AIIMS Nov – 2017 Physiology Review

Prepared by – Dr. S. Krishna Kumar MD PHY (AIIMS)

Author – CRISP Physiology for PGMEE

Email id – tallboykk@gmail.com

Contact No. 8344342152

1. Slow waves are generated by

a) Myentric neurons
b) Smooth muscle
c) Interstitial cells of Cajal
d) Parasympathetic neurons

Ans – C. Interstitial cells of Cajal

Ref - Ganong, 25th ed/p.496

Explanation:

Gastrointestinal smooth muscles

 The oscillating membrane potential between -60 and -40 mV in GI smooth muscles is termed as
basic electrical rhythm (BER)
 BER is also called “slow waves”
Characteristics of basal electrical rhythm (BER)
 BER is not an action potential – it doesn’t cause
any smooth muscle contraction
 There are only a simple fluctuation in Resting
membrane potential
 If that fluctuation crosses threshold, action
potential (spike potential) will be fired. Only
“Note in the figure that Acetylcholine such action potentials can cause muscle
increases the number of spikes and the contraction
 Depolarization of action potential here is due
tension of the smooth muscle, whereas
to ca2+ and repolarization is due to K+
epinephrine decreases the number of
spikes and tension”

Rate of Basal electrical rhythm (BER)

GI segment Rate of BER
Duodenum 12/min
Terminal Ileum 8/min
stomach 4/min
Cecum 2/min
Sigmoid colon 6/min
 Pacemakers of GI tract – “Interstitial cells of Cajal”
 Interstitial cells of Cajal are the pacemaker cells
 They form gap junctions with GI smooth muscles
 They are mainly responsible for the “generation of Basic electrical rhythm (BER)”
 Pacemaker cells in stomach are located in the midbody of the stomach along the greater
curvature
 In colon, they are located at the submucosal border of the circular muscle layer

2. Reflex responsible for tachycardia during right atrial distension is

a) Bezold Jarisch reflex
b) Bainbridge reflex
c) Cushing reflex
d) J reflex

Ans – b. Bainbridge reflex

Ref - Ganong, 25th ed/p.591

Explanation:

Important cardiac reflexes frequently asked in PGMEE

1. Bainbridge reflex or atrial reflex
 This reflex is activated whenever there is increase in venous return to the heart
 The receptors for this reflex are located in both right and left atria
 Afferent of this reflex travel through vagus nerve and the efferent mainly travel through
sympathetic nerves that increase heart rate (Tachycardia) and strength of cardiac
contraction
2. Bezold-Jarisch reflex
 Intracardiac injections of chemicals like serotonin, veratridine, capsaicin,
phenyldiguanide activates this reflex
 Afferents for this reflex travel through unmyelinated vagal C fiber endings
 The reflex responses are,
 Apnea followed by rapid breathing
 Hypotension
 Bradycardia
 Clinical importance of Bezold-Jarisch reflex
 This reflex is responsible for sinus bradycardia seen during myocardial infarction
 This reflex is one of the cause for profound bradycardia and circulatory collapse
after spinal anesthesia
3. The Oculocardiac reflex
 Also called as Aschner phenomenon or Aschner-Dagnini reflex
 This reflex is activated during traction applied to extraocular muscles and/or
compression of the eyeball
 Afferents for this reflex travel through long and short ciliary nerves to the trigeminal
nucleus
 Efferent travel through vagus nerve to the heart
  Oculocardiac reflex is characterized by profound bradycardia
4. Brewer-Luckhardt reflex
 Stimulation of anal canal or cervix leads to vagal stimulation that causes,
 Bradycardia
 Laryngospasm
 Bronchospasm
5. Marey’s Law
 This law states that heart rate and BP are inversely related
 This law explains reflex bradycardia associated with increase in BP

3. Identify the stage of sleep from the given picture

a) Stage I NREM
b) Stage II NREM
c) Stage III NREM
d) REM

Ans – d. REM

Ref - Kandel Principle of neural sciences, 5th ed P.1143

Explanation:

 Sawtooth waves corresponding to eye movements are seen during REM sleep
  Sleep is subdivided into two phases. They are,
1. Non Rapid Eye Movement (NREM) Sleep
2. Rapid Eye Movement (REM) Sleep

Non Rapid Eye Movement (NREM) Sleep

 Also called as,
 Deep sleep
 Slow wave sleep
 Orthodoxical sleep
 Quiet sleep
 Comprises of 4 stages : Stage 1, Stage 2, Stage 3, Stage 4

Stage 1 NREM Stage 2 NREM

 Transition between waking  Waves with frequency 12 – 14

and sleep Hz called sleep spindles seen
 EEG shows low frequency  high voltage biphasic waves
(4 – 7 Hz) theta waves called K complexes also seen

