Part -1:

1. The osmolality of 0.9% NaCl is ___________. How is osmolality different from molarity? How intravenous administration of hypertonic solution can affect blood circulation?

2. What factors determine the contraction of skeletal muscle?
How is skeletal muscle contraction and relaxation different from cardiac muscle? How smooth muscle can regulate blood flow and perfusion?

3. Why is the cardiac action potential propagated more slowly in an AV node cell then in an atrial or ventricular myocyte? How can be AV conduction affected by hypokalemia? How hypokalemia can affect cardiac rhythm?

4. What physiological factors influence capillary blood flow? How can this be changed during stress conditions? How capillary blood flow changes during exercise?

5. What are the major compensatory responses to blood loss? List the most important hormones involved. How vasopressin can regulate blood flow?

6. An individual has an episode of gastroenteritis with vomiting and diarrhea. How will this affect his intracellular and extracellular fluid compartments volume and osmolality? What acid-base abnormality will he develop? What treatment regarding water balance would be necessary?

7. What effect would administration of a drug that inhibits carbonic anhydrase will be expected to have on urine HCO3- excretion, and by what mechanism? What type of acid-base disorder could result from the use of this drug? Give an example of this type of the drug used in the clinic?

What mechanism of action has furosemide? Why is furosemide very frequently used in patients with heart failure?

8. Why there is no universal donor anymore? What type of blood you can transfuse if patient has type A- blood? What is a significance of blood type? What is a significance of Rh factor?

9. Explain the mechanism how the most popular diuretic furosemide affects kidney tubules. How does this affect K+ balance? How different is the mechanism that thiazide diuretics affect urine production?

10. Why botulinus toxin causes paralysis? How does it affect the neurotransmitter release at the neuromuscular junction? Is there any treatment for this condition?

11. Predict the effect of 1 L of 600 mOsm/L infusion of sucrose on patients RBC's osmolality and volume, if previous osmolality of RBC's was 250 mOsm/L, plasma volume - 3.6 L and RBC's volume - 2.4 L.

12. Briefly describe how is memory process affected in Alzheimer's Disease. How can this disease progress? Is there any treatment to help these patients?

13. Briefly explain what is the advantage to the body of inhibiting insulin release during a sympathetically mediated fight-or-flight response?

14. Explain how hypothalamic and pituitary hormones regulate and control the process of reproduction.

Part B. Case-based questions

1. Patient with chronic heart failure is using digoxin (digitalis) for more than 1 year. Describe what effect has this treatment with digitalis have on the distribution of ions across the membrane of cardiac muscle cells? How digitalis helps to treat patients with heart failure? Can be digitalis used with beta-blockers or diuretics? What monitoring would be necessary?

2. Indicate the simple acid-base disorder for the given laboratory data:

A 46-year-old woman is diagnosed with chronic renal failure. = 102 mEq/L, pH = 7.14, HCO3- = 8 mEq/L, PaCO2 = 24 mmHg, creatinine = 8.6 mg/dL, BUN = 90 mg/dL.
Is there any compensation? _______________________
Briefly describe the most significant abnormalities related to renal function.

3. Patient with dehydration was started on fluid therapy.
If 5% dextrose is isoosmotic to plasma what effect would infusion of 1L of a 10 % dextrose solution have on ECF and ICF volumes? How it would affect body fluid osmolality of a 70 kg individual and why?

Part I.

