PHSL2004

Test 1, 2018
Page 1 of 14 pages

PHSL2004, Test 1 APQ model answers

APQ 1

The data in the table below show the osmolarity, extracellular fluid volume, intracellular fluid
volume and plasma protein concentration for a 70 kg man in different states of hydration.
The second column (Normal) shows the variables when the man is euhydrated.

Normal 1 2 3 4 5 6

Plasma osmolarity (mOsm/ℓ) 280-295 294 276 285 315 275 300

Extracellular fluid volume (ℓ) 14 12 12 15 15.5 15 11.5

Intracellular fluid volume (ℓ) 28 28 28 28 27.5 28.5 27.5

Plasma protein concentration (g/ℓ) 60-85 70 55 30 58 58 80

Answer questions 1 - 8 using the information and data given in the table above.

1. The data set that most likely represents the man’s hydration status ten minutes after
losing 2 litres of blood is
a) data set 1.
b) data set 2.
c) data set 3.
d) data set 5.
Answer: a, Blood loss would result in isotonic dehydration (decreased total body water with
isotonic plasma). Data set 2 shows dehydration however it is hypotonic. Data sets 3, 4 and 5
represent over hydration. Data set 6 represents a hypertunic dehydration with 1 liter of fluid
loss.

2. The hydration state represented by data set 3 is commonly associated with oedema. The
most likely cause of the oedema in this case is
a) decreased ability of the heart to pump blood.
b) decreased liver function.
c) blockade of the lymphatic system.
d) decreased secretion of aldosterone.
Answer: b, Data set 3 is characterized by isotonic overhydration with a markedly reduced
plasma protein concentration. The main source of plasma proteins is the liver. Decreased liver
function would result in a decreased ability to synthesise proteins e.g. albumin. Consequently
plasma oncotic pressure is reduced and oedema occurs.
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3. The hydration state represented by data set 4 most likely occurred one hour after
a) excessive sweating (1 litre) without drinking any water.
b) drinking 1 litre of hypertonic fluid.
c) intravenous infusion of 1 litre of 0.9% saline (sodium chloride solution).
d) intravenous infusion of 1 litre of blood.
Answer: b, Data set 4 shows hypertonic overhydration. Drinking hypertonic fluid would increase
the osmolarity of extracellular fluid and its volume. The increased extracellular fluid osmolarity
would draw fluid from the intracellular compartment decreasing the ICF volume. Excessive
sweating would result in hypertonic deyhydration. Intravenous infusion of 0.9% saline or blood
would cause isotonic overhydration.

4. The hydration states that are most likely to result in an increased secretion of antidiuretic
hormone are data sets
a) 1 and 3.
b) 1 and 6.
c) 2 and 3.
d) 3 and 5.
Answer: b, The stimuli for ADH release include a decreased blood volume and increased plasma
osmolarity. Data sets 1, 2 and 6 show dehydration. Data sets 3 and 5 indicate over hydration.
The states of dehydration are thus likely to have a reduced blood volume which would stimulate
ADH secretion in an attempt to conserve water. However the dehydration in data set 2 is
hypotonic. That of dataset 6 is hypertonic. Thus the most likely data sets are 1 and 6.

5. The hydration state depicted by data set 5 most likely occurred 30 minutes after
a) drinking sea water.
b) drinking tap water.
c) eating dry salty food without drinking water.
d) vomiting profusely.
Answer: b, The hydration state associated with data set 5 depicts hypotonic overhydration. Sea
water is hypertonic. Tap water is hypotonic, its intake would decrease plasma osmolarity making
fluid move into cells due to osmotic differences between the two compartments. Eating dry salty
food without fluid intake would increase plasma osmolarity without changing the amount of total
body water.

6. The hydration states that are most likely to result in decreased elasticity (turgor) of the
skin when pinched are
a) 1 and 2.
b) 1 and 3.
c) 2 and 3.
d) 2 and 5.
Answer: a, Skin loses its turgor/elasticity when dehydrated. When pinched the skin remains
tented for longer than normal. Data sets 1 & 2 depict dehydration.
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7. Red bloods cells taken from the man when in the hydration state depicted by data set 4
are most likely to be
a) increased in volume compared to normal.
b) lysed compared to normal.
c) swollen compared to normal.
d) decreased in volume (crenated) compared to normal.
Answer: d, The plasma osmolarity in data set 4 is high. This would draw fluid out of the
erythrocytes by osmosis causing crenation of the cells.

