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:


  Lack of Vitamin D.

  Excess parathyroid hormone.

  Low plasma calcium.

  High plasma phosphate.

  Low calcitonin levels.

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?


  Iron deficiency.

  Bone marrow hypoplasia.

  Poor protein metabolism.

  Shortened half life of red cells.

  Low erythropoietin.

3

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


  Sodium retention associated with his renal failure.

  Increased angiotensin II due to excess renin secretion.

  A high level of aldosterone.

  Essential hypertension.

  An increased cardiac output.

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?


  Serum creatinine.

  Serum urea.

  Urinary concentrating ability.

  Urinary diluting ability.

  Plasma aldosterone levels.

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:


  Decreased muscle glycogen.

  Increased muscle lactate.

  Accumulation of phosphate.

  Decreased creatine phosphate.

  Reduced SR (sarcoplasmic reticulum) calcium release.

6

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


  Free fatty acids.

  Blood-borne glucose.

  Muscle glycogen.

  Amino acids.

  Lactate.

7

Select the one CORRECT statement about nitrogen homeostatis.


  Negative nitrogen balance occurs during recovery from trauma such as surgery.

  The kidney is the major site of synthesis of the urea produced by the body.

  Amino groups from the breakdown of muscle protein eventually return to the liver as alanine.

  Protein is the body’s storage form of nitrogen.

  The enzyme carbamoyl phosphate synthetase is located in the cytosol.

8

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


  The synthesis of the five enzymes required to synthesise urea is increased as a result of a very high protein diet.

  People with an arginase deficiency are unable to handle high protein diets.

  Urea cycle defects can be partially managed by treatment with benzoate or phenylacetate which bind amino acids to form nitrogenous compounds that are excreted in urine.

  The reaction catalysed by argininosuccinate lyase takes place in the cytosol.

  The excretion of one molecule of urea results in the net removal of one NH4+ from the body.

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?


  Maintenance of blood glucose levels is the highest priority.

  Preservation of protein is important because loss of protein means loss of protein function.

  The degradation of skeletal muscle protein as a source of energy increases gradually throughout a period of starvation to reach a peak at 10 days and remain constant thereafter.

  The brain adapts to the use of ketone bodies after about three days of starvation.

  Ketone bodies are a source of fuel for skeletal muscle, heart and kidney.

10

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


  The stresses listed cause increased secretion of cortisol, glucagon and adrenaline.

  Negative nitrogen balance in injured or infected patients is mediated by cytokines from monocytes and lymphocytes.

  One cyokine, TNF-a, increases the lipolysis of triacylglycerols and increases the resistance of peripheral tissues to insulin action.

  The stresses listed cause the levels of blood glucose and fatty acids to decrease.

  The stresses listed cause muscle protein synthesis to decrease and muscle protein degradation to increase.

11

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


  Insulin binding to the insulin receptor causes autophosphorylation of tyrosine residues in the carboxy terminal domain of the ß subunit of the receptor.

  GLUT2, present in the liver and pancreatic ß cells, transports glucose into these tissues at a near constant rate over the range of normal glucose concentrations.

  The tyrosine kinase of the insulin receptor initiates a series of phosphorylations in the cell, producing effects that include changes in nuclear gene transcription and inhibition of glycogen synthase kinase 3 (GSK3).

  The number of GLUT4 molecules at the membrane of cells in muscle and adipose tissue is greatly increased by the actions of insulin.

  GLUT4 is recycled intact between the plasma membrane and intracellular membranes.

12

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


  Polar phospholipids are freely soluble in water.

  Olive oil is liquid at 25°C whereas animal fat is solid because olive oil contains a higher proportion of cis-unsaturated fatty acids and animal fat contains a higher proportion of saturated fatty acids.

  Due to their free carboxyl groups, cholesteryl esters are more hydrophilic than cholesterol.

  The steroid nucleus of cholesterol consists of four six-membered rings.

  The carbon backbone of phospholipids is dihydroxyacetone.

13

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


  Familial combined hyperlipidemia is caused by the overproduction of hepatic apolipoprotein E associated with VLDL.

  Secondary causes of hypertriglyceridemia include obesity, diabetes and medications.

  Chylomicronemia may be caused by a lack of lipoprotein lipase or apolipoprotein CII.

  Insulin resistance due to diabetes increases the production of triacylglycerols and also decreases the rate at which they are cleared from the circulation.

  Hypertriglyceridemia is often associated with low HDL cholesterol, insulin resistance and the elevation in blood of atherogenic triacylglyceride-rich lipoprotein remnants.

14

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


  PYY 3-36.

  Melanin Concentrating Hormone (MCH).

  Leptin.

  CCK.

  Ghrelin.

15

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


  Hypothyroidism.

  Corticosteroid excess.

  Craniopharyngioma.

  Prader Willi syndrome.

  Uncontrolled type 1 diabetes.

16

Which one of the following does NOT cause insulin resistance?


  TNFa.

  Adiponectin.

  Resistin.

  Free fatty acids.

  Hyperglycaemia.

17

Which one of the following statements is NOT CORRECT?


