NDM MCQ Final 2004

1

The specific dynamic effect (SDE) is one of the categories of energy use in the normal daily routine of humans. Which one of the following statements is CORRECT?


  The SDE is typically 20% of total daily energy turnover.

  Relative to a typical mixed diet the SDE will be elevated by a high-fat diet.

  Relative to a typical mixed diet the SDE will be elevated by a high-carbohydrate diet.

  An alternative name for the SDE is postprandial thermogenesis.

  The energy expenditure of exercise has a component attributable to the SDE.

2

When humans become morbidly obese all of the following diseases increase in incidence. Indicate the one condition that has the highest elevation of incidence in the morbidly obese.


  Cancer.

  Stroke.

  Heart disease.

  Diabetes.

  Kidney failure.

3

Which one of the following observations about nutrition is consistent with currently available evidence?


  Human height shows little significant variation with nutritional status, but weight varies significantly.

  The dentition (teeth) of humans is supportive of adaptation to a mixed vegetable and meat diet.

  The structure of human intestines shows that meat was the major food of humans in evolutionary times.

  The healthiest primitive tribes of humans are those that have adopted vegetarian diets.

  Historically it is observed that great civilisations have only arisen when fat-rich foods are abundant.

4

Atwater measured the heat output from various categories of food. Which one of the following foods produces 37 kJ/gram in humans (as measured by Atwater)?


  Fat.

  Protein.

  Complex carbohydrate.

  Glucose.

  Alcohol.

5

With respect to the vitamin thiamin, which one of the following statements is INCORRECT?


  Thiamin has a role as a coenzyme in decarboxylations.

  Thiamin deficiency can lead to neurological problems during (and after) chronic starvation.

  Thiamin deficiency can lead to Beriberi.

  Thiamin deficiency can lead to elevated levels of serum protein (albumin) due to altered liver function.

  Vegemite is a good food source of thiamin.

6

Select the one CORRECT statement completion. Vitamin C is:


  a cofactor in collagen synthesis.

  a neurotransmitter.

  a promoter of calcium absorption.

  a pro-oxidant vitamin.

  relatively abundant in most meats.

7

Which one of the following statements relating to nitrogen metabolism is CORRECT?


  The major waste nitrogen product of human protein metabolism is uric acid.

  Pyruvate can accept nitrogen by direct transamination to become aspartate that enters the urea cycle.

  Hydrolysis of carbamoyl phosphate produces urea.

  Cachexia is a state of weight gain related to positive nitrogen balance.

  In the mitochondrion carbamoyl phosphate adds a carbon atom and a nitrogen atom (as H2N-CO-) to ornithine to make citrulline.

8

Identify the one CORRECT statement about alcoholic diseases and treatment.


  The condition of alcoholic hepatitis is a severe end-stage disease that follows after cirrhosis of the liver.

  The condition Wernicke-Korsakoff syndrome can be observed in many alcoholics and is often well treated by niacin supplements.

  Serum albumin levels decline significantly at an early stage of chronic heavy drinking.

  The serum enzyme gamma-glutamyltranspeptidase (GGT) is currently the pathology test of choice for specific recognition of alcohol induced liver damage.

  In male alcoholics, microsomal modification and destruction of steroids contribute to altered sex hormones levels leading to gynaecomastia.

9

Identify the one CORRECT statement about alcohol effects, pathology and treatment.


  Alcohol acts to elevate levels of ADH (vasopressin).

  Chronic high alcohol consumption typically leads to high adiposity. This follows from the fact that alcohol is metabolised to acetate and acetate is a precursor for fat synthesis.

  Fetal alcohol syndrome (FAS) is typically a transient problem for children born to alcoholic mothers and is well treated by good nutrition.

  Naltrexone is an aldehyde dehydrogenase inhibitor used to treat some alcoholics because aldehyde accumulation leads to tachycardia, flushing, dyspnoea and nausea.

  Disulfiram (antabuse) blocks alcohol-induced release of dopamine in the nucleus accumbens thereby diminishing the pleasurable effects of alcohol and reducing addiction.

10

Consider the metabolic interactions shown in the diagram below. Identify the one CORRECT statement. [PICTURE HERE]


  The total number of electrons moved through the pathway for one molecule of RH is two.