8. The hydration states which are most likely to result in the man having an increased
sensation of thirst are data sets
a) 1 and 3.
b) 1 and 6.
c) 2 and 3.
d) 3 and 5.
Answer: b, The stimuli for thirst include a decreased blood volume and increased plasma
osmolarity. Data sets 1 and 2 show dehydration. Data sets 3 and 5 indicate over hydration. The
states of dehydration are thus likely to have a reduced blood volume which would stimulate the
sensation of thirst in an effort to try and replenish the body water. However the dehydration in
data set 2 is hypotonic. That of dataset 6 is hypertonic. Thus the most likely data sets are 1 and
6.

APQ 2

The blood results of three patients with immunological challenges are shown in the table below.

Patient 1 Patient 2 Patient 3 Normal values

9
White blood cells (x 10 /ℓ ) 16.0 4.0 9.0 3.92-9.88
Monocytes (x 109/ℓ ) 0.7 0.4 0.5 0.18-0.8
Neutrophils (x 109/ℓ ) 13.2 2.0 2.5 2.0-7.5
Eosinophils (x 109/ℓ ) 0.3 0.3 4.5 0.00-0.45
Lymphocytes (x 109/ℓ ) 2.8 1.3 1.5 1.0-4.0
CD4+ T lymphocytes (x 109/ℓ ) 0.9 0.1 1.0 0.5-1.5

Answer questions 9 - 16 based on the data provided in the table above.

9. The patient(s) most likely to have a bacterial infection is/are

a) patient 1 only.
b) patients 1 and 3.
c) patient 2 only.
d) patients 2 and 3.
Answer: a, Patient 1 has elevated neutrophils, which are the phagocytes specific of bacterial
infection. Patient 2 has a normal neutrophil count as well as Patient 3 and they are therefore
less likely to have a bacterial infection.
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10. Patient 1’s neutrophil count was most probably caused by the initial activation of
a) a dendritic cell.
b) a macrophage.
c) a Natural Killer (NK) lymphocyte.
d) the complement.
Answer: b, neutrophils are a secondary innate immune response to an infection. Their elevation
in the blood is triggered by the initial activation of a tissue macrophage which has engulfed the
bacterium, and the secretion of IL-1β, IL-6 and TNF-α as the macrophage becomes activated by
the bacterial products. Dendritic cells specialize in the activation of CD4 T cells and also taking
the pathogen to the lymph nodes to activate B lymphocytes. Natural killer lymphocytes recognize
the non self and induce the destruction of the pathogen. The complement will lead to the
inflammatory process by causing vasodilation, it will also lead to the opsonisation of the
pathogen and the membrane attack complex. However none of these other cells lead to the
enhanced recruitment of neutrophils from the bone marrow- the macrophage does.

11. The immunological challenge in patient 3 is most likely to be

a) an acute bacterial infection.
b) a viral infection.
c) a parasitic infection.
d) a leukaemia.
Answer: c, Patient 3’s eosinophils are elevated. Eosinophils are phagocytes specific of parasitic/
worm infections. The normal level of the neutrophils makes it unlikely that it is a leukaemia with
eosinophil proliferation which invades the bone marrow and would then decrease markedly the
number of neutrophils. The normal level of neutrophils also makes it unlikely to be a bacterial
infection.

12. Patient 2’s diagnosis is most likely to be

a) leukaemia.
b) a human immunodeficiency virus (HIV) infection.
c) an allergic reaction.
d) a viral infection other than HIV.
Answer: b, The patient’s main feature is the low CD4 count (at 0.1 x 10 9/l) whereas the other
white blood cell lineages are preserved. An infection with HIV leads to a depletion in CD4
counts as HIV uses CD4s to multiply, but also because the CD8s recognize CD4 cells infected
with HIV and targets them for destruction. The preservation of other white blood cell lineages
makes leukaemia very unlikely. An allergic reaction would not lead to low CD4 counts but would
lead to an increase in eosinophils. A viral infection (other than HIV) should increase the
lymphocytes overall as the adaptive immunity (B lymphocytes and CD4 T helpers for
extracellular targeting of the virus and CD8 cytotoxic lymphocytes for elimination of cells
infected by the virus) is recruited and in particular would not lead to a decrease in CD4 counts.

