NDM MCQ Final 2005

1

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


2

Indicate the CORRECT statement regarding the intestinal microbiota:


3

Which of the following statements about the action and effects of insulin is CORRECT?


4

Which of the following statements about protein breakdown is CORRECT?


5

Which of the following statements about LDL (low density lipoprotein), HDL (high density lipoprotein) and the risk of coronary heart disease (CHD) is CORRECT?


6

Which of the following statements about enzymes and other proteins involved in lipid metabolism is CORRECT?


7

Which of the following statements about intracellular cholesterol metabolism is CORRECT?


8

Which of the following statements about ketone bodies in fasting is CORRECT?


9

Which of the following statements about insulin is CORRECT?


11

The major source of ATP production during a 30 second "all-out", high intensity exercise bout is:


12

Regular physical exercise can enhance insulin action and may benefit individuals with type 2 diabetes. A crucial skeletal muscle adaptation contributing to improved insulin action is:


13

In pathology assays for a specific enzyme in blood, released from damaged tissue, the level measured is NOT expected to correlate with which one of the following?


14

Elevation of blood levels of which enzyme is most specific as an indicator of hepatocyte damage?


16

Regarding leptin which of the following statements in NOT CORRECT?


17

Regarding potential complications of obesity which of the following in NOT CORRECT?


19

With regard to the enteric nervous system indicate the one CORRECT statement below.


20

With regard to digestive system endocrine functions, indicate the one CORRECT statement below.


21

In order to create a muscle flap for reconstructive surgery, a plastic surgeon dissects out the rectus abdominus muscle and identifies the posterior compartment of the rectus sheath. Above the level of the arcuate line the posterior layer of the rectus sheath is:


22

Emergency surgery is performed on a night club patron who has been stabbed and a large laceration in the liver is identified. In order to stop the bleeding the portal vein and hepatic artery can be clamped proximal to the porta hepatis where they:


23

In portal hypertension alternative pathways for blood flow result in engorgement of anastomotic channels at sites of porto-systemic overlap. Which one of the following is NOT a site of porto-systemic anastomosis?


24

A patient has infarction of the jejunum and ileum due to an embolus arising from the left atrium of the heart. The vessel most likely occluded by this embolus is the:


25

A 32 year old man with severe left sided abdominal pain is suspected of having a left ureteric calculus (stone lodged in the left ureter). On plain abdominal X-ray the course of the left ureter can be traced along:


26

A young motorcyclist sustains a fracture of his left 10th and 11th ribs in a fall from his bike. The abdominal viscus most likely to be injured is the:


27

Which type of large intestinal polyp is associated with an increased risk of developing colorectal carcinoma?


28

Adenocarcinoma of the large bowel:


29

Indicate the one CORRECT statement about Coeliac disease.


30

Which of the following statements regarding arachidonic acid metabolism is CORRECT?


31

Antoine Lavoisier is considered to have founded the study of modern chemistry and quantitative nutrition. His pioneering work led to which one of the following conclusions?


32

Given that four (4) of the following terms are synonyms, indicate the one term that is not comparable to the others.


33

Given that the aim is to keep a stable weight, or to permit normal growth for a child, which one of the following applies to a diet in terms of energy per kilogram?


34

You have been presented with some of the statistics and conclusions from Batch and Baur who published a paper about childhood obesity in the Medical Journal of Australia in 2005. According to this paper which one of the following is NOT a correct summary of best evidence (or practice) about childhood obesity in Australia?


35

Select the one statement about leptin that is NOT CORRECT.


36

Food pyramids are a convenient way of making dietary recommendations to patients. The USDA food pyramid of 1992 was widely used in the world until replaced by “MyPyramid” in 2005. In the following list indicate the only feature that is a common recommendation between the two pyramids.


37

The glycaemic index is:


38

Indicate the one CORRECT statement about free fatty acids (FFA), also known as non-esterified fatty acids.


39

Indicate the one CORRECT statement about dietary protein.


40

The Gluconeogenic pathway:


41

In mitochondria the gamma-subunit of ATP synthase (respiratory complex V) has the function of:


42

Which one of the following is a CORRECT characteristic common to all cytochrome P450 enzymes involved in detoxification?


43

The liver component designated CYP 2E1 is involved in which one of the following ways with drug/metabolite metabolism?


44

The podocyte is a key cell in the functioning of the renal corpuscle. Which of the following correctly describes the location and function of podocytes?


45

After an ultrafiltrate is formed in the renal corpuscle, it is further modified as it flows through a tubular system before leaving the kidney in the ureter. Which part of the tubular system includes a region made up of thin, squamous cells?


46

Anaemia due to iron deficiency is typically associated with four of the five conditions listed. Which one of the following is not an indicator of anaemia due to iron deficiency?


47

Beta thalassaemia minor is typically associated with which one of the following?


48

Which one of the following is NOT CORRECT with respect to the binding of oxygen to haemoglobin? Oxygen binding to normal haemoglobin:


49

Indicate the one statement about smooth muscle that is CORRECT.


