NDM MCQ Final 2001

1

Sumita Neg, a 18-year-old nursing student presents to her local GP, Dr Sarah Richards with a 5- month history of tiredness, lack of concentration, fatigue, and shortness of breath on mild effort. During the last 12 months her menstrual periods have become heavier and longer (7 to 1 O days). Her periods used to last for 2-3 days only with light to moderate bleeding. She gives no history of changes in her appetite but admits that since she moved to Australia as an international student she eats more junk food. Her bowel movements are regular except for a few bouts of diarrhoea. Her family history is unremarkable and she has no history of allergy. She is not on any medication. On examination, Sumita looks pale. Her vital signs are shown below:

Vital signs Patient Normal Range
Blood pressure 100/70 mmHg 100/60 -135/85 mmHg
Pulse rate 86/min 60- 100/min
Temperature 36.9°C 36.6 - 37.2 °C
Respiratory rate 16 12 -16 /min
Abdominal examination: No organomegaly. Her FBE reveals:
  • Haemoglobin 95
  • WBC4.5
  • Platelets 190,000
  • Blood film: Red blood cells (RBCs) are microcytic and appear to be hypochromic
Which one of the following is the most likely cause of Sumita's anaemia?


2

This question relates to the patient described in Q1. Which one of the following would you expect to be increased in Sumita's blood?


3

This question relates to the patient described in Q1. Which one of the following findings is expected from Sumita's bone marrow smears?


4

This question relates to the patient described in Q1. Which one of the following abnormalities/lesions is associated with Sumita's anaemia?


5

This question relates to the patient in Q1. Which one of the following statements regarding the binding of oxygen to haemoglobin is CORRECT?


6

In which one of the following renal diseases does diabetes mellitus NOT cause or play a role?


7

Which one of the following statements regarding the anatomy of the pancreas is CORRECT?


8

Which one of the following factors will result in a DECREASE in the basal metabolic rate (BMR)?


9

Which one of the following regarding acute tubular necrosis (ACT) is CORRECT?


10

Which one of the following statements regarding peptic ulcer of the stomach is NOT correct?


11

With regard to vitamin E, which one of the following statements is CORRECT?


12

Which one of the following statements regarding the right ureter is NOT correct? 1 . The right ureter passes posterior to the genitofemoral nerve on psoas major.


13

Which one of the following statements regarding the stomach is NOT correct? 1 . The pylorus lies at the level of the L 1-2 intervertebral disc.


14

Which one of the following statements about amino acid metabolism is NOT correct?


15

Which one of the following statements regarding the left renal vein is NOT correct?


16

Which one of the following statements regarding the bile duct is NOT correct?


17

Which one of the following statements about the response of amino acid metabolism to stress is NOT correct?


18

Which one of the following statements regarding the kidney is NOT correct?


19

Which one of the following statements regarding prostaglandin 12 (prostacyclin) is CORRECT?


20

Which one of the following statements regarding the role of ATP in skeletal muscle function is NOT correct?


21

Which one of the following biological substances is NOT produced by the kidney?


22

Which one of the following statements regarding smooth muscle function is NOT correct? (In comparison to skeletal muscle)


23

Cyanide inhibits the transfer of electrons to oxygen in the mitochondrial electron transport chain. Which one of the following is NOT a likely metabolic consequence of cyanide poisoning?


24

Which one of the following statements regarding hepatitis B infection is NOT correct?


25

Which one of the following statements regarding imaging of the abdomen is NOT correct?


26

Which one of the following statements about the synthesis of triacylglycerol is NOT correct?


27

Which one of the following statements regarding primary hepatocellular carcinomas in the liver is NOT correct?


28

Which one of the following statements regarding colorectal carcinoma is NOT correct?


29

Which one of the following statements regarding glycogen metabolism is CORRECT?


30

Which one of the following statements regarding alcoholic hepatitis is NOT correct?


31

Which one of the following statements regarding the transverse colon is NOT correct?


32

Which one of the following statements regarding kidney disease associated with type 1 diabetes mellitus is NOT correct?


33

Which one of the following statements regarding liver enzyme changes in viral hepatitis is NOT correct?


34

In which one of the following does the microbiota of the gastrointestinal tract of humans NOT play a role?


35

Which one of the following statements regarding cholesterol in the blood of humans is CORRECT?


36

Which one of the following is the primary mechanism or system involved in the elimination of small hydrophobic foreign molecules from the circulation?


37

Which of the following statements regarding the pharmacokinetic behaviour of drugs is/are CORRECT? A) Absorption of drugs often takes place via the process of lipid diffusion. B) Renal excretion of a drug depends upon the processes of glomerular filtration, tubular secretion and tubular reabsorption. C) Extensive first pass hepatic metabolism may reduce the oral bioavailability of a drug. D) Following oral administration, drugs usually distribute evenly throughout the body.


38

Which of the following statements related to malabsorption is/are CORRECT? A) Fatty acids aid the dispersion of fat into small particles. B) Disease of the terminal ileum may cause problems with calcium absorption. C) Bile acids are essential for absorption of fat soluble vitamins. D) Absorption of calcium takes place predominantly in the terminal ileum.