  The reductase and cytochrome P450 components are part of the same protein.

  The reaction is called a dioxygenase reaction because two oxygen atoms participate.

  Cytochrome P450 has a copper atom that participates in electron transfer.

  Liver and kidney both exhibit high activities of this class of reaction, relative to other tissues.

11

The drug metabolising factor designated as CYP 2D6 is inactive in 5-10% of Caucasians and 2% of Asians and Arabs. Affected individuals exhibit:


  An elevated pharmacological response to paracetamol.

  An elevated physiological response to alcohol.

  A poor analgesic response to codeine.

  A high toxicity response to the anticoagulant warfarin.

  An elevated cancer incidence (particularly lung cancer in smokers) attributed to impaired handling of carcinogens.

12

Select the one CORRECT completion of the following statement. Carnitine is sometimes used as a dietary supplement for athletes because:


  The phosphorylated form is an instant-energy storage molecule that is used for spurts of muscular activity.

  Carnitine stimulates glycogen synthetase and promotes carbohydrate (glycogen) loading.

  Carnitine inhibits fat deposition and promotes a leaner body composition.

  Carnitine is a factor in the rate limiting step of fatty acid oxidation, the transfer of fatty acyl groups from the cytosol to the mitochondrial matrix.

  Carnitine is a high energy fat-like compound that gives much the same energy as fat, but is not stored.

13

Folate is a vitamin. Choose the one CORRECT statement relating to the vitamin folate.


  Folate deficiency in pregnant women is significantly correlated with neural tube defects (spina bifida) in foetuses.

  In adults, folate deficiency can be manifested as pernicious anaemia and peripheral neuritis.

  Fish oils are rich sources of folate.

  In folic acid deficiency the skin may become very red and painful displaying a shiny, smooth surface.

  Folate deficiency can lead to haemorrhagic disease from compromised blood clotting.

14

One round of the Krebs (TCA) cycle (considered independently of other reactions) produces:


  Two (2) FADH2.

  Three (3) FADH2.

  One GTP (or one ATP in some variations).

  One carbon dioxide.

  Two (2) NADH.

15

Peter Mitchell formulated the idea that a proton motive force (expressed as free energy) drives ATP synthesis associated with oxidative phosphorylation. It is known that a pH gradient and an electrical gradient both form about the inner mitochondrial membrane and we know that:


  Both the pH gradient and electrical gradient contribute to the proton motive force.

  Only the pH gradient contributes to the proton motive force.

  The pH is lower in the mitochondrial matrix than in the external space.

  The pH gradient is created by the sequential action of respiratory complexes I, II and III.

  The pH gradient is created by the sequential action of respiratory complexes II, III and IV.

16

Pyruvate dehydrogenase is an enzyme:


  That catalyses the last of the ten steps in glycolysis.

  That acts as the link between glycolysis and the Krebs (TCA) cycle.

  That decarboxylates pyruvate to produce ethanol in anaerobic yeast metabolism.

  That creates lactate from pyruvate to support anaerobic glycolysis.

  That initiates gluconeogenesis from pyruvate.

17

Which one of the following statements about protein degradation is CORRECT?


  Muscle wasting due to protein degradation can be inhibited by the administration of cytokines.

  Endurance training causes muscle hypertrophy primarily by decreasing protein degradation.

  Most ubiquinated proteins are digested by the calcium dependent proteases called calpains.

  The attachment of ubiquitin to ubiquitin activating enzyme E1 requires biotin.

  In the ubiquitin system, proteins destined for degradation are tagged by the addition of ubiquitin to the epsilon amino group of a lysine residue.

18

Regarding the metabolism of nitrogen arising from protein degradation, which one of the following statements is CORRECT?


  Nitrogen is mainly transported in the blood as alanine and glutamine.

  Carbamoyl phosphate is made in cytosol then transported into mitochondria as part of the urea cycle.

  Alanine is converted in the liver to oxaloacetate by an aminotransferase.

  Urea is produced in the mitochondrial matrix.

  Aminotransferase reactions occur at the endoplasmic reticulum.

19

Regarding the role of ketone bodies in metabolism, which one of the following statements is CORRECT?