50

In radiological imaging of the abdomen which one of the following is CORRECT?


51

In radiographic (X-ray) imaging of the abdomen which of the following does NOT influence the amount of absorption of X-rays by the body:


52

In regard to the blood supply of the liver which one of the following is CORRECT?


53

Which of the following statements regarding full and partial agonists is always CORRECT?


54

Which of the following statements is CORRECT?


55

Which of the following types of drugs could selectively inhibit the increase in cardiac contractile force in response to adrenaline but not in response to histamine?


57

Which one of the following statements concerning hepatic sinusoidal endothelial cells is CORRECT?


58

Which one of the following statements concerning Kupffer cells is CORRECT?


59

Which one of the following statements concerning hepatic regeneration is CORRECT?


60

Which one of the following statements concerning haemochromatosis is CORRECT?


61

Which one of the following statements concerning the features of fulminant hepatitis is CORRECT?


62

The nephrotic syndrome is characterized by oedema and:


63

Acute renal failure may have renal causes or be due to extra-renal causes. Of the renal causes of acute renal failure, the most common is:


64

Diabetes mellitus causes several forms of renal damage, including:


65

Administration of the competitive β-adrenoceptor antagonist propranolol to a patient can sometimes cause an decrease in heart rate, but sometimes does not. When would propranolol cause a decrease in heart rate? A) When the sympathetic tone to the heart is high because of acutely lowered blood pressure. B) When both parasympathetic and sympathetic tone to the heart are elevated. C) When the patient is being treated with a stable β-adrenoceptor agonist. D) When the parasympathetic tone to the heart is high because of acutely elevated blood pressure.


66

An initial drug loading dose is likely to be desirable when: A) the drug has rapid distribution to its site of action. B) the drug has a narrow therapeutic window. C) the drug is eliminated with zero-order kinetics. D) the drug has a long half life.


69

Which of the following properties will contribute to a drug being effective at low doses? A) High efficacy. B) High bioavailability. C) High affinity. D) Rapid dissociation from receptors.


70

Drug metabolism in the liver may: A) decrease the activity of a drug. B) be altered by the patient’s diet. C) make a drug more water soluble. D) increase the activity of a drug.


71

Which of the following statements related to gastrin is/are CORRECT? A) Gastrin increases gastro-oesophagal sphincter tone. B) Gastrin release is stimulated by protein breakdown products. C) Gastrin is a competitive inhibitor of cholecystokinin. D) Gastrin relaxes the pylorus.


72

Which of the following statements related to acid secretion by the gastric gland is/are CORRECT? A) Acid is secreted by the peptic cell. B) Acid secretion is increased by protein digestion products in the duodenum. C) The effect on acid secretion of histamine and gastrin is additive. D) Acid secretion is increased by protein digestion products in the antrum.


73

Which of the following statements related to peptic ulceration is/are CORRECT? A) Histamine increases acid secretion by a direct effect on the peptic cell. B) Aspiration of gastric juice will lead to a metabolic acidosis. C) Most peptic ulcers can be cured by antacid therapy. D) Aspiration of gastric juice will lead to hypokalaemia.


74

Which of the following statements related to peptic ulceration is/are CORRECT? A) Most acid is secreted from the body of the stomach. B) Aspiration of gastric juice will lead to a metabolic alkalosis. C) Acid secretion can be reduced by antrectomy. D) Bicarbonate is secreted by gastric mucosal cells.


75

Which of the following statements related to digestion of food is/are CORRECT? A) α amylase breaks starches down to disaccharides. B) Trypsinogen is activated by trypsin. C) Disaccharidases are secreted into the intestinal lumen. D) Trypsinogen is activated by enterokinase.


76

Which of the following statements related to the pancreas and its secretion is/are CORRECT? A) α amylase is secreted from α cells of the pancreas. B) Glycogen is secreted by alpha (α) cells of the pancreas. C) Trypsinogen is activated by a high pH. D) Pancreatic acinar cell secretions are stimulated by vagal activity.


77

Which of the following statements related to the pancreas and its secretion is/are CORRECT? A) Limit dextrins are formed from starch by α amylase. B) Secretion of bicarbonate is stimulated by secretin. C) α amylase breaks down 1-4 glucosidic linkage. D) Trypsin is an endopeptidase.


78

Which of the following statements related to digestion of food is/are CORRECT? A) α dextrinase breaks 1-6 glucosidic bonds. B) Trypsinogen is activated by a high pH. C) Pepsin is an endopeptidase. D) Trypsinogen is activated in the pancreas.


79

Which of the following statements related to the causation of diarrhoea is/are CORRECT? A) Increased intestinal cell cytosolic Ca++ causes diarrhoea. B) Excess histamine may cause diarrhoea. C) Increased cyclic AMP in intestinal mucosal cells may cause diarrhoea. D) Decreased levels of cyclic AMP in intestinal mucosal cells may cause diarrhoea.