39

Which of the following is/are the likely metabolic consequences of an overnight fast? A) An increase in glycogen phosphorylase activity in the liver. B) An increase in hormone sensitive lipase activity in adipose tissue. C) A decrease in the muscle glucose transporter, GLUT 4, due to decreased insulin levels. D) Increased synthesis of very low density lipoproteins (VLDL) for the transport of fatty


40

Which of the following statements regarding the glomerular filtration barrier is/are CORRECT? A) The glomerular filtration barrier consists of three layers -fenestrated endothelium, a fused basement membrane and podocytic epithelium. B) The glomerular filtration barrier has fenestrated endothelium with diaphragms. C) The glomerular filtration barrier has expanses of interdigitating podocyte foot processes. D) The glomerular filtration barrier is about the width of an erythrocyte (7-8 microns).


41

Which of the following statements regarding red blood cell destruction is/are CORRECT? A) When increased, red blood cell destruction causes increased numbers of blood retic~locytes. B) Red blood cell destruction normally occurs in macrophages. C) Red blood cell destruction is the main source of bilirubin production. D) Red blood cell destruction results in increased iron loss from the body.


42

Which of the following is/are able to contribute to glucose synthesis in the liver during fasting? A) Even chain length fatty acids (e.g. palmitic acid, 16:0). B) Lactate. C) Ketone bodies. D) Branched chain amino acids (e.g. valine).


43

Which of the following statements regarding the metanephric diverticulum (ureteric bud) is/are CORRECT? A) The metanephric diverticulum is invaded by the metanephric mesoderm. B) The metanephric diverticulum arises from the mesonephric duct. C) The metanephric diverticulum gives rise to the nephron. D) The metanephric diverticulum gives rise to the collecting ducts.


44

In a patient with anaemia, which of the following findings is confirmatory of a diagnosis of iron deficiency? A) Subnormal red cell MCV (Mean Cell Volume). B) Subnormal serum iron level. C) Normal percentage of Haemoglobin A2 in red cells. D) Subnormal serum ferritin level.


45

Which of the following is/are the metabolic consequences of insulin deficiency? A) Significantly decreased glucose uptake into the liver cell (hepatocyte). B) Stimulation of protein synthesis in the liver. C) Unregulated glycogen synthesis in the liver. D) Enhanced production of ketone bodies.


46

Which of the following statements regarding variability of drug action is/are CORRECT? A) Renal clearance of drugs is low in neonates. B) Elderly patients typically have reduced renal clearance. C) Enzymic polymorphism accounts for differences in the rates of metabolism of some drugs by certain ethnic groups. D) In patients with renal disease, it will be necessary to reduce the dose of any drug


47

Which of the following statements regarding abnormal liver function and bilirubin is/are CORRECT? A) Vitamin C is not well absorbed in obstructive jaundice. B) Unconjugated bilirubin is converted to soluble bilirubin by ultra violet light. C) Vitamin K is not well absorbed in hepato cellular jaundice. D) Conjugation of bilirubin is defective in premature infants.


48

Which of the following statements regarding the pathogenesis of type 2 diabetes is/are CORRECT? A) Impaired insulin secretion is the first abnormality noted. B) There is an increase in endogenous glucose production. C) Insulin resistance is demonstrable in every tissue in the body. D) Insulin resistance is an early defect.


49

Which of the following statements regarding the proximal tubule is/are CORRECT? A) Na+-H+ cotransport takes place in the proximal tubule. B) Weak acids are actively reabsorbed by the proximal tubule. C) Na+-glucose countertransport takes place in the proximal tubule. D) Weak acids are actively secreted by the proximal tubule.


50

Which of the following statements related to liver metabolic functions is/are CORRECT? A) Globulins are synthesised by the liver. B) Aldosterone is metabolized by the liver. C) The liver synthesises glucose from fatty acid metabolic products (Acetyl Co A). D) Glycogen is broken down by the liver.


51

Which of the following is/are components of the Metabolic Syndrome (Syndrome X)? A) Obesity. B) Insulin resistance. C) Dyslipidaemia. D) Hyperuricaemia.


52

Which of the following statements regarding the collecting tubule is/are CORRECT? A) Low plasma K+ increases K+ secretion by the collecting tubule. B) HC03- in lumen of the collecting tubule increases H+ excretion by th_e kidney. C) Low plasma Na+ increases Na+ reabsorption by the collecting tubule. D) HC03- in the lumen increases H+ secretion in the collecting tubule.


53

Which of the following statements related to liver dysfunction is/are CORRECT? A) Albumin synthesis is impaired in chronic liver dysfunction. B) Albumin synthesis is impaired in acute liver failure. C) A low plasma albumin is a common finding in chronic liver dysfunction. D) A low plasma albumin is a common finding in acute liver dysfunction.