  Ketone bodies are synthesised in the brain.

  Acetoacetyl-CoA is a ketone body.

  Ketone bodies are produced from acetyl-CoA.

  Under normal fed conditions the brain derives about 1/3 of its energy from ketone bodies.

  The sole source of ketone body carbon is fatty acid oxidation.

20

Which one of the following statements about the antagonists of insulin is INCORRECT?


  Cortisol acts via the glucocorticoid receptor to produce changes in metabolism through changes in gene transcription.

  Glucagon action decreases gluconeogenesis in the liver.

  Adrenaline causes receptor-mediated activation of adenylate cyclase.

  Liver is the major target tissue for glucagon.

  Glucagon action leads to inactivation of glycogen synthase.

21

Regarding the lipids associated with lipoproteins, which one of the following statements is CORRECT?


  Phospholipids are transported in the core of lipoproteins.

  The polar head group of the lipid lecithin is ethanolamine.

  Cholesteryl esters taken in by liver cannot be converted to free cholesterol.

  The triacylglycerols at the core of lipoproteins contain mainly short-chain fatty acids of 14 or less carbons.

  Cholesteryl esters transported in lipoproteins are less polar than cholesterol.

22

Regarding the LDL receptor, which one of the following statements is CORRECT?


  The LDL receptor recognises the ligands apoB-100 and apoE.

  The LDL receptor has three structural domains.

  Following LDL receptor mediated endocytosis, apoB-100 is recycled.

  Synthesis of the LDL receptor is regulated in part by the intracellular concentration of triacylglycerols.

  The ligand binding domain of the LDL receptor is rich in basic amino acid residues.

23

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


  Creatine phosphate breakdown.

  Intramuscular ATP stores.

  Lactate oxidation.

  Anaerobic glycolysis of muscle glycogen.

  Circulating glucose.

24

As exercise intensity approaches maximal oxygen uptake, the predominant substrate for energy metabolism is:


  Muscle glycogen.

  Intramuscular triglyceride.

  Alanine.

  Plasma-derived free fatty acids.

  Blood glucose.

25

Which one of the following is not used in the classification of a muscle fibre into a particular fibre type (i.e. fast or slow, Type I, IIA or IIB etc)?


  Maximum speed of muscle fibre shortening.

  ATPase activity (rate of using ATP).

  Cross-sectional area of the muscle fibres.

  Fatigue characteristics.

  Oxidative capacity.

26

Which one of the following statements about smooth muscle structure and function is INCORRECT?


  Thick filaments are scarce relative to thin filaments.

  Smooth muscle generates less force per cross-sectional area than skeletal muscle.

  The cost of contraction (use of ATP) is less for smooth muscle than skeletal muscle.

  Smooth muscle cells may contract to a small percentage of their initial length.

  Maximum contraction velocity is lower in smooth than skeletal muscle.

27

Which one of the following statements comparing smooth and striated muscle is INCORRECT?


  Both muscle types possess actin- and myosin-containing filaments.

  In both muscle types actin and myosin interact transiently to form crossbridges.

  In smooth muscle calcium binding to calmodulin allows for activation of muscle contraction.

  In both muscle types phosphorylation of myosin light chains is essential for crossbridge cycling.

  In striated muscle calcium binding to troponin-C allows for activation of muscle contraction.

28

Which one of the following is an INCORRECT completion? Muscle fatigue may correlate with:


  Reduced creatine phosphate concentration

  Increased pH

  Increased lactate concentration

  Increased phosphate concentration

  Reduced ATP concentration

29

Which one of the following statements concerning skeletal muscle damage is INCORRECT?


  Lengthening (pliometric or eccentric) contractions are the most likely type of contraction to cause muscle damage.

  Muscle damage always decreases the maximum force output of the damaged muscle.

  Intramuscular calcium elevation following muscle damage may increase the extent of muscle damage.

  Elevated levels of muscle specific enzymes can be detected in the plasma following every incident of muscle damage.

  Muscle fatigue is reversible with rest.

30

Which one of the following statements about motor units in skeletal muscle is INCORRECT?


  Motor units contain a variable number of muscle fibres.

  A motor unit consists of a group of muscle fibres innervated by a single alphamotor neuron.