  In type 1 diabetes the beta cells of the pancreas are destroyed by the immune system.

  Chronic hyperglycaemia is both a cause and a consequence of insulin resistance.

  In type 2 diabetes, the beta cells of the pancrease are blind to glucose stimulation but respond to arginine.

  Adiponectin is a large protein secreted by fat cells that has been shown to cause insulin resistance.

  Free fatty acids stimulate hepatic gluconeogenesis.

18

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


  Superior mesenteric artery occlusion endangers the jejunum.

  Superior mesenteric artery occlusion endangers the ileum.

  Superior mesenteric artery occlusion endangers the 1st part of the duodenum.

  Superior mesenteric artery occlusion endangers the midgut.

  Superior mesenteric artery occlusion endangers the ascending colon.

19

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


  A penetrating injury in the right loin endangers the right kidney.

  A penetrating injury in the right loin endangers the right ureter.

  A penetrating injury in the right loin endangers the right suprarenal gland.

  A penetrating injury in the right loin endangers the liver.

  A penetrating injury in the right loin endangers the caecum.

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?


  Erosion from a peptic ulcer on the posterior wall of the body of the stomach particularly endangers peritoneum.

  Erosion from a peptic ulcer on the posterior wall of the body of the stomach particularly endangers the lesser sac of the peritoneal cavity.

  Erosion from a peptic ulcer on the posterior wall of the body of the stomach particularly endangers the pancreas.

  Erosion from a peptic ulcer on the posterior wall of the body of the stomach particularly endangers the splenic vein.

  Erosion from a peptic ulcer on the posterior wall of the body of the stomach particularly endangers the splenic artery.

21

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


  The portal vein drains blood from the hindgut.

  The portal vein drains blood from the spleen.

  The portal vein drains blood from the lower end of the oesophagus.

  The portal vein drains blood from the caecum.

  The portal vein drains blood from the right kidney.

22

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


  The gallbladder is partly covered by peritoneum.

  The gallbladder fundus lies adjacent to the caudate lobe of the liver.

  The gallbladder fundus lies adjacent to the right 9th costal cartilage.

  The gallbladder fundus lies adjacent to the transverse colon.

  The gallbladder is supplied by a branch derived from the coeliac artery.

23

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


  The left kidney is partly covered by peritoneum.

  The left kidney lies adjacent to the left quadratus lumborum muscle.

  The left kidney lies adjacent to the splenic flexure of the colon.

  The left kidney lies adjacent to the head of the pancreas.

  The left kidney lies adjacent to the stomach.

24

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.

25

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


  Commensal bacteria commonly causes infections when they gain access to extra-intestinal tissues.

  An intact gastrointestinal microbiota can enhance protection from infection with exogenous pathogens.

  Treatment with antibiotics and immunosuppressive drugs increases susceptibility to infection with Clostridium difficile.

  Intestinal bacteria possess hydrolytic, dehydroxylating and reducing activities which can influence the absorption of certain drugs and hormones from the intestine.

  The ingestion of large numbers of probiotic bacteria, such as lactobacilli, can radically alter the composition of the intestinal microbiota of healthy people.

26

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


  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 relaxed length.

  Maximum contraction velocity is lower in smooth than skeletal muscle.

27

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


  Reduced creatine phosphate concentration.

  Increased pH.

  Increased lactate concentration.

  Increased phosphate concentration.

  Reduced ATP concentration.

28

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


  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 sufficient inactivity (rest).

29

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


  The renal corpuscle includes the glomerulus surrounded by Bowman’s capsule.

  The filtration barrier in the renal corpuscle includes a thickened basal lamina and the slit membrane spanning the space between the podocyte processes.

  The afferent and efferent arterioles have modified smooth muscles in their wall that can release the enzyme renin in the blood.

  Mesangial cells are found between the capillaries at the base of the glomerulus.

  Parietal epithelial cells play a crucial role in modifying the ultrafiltrate formed in Bowman’s space.

30

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


  Magnetic resonance imaging cannot display the bile ducts without the use of intravascular contrast agents.

  Ultrasound, computed tomography and magnetic resonance imaging can all display images of blood vessels in the liver.

  The direction of blood flow cannot be determined with ultrasound.

  Cholangiography refers to the imaging display of small hepatic arteries.

  Ionizing radiation is used in magnetic resonance imaging.

31

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


  The renal pelvis is the expanded head of the ureter.

  A histological section through the medulla would be expected to include collecting ducts, loops of Henle, blood vessels of the vasa recta and juxtamedullary renal corpuscles.

  The blood vessels of the vasa recta arise from the efferent arteriole.

  Arcuate veins will be present at the boundary between the medulla and the cortex.

  Renal arteries, veins and the ureter all enter the kidney at the hilum.

32

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


  A young child has a greater BMR than an adult.

  On average women have a lower BMR than men.

  In an individual the BMR declines as the proportion of weight in fat increases.

  BMR is independent of body shape.

  BMR is greater in a person undergoing stress.

33

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


  Simple sugars.

  Plant proteins.

  Complex carbohydrates.

