NBDE I

Physiology Review
I.
– Structure and function of connective tissue (8)
– Structure and function of membranes (4)
– Nervous System (9)
– Muscle System (6)
– Circulatory System (9)
_____________________________________
II.
– Respiratory System (6)
– Renal System (6)
– Digestive System / Nutrition (10)
– Endocrine System (8)
– Genetics (5)
PHYSIOLOGY I
 Embryology
• Mesoderm
– Mesenchyme/Connective tissue: skeleton, muscle,
neurovascular, spleen
• In-between (endoderm and ectoderm)

• Endoderm
– Digestive tract, Liver, Pancreas (GI organs)
• Inside

• Ectoderm
– Skin, Neural crest derivatives (brain/head and neck nerves)
• Outside
 Embryology
1. Morula 2. Blastula

3. Gastrula
Archenteron:
primitive gut
Establishment of 3 germ layers
 CONNECTIVE TISSUE
• Soft tissue
• Hard tissue
The craniofacial bones differ from long
bones embryologically because most
craniofacial bones develop through

A. Endochondral ossification
B. Membranous ossification
C. Primary mineralization
D. Secondary mineralization
Which of the following proteins is LEAST
likely to be found in fully developed fibrous
connective tissue?

A. Fibronectin
B. Elastin
C. Osteonectin
D. Collagen
E. Vimentin
Which of the following proteins is LEAST
likely to be found in fully developed
mineralized hard tissue?
A. Osteopontin
B. Tuftelin
C. Osteonectin
D. Endothelin
E. Bone morphogenic protein (BMP)
Which of the following represent(s) a matrix
protein of enamel?

A. Carboxyglutamic acid-containing proteins

B. Type I collagen
C. Amelogenin
D. Proteoglycan
E. Elastin
Which of the following proteins is LEAST
likely to be found in enamel formation?

A. Amelogenin
B. Ameloblastin
C. Enamelin
D. Elastin
E. Tuftelin
Which of the following noncollagenous
protein components BEST characterizes
dentin matrix?
A. Laminin
B. Vimentin
C. Phosphophoryn
D. Osteonectin
E. Fibronectin
Which of the following is the major protein
component of cementum?

A. Elastin
B. Keratin
C. Collagen
D. Amelogenin
E. Fibrin
Which of the following proteins is LEAST
likely to be found in mucosal epithelium?

A. Filaggrin
B. Cytokeratin
C. Involucrin
D. Vimentin
E. Transglutaminase
 Predominant tissue matrix proteins,
hardest to softest…
• Enamel
– Amelogenin, Ameloblastin, Enamelin, Tuftelin
• Bone
– Osteonectin, Osteopontin, Osteogenin, BMP, Collagen
• Cementum
– Collagen
• Dentin
– Collagen (type I), DMP, Phosphophoryn
• Fibrous connective tissue
– Collagen, Fibronectin, Elastin, Vimentin, Laminin
• Epithelium
– Keratin, Involucrin, Filaggrin, Transglutaminase, Melanin
• Vessels
– Endothelin, VWF, VEGF
MEMBRANES
The fluid mosaic model for membrane
structure proposes that

A. The outer and inner faces of the membrane

are identical
B. Peripheral proteins are situated only on the
outer face of the plasma membrane
C. Integral proteins are associated with the
hydrophobic phase of the bilayer
D. Both polar and non-polar ends of membrane
phospholipids are within the hydrophobic
phase of the bilayer
 The cell membrane
Integral protein
Cholesterol

Phospholipid bilayer
The most abundant non-phospholipid
component of the cell membrane is

A. Cholesterol
B. Deoxycholate
C. Prostaglandin
D. Macroglobulin
E. Triacylglyceride
Each of the following lipid classes is
incorporated into membranes EXCEPT one.
Which one is the EXCEPTION?
A. Cholesterol
B. Ganglioside
C. Triglyceride
D. Sphingomyelin
E. Phosphatidylcholine
Which of the following is LEAST descriptive
of lipids?

A. Nonpolar
B. Carbon-containing
C. Hydrophobic
D. Hydrophilic
The largest amount of body water can be
found in which of the following?

A. Urine
B. Blood plasma
C. Intracellular fluid
D. Interstitial fluid
E. Stomach and intestines
Intracellular and interstitial body fluids have
similar

A. Total osmotic pressure

B. Colloid osmotic pressures
C. Sodium ion concentrations
D. Chloride ion concentrations
E. Potassium ion concentrations
NERVOUS SYSTEM
The spinal cord is the only structure in the
central nervous system necessary for which
of the following body functions?

