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NDM MCQ Final 2003

1

J.N., a 17 year old male, presented to the emergency room with a history that while playing football he developed severe pain in his right knee which prevented him continuing. An Xray was taken which showed a stress fracture of the right patella and there were also some signs of hyperparathyroidism. There was no past history of any major illness except for some recent nose bleeds. There was no family history of major illnesses. On examination he was a fit, healthy, well muscled youth with no abnormality except as listed on physical examination. Blood pressure was 180/105 mmHg but fell to 165/97 mmHg with rest. Pulse rate was 60 b/min. Haemoglobin was 10.5 gm/l with a haematocrit of 33% and a normochromic, normocytic anaemia. White cell count was normal. Plasma creatinine was 0.25 mmol/l. Urine testing revealed a trace of protein, no blood and microscopic examination was normal. Which one of the following is most likely to be the trigger for development of his bone disease:


2

This question relates to the patient described in Q1. Which one of the following is likely to be the primary reason for his anaemia?


3

This question relates to the patient described in Q1. In this patient the elevated blood pressure is most likely to be due to:


4

This question relates to the patient described in Q1. If the renal function of J.N. had been investigated 5 years ago when the GFR was 60 ml/min, which one of the following was most likely to be abnormal?


5

Select the one CORRECT completion to the following statement. The decline in power output during the first 10-20 sec of an "all-out", high intensity exercise bout is most likely due to:


6

Select the one CORRECT completion to the following statement. As exercise intensity approaches maximal oxygen uptake, the predominant substrate for energy metabolism is:


7

Select the one CORRECT statement about nitrogen homeostatis.


8

Which one of the following is NOT CORRECT with respect to the urea cycle?


9

Which one of the following statements is NOT CORRECT with respect to the way in which the body adapts to starvation by changes to metabolic processes?


10

Consider the metabolic stresses caused by injury, burns, surgery and infections. In this context, which one of the following statements is NOT CORRECT?


11

Which one of the following statements about insulin action and glucose transport is NOT CORRECT?


12

Which one of the following statements is CORRECT regarding the properties of lipids?


13

Hypertriglyceridemia is a form of dyslipidemia. Which one of the following statements about hypertriglyceridemia is NOT CORRECT?


14

Which one of the following is NOT a peripheral signal to the brain?


15

Which one of the following is a cause of weight loss?


16

Which one of the following does NOT cause insulin resistance?


17

Which one of the following statements is NOT CORRECT?


18

Which one of the following statements regarding superior mesenteric artery occlusion is NOT CORRECT?


19

Which one of the following statements regarding a penetrating injury in the right loin is NOT CORRECT?


20

Which one of the following statements regarding erosion from a peptic ulcer on the posterior wall of the body of the stomach is NOT CORRECT?


21

Which one of the following statements regarding the portal vein is NOT CORRECT?


22

Which one of the following statements regarding the gallbladder is NOT CORRECT?


23

Which one of the following statements regarding the left kidney is NOT CORRECT?


24

In vitro cultivation of intestinal contents from healthy humans has indicated that the predominant community of the intestinal microbiota comprises:


25

Which one of the following statements is NOT CORRECT with respect to the intestinal microbiota?


26

Which one of the following statements is NOT CORRECT with respect to smooth muscle structure and function?


27

Which one of the following statement completions is NOT CORRECT? Skeletal muscle fatigue may correlate with:


28

Which one of the following statements is NOT CORRECT with respect to skeletal muscle damage?


29

Which one of the following statements is NOT CORRECT with respect to the renal corpuscle?


30

Which one of the following statements is CORRECT with respect to imaging of the liver?


31

Which one of the following statements is NOT CORRECT with respect to the kidney?


32

Which one of the following statements is NOT CORRECT with respect to to the basal metabolic rate (BMR)?


33

Which one of the following dietary compounds would have the least influence on insulin levels in the blood?


34

A deficiency in which one of the following vitamins would contribute to poor control of blood clotting?


35

Which one of the following statements is NOT CORRECT with respect to the control of calcium?


36

Which one of the following states is least likely to elevate lactate formation?


37

Which one of the following statements is CORRECT with respect to the well-fed state?


38

Which one of the following does NOT contribute directly to the maintenance of blood glucose following an overnight fast?


39

Which one of the following statements is most CORRECT with respect to explaining why partial agonists mediate smaller maximal effects than full agonists?


40

Which one of the following effects does NOT occur after chronic excessive stimulation of cardiac beta adrenoceptors?


41

Which one of the following drug characteristics would NOT generally increase the range of doses that can be safely used?


42

Competitive antagonism occurs when an antagonist binds to which one, or more, of the following?


43

Which one of the following statements is NOT CORRECT with respect to the cytochrome P450 in humans?


44

Which one of the following statements is NOT CORRECT with respect to the disease Kwashiorkor, as observed in equatorial Africa?


45

Which one of the following statements is NOT CORRECT with respect to ethanol metabolism?


46

Microsomes are observed in the laboratory as spherical vesicles. Select the one CORRECT completion to the following statement. Before extraction and purification microsomes are:


47

Which one of the following statements regarding the handling of drugs by the kidney is INCORRECT?


48

Which one of the following statements regarding the elimination of drugs by the kidney is INCORRECT?


49

Which of the following statements related to liver metabolic functions is/are CORRECT? A) Synthesis of blood clotting factors by the liver is Vitamin K dependent. B) The liver is the site of gluconeogenesis. C) Fibrinogen is synthesised by the liver. D) The liver synthesises glucose from fatty acid metabolic products (Acetyl Co A).


