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NDM Midsemester Exam 2005

1

Which ONE of the following statements regarding the deep (internal) inguinal ring is CORRECT?


  It is a deficiency in the external oblique aponeurosis.

  It is situated a fingers breadth below the inguinal ligament.

  It lies half-way between the ASIS and pubic symphysis.

  It transmits the spermatic cord in males.

  It is the entry point to the inguinal canal for both direct and indirect inguinal herniae.

2

Patients with acute appendicitis typically complain of vague, diffuse and colicky central abdominal pain prior to the pain becoming constant and localized in the right iliac fossa. The vague and diffuse nature of the initial (central abdominal) pain is because:


  the appendix and visceral peritoneum have a somatic sensory supply.

  the appendix and visceral peritoneum have a visceral sensory supply.

  the appendix and visceral peritoneum have both somatic and visceral sensory supply.

  the appendix and visceral peritoneum have no sensory supply.

  the appendix is not an intraperitoneal structure.

3

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


  blood glucose.

  intramuscular triglyceride.

  alanine.

  plasma-derived free fatty acids.

  muscle glycogen.

4

Wernicke’s Encephalopathy is a diet-related condition that can include which one of the following as a presenting symptom:


  A swollen magenta tongue.

  Bone deformation, typically knock-knees.

  Casal’s collar (a form of dermatitis).

  Diarrhoea.

  Nystagmus (uncoordinated eyes).

5

If a 70kg young woman has Basal Metabolic Rate (BMR) = 6.6 MJ per day and a same weight male has BMR = 7.9 MJ, a credible explanation is that:


  The male was doing more exercise than the female.

  The female was doing more exercise than the male.

  The male was working in a colder environment than the female.

  The female was working in a colder environment than the male.

  The female had a higher proportion of adipose tissue than the male.

6

Select the one CORRECT statement about diet and nutrition.


  As measured by an Atwater Chamber (calorimeter), alcohol is a relatively inefficient fuel in humans due to energy lost as exhaled or excreted alcohol.

  Carbohydrates are typically the most energy dense macro-nutrients.

  Proteins are typically the most energy dense macro-nutrients.

  Most fats in a typical Australian diet would enter the circulation as triacylglycerols (TAGs) in chylomicrons.

  Dieticians recommend foods of high glycaemic index to minimise the risk of diabetes.

7

Select the one CORRECT statement about fat release from adipose tissue.


  The released fat is packaged as chylomicrons.

  The released fat is typically carried attached to serum albumin.

  Insulin acts as a stimulus for release.

  Leptin acts as a stimulus for release.

  The fat that is released is in the form of triacylglycerols (TAGs).

8

Select the one CORRECT statement about the following reaction. [PICTURE HERE]


  It is the second reaction of glycolysis.

  The enzyme that catalyses the reaction is triose phosphate isomerase

  The enzyme that catalyses the reaction is fructose-1,6-bisphosphatase

  The six carbon sugar is glucose.

  One of the products is glyceraldehyde-3-phosphate

9

Select the one summary of glycolysis that is CORRECT (ignoring the participation of water and H+).


  glucose + NADH + ATP → NAD+ + 2pyruvate + ADP + Pi

  glucose + 2NADH + 2ATP → 2 NAD+ + 2pyruvate + 2ADP + 2Pi

  glucose + NAD+ + ADP + Pi → ATP + 2pyruvate + NADH

  glucose + 2NAD+ + 2ADP + 2Pi → 2ATP + 2pyruvate + 2NADH

  glucose + 2NAD+ + 4ADP + 4Pi → 4ATP + 2pyruvate + 2NADH

10

Select the one CORRECT statement about the F1Fo protein complex in mitochondrial membranes.


  The F1 component is oligomycin sensitive.

  The F1Fo complex normally passes H+ ions from the intermembrane space to the inside (matrix) of mitochondria.

  The F1Fo complex contains the enzyme succinate dehydrogenase that is a membrane bound component of the TCA (Krebs) cycle.

  Electrons passing through the F1Fo complex, initially from NADH, are passed on to cytochrome Q.

  The F1Fo complex passes electrons to oxygen and is also known as respiratory complex IV.

11

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


  There are two forms of cyclooxygenase, constitutive and inducible.

  Phospholipase is involved in the synthesis of prostaglandins but not leukotrienes.

  Lipoxygenase is involved in the synthesis of leukotriene B4 (LTB4) but not leukotriene C4 (LTC4).

  Cyclooxygenase is one enzyme involved the synthesis of leukotriene C4 (LTC4).

  Cyclooxygenase is involved in the synthesis of prostaglandins but not thromboxane.

12

Select the one CORRECT statement with respect to Type I diabetes.


  In animal models, the disease can be transferred to normal individuals by transfer of T cells.

  Migrants tend to retain the risk of their home country rather than adopt the risk for the region they move into.

  The twin concordance rate (to 35 years of age) is 10%, suggesting only a weak contribution by genetic factors.

  95% of patients have islet cell autoantibodies.

  Approx 50% of patients have associated autoimmune diseases (e.g. thyroiditis or myasthenia gravis).