13. The CD4+ count observed in Patient 2 is most likely caused by

a) antibodies against CD4+ T lymphocytes.
b) CD8+ T lymphocyte activation.
c) macrophage activation.
d) expression of Major Histocompatibility Complex (MHC) class II molecules.
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Answer: b, In HIV infection, HIV enters CD4 T cells and uses it to multiply itself. In the process,
viral peptides are taken up by MHC Class I molecules and shown at the surface of the CD4. The
MHC Class I/HIV specific peptide will then be recognized by a specific CD8 cytotoxic T cell
which will become activated and cause the apoptosis of the infected CD4, clone itself and cause
the apoptosis of other infected CD4s.

14. The most likely consequence of the CD4+ T lymphocyte count in patient 2 is B
lymphocyte and impaired
a) macrophage activation due to lower CD4+ T lymphocyte interaction with peptide
bound to MHC class I.
b) NK cell activation due to lower CD4+ T lymphocyte interaction with peptide
bound to MHC class I.
c) macrophage activation due to lower CD4+ T lymphocyte interaction with peptide
bound to MHC class II.
d) NK cell activation due to lower CD4+ T lymphocyte interaction with peptide
bound to MHC class II.
Answer: c, A CD4+ Helper T lymphocyte recognizes a specific peptide presented in MHC class
II molecules on the surface of antigen presenting cells (macrophages, B lymphocytes and
dendritic cells) and help activate macrophages and B lymphocytes which present the same
specific peptide + MHCII on their cell membrane. So not MHC class I (acts with CD8 and
induces the apoptosis of the cell presenting the peptide +MHC class I), nor NK cells.

15. In patient 3, the most likely effect of the activation of a naïve B lymphocyte will be
a) clonal expansion of the B lymphocyte and immunoglobulin switch from IgM to
IgE in the B lymphocyte.
b) release of perforins.
c) clonal expansion of the B lymphocyte and immunoglobulin switch from IgM to
IgA in the B lymphocyte.
d) activation of a CD4+ T lymphocyte.
Answer: a. Patient 3 has most likely a parasitic infection, as seen by the elevation of his
eosinophil count. A naïve B lymphocyte meeting its antigen on the parasite would therefore
activate a B lymphocyte most capable of clearing the parasite. This means it will most likely
switch its class of immunoglobulin expression from an IgM (characteristic of the naïve B cell) to
an IgE of which the Fc fragment (ε constant chain) interacts with high affinity with the Fc-ε
receptor on eosinophils, increasing therefore the phagocytosis and clearance of the parasite. It
would therefore not switch the class to an IgA (specific of mucosal tissue). The activation of a
CD4 T cell will help the activation of the B cell but not the opposite (suggested by d.). Perforins
are released by CD8+ T or NK lymphocytes, not by B lymphocytes.
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16. The patient(s) most likely to have elevated C-reactive protein (CRP) is/are
a) patient 1 only.
b) patients 1 and 2.
c) patients 2 and 3.
d) patients 1, 2 and 3.
Answer: d, Patient 1 has an acute bacterial infection, which would have triggered macrophage
activation and therefore CRP secretion during the acute phase protein production. Patient 2 has
HIV (CD4 counts are low) and is likely to have an activation of his macrophages to clear HIV,
also leading to CRP secretion during the acute phase protein production. Patient 3 has a
parasitic infection, which is also likely to have triggered macrophage activation and therefore
CRP elevation.

[8]

APQ 3

The diagram below represents carbohydrate metabolic pathways that occur in the liver. Numbers
in boxes (1-12) represent enzymes that catalyse the indicated reactions.

Arrows with a single directional arrowhead indicate irreversible reactions, arrows with two
arrowheads indicate reversible reactions and dashed arrows indicate multiple reactions.
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Answer questions 17 - 24 based on the figure above.