1. Blockage of the flow of bile into the duodenum interferes with the digestion of which of the following?
A. carbohydrates only
B. lipids only
C. proteins only
D. carbohydrates and lipids
E. carbohydrates and proteins
2. Absorption of vitamin B12 can not occur
A. if a person is anemic
B. if the stomach secretes intrinsic factor
C. if the ileum is missing
D. in the absence of bile
3. Which of the following tends to inhibit acid secretion by the stomach?
A. an increase in the osmolarity of duodenal content
B. entry of stomach acid into the duodenum
C. the arrival of food in the stomach
D. a and b
E. all of the above
4. The hormone CCK
A. is triggered by fatty acids in the chyme
B. potentiates the effects of secretin
C. causes gall bladder contractions
D. all of the above
5. Extended diarrhea can cause acidity of the blood due to
A. depletion of potassium
B. depletion of bicarbonate
C. dehydration
D. depletion of sodium
6. Absorbed fats first go to the
A. heart, to be circulated throughout the body
B. liver, to be further processed
C. lungs, to receive necessary oxygen
D. lymph system, then the venous system and back to the heart
7. The main cholesterol carriers in the blood that deliver cholesterol to the cells are
A. HDL
B. LDL
C. VLDL
D. lipoprotein lipase
8. The enzyme that breaks down starch to short chains is made by
A. brush border membranes
B. salivary glands and pancreas
C. the liver
D. the gall bladder
9. Which one is a hormone that can enter a cell and attach to DNA.
A. steroid hormone.
B. amino acid-based hormone.
C. calcitonin.
D. glucagon.
10. The endocrine gland most affected by stress is
A. the thymus.
B. the thyroid.
C. the hypothalamus
D. the adrenal cortex.
E. the parathyroids.
11. Production of the gonadal sex hormones is
A. relatively constant from fetal life to old age
B. low until puberty, after which it becomes quite high and remains so until old age
C. low until puberty, and remains so until old age
D. high during fetal life, low during childhood, high during puberty, and then declines later in life
12. Posterior pituitary hormones
A. are produced in the hypothalamus
B. travel to the posterior pituitary along the hypothalamo-pituitary portal system
C. are called hypophysiotropic hormones
D. all of the above
13. Ovulation is induced by a surge of
A. LH
B. progesterone
C. inhibin
D. FSH
14. Steroid hormones
A. are manufactured from cholesterol
B. easily pass across the plasma membrane because of their high lipid solubility
C. are in ways similar in basic structure
D. all of the above
15. Secondary hyposecretion is when
A. a gland is abnormal and therefore produces too little of a hormone
B. a gland is abnormal and therefore produces too much of a hormone
C. a gland is normal but is stimulated to produce too much of a hormone by another tropic hormone
D. a gland is normal but is insufficiently stimulated by a tropic hormone to produce enough of the primary hormone
16. After ovulation, the endometrium enters the
A. follicular phase
B. proliferative phase
C. secretory phase
D. luteal phase
17. The hormone detected by plasma or urine pregnancy tests is
A. placental lactogen
B. progesterone
C. luteinizing hormone
D. chorionic gonadotropin
18. The gonadotropins in males are the
A. gonadotropin releasing hormones
B. follicle-stimulating hormone and luteinizing hormone
C. estrogens
D. inhibins
19. The adrenal glands
A. are really two distinct glands, each with different functions
B. include the adrenal medulla, which secretes steroid hormones
C. include the adrenal cortex, which secretes epinephrine and norepinephrine
D. all of the above
20. All of the following statements about the human female reproductive process are true except:
A. The monthly discharge of the uterus (menses) is initiated by the fall in secretion of female hormones.
B. Ovulation usually occurs 14 days after the beginning of menses.
C. Rebuilding the endometrium is under the control of prolactin.
D. Fertilization usually occurs in the fallopian tube.

1. What are the vasoconstricting factors regulated by endothelium?
A. Thromboxane A and endothelin
B. Norepinephrine and acetylcholine
C. Bradykinin and leukotriene
D. Serotonin and prostacyclin

2. What alteration occurs in injured endothelial cells that contributes to atherosclerosis?
A. They release toxic oxygen radicals that oxidize low-density lipoproteins (LDL).
B. They are unable to make the normal amount of vasodilating cytokines.
C. They produce an increased amount of antithrombic cytokines.
D. They develop a hypersensitivity to homocystine and lipids.

3. Where does ADH act in the kidneys, and what does it do?

4. What is the baroreceptor reflex?

5. What organ synthesizes new erythrocytes and thrombocytes? Does warfarin affect thrombocytes or not?