13

Which one of the following is NOT a product of the Islets of Langerhans?


  Glucagon.

  PYY.

  Somatostatin.

  Amylin.

  Pancreatic polypeptide.

14

Which of the following statements is NOT CORRECT?


  Oxytocin inhibits food intake and influences maternal behaviour in animals.

  Melanocyte Stimulating Hormone (MSH) inhibits food intake and increases pigmentation of the skin.

  Glucagon-Like Peptide 1 (GLP-1) stimulates both insulin secretion and food intake.

  Orexin stimulates food intake and influences the wakeful state.

  Cholecystokinin (CCK) enhances satiety and stimulates gall bladder contraction.

15

Which one of the following statements is CORRECT?


  Adiponectin is a hormone made by fat cells that causes insulin resistance.

  Free fatty acids cause insulin resistance by inhibiting the expression of the insulin receptor.

  Tumor Necrosis factor alpha (TNFα) causes insulin resistance by inhibiting the function of the glucose transporter GLUT4.

  Activation of PKC theta by intracellular fat has been shown to be a mechanism of fatinduced insulin resistance.

  The beta chain of the insulin receptor is a serine/threonine kinase.

16

Urinalysis of a subject three weeks after the start of a hunger strike showed the presence of ketones (ketone bodies). Which of the following statements about the metabolism and function of the ketones bodies in this subject is NOT CORRECT?


  The synthesis of ketone bodies spares liver glycogen.

  The ketone bodies are synthesized in the liver.

  Beta hydroxybutyrate is formed by the reduction of acetoacetate.

  The ketone bodies are an important energy supply to the brain.

  The synthesis of ketone bodies regenerates the free CoA needed for continued oxidation of fatty acids.

17

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


  The binding of insulin to its receptor leads to autophosphorylation of the extracellular domains of the insulin receptor.

  Insulin enters the cell via a process of receptor-mediated endocytosis.

  Insulin causes down-regulation of pyruvate kinase.

  Insulin secretion after a meal increases the number of GLUT4 molecules on the plasma membranes of muscle cells.

  Insulin binding initiates a series of phosphorylations that lead to activation of GSK3.

18

Which of the following statements about protein as a source of energy is CORRECT?


  The rate of depletion of skeletal muscle protein, to support gluconeogenesis, remains at much the same level from day-1 to day-40 during starvation.

  Oxidative metabolism of branched chain amino acids provides the major source of energy for the kidney.

  The first step in the metabolism of amino acids involves removal of the alpha-amino group by aminotransferase enzymes.

  All amino acid carbon skeletons are able to undergo complete oxidation or conversion to glucose.

  Muscle protein degradation occurs most significantly in the lysosomal compartment of the cell.

19

Which one of the following statements about the metabolism of HDL is NOT CORRECT?


  HDL interacts with ABCA1 at cell membranes.

  The liver selectively takes up cholesteryl esters of HDL.

  The major apolipoprotein of HDL is apoAI.

  HDL is a heterogeneous group of particles, varying in size, lipid content and apolipoprotein composition.

  HDL is derived in the circulation from VLDL.

20

Which of the following statements about smooth muscle structure and function is NOT CORRECT?


  Thick filaments are scarce relative to thin filaments

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

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

  Smooth muscle generates similar force per cross-sectional area to skeletal muscle

  Maximum contraction velocity is of comparable magnitude in smooth and skeletal muscle

21

Which is NOT CORRECT of the enteric nervous system?


  The enteric nervous system forms complete functional neuronal circuits in the walls of the small and large intestine.

  The enteric nervous system plays an essential role in whole body fluid and electrolyte homeostasis.

  You could survive without an enteric nervous system.

  Major enteric neurotransmitters include acetylcholine, nitric oxide and vasoactive intestinal peptide

  The enteric nervous system is innervated by sympathetic post-ganglionic neurons.

22

Which of the following statements related to gastrin is/are CORRECT? A) Gastrin acts on oxyntic (parietal) cell to increase H+ secretion. B) Gastrin receptors are present on the oxyntic (parietal) cell. C) Gastrin decreases tone of gastro oesophagal sphincter. D) Gastrin receptors are present on the gastric gland endocrine cell.


  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.

23

Which of the following statements related to acid secretion by the gastric gland is/are CORRECT? A) Acid secretion is increased by gastric mucosa breakdown. B) Acid secretion is mainly controlled by the gastric gland endocrine cell. C) Acid secretion is increased by gastrin. D) The effect on acid secretion of acetyl choline and histamine 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.

24

Which of the following statements related to digestion of food is/are CORRECT? A) Carboxypeptidase is an exopeptidase. B) Pepsinogen is activated by a low pH. C) Pepsin is an endopeptidase. D) Trypsinogen is activated by a high pH.


  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.

25

Which of the following statements related to sodium and water absorption by the small intestine is/are CORRECT? A) A high pH stimulates sodium and water absorption. B) Sodium absorption is decreased by increased levels of cyclic GMP. C) Sodium absorption proceeds by Na+-H+ countertransport. D) Cholera toxin increases cyclic AMP in intestinal 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.