17. Enzyme 1 is most likely to be

a) glucokinase.
b) glucose-6-phosphatase.
c) hexokinase.
d) phosphoglucomutase.
Answer: a, Glucokinase is the enzyme that phosphorylates glucose in liver (and pancreatic β-
cells), whereas hexokinase does this in other tissues. Glucokinase has a high Km and Vmax,
which allows it to act on the high concentrations of glucose that enter the cells through insulin-
independent glucose transporters after a meal. The resulting rapid conversion of glucose allows
accumulation of glucose-6-phosphate in the liver for storage as glycogen or synthesis of fats
(and triggers insulin release from pancreatic β-cells).

18. Reactions that consume ATP are most likely to be catalysed by enzymes
a) 1, 2 and 3.
b) 1, 2 and 6.
c) 1, 2 and 7.
d) 1, 2 and 8.
Answer: b, Enzymes 1 (glucokinase) and 2 (phosphofructokinase-1) catalyse transfer of a
phosphate group from ATP to a substrate, thus consuming ATP. Enzyme 6 (pyruvate
carboxylase) uses ATP to catalyse addition of CO 2 to Pyruvate to form oxaloacetate. Enzyme 7
(phosphoenolpyruvate carboxy kinase, PEPCK) uses GTP to form phosphoenolpyruvate. Enzyme
8 (fructose-1,6-bisphosphatase) does not use, or produce, ATP.

19. Enzyme 5 catalyses a reversible interaction and favours synthesis of different products in
different cell types. The type of cells in which enzyme 5 is most likely to produce
pyruvate is
a) adipocytes.
b) hepatocytes.
c) erythrocytes.
d) myocytes (skeletal muscle cells).
Answer: b, All cells produce pyruvate by glycolysis. Under anaerobic conditions and in red
blood cells excess NADH is used to convert pyruvate to lactate. Peripheral tissues and red blood
cells release lactate into the plasma. The liver converts the lactate back to pyruvate to use for
gluconeogenesis in anaerobic conditions or to use in the TCA cycle and oxidative
phosphorylation in aerobic conditions.

20. The enzyme that is most likely to be activated by AMP is

a) enzyme 1.
b) enzyme 2.
c) enzyme 3.
d) enzyme 4.
Answer: b, Enzyme 2 (phosphofructokinase-1) is allosterically activated by AMP, the signal that
cellular energy is low. Enzyme 1, glucokinase, is activated mostly by increased glucose
concentration and insulin increases how much protein is expressed. Enzyme 3, pyruvate kinase is
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activated by fructose-1,6-bisphosphate (feed forward regulation) and insulin. Enzyme 4,

pyruvate dehydrogenase, is activated by ADP, Ca2+ & insulin.

21. The enzyme that is most likely to be activated by insulin is

a) enzyme 5.
b) enzyme 10.
c) enzyme 11.
d) enzyme 12.
Answer: b, Enzyme 10 is glycogen synthase, which is activated by dephosphorylation in response
to insulin and inhibited by glucagon or adrenaline, which stimulate phosphorylation which
decreases activity. Enzyme 5, lactate dehydrogenase, is regulated by relative concentrations of
its co-enzymes NAD+ and NADH. Enzyme 11, glycogen phosphorylase is activated by glucagon
and inhibited by insulin. Enzyme 12, Glucose-6-phosphate dehydrogenase, is activated by
increased cellular concentrations of NADP+.

22. The enzyme that is most likely to be activated by glucagon is

a) enzyme 1.
b) enzyme 4.
c) enzyme 10.
d) enzyme 11.
Answer: d, Enzyme 11 is glycogen phosphorylase, which glucagon activates by phosphorylation.
Enzyme 1 (glucokinase) is activated by glucose and insulin increases protein expression, which
is decreased by glucagon. Enzyme 4, pyruvate dehydrogenase, is activated by ADP, Ca2+ &
insulin not affected by glucagon.

23. Enzyme 12 is most likely to produce the co-enzyme

a) NADH.
b) NAD+.
c) NADPH.
d) NADP+.
Answer: c, Enzyme 12 is glucose-6-phosphate dehydrogenase (G6PDH), the rate-limiting
enzyme of the pentose phosphate pathway/hexose monophosphate shunt. The function of the
pathway is to produce ribose-5-phosphate, for nucleotide synthesis in growing cells, and
NADPH which is needed to prevent oxidative damage and for synthesis of fatty acids and
cholesterol. G6PDH directly catalyses conversion of NADP+ to NADPH.