Stage 3 NREM Stage 4 NREM

 Low frequency (0.5–4 Hz),  Deepest sleep

high amplitude Delta  Delta waves appear > 50% of
waves begins to appear the time in the EEG

Physiological changes during NREM sleep

 Characterized by a decrease in,
1. body movements
2. heart rate
3. breathing – Respiration becomes slow and regular
4. blood pressure
5. metabolic rate
6. temperature
 Rapid Eye Movement (REM) Sleep
 So called because of the characteristic eye movement associated with this sleep
 Also called as,
 Superficial sleep
 Active sleep
 Paradoxical sleep
 Called paradoxical sleep because EEG resembles like that of an awake individual

 PGO spikes
 Called as pontogeniculo-occipital (PGO) spikes
 These large phasic potentials are highly characteristic of REM sleep
Physiological changes during REM sleep
 Muscle atonia
 Due to the inhibition of the spinal motor neurons by descending pathways
 Muscles that doesn’t undergo atonia during REM sleep are extraocular muscles and
diaphragm
 Accompanied by increases in blood pressure, heart rate, and metabolism
 Spontaneous penile erection in men
 Women experience sexual arousal

4. Identify the hormone from the picture

a) Growth hormone
b) Cortisol
c) Estrogen
d) Insulin
Ans – a. Growth hormone

Ref – GuytonTextbook of medical physiology, 13th ed, p.945

Explanation:

Factors that control growth hormone secretion

Factors that increase growth hormone secretion Factors that inhibit growth hormone secretion
1. The most potent factor that increases 1. Infusion of glucose
growth hormone secretion is Hypoglycemia  This is useful in diagnosis of
 Growth hormone is a acromegaly
“diabetogenic hormone”. It  Normally glucose infusion
increses blood glucose levels suppresses growth hormone (GH)
2. Other conditions that causes hypoglycemia secretion
like  Failure of GH suppression to <0.4
 Stress μg/L within 1–2 h of an oral
 Fasting glucose load (75 g) is a definitive
 Exercise diagnostic test for acromegaly
3. During sleep – Particularly deep sleep 2. Insulin like growth factor -1 (IGF-1)
(NREM stage 3 &4) 3. Cortisol
4. Glucagon 4. Free fatty acids
 Response to glucagon is an useful 5. β adrenergic agonists
test to find out growth hormone 6. Normal REM sleep
reserve
5. Protein rich meal that increses circulating
levels of amino acids
 Growth hormone has an anabolic
effect on the protein metabolism. It
increses the rate of amino acid
uptake into cell
6. Person in whom REM sleep is deprived
7. Hormones that increase growth hormone
secretion are,
 Vasopressin
 Androgen
 Estrogen
 Dopamine agonists
 Thyroid hormones
 α adrenergic agonists
5. Feed forward control system is employed during the regulation of

a) Blood volume
b) pH
c) Temperature
d) Blood pressure

Ans – c. temperature

Ref – UMP, 4th edition, RL Bijlani p.12

Explanation:

 There is a control system in our body when no stimulus is required but still the system
ANTICIPATES and makes corrective changes. Such a system is called Feed forward or
Anticipatory or Adaptive Control

Examples of feed forward control

1. Temperature control – Thermoregulatory responses are initiated by hypothalamus

BEFORE the changes in environmental temperature have succeeded in changing
the body’s core body temperature
2. Cephalic phase of gastric secretion- Just thinking about food increases gastric acid
production
3. Thinking about exercise itself increases heart rate & respiratory rate
4. Role of cerebellum in motor coordination

6. Efferent arteriolar constriction causes all except

a) Decrease in GFR
b) Decreases renal blood flow
c) Decreases oncotic pressure in peritubular capillaries
d) Increases hydrostatic pressure in glomerular capillaries

Ans – c. Decreases oncotic pressure in peritubular capillaries

Ref – Guyton Textbook of medical physiology, 11th ed, p.343

Explanation:

Constriction of efferent arteriole effects:

 Constriction of efferent arteriole has biphasic response on GFR

 If there is less than threefold increase in resistance – GFR increase because of increase in PG
  If there is more than threefold increase in resistance – GFR decreases because of decrease in
RBF and increase in colloid osmotic pressure
 efferent arteriolar constriction reduces peritubular capillary hydrostatic pressure, which
increases net tubular reabsorption
 Increase in proteins that escape filtration in glomerular capillaries RISES oncotic pressure in the
glomerular capillaries and peritubular capillaries