80

Which of the following statements related to malabsorption is/are CORRECT? A) Iron malabsorption is the most common cause of iron deficiency. B) Parathyroid hormone directly stimulates intestinal calcium absorption. C) Approximately 40% of iron in the diet is absorbed in a normal person. D) Calcium malabsorption is common in renal disease.


81

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.


82

Which of the following statements related to liver metabolic functions is/are CORRECT? A) Steroid hormones are broken down by the liver. B) The liver synthesizes glucose from proteins. C) Cytochrome P450 is an active catabolic system of the liver. D) The liver cannot synthesize glucose from acetyl CoA.


83

All of the following statements related to abnormal liver function and bilirubin are correct except for: A) conjugation of bilirubin is defective in premature infants. B) the presence of unconjugated bilirubin in plasma helps to distinguish hepato cellular from obstructive jaundice. C) unconjugated bilirubin is converted to a soluble form of bilirubin by ultra violet light. D) failure of conjugation of bilirubin is the primary defect leading to jaundice in hepato cellular disease.


84

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 hepato cellular jaundice. B) Albumin synthesis is impaired in acute hepato cellular jaundice. C) Vitamin K administration parenterally corrects the bleeding associated with obstructive jaundice. D) Oedema due to a low plasma albumin is common in acute hepato cellular jaundice.


85

Which of the following statements related to acute jaundice and liver is/are CORRECT? A) Bruising and bleeding occur with all types of jaundice. B) In hepato cellular jaundice bilirubin in plasma is conjugated. C) In haemolytic jaundice bilirubin in plasma is principally unconjugated. D) In obstructive jaundice bilirubin in plasma is conjugated.


86

Which of the following statements related to the glomerulus and glomerular filtration is/are CORRECT? A) Glomerular capillary pressure is about 70-80 mmHg. B) Oncotic pressure in afferent arteriolar blood is about 25-30 mmHg. C) Net glomerular filtration pressure is about 50-60 mmHg. D) GFR is maintained relatively constant despite blood pressure fluctuations.


87

Which of the following statements related to the proximal tubule is/are CORRECT? A) Weak acids are actively secreted by the proximal tubule. B) Weak bases are actively reabsorbed by the proximal tubule. C) Weak bases are actively secreted by the proximal tubule. D) Weak acids are actively reabsorbed by the proximal tubule.


88

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


89

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.


90

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


91

Which of the following statements related to the renin angiotensin aldosterone system is/are CORRECT? A) Aldosterone increases K+ secretion. B) A high NaCl at the macula densa causes afferent arteriole constriction. C) A high plasma K+ increases aldosterone release from the adrenal. D) A low NaCl at the macula densa causes afferent arteriole dilatation.


92

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) NH4+ in the urine contributes to titratable acidity. C) HPO42- in the urine contributes to titratable acidity. D) More H+ are secreted by the proximal than by the distal nephron.


93

Which of the following statements related to acid base is/are CORRECT? A) HCO3- loss in the urine corrects metabolic alkalosis. B) Aldosterone causes an alkalosis. C) H+ K+ ATPase causes H+ secretion in the collecting tubule. D) Volume depletion prevents correction of alkalosis.


94

Which of the following statements related to water balance and urine concentration is/are CORRECT? A) Vasopressin increases collecting duct permeability to water. B) Loop of Henle is essential for urine concentration. C) Vasopressin increases K+ permeability in the collecting tubule. D) Loop of Henle is essential for urine dilution.


95

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) Plasma ionized calcium levels controls parathyroid hormone secretion. C) Parathyroid hormone decreases proximal tubule Na+ reabsorption. D) Administration of parathyroid hormone causes calcium to be lost in the urine.


96

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.


97

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) Total body sodium is the 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+.


98

Which of the following statements related to hypotension and acute renal failure is/are CORRECT? A) A person with acute tubular necrosis usually has a urine output < 400 ml/day. B) Acidosis is common in acute renal failure. C) A urine sodium > 60 mmol/litre in an oliguric patient suggests that the process is not immediately reversible. D) Hypokalaemia is common in acute renal failure.


99

Which of the following statements related to hypotension and acute renal failure is/are CORRECT? A) A urine sodium > 60 mmol/litre in a hypotensive patient suggests that acute tubular necrosis has occurred. B) A urine osmolality > 450 mosmol in an oliguric patient suggests that acute tubular necrosis has occurred. C) The function of the loop of Henle is usually the 1st segment impaired when renal failure follows hypotension. D) A person with acute tubular necrosis usually has polyuria.


100

Which of the following statements related to chronic renal failure is/are CORRECT? A) Plasma calcium is below the normal range early in the course of chronic renal failure. B) pH is usually normal early in the course of chronic renal failure. C) pH is usually below the normal range early in the course of chronic renal failure. D) Plasma bicarbonate is usually below the normal range in patients with chronic renal failure.