24. Enzymes that are most likely to also be present in red blood cells include enzymes
a) 1, 2, 3, 4 and 5.
b) 1, 2, 3, 5 and 6.
c) 1, 2, 3, 5 and 12.
d) 1, 2, 3, 10 and 11.
Answer: c, Red blood cells contain all of the enzymes for anaerobic glycolysis, enzymes 1
(glucokinase), 2 (phosphofructokinase-1), 3 (pyruvate kinase) and 5 (lactate dehydrogenase).
They also have the pentose phosphate pathway, which includes enzyme 12 (glucose-6-phosphate
dehydrogenase, G6PDH), which protects them from oxidative damage.
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APQ 4
The diagram below shows a representation of the cellular components and processes involved in
oxidative phosphorylation. Numbers in boxes (1 - 9) represent metabolites involved in the
oxidative phosphorylation pathway.

Pi = inorganic phosphate

Answer questions 25 - 32 based on the data in the diagram above.

25. Metabolites 1 and 2 are most likely to be, respectively

a) ADP and ATP.
b) FADH2 and FAD.
c) NAD+ and NADH.
d) NADH and NAD+.
Answer: d Metabolite 1 is NADH, the major substrate/electron donor of electron transport and
metabolite 2 is NAD+, the oxidised form of NADH (i.e. it has lost 2 electrons).

26. Metabolites 5, which are transported across the mitochondrial membrane, are best
described as
a) electrons.
b) hydride ions (H-).
c) hydrogen atoms (H).
d) protons (H+).
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Answer: d, Complexes I, III and IV transport protons (H+) out of the mitochondrion to generate
the proton motive force that drives ATP synthesis.

27. Metabolite 9 is most likely to be

a) ATP.
b) a hydrogen atom.
c) oxygen.
d) water.
Answer: d, Water is formed when complex IV transfers 2 electrons to oxygen, forming O2-, which
then combines with 2 protons to form water.

28. Metabolite 8, which is the final acceptor of electrons in the electron transport chain, is
most likely to be provided by/come from
a) aerobic glycolysis.
b) gluconeogenesis.
c) the blood.
d) the tricarboxylic acid (TCA)/Krebs cycle.
Answer: c, Metabolite 8 is oxygen, which is delivered to the cell by the blood.

29. The metabolites that are most likely to provide the electrons for the electron transport
chain component of oxidative phosphorylation, are metabolites
a) 1 and 2.
b) 1 and 3.
c) 2 and 3.
d) 2 and 4.
Answer: b, Two reduced co-enzymes, NADH (metabolite 1) and FADH2 (metabolite 3) provide
the electrons (in the forms of H- and 2H, respectively) that provide energy, as they move through
the electron transport chain, to produce the proton electrochemical gradient that drives ATP
synthesis.

30. Oxidative phosphorylation depends on an electrochemical gradient of metabolite 5.

Protein complexes that generate the gradient include
a) complexes I, II and III.
b) complexes I, II and IV.
c) complexes I, III and IV.
d) complexes II, III and V.
Answer: c, Oxidation of complexes I, II and IV (i.e. when they lose electrons) provides enough
energy to pump 4 protons (metabolite 5) across the mitochondrial membrane into the
intermembrane space.

31. Uncoupling protein (UCP1) increases metabolic heat production by

a) transporting metabolite 5 from the mitochondrial inter-membrane space to the
matrix and increasing synthesis of metabolite 7.
b) transporting metabolite 5 from the mitochondrial inter-membrane space to the
matrix and decreasing synthesis of metabolite 7.
c) increasing transport of metabolite 5 by complex V and increasing synthesis of
metabolite 7.
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d) inhibiting transport of metabolite 5 by complex V and inhibiting synthesis of

metabolite 7.
Answer: b, Uncoupling proteins are proton channels (their protein expression is stimulated by
thyroid hormone and adrenal) that allow protons to leak back into the mitochondrial matrix,
decreasing the proton electrochemical gradient. This decreases ATP synthesis by complex V.
This uncoupling of the electron transport chain from ATP synthesis results in the energy of the
electrons being released as heat.