7. Difference in trajectory between inspiratory loop and the expiratory loop in the curve is due
to

a) Difference in alveolar pressure during inspiration and expiration

b) Difference in conc. of surfactant during inspiration and expiration
c) Difference in airway resistance during inspiration and expiration
d) Inspiration is active and expiration is passive

Ans – b. Difference in conc. of surfactant during inspiration and expiration

Ref – Boron, Medical physiology, 2nd ed p.634

Explanation:

Important points to be noted in compliance curve are,

 The curve has inspiratory and expiratory components

 Note that the inspiratory and expiratory compliance curves do not coincide. This difference is
called hysteresis
 The difference between the inflation and the deflation paths—hysteresis—exists because a
greater transpulmonary pressure is required to open a previously closed airway, owing to a
deficit of surfactant at the air-water interface, than to keep an open airway from closing,
reflecting abundant surfactant
 Compliance is the slope ΔV/ΔP
 The lung volume at any given pressure is greater during expiration than during inspiration
 Compliance is greatest at mid pressure range
 8. Cellular junctions present in cardiac muscle are all except
a) Zonula occludens
b) Fascia adherens
c) Gap junctions
d) Macula adherens

Answer – a. Zonula occludens

Reference: Ganong’s Review of medical physiology 25th ed.Page no. 112

Explanation:

Cardiac muscle cells are connected by,

I. Fascia adherens – it is the structural analog of zonula adherens

II. Gap junctions
III. Macula adherens

“Zonula occludens is the other name for tight junction. It is absent in cardiac muscle”

Gap  Gap junctions permits substances to pass between the cells without entering the
Junctions extracellular fluid (ECF)
 Gap junctions are composed entirely of an integral membrane protein called
connexons
 Each connexon is made up of six protein subunits called connexins
 Gap junctions are abundant in cardiac muscles which are called as intercalated
discs. It is because of this,cardiac muscle functions as single unit called as
functional syncytium
 Gap junctions are also seen in single unit smooth muscles seen in visceral organs
 Mutations in connexin leads to many human diseases namely,

Connexin(Cx) subtype mutation Disease

Cx32 X-linked Charcot-Marie-Tooth disease
Cx26, Cx30, and Cx31 Congenital sensorineural hearing loss
Cx30 Clouston syndrome
Cx40 idiopathic atrial fbrillation
Cx46 and Cx50 Cataract
 9. Absolute refractory period is due to
a) Opening of calcium channels
b) Closure of potassium channels
c) Closure of active gates of sodium channel
d) Closure of inactive gates of sodium channel

Answer – d. Closure of inactive gates of sodium channel

Reference: BRS physiology, Costanzo, 5th ed p.11

Explanation:

Absolute refractory period:

 Corresponding to the period from the time the firing level is reached until repolarization is about
one-third complete.
 No stimulus, no matter how strong, will not excite the nerve during absolute refractory period
 Cause - inactivation gates of the Na+ channel are closed when the membrane potential is
depolarized. They remain closed until repolarization occurs. No action potential can occur until
the inactivation gates open

Relative refractory period:

 Begins from the remaining part of repolarization to the end of action potential
 Stronger than normal stimulus(suprathreshold stimulus) produces action potential in relative
refractory period
 Cause - The K+ conductance is higher than at rest, and the membrane potential is closer to the
K+ equilibrium potential and, therefore, farther from threshold; more inward current is required
to bring the membrane to threshold
 10. X,Y,Z are the three ions permeable. X = -50 and Y = -30. If at RMP, when there is no net electro
genic transfer, what is the value of Z?
a) +20
b) -20
c) +80
d) -80

Answer – c. +80

Reference: Guyton Textbook of medical physiology, 11th ed, p.58

Explanation:

 No net electro genic transfer at RMP means X + Y + Z = 0

 Since X = -50 and Y = -30, then Z must be +80 since (-80 +80 = 0)

11. Which group of nerve fibers are least susceptible to local anesthetics
a) A alpha
b) A beta
c) B
d) C

Answer – d. C fibers

Reference: The New York School of Regional Anesthesia (NYSORA)

Explanation:

 Two general rules apply regarding susceptibility of nerve fibers to LAs:

 First, smaller nerve fibers are more susceptible to the action of LAs than large fibers.
 Smaller fibers are preferentially blocked because a shorter length of axon is required to be
blocked to halt the conduction completely.
 Second, myelinated fibers are more easily blocked than nonmyelinated fibers because local
anesthetic pools near the axonal membrane.
 This is why C-fibers, which have a small diameter (but are unmyelinated), are the most resistant
fibers to LA
 A δ > A γ > A β > A α > B > C in terms of sensitivity to local anesthetics