A. Respiration
B. Simple reflex
C. Temperature regulation
D. Coordinated muscle movement
Decreased response of sense organs when
exposed to a constant stimulus is called

A. Occlusion
B. Summation
C. Adaptation
D. Facilitation
E. Sensory deprivation
An action potential in a nerve fiber is
considered to be related to
A. The changed orientation of molecules in the
membrane giving rise to a static potential
difference
B. The entry of sodium ions followed by the exit of
potassium ions
C. A breakdown of metabolic products resulting in
different concentrations of potassium across
the membrane
D. The flow of electrons across the membrane
following change in membrane permeability
 “All or nothing”

Na+ into cell K+ out of cell

Absolute Relative
If an axonal membrane transiently becomes
very permeable to Na+ ions, then the
membrane potential of the cell wall will
approach
A. -70 mV
B. -60 mV
C. -50 mV
D. 0 mV
E. +60 mV
When are nerve fibers hypoexcitable?

A. During resting potential

B. At the firing level
C. During local depolarization
D. During negative after-potential
E. During positive after-potential
The maximal frequency of impulses that can
be carried by a nerve fiber is limited by
which of the following?
A. Intensity of the stimulus
B. Diameter of the nerve fiber
C. Duration of the absolute refractory period
D. Duration of the relative refractory period
GABA increases the permeability of
postsynaptic membranes to which of the
following ions?
A. Sodium
B. Calcium
C. Chloride
D. Magnesium
E. Potassium
Glutamate decarboxylase, an enzyme that
catalyzes the formation of gamma-amino
butyric acid (GABA), is unique to

A. Bone
B. Skin
C. Heart muscle
D. Nervous tissue
E. Connective tissue
 Key neurotransmitters:
Catecholamine biosynthetic pathway
Tyrosine ! L-Dopa (dopamine) !
Norepinephrine ! Epinephrine

Degraded by enzymes:
– MAO
– COMT
 MUSCLE SYSTEM
• Cardiac
• Skeletal
• Smooth
Which of the following represents a striated
muscle that contains transverse tubules, a
slow rate of calcium sequestration, and is
inhibited by acetylcholine?
A. Cardiac
B. Skeletal
C. Multi-unit smooth
D. Single-unit smooth
Calcium ions initiate contraction in skeletal
muscle when they

A. Bind to T tubules
B. Bind to troponin
C. Interact with actin
D. Interact with myosin
E. Bind to sarcoplasmic reticulum
 During exercise, muscle tissue accumulates
lactic acid. As a result, erythrocytes passing
through capillaries in the muscle

A. Release more CO2

B. Absorb more CO2
C. Release more O2
D. Both 1 and 3 above
E. Both 2 and 3 above
CO2 + H2O "! H2CO3+ "! HCO3- + H+
Le Chatelier’s (note it has nothing to do with Oxygen)
The absolute refractory period of skeletal
muscle is an interval during which

A. The stimulus is more than normally effective

B. The threshold is lowered
C. The muscle is relaxed
D. No stimulus is effective
 CIRCULATORY SYSTEM
• Cardiovascular
Which of the following portions of the
cardiovascular system contains the greatest
volume of blood?
A. Arterioles
B. Capillaries
C. Systemic veins
D. Chambers of the heart
E. Pulmonary vasculature
Edema may be caused by

A. Constriction of arterioles
B. Increased permeability of capillaries
C. Reduced blood pressure in the capillaries
D. A tissue oncotic pressure that is lower than
that of plasma
Lymph
Interstitial space/fluid

Artery

Interstitial space/fluid
Which of the following changes promotes
the formation of extracellular edema?

