Q: Mechanism by which Ach decreases heart rate is by:

Delayed diastolic depolarization. ***Delayed diastolic depolarization*** - Acetylcholine (ACh) binding to muscarinic receptors on nodal cells increases **potassium permeability**, leading to a more negative maximal diastolic potential. - This slows the rate of **spontaneous depolarization** (pacemaker potential), thereby delaying the point at which the threshold for an action potential is reached and reducing heart rate. *Prolongation of action potential duration* - ACh typically **shortens** the action potential duration in atrial and nodal cells by increasing potassium efflux, which hyperpolarizes the cell and hastens repolarization. - A prolonged action potential duration would generally lead to a **slower heart rate** by increasing the refractory period, but this is achieved through different ionic mechanisms and is not the primary mechanism of ACh. *Reduction in calcium influx* - While ACh does reduce the inward **calcium current (ICa)** in nodal cells, contributing to a slower heart rate and weaker contractility, this effect primarily influences the upstroke and peak of the action potential. - The more **fundamentally important mechanism** for heart rate reduction is the impact on the pacemaker potential's slope, which is governed by altered ion conductances, predominantly potassium. *Inhibition of sympathetic activity* - ACh acts directly on **muscarinic receptors** on cardiac cells to decrease heart rate, which is a parasympathetic effect. - It does not directly inhibit sympathetic nerve activity but rather **counteracts sympathetic effects** by directly modulating cardiac cell physiology.

Q: What is the normal range for the CSF/plasma glucose ratio?

0.6 - 0.8. ***Correct: 0.6 - 0.8*** - This ratio indicates that cerebrospinal fluid (CSF) glucose concentration is typically 60-80% of plasma glucose concentration - This range is crucial for identifying metabolic or infectious pathologies affecting the central nervous system - Normal CSF glucose is approximately 50-80 mg/dL when plasma glucose is 70-120 mg/dL *Incorrect: 0.2 - 0.4* - A ratio in this range indicates significantly low CSF glucose, suggesting conditions like bacterial meningitis or hypoglycorrhachia - This is well below the normal physiological proportion of glucose in the CSF relative to plasma - Seen in bacterial/tuberculous meningitis, fungal infections, or malignancy *Incorrect: 1.0 - 1.2* - A CSF/plasma glucose ratio close to or above 1.0 would imply that CSF glucose levels are equal to or higher than plasma levels, which is physiologically impossible under normal conditions - Glucose transport into the CSF is regulated by GLUT-1 transporters and typically results in lower concentrations than in plasma - The blood-brain barrier maintains this gradient *Incorrect: 1.2 - 1.6* - This range is even more exaggerated and physiologically impossible, as CSF glucose cannot exceed plasma glucose in a healthy individual - Such a high ratio would contradict the mechanisms of glucose transport across the blood-brain barrier - Would suggest laboratory error if observed

Q: Which of the following is most important in sodium and water retention ?

Renin angiotensin system. ***Renin angiotensin system*** - The **renin-angiotensin-aldosterone system (RAAS)** is the most important mechanism for **both sodium AND water retention**, which is what the question specifically asks about. - **Aldosterone** directly promotes **sodium reabsorption** in the principal cells of the collecting duct by increasing apical ENaC channels and basolateral Na-K-ATPase pumps. - **Angiotensin II** stimulates sodium reabsorption in the proximal tubule and also stimulates ADH release, contributing to water retention. - When sodium is retained, **water follows passively** due to the osmotic gradient, resulting in effective volume expansion. - RAAS is the primary system activated in states of volume depletion and is most important for combined sodium and water retention. *Vasopressin* - **Vasopressin (ADH)** primarily controls **water retention only** by increasing aquaporin-2 channels in the collecting duct. - While crucial for water balance, it has minimal direct effect on sodium reabsorption. - It causes retention of **free water**, which can actually dilute plasma sodium concentration. - ADH is the answer if the question asked about water retention alone, but not for combined sodium and water retention. *ANP* - **Atrial natriuretic peptide (ANP)** promotes **sodium and water excretion** (natriuresis and diuresis). - Released in response to atrial stretch from volume expansion. - Acts to *oppose* retention mechanisms, making it incorrect for this question. *BNP* - **Brain natriuretic peptide (BNP)** similarly promotes **natriuresis and diuresis**. - Released from ventricular myocytes in response to volume overload. - Like ANP, it acts to *excrete* sodium and water, not retain them.