54

Which of the following statements regarding gastrin is/are CORRECT? A) Gastrin increases gastric acid secretion. B) Gastrin decreases the tone of the gastro oesophageal sphincter. C) Gastrin increases stomach contractility. D) Gastrin relaxes the sphincter of Oddi.


55

Which of the following statements related to the loop of Henle is/are CORRECT? A) ADH increases reabsorptive capacity of the thick ascending limb of the loop of Henle. B) If the loop of Henle is not functioning the kidney cannot concentrate urine. C) Osmolality at end of the loop of Henle is about 100 mosmol/I. D) If the loop of Henle is not functioning the kidney cannot dilute urine.


56

Which of the following statements regarding partial agonists is/are CORRECT? A) Partial agonists have greater affinity than full agonists. B) Partial agonists can produce a response on their own. C) Partial agonists have higher potency than full agonists. D) Partial agonists can hinder the action of full agonists acting at the same receptors.


57

Which of the following statements regarding sodium absorption by the small intestine is/are CORRECT? A) Sodium absorption proceeds by Na+ glucose cotransport. B) Sodium absorption proceeds by Na+ -H+ countertransport. C) Sodium absorption proceeds by Na+-amino acid cotransport. D) Sodium absorption depends on luminal membrane Na+ K+ ATPase.


58

Which of the following statements related to juxtaglomerular apparatus or the cortical diluting segment is/are CORRECT? A) High NaCl at macula densa results in increased renin release. B) Efferent arteriole is more sensitive to circulating angiotensin 11 than the afferent arteriole. C) Angiotensin 11 mediates tubular glomerular feedback. D) Renin is present predominantly in the afferent arteriole.


59

Which of the following statements regarding drug-drug interactions is/are CORRECT? A) Pharmacodynamic drug-drug interactions may result from receptor antagonism. B) Both of the drugs involved in the interaction will usually have a large therapeutic index. C) Displacement of drug A from plasma protein by drug B may result in a transient increase in the plasma concentration of free (unbound) drug A. D) Drug-drug interactions always result in unwanted effects clinically.


60

Which of the following statements regarding the causation of diarrhoea is/are CORRECT? A) Histamine increases free Ca++ in small intestinal cells. B) Excess somatostatin may cause diarrhoea. C) Cholera toxin increases cyclic AMP levels in intestinal cells. D) Excess sodium chloride in the diet may cause diarrhoea.


61

Which of the following statements related to chronic renal failure is/are CORRECT? A) Body sodium depletion may occur in chronic renal failure. B) Body sodium excess may occur in chronic renal failure. C) Hypotension may occur in chronic renal failure. D) Hypertension may occur in chronic renal failure.


62

Which of the following statements regarding the intravenous infusion of drugs is/are CORRECT? A) The peak plasma concentration of a drug will be higher than that obtained for the same dose of the drug administered by an intravenous bolus injection. B) Once infusion is stopped, the plasma level of the drug remains at a constant, steady state level. C) Generally, the rise in plasma concentration of the drug is exponential. D) For most drugs, doubling the infusion rate will lead to a doubling of the plasma


63

Which of the following statements related to the pancreas and its secretion is/are CORRECT? A) Secretion of bicarbonate by the pancreas is stimulated by cholecystokinin. B) Pancreatic duct cell secretions are stimulated by secretin. C) Trypsinogen is activated in the pancreas. D) Pancreatic secretions contain a lipase.


64

Which of the following statements related to calcium and phosphate is/are CORRECT? A) Calcium absorption in the loop of Henle and distal nephron is increased by parathyroid hormone. B) Increased parathyroid hormone causes increased absorption of Ca++ by the kidney. C) Parathyroid hormone decreases proximal tubule Na+ reabsorption. D) Parathyroid hormone increases renal calcium excretion.


65

Which of the following statements regarding volume of distribution (V d) is/are CORRECT? A) Volume of distribution may be used to calculate the loading dose of a drug. B) Volume of distribution is equal to the amount of drug in the body divided by the concentration of drug in the plasma. C) Volume of distribution may correspond to a physiological volume, such as extracellular fluid volume. D) Volume of distribution may be one or two orders of magnitude greater than total body water.


66

Which of the following statements related to the absorption of food is/are CORRECT? A) Glucose is absorbed by primary active transport in the small intestine. B) Glucose must be present for the absorption of sodium. C) The hexose sugars use a common transport carrier. D) Disaccharides are poorly or not absorbed by the small intestine.


67

Which of the following statements related to diuretics is/are CORRECT? A) Hypokalaemic alkalosis is a common side effect of diuretic therapy. B) Hyperkalaemic alkalosis may occur with diuretic therapy. C) Hyperkalaemic acidosis may occur with diuretic therapy. D) Amiloride prevents all biochemical adverse effects of thiazide diuretics.


68

Which of the following statements concerning the potency of a competitive antagonist is/are CORRECT? A) It may be affected by the efficacy of the antagonist. B) It may be affected by the density of the receptors for the antagonist. C) It may be affected by the efficiency of the stimulus-response coupling of the agonist and its receptor. D) It may be affected by the equilibrium dissociation constant of the antagonist.