A. Increase in tissue fluid hydrostatic pressure

B. Increase in plasma protein concentration
C. Decrease in capillary hydrostatic pressure
D. Capillary filtration exceeds capillary absorption
E. Capillary absorption exceeds capillary filtration
Which of the following could be beneficial in
reducing edema in the arms of women who
have had radical mastectomy with removal
of axial lymph nodes?
A. Hypertensive agents
B. Avoidance of all diuretic agents
C. Increase interstitial oncotic pressure
D. Decrease interstitial hydrostatic pressure
E. Administration of a plasma volume expander
Which of the following is MOST often
associated with free fatty acid transport in
human blood?
A. Albumin
B. Globulin
C. Cholesterol
D. Sphingolipid
E. Mucopolysaccharide
The main function of plasma globulins is to

A. Maintain colloid osmotic pressure

B. Provide the body with both natural and
acquired immunity
C. Act as a framework on which clot formation
may occur
D. None of the above
Distended veins in the neck result from
which of the following?
A. Pulmonary edema
B. Hemolytic anemia
C. Systemic hypotension
D. Congestive heart failure
Cardiac output is expressed as a product of

A. Stroke volume and heart rate

B. Venous pressure and heart rate
C. Stroke volume and respiratory rate
D. Stroke volume and diastolic filling
E. Venous pressure and coronary blood flow

CO=HR x SV (Starling’s Law: CO=CR)

In the absence of compensatory changes, a
drop in blood pressure results from

A. Vasoconstriction
B. Increased hematocrit
C. Increased stroke volume
D. Increased cardiac output
E. Decreased venous return
A marked fall in the oxygen tension in
arterial blood would stimulate the receptors
in the

A. Aortic arch and carotid sinus

B. Walls of the great veins
C. Aortic and carotid bodies
D. Respiratory center
Sounds heard during systole in the
antecubital space are produced by

A. Closure of AV valves
B. Closure of the aortic valve
C. Turbulent blood flow through the artery
D. Laminar blood flow through the occluded artery
The first heart sound is produced by

A. Ejection of blood from the ventricles

B. Filling of the ventricles
C. Closure of the AV valves
D. Closure of the semilunar valves
E. Turbulent blood flow through the artery
 Heart Sounds
• Systole – ejection of
blood from ventricles
• Diastole – filling of
ventricles
• S1 – 1st heart sound
– Closing of the
atrioventricular valves:
mitral and tricuspid
• S2 – 2nd heart sound
– Closing of the
seminular valves: aortic
and pulmonary
In which of the following conditions might the
systolic blood pressure be abnormally high?

A. Cardiac shock
B. Heart failure
C. Anaphylactic shock
D. Decreased arterial blood compliance
E. Ventricular fibrillation
Decreased arterial blood pressure upon
standing is compensated by

A. Decreased heart rate

B. Dilation of mesenteric vessels
C. Constriction of systemic arterioles
D. Dilation of venules
Administration of a local anesthetic with
epinephrine will MOST likely produce which
of the following cardiovascular effects?

A. Increased heart rate

B. Decreased heart rate
C. Increased diastolic blood pressure
D. Decreased systolic blood pressure
 NBDE I
Physiology Review
I.
– Structure and function of connective tissue (8)
– Structure and function of membranes (4)
– Nervous System (9)
– Muscle System (6)
– Circulatory System (9)
_____________________________________
II.
– Respiratory System (6)
– Renal System (6)
– Digestive System / Nutrition (10)
– Endocrine System (8)
– Genetics
PHYSIOLOGY II
RESPIRATORY SYSTEM
 In respiratory acidosis, arterial CO2 content and pH
become abnormal. Which of the following BEST
describes their respective changes?
CO2 pH

A. Increases Increases
B. Increases Decreases
C. Decreases Increases
D. Decreases Decreases

CO2 + H2O "! H2CO3+ "! HCO3- + H+

Le Chatelier’s (note it has nothing to do with Oxygen)
Most of the CO2 in blood is combined as

A. Acetic acid
B. Bicarbonate
C. Carbonic acid
D. Carbaminohemoglobin
 Hyperventilation alters acid-base balance of
arterial blood by
A. Increasing CO2 and increasing pH
B. Increasing CO2 and decreasing pH
C. Decreasing CO2 and decreasing pH
D. Decreasing CO2 and increasing pH

CO2 + H2O "! H2CO3+ "! HCO3- + H+

Le Chatelier’s
Which of the following stimulates vagal
nerve endings in the lung parenchyma and
inhibits respiration?
A. Decreased arterial pH
B. Expansion of the lungs
C. Decreased alveolar oxygen tension
D. Increased alveolar carbon dioxide tension
RENAL SYSTEM
MOST fluid reabsorption by the kidneys
occurs in which of the following?
A. Distal tubule
B. Proximal tubule
C. Collecting duct
D. Ascending loop of Henle
E. Descending loop of Henle
Each of the following appears in the
glomerular filtrate in concentrations
approximately equal to those in plasma
EXCEPT one. Which one is the exception?
A. Urea
B. Glucose
C. Amino acids
D. Steroid hormones
E. Plasma electrolytes
ADH receptors in the nephron are located
on the tubular membrane of which of the
following?
A. Distal tubule
B. Proximal tubule
C. Ascending loop of Henle
D. Descending loop of Henle
Which of the following represents the major
force that causes glomerular filtration?