Q: Peripheral and central chemoreceptors may both contribute to the increased ventilation that occurs as a result of which of the following?

An increase in arterial carbon dioxide tension. ***An increase in arterial carbon dioxide tension*** - An increase in **arterial PCO2** (hypercapnia) leads to a rapid decrease in the **pH of the cerebrospinal fluid (CSF)**, which strongly stimulates **central chemoreceptors** in the medulla. - While overwhelmingly driven by central chemoreceptors, a significant increase in **arterial PCO2** also causes a slight decrease in **arterial pH**, which can additionally stimulate **peripheral chemoreceptors** in the carotid and aortic bodies, leading to increased ventilation. *A decrease in arterial oxygen content* - A decrease in **arterial oxygen content** (e.g., due to anemia or carbon monoxide poisoning) without a significant drop in **arterial PO2** primarily affects oxygen delivery to tissues. - It does not directly stimulate peripheral chemoreceptors, which are sensitive to **PO2**, not content, nor does it affect central chemoreceptors directly to increase ventilation in this manner. *A decrease in arterial blood pressure* - A decrease in **arterial blood pressure** is sensed by **baroreceptors** and primarily triggers cardiovascular reflexes (e.g., increased heart rate and vasoconstriction) to restore blood pressure. - It does not directly stimulate peripheral or central chemoreceptors to significantly increase ventilation unless severe hypoperfusion leads to significant changes in arterial blood gases. *A decrease in arterial oxygen tension* - A decrease in **arterial oxygen tension (PO2)**, especially when it falls below approximately 60 mmHg, acts as a potent stimulus for **peripheral chemoreceptors**. - However, **central chemoreceptors** are primarily sensitive to **PCO2** and CSF pH, and a decrease in **arterial PO2** alone has little direct effect on their activity.

Q: Which tract is responsible for the loss of proprioception and fine touch?

Dorsal column. ***Dorsal column*** - The **dorsal column-medial lemniscus pathway** is responsible for transmitting **fine touch**, **vibration**, and **proprioception** from the body to the cerebral cortex. - Damage to this tract (e.g., in **tabes dorsalis** or **vitamin B12 deficiency**) leads to a loss of these sensations. *Anterior spinothalamic tract* - This tract primarily conveys crude touch and pressure sensations. - While it carries tactile information, it does not transmit the fine discriminative touch or proprioception associated with the dorsal columns. *Lateral spinothalamic tract* - This pathway is responsible for transmitting **pain** and **temperature** sensations. - It does not play a role in proprioception or fine touch. *Corticospinal tract* - The **corticospinal tract** is a **motor pathway** responsible for voluntary movement. - It has no role in transmitting sensory information such as proprioception or fine touch.

Q: Insensible water loss per day is ?

1000 ml. ***1000 ml*** - **Insensible water loss** occurs through the skin (evaporation) and respiratory tract (exhalation) without conscious perception. - The typical daily insensible water loss in an adult is approximately **800-1000 ml/day**. - **Breakdown**: Skin evaporation (~400-500 ml) + Respiratory tract (~300-400 ml) = **~900-1000 ml total**. - **1000 ml** is the standard value cited in major physiology textbooks (Guyton & Hall, Ganong) and is the most commonly accepted answer for NEET PG examinations. *100 ml* - This value is significantly **lower** than the actual insensible water loss, which occurs continuously throughout the day. - Such a low volume would imply negligible evaporation and respiratory loss, which is not physiologically accurate. *300 ml* - While greater than 100 ml, 300 ml is still **far below** the typical range for daily insensible water loss. - This amount represents only about one-third of the actual insensible losses from the skin and respiratory system combined. *700 ml* - Although this value is sometimes mentioned in literature, it is at the **lower end** of the physiological range. - The more widely accepted standard value for insensible water loss in a healthy adult under normal conditions is **900-1000 ml/day**. - 700 ml would underestimate the normal daily insensible losses.

Q: Ptyalin is secreted by?