50

Which of the following statements related to abnormal liver function and bilirubin is/are CORRECT? A) Defective uptake of bilirubin by liver cells is the major reason for jaundice in premature babies. B) Secretion of bilirubin is defective in hepatocellular jaundice. C) Unconjugated bilirubin is excreted by the kidney. D) An early sign of hepatocellular disease is a dark urine.


51

Which of the following statements related to acute jaundice and liver is/are CORRECT? A) Bruising and/or bleeding tendency occurs in both obstructive and hepatocellular jaundice. B) Oedema due to a low plasma albumin is common in acute hepatocellular jaundice. C) Albumin synthesis is impaired in acute hepatocellular jaundice. D) Vitamin K administration corrects the bleeding associated with hepatocellular jaundice.


52

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.


53

Which of the following statements related to liver dysfunction is/are CORRECT? A) An impaired coagulation mechanism is often present in acute liver dysfunction. B) Impaired coagulation responds to Vit K injections in acute liver failure. C) Synthesis of some of the coagulation factors requires Vitamin K. D) Signs of abnormal oestrogen metabolism are frequently seen in acute liver failure.


54

Which of the following statements related to the glomerulus and glomerular filtration is/are CORRECT? GFR = glomerular filtration rate. A) GFR depends upon filtration area. B) There is little or no pressure drop along the glomerular capillary. C) GFR may increase with increased blood flow. D) The albumin concentration in the efferent arteriole is lower than in the afferent arteriole.


55

Which of the following statements related to the proximal tubule is/are CORRECT? A) Phosphate is reabsorbed in proportion to sodium reabsorption by the proximal tubule. B) Increased cyclic AMP in proximal tubule increases sodium reabsorption. C) Natriuretic peptide reduces sodium and water reabsorption by the proximal tubule. D) Angiotensin II stimulates Na+-H+ cotransport in the proximal tubule.


56

Which of the following statements related to the collecting tubule and/or duct is/are CORRECT? A) Aldosterone decreases H+ secretion by the collecting tubule. B) HCO3 - in lumen decreases H+ excretion by the kidney. C) Low plasma pH causes increased K+ excretion. D) HCO3 - in lumen increases H+ secretion in the collecting tubule.


57

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/l. D) If the loop of Henle is not functioning the kidney cannot dilute urine.


58

Which of the following statements related to the juxtaglomerular apparatus (JGA) is/are CORRECT? A) Renin is present predominantly in the afferent arteriole. B) Renin secretion from the afferent arteriole controls tubuloglomerular feedback. C) Efferent arteriole is more sensitive to circulating angiotensin II than the afferent arteriole. D) Efferent arteriole is the main controller of tubuloglomerular feedback.


59

Which of the following statements related to acid base is/are CORRECT? A) Free H+ in the urine are a major mode of excretion of an acid load. B) H+ K+ ATPase causes H+ secretion in the collecting tubule. C) NH4 + in the urine contributes to titratable acidity. D) HCO3 - loss in the urine corrects metabolic alkalosis.


60

Which of the following statements related to vasopressin is/are CORRECT? A) Vasopressin activates adenyl cyclase in the collecting duct. B) Vasopressin release is increased by alcohol. C) Vasopressin action altering water permeability depends on activation of microfilaments. D) Vasopressin is secreted in response to a low plasma osmolality.


61

Which of the following statements related to water balance and urine concentration is/are CORRECT? A) Impairment of urine concentrating ability is an early sign of renal insufficiency. B) Concentrating ability of the kidney is impaired in chronic renal failure. C) Papillary necrosis impairs the ability to form a concentrated urine. D) Thiazide diuretics reduce the kidney diluting ability.


62

Which of the following statements related to calcium and phosphate is/are CORRECT? A) Bone disease is a late manifestation of renal failure. B) Parathyroid hormone causes calcium and phosphate to come out of bones. C) Parathyroid hormone causes increased urine Na+ excretion. D) Calcium absorption in the loop of Henle and distal nephron is increased by parathyroid hormone.


63

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.


64

Which of the following statements related to diuretics is/are CORRECT? A) Thiazide diuretics reduce the diluting ability of the kidney. B) Loop of Henle diuretics cause a greater diuresis than thiazide diuretics. C) Most sodium is absorbed in the proximal tubule. D) The effect of thiazide diuretics and loop diuretics on natriuresis is additive.


65

Which of the following statements related to proteinuria is/are CORRECT? A) In established oedema, due to hypoalbuminaemia, plasma volume measured by albumin space may be normal or increased. B) Plasma albumin is the most important determinant of plasma volume. C) Urinary albumin excretion in normal people is < 30 mg/day. D) A person with pitting oedema up to their knees and a serum of Na+ of 125 mmols/l will be depleted of Na+.


66

Which of the following statements related to chronic renal failure is/are CORRECT? A) Plasma sodium is usually normal in chronic renal failure. B) In chronic renal failure plasma K+ may remain in the normal range. C) Plasma phosphate is usually elevated in patients with chronic renal failure. D) Plasma pH is usually below the normal range early in the course of chronic renal failure.


67

Which of the following statements related to chronic renal failure is/are CORRECT? A) In chronic renal failure plasma potassium rises in proportion to the decline in GFR. B) The plasma sodium concentration is controlled by the secretion of aldosterone. C) Blood urea concentration is a good index of renal function. D) Plasma calcium is frequently normal in patients with chronic renal failure.