A. Tubular hydrostatic pressure

B. Tubular colloid osmotic pressure
C. Glomerular capillary hydrostatic pressure
D. Glomerular capillary colloid osmotic pressure
Which of the following structures of the
kidney most actively regulates blood
pressure?
A. Proximal tubule
B. Distal tubule
C. Loop of Henle
D. Juxtaglomerular apparatus
The clearance rate for a substance that is
completely removed from the blood in the
urine during one pass through the kidney is
equal to which of the following?

A. Renal plasma clearance

B. Filtration fraction
C. Glomerular filtration rate
D. Tubular transport maximum
Filtration *Inulin is filtered, but not
reabsorbed or secreted,
so the RPC=GFR

Tubule

Reabsorbed into blood

Secreted into tubule

If the renal plasma clearance of a substance
which is freely filtered is less than that of
inulin, then
A. The substance becomes bound to protein in
the tubules
B. There is a net secretion of the substance in the
tubules
C. There is a net reabsorption of the substance in
the tubules
D. The substance is neither secreted nor
reabsorbed in the tubules
DIGESTIVE SYSTEM /
NUTRITION
Which of the following is NOT a primary
electrolyte of saliva?
A. Sodium
B. Calcium
C. Fluoride
D. Potassium
E. Bicarbonate
Tooth erosion in bulimic patients is due to

A. Hyposalivation
B. Hypersalivation
C. Action of pepsin
D. Excessive fluoride intake
E. Solubility of hydroxyapatite in acid
Bulimia
Hyposalivation
 Digestive System
Physiology / Biochemistry
– What happens to a bolus of food during
digestion? What do the components become?
– Use your knowledge of anatomy.
Gross metabolism:
• Proteins (-amino acids)
• Carbohydrates (-saccharides)
• Lipids (-fatty acids)
• Vitamins, Minerals
Each of the following segments of the GI tract
consists of smooth muscle under autonomic
nervous control EXCEPT one. Which one is the
exception?
A. Rectum
B. Internal anal sphincter
C. Antrum of the stomach
D. Upper esophagus
Pellagra, or niacin deficiency, can manifest
as all of the following EXCEPT?

A. Dermatitis
B. Diarrhea
C. Dementia
D. Death
E. Anemia
 Vitamins
Fat-soluble:
D- made in skin, pathology=rickets/osteomalacia
A- made from β-carotene, pathology=night blindness
K- made in intestine by bacteria, pathology=bleeding
E- from tocopherols=antioxidant, pathology=rare
Water-soluble:
C- made from glucose=antioxidant, connective tissue formation
pathology=scurvy
B1-thiamine, coenzyme for acetyl-CoA production from pyruvic acid
pathology=Beriberi
B2-riboflavin, coenzyme FAD and FMN
pathology=vision problems, cheilosis, glossitis
B3-niacin, NAD+ constituent
pathology=pellagra
B5-pantothenic acid, coenzyme A function
pathology=loss of appetite, depression
B6-pyridoxine, functions in cellular metabolism
pathology=convulsions, pain, anemia
B12-DNA synthesis (requires Intrinsic Factor from stomach for absorption)
pathology=pernicious anemia
Folic acid-DNA synthesis with Vit. B12, RBC production
pathology=megaloblastic anemia
Biotin-urea derivative, coenzyme function in cellular metabolism
pathology=pallor, anorexia, fatigue, alopecia
Ingestion of which of the following MOST
markedly decreases gastric emptying?
A. Lipids
B. Water
C. Minerals
D. Proteins
E. Carbohydrates
 Cellular Metabolism
Fats/Lipids…Function?
• Membranes, myelin, cholesterol, bile,
steroid hormones, prostaglandins,
transport other fats, energy storage,
energy 2°.
– Lipogenesis
• Anabolism of fats when ATP levels are adequate
or high, or when glucose is high.
– Lipolysis
• Catabolism of fats for fuel. When glucose is low,
ketogenesis occurs so the brain can use ketone
bodies for fuel, but this results in metabolic
ketoacidosis…
Excessive use of fats by the body as a source of
energy during starvation or disturbances in
carbohydrate metabolism may lead to any of the
following conditions EXCEPT