  A motor unit contains only muscle fibres of one muscle fibre type.

  In the activation of a muscle, recruitment of individual motor units is ordered according to the size of the muscle fibres.

  All skeletal muscles in humans contain more than one motor unit.

31

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:


  Coeliac artery.

  Superior mesenteric artery.

  Inferior mesenteric artery.

  Aorta below the level of the renal arteries.

  Portal vein.

32

A patient was stabbed in the left costovertebral angle (between the 12th rib and the 1st lumbar vertebra). The organ most likely penetrated is the:


  Spleen.

  Stomach.

  Liver.

  Pancreas.

  Left kidney.

33

A patient has obstructive jaundice due to a cancer in the head of the pancreas. The part of the biliary tract most likely compressed by the cancer at this site is the:


  Common hepatic duct.

  Cystic duct.

  Neck of the gallbladder.

  Proximal part of the bile duct.

  Distal part of the bile duct.

34

A patient presents with massive haemorrhage due to a peptic ulcer on the posterior wall of the body of the stomach. The vessel most likely eroded by this ulcer is the:


  Left renal artery.

  Superior mesenteric artery.

  Gastroduodenal artery.

  Splenic artery.

  Portal vein.

35

A vertical incision, through all layers of the anterior abdominal wall, just lateral to the margin of the rectus sheath and above the level of the arcuate line is contraindicated because:


  External oblique muscle fibres are cut.

  Rectus abdominis muscle fibres are cut.

  The nerve supply to rectus abdominis is endangered.

  The superior epigastric artery is endangered.

  The inferior epigastric artery is endangered.

36

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


  Hepatic sinusoidal endothelial cells contain fenestrae covered by a thin membrane.

  Hepatic sinusoidal endothelial cells contain clusters of fenestrae forming “sieve plates”.

  Hepatic sinusoidal endothelial cells are located on a boundary of the Space of Disse.

  Hepatic sinusoidal endothelial cells do not rest on a basement membrane.

  Hepatic sinusoidal endothelial cells promote hepatic stellate cell activation in response to injury.

37

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


  Kupffer cells have cytoplasmic extensions called filopodia.

  Kupffer cells phagocytose damaged erythrocytes.

  Kupffer cells may be found within portal tracts in alcoholic hepatitis.

  Kupffer cells crawl over the sinusoidal surface by active amoeboid movement.

  Kupffer cells release reactive oxygen species and prostaglandins when activated.

38

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


  Following hepatectomy, the hepatocytes are capable of replacing at least twice their mass by proliferation.

  Following extensive liver injury, regeneration results from stimulation of the division of hepatocyte stem cells.

  Hepatic regeneration results in increased numbers of binucleate hepatocytes.

  Hepatic regeneration results in liver cell pltaes more than one cell-thick.

  Under normal circumstances, most hepatocytes are in the G0 phase of the cell cycle.

39

Which one of the following statements concerning haemochromatosis is INCORRECT?


  Haemochromatosis may result in cardiomyopathy.

  Haemochromatosis is associated with an increased risk of diabetes.

  Haemochromatosis may be acquired as a result of haemolytic anaemia.

  Haemochromatosis is more likely to occur in females.

  Haemochromatosis is associated with an increased risk of hepatocellular carcinoma.

40

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


  Fulminant hepatitis is associated with increasing levels of bilirubin.

  Fulminant hepatitis is associated with a bleeding tendency.

  Fulminant hepatitis is associated with hepatomegaly.

  Fulminant hepatitis is associated with encephalopathy.

  Fulminant hepatitis is associated with hepatitis B virus.

41

Which one of the following statements concerning hepatic stellate cells is INCORRECT?


  Hepatic stellate cells give rise to a myofibroblast phenotype when activated.

  Hepatic stellate cells have a role in regulating sinusoidal blood flow.

  Hepatic stellate cells synthesise type 3 collagen.

  Hepatic stellate cells store vitamin A once activated by liver injury.

  Hepatic stellate cells up-regulate cell surface PDGF receptors when activated.

42

Which one of the following is an INCORRECT statement?


  The prevalence of obesity is rising throughout the world.

  Obesity is caused by an obesogenic environment super-imposed on a genetic predisposition.