  Animal proteins.

  Olive oil.

34

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


  Vitamin D.

  Vitamin K.

  Vitamin C.

  Vitamin A.

  Riboflavin.

35

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


  When calcium levels in the blood are low there is an increase in bone demineralization.

  When calcium levels in the blood are low there is increased absorption of calcium from the intestine.

  When calcium levels in the blood are high there is increased secretion of calcium through the kidney.

  Cellular levels of calcium are regulated because it is important in the control of cell function.

  Calcium levels in the blood are controlled through the action of the vitamin, biotin.

36

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


  Inhibition of the mitochondrial ATP synthase.

  Asphyxiation.

  Uncontrolled type 1 diabetes.

  Anaerobic exercise.

  Inhibition of the pyruvate dehydrogenase (PDH) complex.

37

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


  Ketone body levels in the blood are elevated relative to the fasted state.

  Glucagon levels in the blood are elevated relative to the fasted state.

  Triacylglycerol levels in the blood are low relative to the fasted state.

  Fatty acid levels in the blood are elevated relative to the fasted state.

  Acetyl-CoA carboxylase activity is elevated.

38

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


  Increased activity of glycogen phosphorylase in the muscle.

  Decreased levels of the glucose transporter, GLUT4, in the muscle.

  Decreased insulin to glucagon ratio.

  Hormone sensitive lipase hydrolysis of triacylglycerol to fatty acids and glycerol.

  Increased protein breakdown in the liver.

39

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


  Partial agonists have lower affinity than full agonists.

  Partial agonists occupy fewer receptors than full agonists.

  Partial agonists activate receptors less well than full agonists.

  Partial agonists act as antagonists.

  All of the above are true.

40

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


  Reduced synthesis of beta adrenoceptors.

  Internalisation of beta adrenoceptors.

  Reduced affinity of beta adrenoceptors for agonists.

  Reduced potency of the full agonist isoprenaline.

  Reduced responses to the partial agonist prenalterol.

41

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


  High therapeutic ratio.

  High selectivity.

  Low maximal effect.

  Low affinity.

  Different mechanisms of the primary therapeutic and toxic effects.

42

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


  The agonist.

  The same site as the agonist.

  Receptors different to those bound by the agonist.

  Transduction proteins downstream of the receptor activated by the agonist.

  All of the above.

43

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


  The most common reaction of cytochrome P450 uses molecular oxygen to produce an hydroxylated product of an alkyl substrate plus hydrogen peroxide.

  Cytochrome P450 reductase is a separate accessory activity, sequentially passing two electrons to cytochrome P450 during the normal cycle of a cytochrome P450 reaction.

  Forms of cytochrome P450 can be found both in endoplasmic reticulum and mitochondria.

  Human cytochrome P450 forms are known to have over 300 variants.

  All cytochrome P450 molecules have a haem prosthetic group anchored (liganded) by a cysteine group.

44

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


  It is a disease leading to a form of anaemia that can be protective against malaria.

  It is classified as a protein-energy malnutrition syndrome.

  Liver is affected in the disease and consequent underproduction of serum albumin causes a pot-belly appearance.

  The intake of aflatoxins from fungi, growing on food, contributes to the severity of the disease.

  The incidence of hepatocellular carcinoma is elevated among Kwashiorkor sufferers.

45

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


  Ethanol is produced by the action of the microbial enzyme pyruvate decarboxylase.

  Ethanol has at least three distinct metabolic routes in humans to form acetaldehyde.

  The Microsomal Ethanol Oxidising System (MEOS) predominantly involves an activity abbreviated CYP 1A1.

  Long term ingestion of alcohol leads to proliferation of endoplasmic reticulum in liver.

  The action of alcohol dehydrogenase on ethanol normally produces NADH.

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:


  Circulating liporotein complexes.

  Inclusions within mitochondria.

  Inclusions within nuclei.

  Intracellular digestive vesicles (additional to lysosomes and peroxisomes).

  Endoplasmic reticulum.

47

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


  Drugs that are weak acids are more likely to be excreted when the urine is basic.

  Regulating urine pH can increase the elimination of some drugs.

  Drugs must be actively secreted into the tubule from the blood in order to be eliminated.

  For drugs that are reabsorbed by the kidney, renal elimination of the drug is proportional to urine flow.

  Protein bound drugs may be secreted into the proximal tubules.

48

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


  Probenecid prolongs the action of penicillin by preventing its glomerular filtration.

  Drugs bound to plasma protein do not readily undergo glomerular filtration.

  Lipid soluble drugs tend to undergo tubular reabsorption.

  Glomerular filtration is a process that removes some drugs from the blood.

  If the renal clearance of a drug exceeds the glomerular filtration rate, the drug is likely to be secreted by the kidney.

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).


  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.

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.


  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.

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.


  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.

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.


  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.

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.


  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.

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.


  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.

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.


  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.

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.


  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.

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.


  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.

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.


  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.

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.


  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.

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.


  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.

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.


  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.

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.


  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.

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.


  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.

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.


  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.

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+.


  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.

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.


  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.

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.


  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.