A. Ketosis
B. Acidosis
C. Ketonurea
D. Alkalosis
 Cellular Metabolism
Proteins/Polypeptides…Function?
• Structural, enzymatic, hormonal.
– Proteogenesis
• DNA! RNA!Protein
• 10 essential amino acids, can’t be synthesized
– Without them you get PEM (kwashiorkor or marasmus),
edema (osmotics/oncotics and albumin) and wasting
(muscle breakdown)
– Proteolysis
• Catabolism of proteins as a final energy source
in cases of malnutrition (wasting, muscle loss
and herniation)
Kwashiorkor
⇓serum albumin ! edema signs

Marasmus
 Cellular Metabolism
Carb’s/Sugars…Function?
• Energy/ATP from Glycolysis, Kreb’s, and
ETC!
– Gluconeogenesis or Glycogenesis
• Anabolism of glucose (when ATP low) or glycogen
(when ATP high) by liver from non-carbohydrate
sources, such as lactic acid from muscle waste –
such as Cori Cycle in Liver.
– Glycogenolysis
• Catabolism of glycogen to glucose for glycolysis by
glucose-6-phosphatase, an enzyme which is found
only in liver, kidney and intestinal cells. Occurs
when energy/ATP is needed.
A sustained, severe carbohydrate deficiency
will result in which of the following?

A. Ketoacidosis
B. Severe metabolic alkalosis
C. A deficiency in prostaglandin formation
D. An inability to synthesize ascorbic acid
The catabolism of which of the following results in
no energy production in the form of ATP?

A. Lipid
B. Protein
C. Nucleotide
D. Carbohydrate
ENDOCRINE SYSTEM
Prolonged medication with cortisol produces
atrophy of the adrenal cortex through
A. Inhibition of ACTH production
B. Inhibition of aldosterone secretion
C. Direct action on the synthesis of corticoids
D. None of the above
Hypothalamus !
+
Pituitary: FLAT PIG(s)!
+
Adrenals or other target organs - negative feedback
Androgens are produced in the testis and

A. Adrenal cortex
B. Thyroid
C. Adrenal medulla
D. Pituitary
E. Hypothalamus
 Adrenal Gland
MEDULLA:
Catecholamines epinephrine/norepinephrine

CORTEX: (outermost to innermost layers)

Zona Glomerulosa: Mineralcorticoids (Aldosterone)
Zona Fasciculata: Glucocorticoids (Cortisol)
Zona Reticularis: Androgens (Testosterone)

“Three S’s”: Salt, Sugar, Sex

Acromegaly is due to an excessive
production of which of the following?
A. Thyrotropin
B. Gonadotropin
C. Somatotropin
D. Adrenocorticotropin
Glucosuria with hyperglycemia usually
occurs in which of the following?
A. Addison’s disease
B. Diabetes mellitus
C. Cushing’s disease
D. Parkinson’s disease
 In a parathyroid deficiency state, there is
A. An increase in serum calcium and a decrease
in serum phosphate
B. A decrease in serum calcium and an increase
in serum phosphate
C. An increase in serum calcium and a normal
serum phosphate
D. A normal serum calcium and an increase in
serum phosphate

PTH=“Break bone” vs. CALCITONIN (from thyroid)=“Build bone”

 GENETICS

Central dogma:
DNA ! RNA ! Proteins

Known enzymes and players at

each step!
Which of the following types of blotting can be
used to identify DNA restriction fragments?

A. Eastern
B. Southern
C. Northern
D. Western

↑RNA SNOW
←Protein DROP
↓DNA
Which of the following is a pyrimidine base
that is present in RNA but is NOT present in
DNA?

A. Uracil
B. Guanine
C. Thymine
D. Adenine
E. Cytosine

CUT the Pie (Pyrimidines)

GA=Purines
If the molar percentage of A (adenine) in a
native DNA specimen is 22%, then what is
the molar content of G (guanine)?

A. 22%
B. 28%
C. 44%
D. 56%
E. 78%
In the DNA molecule, guanine on one strand
is joined to cytosine on the complementary
strand by which of the following bonds?
A. Amide
B. 1 hydrogen
C. 2 hydrogen
D. 3 hydrogen