  Leptin deficiency will lead to severe obesity.

  Most obese subjects have high leptin levels.

  A mutation in the leptin receptor is the most common genetic cause of severe obesity so far identified.

43

Which one of the following is NOT a clinical feature of anorexia nervosa?


  Lanugo hair.

  Menorrhagia (heavy periods).

  Bradycardia.

  Anaemia.

  Osteoporosis.

44

Which one of the following is NOT a feature of the metabolic syndrome?


  Obesity.

  Insulin resistance.

  Proteinuria.

  Hypertension.

  Dyslipidaemia.

45

Nephrotic kidney disease presents with which one of the following key symptoms?


  Anaemia.

  Oedema.

  Nystagmus.

  Jaundice.

  Fever.

46

There are multiple causes of insulin resistance. Select one of the following that is NOT considered to be a contributor to insulin resistance.


  Mutations in proteins involved in the action of insulin such as the insulin receptor.

  Excess free fatty acid availability.

  Excess glucose supply (glucose toxicity).

  Low levels of erythropoietin secondary to kidney failure.

  Excess production of Tumor Necrosis Factor alpha (TNFalpha).

47

Which one of the following statements regarding arachidonic acid metabolism is INCORRECT?


  Leukotriene B4 (LTB4) is a potent chemotactic agent that does not affect smooth muscle tone.

  An increase in the synthesis of prostaglandin E2 in the hypothalamus causes fever.

  Inhibition of cyclooxygenase 1 (COX 1) in the stomach, and therefore decreased synthesis of prostacyclin (PGI2) and PGE2, may lead to irritation and ulceration.

  Cyclooxygenase converts arachidonic acid to the unstable intermediate prostaglandin G2.

  After release from phospholipid stores arachidonic acid is metabolised to prostaglandins predominantly in the liver.

48

Select one statement about gastritis that is CORRECT.


  Gastritis is not associated with non steroidal anti-inflammatory drug use.

  Gastritis is not associated with tobacco smoking.

  Gastritis in the presence of Helicobacter pylori, often resolves following antibiotic therapy.

  Gastritis is not an outcome expected from the ingestion of corrosives.

  Gastritis may be associated with Helicobacter pylori, but the symptoms rarely respond to antibiotic therapy.

49

Select one statement about gastric ulcers that is CORRECT.


  Gastric ulcers are not associated with either chronic or acute inflammation.

  Gastric ulcers may be complicated by hemorrhage but are not complicated by perforation or penetration.

  Gastric ulcers are not complicated by hemorrhage.

  Gastric ulcers may be complicated by hemorrhage and perforation but not penetration.

  Gastric ulcers may result from impaired mucosal defence.

50

Select one statement about acute appendicitis that is CORRECT.


  Acute appendicitis is an uncommon reason for emergency operation.

  Acute appendicitis may be caused by blockage of the intestinal lumen.

  Acute appendicitis is not caused by compromise of the blood supply.

  Acute appendicitis does not result from blood borne infection.

  Acute appendicitis is not associated with the action of aerobic and anaerobic organisms.

51

With regard to enteric neurons which one of the following statements is INCORRECT?


  Enteric neurons form complete functional circuits in the walls of the small and large intestine.

  Enteric neurons control gut movement, secretion of water and electrolytes and blood flow.

  Enteric neurons are post-ganglionic parasympathetic neurons.

  Enteric neurons are deficient in Hirschprung's disease.

  Enteric neurons are innervated by sympathetic post-ganglionic neurons.

52

Which one of the following is NOT among the known enteric neurotransmitters?


  Acetylcholine.

  Nitric oxide.

  Vasoactive intestinal peptide.

  Tachykinins.

  Glutamate.

53

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


  Thickness of tissue.

  Density of tissue.

  Atomic number of absorbing atoms.

  The type of X-ray film.

  The use of intravascular contrast agents.

54

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


  The hepatic artery normally arises from the superior mesenteric artery.

  Contrast agents administered in a forearm vein will reach the hepatic artery after they reach the portal vein.

  The portal vein supplies about 25% of the volume of blood flow to the liver.

  There are two main hepatic veins that drain into the inferior vena cava.

  The portal vein receives blood from the spleen.