32. The mechanism by which cyanide disrupts oxidative phosphorylation involves

a) binding to complex I, blocking transfer of electrons to co-enzyme Q and
decreasing transport of metabolite 5.
b) binding to complex IV, blocking transfer of electrons to co-enzyme Q and
decreasing transport of metabolite 5.
c) binding to complex IV, blocking transfer of electrons to metabolite 8 and
decreasing transport of metabolite 5.
d) binding to complex V, blocking transport of metabolite 5 by complex V and
decreasing production of metabolite 7.
Answer: c, Cyanide binds to the haem group of complex IV, preventing binding of oxygen
(metabolite 8) and consequently preventing the transfer of electrons to oxygen. Decreased
electron transfer decreases energy release so complex IV does not pump protons across the
mitochondrial membrane.

APQ 5

The following table shows anthropometric measurements recorded from four male students
(1- 4) during the physiology practical laboratory session.
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Anthropometric Student 1 Student 2 Student 3 Student 4 Normal

measurements values
Body weight (kg) 54 72 110 114
Height (cm) 191 168 170 172
Sum of skin-fold 16 40 30 110
thicknesses (mm)
Waist circumference 65 80 86 116 Males
(cm) <102

Answer questions 33 - 36 using the information provided in the table and the graph of skin-fold
thickness versus percentage body fat.

33. Student 1 has a body mass index (BMI) value of

a) 18.
b) 11.
c) 15.
d) 21.
Answer: c, BMI = body weight (kg)/height (m2). BMI = 54/1.912 = 15kg/m2.

34. Student 2 is most likely to have a body fat percentage of

a) 16 %.
b) 20 %.
c) 30 %.
d) 24 %.
Answer: a, The sum of skin-fold thickness of Student 2 is 40mm and using the skin-fold thickness
versus percentage body fat graph Student 2 has 16% body fat.

35. Which student is most likely to be obese?

a) Student 1
b) Student 2
c) Student 3
d) Student 4
Answer: d, Student 4 has a BMI of 39kg/m2, a waist circumference >102cm and 29 % body fat.
Therefore Student 4 is obese.

36. Student 3’s body composition shows that he is likely to have

a) a negative nitrogen balance.
b) greater than normal lean body mass.
c) greater than normal subcutaneous fat.
d) marasmus.
Answer: b, Student 3 has a BMI of 38kg/m 2, a waist circumference < 102cm and 12% body fat.
Although Student 3 has an increased BMI, the waist circumference and %body fat indicates that
Student 3 is not underweight or centrally obese. Student 3 is likely to be a body builder with an
increased lean body mass and thus cannot have a negative nitrogen balance.
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APQ 6
The following graphs show blood measurements recorded from four male students (1- 4) during
the physiology practical laboratory session.

Answer questions 37 - 40 using the information provided in the graphs.

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37. Which student has an International Normalised Ratio (INR) of 0.33?

a) Student 1
b) Student 2
c) Student 3
d) Student 4
Answer: d, international normalised ratio INR= Student 4 prothrombin time (PT) / Normal PT=
5 / 15 = 0.33.

38. Which student is most likely to have a clotting factor IX deficiency?

a) Student 1
b) Student 2
c) Student 3
d) Student 4
Answer: b, Student 2 has increased whole blood clotting time which indicates that student’s
intrinsic pathways are not functioning properly. Clotting factor IX is involved in the intrinsic
pathway of coagulation and thus the student has a clotting factor IX deficiency.

39. Which student is most likely to have a vitamin K deficiency?

a) Student 1
b) Student 2
c) Student 3
d) Student 4
Answer: b, Student 3 has an increased prothrombin time. Vitamin K deficiency will decrease
synthesis of vitamin K dependent clotting factors (VII & X), which are involved in the extrinsic
pathway of coagulation, and thus cause increased prothrombin time.

40. Student 1’s ESR is likely to result from

a) increased plasma C-reactive protein (CRP) concentration.
b) clotting factor X deficiency.
c) decreased erythrocyte ‘rouleaux’ formation.
d) increased haematocrit.
Answer: a, Student 1 has increased ESR. Increased CRP concertration will cause an increased
ESR. Positively charged substances such as CRP (an opsonin synthesised in the liver in response
to inflammation) will promote erythrocyte “rouleaux” formation, which is the clumping together
of red blood cells, and thus increased erythrocyte sedimentation rate.nm