Salivary gland. ***Salivary gland*** - **Ptyalin**, also known as **salivary amylase**, is an enzyme produced by the salivary glands. - Its primary role is to initiate the **digestion of carbohydrates** (starches) in the mouth. *Gastric gland* - Gastric glands primarily secrete **hydrochloric acid** and **pepsinogen**, involved in protein digestion. - They do not produce ptyalin or enzymes for carbohydrate digestion. *Duodenal gland* - Duodenal glands (Brunner's glands) secrete alkaline mucus to protect the duodenum from acidic chyme. - They are not involved in the production of carbohydrate-digesting enzymes like ptyalin. *Pancreatic gland* - The pancreas produces **pancreatic amylase**, which continues starch digestion in the small intestine. - While it secretes an amylase, it is distinct from salivary amylase (ptyalin) and released into the duodenum, not the mouth.

Q: Which type of carbohydrate is absorbed most efficiently from the gastrointestinal tract?

Monosaccharides. ***Monosaccharides*** - **Monosaccharides**, like glucose and fructose, are the simplest forms of carbohydrates and do not require further digestion. - They are directly absorbed into the bloodstream from the intestinal lumen via specific **transporters** on the enterocyte membrane. *Disaccharides* - **Disaccharides**, such as sucrose and lactose, must first be broken down into their constituent monosaccharides by **brush border enzymes** (e.g., lactase, sucrase) before absorption can occur. - This additional enzymatic step makes their absorption less efficient than that of monosaccharides. *Polysaccharides* - **Polysaccharides**, including starch and glycogen, are complex carbohydrates requiring extensive digestion by enzymes like **amylase** in the mouth and small intestine. - This multi-step breakdown into monosaccharides is the least efficient process and takes the longest time. *5-carbon sugars* - While 5-carbon sugars (**pentoses**) like ribose and deoxyribose are monosaccharides and can be absorbed, they are not a primary energy source in the diet and are not absorbed as efficiently or in as large quantities as the metabolically more significant 6-carbon monosaccharides (hexoses like glucose). - The question asks which *type* of carbohydrate is most efficiently absorbed, and **monosaccharides** as a general category (including 6-carbon sugars) are the most efficient.

Question 1

Which mechanism is primarily responsible for the transport of glucose in renal tubular cells?

Accepted Answer

Sodium-glucose cotransport

Answer

Facilitated diffusion

Answer

Glucose diffusion

Answer

Sodium antiport

Question 2

Mechanism by which Ach decreases heart rate is by:

Accepted Answer

Delayed diastolic depolarization

Answer

Prolongation of action potential duration

Answer

Reduction in calcium influx

Answer

Inhibition of sympathetic activity

Question 3

The plateau phase of this graph is due to:

Accepted Answer

The calcium channels remaining open longer than the sodium channels

Answer

Increased membrane permeability to potassium ions

Answer

A decrease in calcium diffusion across the membrane

Answer

The movement of fewer sodium ions across the cell membrane

Question 4

What is the normal range for the CSF/plasma glucose ratio?

Accepted Answer

0.6 - 0.8

Answer

1.2 - 1.6

Answer

0.2 - 0.4

Answer

1.0 - 1.2

Question 5

Which of the following is most important in sodium and water retention ?

Accepted Answer

Renin angiotensin system

Answer

ANP

Answer

BNP

Answer

Vasopressin

Question 6

Peripheral and central chemoreceptors may both contribute to the increased ventilation that occurs as a result of which of the following?

Accepted Answer

An increase in arterial carbon dioxide tension

Answer

A decrease in arterial oxygen content

Answer

A decrease in arterial blood pressure

Answer

A decrease in arterial oxygen tension

Question 7

Which tract is responsible for the loss of proprioception and fine touch?

Accepted Answer

Dorsal column

Answer

Anterior spinothalamic tract

Answer

Lateral spinothalamic tract

Answer

Corticospinal tract

Question 8

Insensible water loss per day is ?

Accepted Answer

1000 ml

Answer

100 ml

Answer

700 ml

Answer

300 ml

Question 9

Ptyalin is secreted by?

Accepted Answer

Salivary gland

Answer

Gastric gland

Answer

Duodenal gland

Answer

Pancreatic gland

Question 10

Which type of carbohydrate is absorbed most efficiently from the gastrointestinal tract?

Accepted Answer

Monosaccharides

Answer

Disaccharides

Answer

Polysaccharides

Answer

5-carbon sugars

NEET-PG 2012 — Physiology