55

In regard to radiological imaging of the bile ducts which one of the following is NOT able to display normal bile ducts?


  Plain abdominal radiograph.

  CT scan.

  Ultrasound.

  Magnetic resonance imaging.

  Radioisotope imaging.

56

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


  Facultatively anaerobic Gram negative rods, e.g., Escherichia spp.

  Microaerophilic Gram negative curved rods, e.g., Helicobacter spp.

  Facultatively anaerobic Gram positive cocci, e.g., Enterococcus spp.

  Obligately anaerobic Gram negative rods, e.g., Bacteroides spp.

  Obligately anaerobic Gram positive rods, e.g., Clostridium spp.

57

Which one of the following enzymes is not elevated in liver damage?


  ALT (Alanine transaminase).

  AST (Asparatate transaminase).

  LD (Lactate dehydrogenase).

  GGT (gamma glutamyl transferase).

  CK (creatine kinase).

58

Identify the one condition that is LEAST LIKELY to be the cause of elevated serum ALP (alkaline phosphatase) levels.


  Alcoholism.

  Biliary obstruction.

  Viral hepatitis.

  Hepatic cirrhosis.

  Skeletal muscle disease.

59

Select the one statement about serum AST (aspartate transaminase) and ALT (alanine transaminase) levels that is INCORRECT.


  Serum AST may be higher than serum ALT in acute alcoholism.

  Serum AST may be higher than serum ALT in skeletal muscle disease.

  Serum AST may be higher than serum ALT in chronic viral hepatitis.

  Serum AST may be higher than serum ALT in haemolysis.

  Serum AST may be higher than serum ALT in paracetamol overdose.

60

Select the one statement about serum enzymes measured in pathology tests that is INCORRECT.


  Serum enzyme levels depend on the severity of organ damage.

  Serum enzymes levels depend on the extent of organ damage.

  Serum enzyme levels depend on the clearance rate of enzymes from the blood stream.

  Serum enzymes levels depend on the enzyme levels in the cell.

  Serum enzymes may not be measured correctly when the patient's blood lacks enzyme cofactors.

61

Select the one statement regarding the role of specific blood cells that is INCORRECT.


  Neutrophil granulocyte: role bacterial killing.

  Eosinophil granulocyte: role response to foreign tissue as in allergic reactions.

  Basophil granulocyte & mast cell: role production of inflammatory response.

  Monocyte and macrophage: role phagocytosis of microbes and damaged tissue.

  Platelet: role antibody production and other immune responses.

62

Given that the molecule diphosphoglycerate is also known as 1,2-bisphosphoglycerate, select the one statement about oxygen transport and red cells that is INCORRECT.


  Adult HbA1 = 2 alpha plus 2 beta globin molecules.

  Adult HbA2 is a minor component (about 2-3% ) = 2 alpha plus 2 delta globin molecules.

  Adult haemoglobin demonstrates greater binding of oxygen relative to the same amount of fetal haemoglobin.

  Red cell life span in the blood is normally about 120 days.

  Oxygen release is promoted by an increase in red cell diphosphoglycerate.

63

Select the one statement about thalassaemia that is INCORRECT.


  Thalassaemia is an inherited group of genetic defects that lead to defective synthesis of one or other of the globin chains.

  Thalassaemia results in an increased amount of haemoglobin per red cell.

  In thalassaemia red cells are smaller and more pale than normal.

  In thalassaemia red cells resemble size and appearance of red cells in iron deficiency.

  The geographic distribution of thalasaemia fits the past and present distribution of malaria.

64

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


  Partial agonists are less effective therapies than full agonists.

  Partial agonists must be given at higher doses than full agonists.

  Partial agonists elicit a smaller maximal effect than full agonists.

  Partial agonists occupy fewer receptors than full agonists.

  Partial agonists act more slowly than full agonists.

65

Which one of the following statements is CORRECT?


  Competitive antagonists do not bind to the same receptors as the agonists that they antagonise.

  Agonists are unable to mediate any effect in the presence of a competitive antagonist.

  Non-competitive antagonists have a lower therapeutic ratio than agonists.

  Weak partial agonists can also act as competitive antagonists.

  Competitive antagonists interfere with agonist signalling at a site distal to the receptor.

66

Which one 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?


  A competitive antagonist of the histamine H2 receptor.

  A competitive antagonist of the beta1-adrenoceptor.

  An agonist that mediates a decrease in contractile force by activating adenosine receptors.

  An inhibitor of the opening of cardiac L-type calcium channels.

  An inhibitor of the release of intracellular calcium stores.

67

The glomerulus consists of a tuft of capillaries within Bowman's capsule. The filtration barrier between the capillary lumen and Bowman's space includes which one of the following cell types?


  Parietal cells.

  Mesangial cells.

  Podocytes.

  Juxtaglomerular cells.

  Proximal tubule cells.

68

The tubule of each nephron runs through both the cortex and medulla before connecting to the collecting duct. Which one of the following segments of this system are confined to the medulla?


  Proximal tubule.

  Distal tubule.

  Loop of Henle.

  Macula densa.

  Collecting duct.

69

Regarding secretion of drugs by the kidney, which one of the following statements is INCORRECT?


  Active secretion of drugs occurs in the proximal tubule.

  Drugs may compete for transporter molecules.

  Drugs may be secreted against their concentration gradient.

  Only drugs that do not bind to plasma protein can be cleared by active tubular secretion.

  Secretion by the kidney may be important in limiting the effects of some drugs.

70

Which of the following statements related to liver metabolic functions is/are CORRECT? A) Fibrinogen is synthesised by the liver. B) The liver synthesises glucagon. C) Urea is synthesised by the liver. D) The liver synthesises glucose from fatty acid metabolic products (Acetyl Co A).


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

71

Which of the following statements related to abnormal liver function and bilirubin is/are CORRECT? A) The presence of unconjugated bilirubin in plasma helps to distinguish hepato cellular from obstructive jaundice. B) Failure of conjugation of bilirubin is the primary defect leading to jaundice in hepato cellular disease. C) Defective uptake of bilirubin by liver cells is the major reason for jaundice in premature babies. D) An early sign of hepato cellular disease is a dark urine.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

72

Which of the following statements related to acute jaundice and liver is/are CORRECT? A) In complete obstruction of the bile duct neurological symptoms develop rapidly. B) Transaminases in plasma are markedly elevated in obstructive jaundice. C) In hepato cellular jaundice bilirubin in plasma is principally unconjugated. D) Serum alkaline phosphatase is elevated in obstructive jaundice.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

73

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


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

74

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.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

75

Which of the following statements related to the glomerulus and glomerular filtration is/are CORRECT? 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.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

76

Which of the following statements related to the proximal tubule is/are CORRECT? A) Na+-K+-2Cl cotransport is important for Na+ reabsorption by the proximal tubule. B) Angiotensin II stimulates Na+-H+ cotransport in the proximal tubule. C) Renin directly stimulates Na+-H+ countertransport by the proximal tubule. D) Weak acids are actively reabsorbed by the proximal tubule.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

77

Which of the following statements related to the proximal tubule is/are CORRECT? A) Phosphate 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.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

78

Which of the following statements related to the collecting tubule or duct is/are CORRECT? A) Lumen PD (potential difference) of the collecting tubule is made more negative by aldosterone. B) HCO3 - in lumen of the collecting tubule increases H+ excretion by the kidney. C) The collecting tubule can dilute the urine. D) Low plasma pH causes increased K+ excretion.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

79

Which of the following statements related to the loop of Henle is/are CORRECT? A) ADH increases water permeability of the thick ascending limb of the loop of Henle Na+ concentration at end of the loop of Henle is about 100 mmol/l. B) K+ leaks back into the lumen of the thick ascending limb of the loop of Henle. C) Transport in the thick ascending limb of the loop of Henle depends upon primary chloride transport. D) Na+ K+ 2Cl- cotransport exists at the luminal membrane of the thick ascending limb of the loop of Henle.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

80

Which of the following statements related to JGA (juxtaglomerular apparatus) or the cortical diluting segment is/are CORRECT? A) Angiotensin II mediates TG (tubulo glomerular) feedback. B) Efferent arteriole is the main controller of TG (tubulo glomerular) feedback. C) Aldosterone increases transport in the macula densa cells. D) Efferent arteriole is more sensitive to circulating angiotensin II than the afferent arteriole.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

81

Which of the following statements related to the renin angiotensin aldosterone system is/are CORRECT? A) Increased angiotensin II will increase filtration fraction. B) A low blood pressure in the kidneys causes renin release. C) Angiotensin II increases salt appetite. D) Angiotensin II decreases thirst.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

82

Which of the following statements related to acid base is/are CORRECT? A) HCO3 - loss in the urine corrects metabolic alkalosis. B) Na+-H+ counter transport is important in the proximal tubule. C) H+ K+ ATPase causes H+ secretion in the collecting tubule. D) Na+-H+ counter transport is important in the collecting duct to secrete H+.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

83

Which of the following statements related to acid base is/are CORRECT? A) Proton (H+) secretion in the collecting tubule is increased by aldosterone. B) Proton (H+) excretion in the urine is increased by a high HCO3 - in the lumen of the collecting tubule. C) Proton (H+) secretion in the collecting tubule is increased by HCO3 - in the lumen. D) NH3 in the urine is the major excretory carrier of an acid load.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

84

Which of the following statements related to water balance and urine concentration 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.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

85

Which of the following statements related to calcium and phosphate is/are CORRECT? A) Plasma phosphate rises in proportion to a decrease in GFR. B) Plasma ionized calcium is decreased by acidosis. C) Parathyroid hormone decreases proximal tubule Na+ reabsorption. D) Parathyroid hormone causes increased urine Na+ excretion.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

86

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


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

87

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.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

88

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 Na+ of 125 mmols/l will be depleted of Na+.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

89

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.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

90

Which of the following statements related to gastrin is/are CORRECT? A) Gastrin increases stomach contractility. B) Gastrin secretion is stimulated by stomach distension. C) Gastrin increases gastro oesophagal sphincter tone. D) Gastrin effects on acid secretion are additive to that of acetyl choline.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

91

Which of the following statements related to acid secretion by the gastric gland is/are CORRECT? A) The effect on acid secretion of acetyl choline and gastrin is additive. B) The effect on acid secretion of histamine and gastrin is additive. C) The effect on acid secretion of acetyl choline and histamine is additive. D) Acid secretion is inhibited by sodium bicarbonate.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

92

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.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

93

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.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

94

Which of the following statements related to sodium and water absorption by the small intestine is/are CORRECT? A) Sodium absorption proceeds by Na+-amino acid cotransport. B) Sodium absorption proceeds by Na+-glucose countertransport. C) Sodium absorption proceeds by Na+-H+ countertransport. D) Sodium absorption proceeds by Na+-fructose cotransport.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

95

Which of the following statements related to liver metabolic functions is/are CORRECT? A) Globulins are synthesised by the liver. B) Fibrinogen synthesis by the liver depends upon Vitamin K. C) Clotting factor synthesis by the liver depends upon Vitamin D. D) Blood clotting factors are synthesised by the liver.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

96

Which of the following statements about volume of distribution is/are CORRECT? A) Drugs which are highly lipid soluble tend to have large volumes of distribution. 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 plasma volume. D) Volume of distribution may be one or two orders of magnitude greater than total body water.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

97

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


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

98

Which of the following statements regarding the behaviour of drugs following oral administration is/are CORRECT? A) The bioavailability of drugs following oral administration is affected by the extent to which they are absorbed. B) The bioavailability of drugs following oral administration is affected by the extent to which they undergo first pass hepatic metabolism. C) The peak concentration of drug in plasma will be lower following oral administration than for the same dose of drug administered by a bolus intravenous injection. D) Drugs administered orally usually distribute evenly throughout the body.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

99

Which of the following statements regarding the half life of drugs is/are CORRECT? A) The half life of a drug can be used to determine the frequency of dosing of a drug. B) Drugs with a long half life may require administration of a loading dose. C) The time taken to reach a steady state concentration of drug in plasma during a long term intravenous infusion is proportional to the half life of the drug. D) Kidney and renal disease often shorten the half life of a drug.


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.

100

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


  If only A, B and C are correct.

  If only A and C are correct.

  If only B and D are correct.

  If only D is correct.

  If all are correct.