NDM MCQ Final 2006

1

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


  Lipoxygenase converts arachidonic acid to the unstable prostaglandin G2 (PGG2).

  A decrease in the synthesis of prostaglandin E2 in the hypothalamus causes fever.

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

  Cyclooxygenase mediates the release of arachidonic acid from phospholipid stores in cell membranes.

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

2

Which one of the following statements about metabolic changes during an overnight fast is CORRECT?


  The production of fatty acids in the liver increases.

  Insulin causes activation of glycogen synthesis.

  The liver uses glycogen for release to the circulation as glucose.

  The rate of gluconeogenesis from pyruvate decreases.

  Glucagon inhibits glycogen breakdown.

3

Which one of the following statements about the structure and secretion of insulin is CORRECT?


  The signal peptide of preproinsulin directs the polypeptide to secretory vesicles.

  The A and B chains of mature insulin are joined by three disulphide bonds.

  The C peptide is removed from proinsulin by a single protease.

  Preproinsulin is the storage form of insulin.

  Secretion of insulin requires reduction of one disulphide bond.

4

Which one of the following statements about turnover (ie synthesis and breakdown) of muscle protein is CORRECT?


  Skeletal muscle lacks branched chain amino acid dehydrogenase.

  Cortisol release from the adrenal cortex causes increased protein synthesis.

  The levels of individual free amino acids in skeletal muscle reflect the corresponding levels in plasma.

  Most muscle protein is degraded by the 26S proteasome.

  Ubiquitination directs muscle proteins to the lysosomal pathway of degradation.

5

Which one of the following statements about the role of the liver in metabolism is CORRECT?


  Liver responds to insulin by converting fatty acids to glucose.

  Liver is the site of LDL synthesis.

  Liver maintains a constant rate of gluconeogenesis over the starved-fed cycle.

  Liver produces glucose from muscle-derived alanine.

  After the kidney, the liver is the second major site of gluconeogenesis.

6

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


  Most of the cholesteryl esters in plasma are transported in VLDL particles.

  Cholesteryl ester transfer protein catalyses the exchange of HDL triacylglycerol for cholesteryl ester from LDL and IDL.

  Free cholesterol is present in the core of lipoprotein particles.

  High intracellular concentrations of cholesterol up-regulate synthesis of the LDL receptor (LDLR).

  Hydroxymethylglutaryl-CoA reductase catalyses the rate-limiting step in cholesterol synthesis.

7

Which one of the following statements about lipid metabolism and lipoproteins is CORRECT?


  Cells take up LDL by receptor mediated endocytosis.

  Dietary cholesterol and triacylglycerols are transported to the liver by VLDL.

  The major apolipoprotein of HDL is apoE.

  Mutations to lipoprotein lipase are associated with decreased levels of plasma triacylglycerols.

  Cholesterol is catabolised by cholesterolase in the liver.

8

Which one of the following statements about the maintenance of blood glucose concentration is CORRECT?


  Glycerol is an important substrate for gluconeogenesis in adipose tissue.

  The major target of glucagon is skeletal muscle.

  Glucagon activates glycogen phosphorylase to increase blood glucose during a period of fasting.

  After prolonged starvation, the brain adapts to using fatty acids.

  The kidney is the most important organ in regulating blood glucose.

9

Which one of the following statements about the role and metabolism of proteins is CORRECT?


  Skeletal muscle protein is the most important source of energy in prolonged fasting.

  Dietary protein is the source of all free amino acids in plasma.

  The urea cycle removes excess nitrogen from the body.

  IGF-1 released from the liver promotes the degradation of skeletal muscle.

  Amino acids that can be converted to oxaloacetate are described as ketogenic.

10

Which one of the following is the major fuel for contracting skeletal muscle during exercise at approximately 75% of maximal aerobic capacity?


  Creatine phosphate.

  Intramuscular triglyceride.

  Lactate.

  Muscle glycogen.

  Plasma free fatty acids.

11

Visceral obesity is associated with an increased risk of metabolic disease. Which one of the following is an important intramuscular characteristic that is related to a lower accumulation of visceral fat?


  Lower muscle glycogen levels.

  Increased activity of ß-oxidative enzymes.

  Reduced GLUT4 expression.

  Reduced mitochondrial density.

  Depressed CPT1 activity.

12

With respect to insulin secretion, which one of the following statements is CORRECT?


  Glucose is the only nutrient that stimulates insulin secretion.

  All major nutrients (glucose, free fatty acids, amino acids) can stimulate insulin secretion.

  A fall in ATP/ADP ratio is the trigger for insulin secretion.

  Glycolysis is not involved in glucose-mediated insulin secretion.

  The glucose transporter GLUT 1 is the predominant glucose transporter in ß cells.

13

With respect to the aetiology of type 2 diabetes, which one of the following statements is NOT CORRECT?


  Impaired glucose-mediated insulin secretion is one of the abnormalities that must be present.

  Insulin resistance has been documented in all three insulin responsive tissues, liver, muscle and fat.

  Most insulin resistance is of genetic origin.

  Excess glucose can cause insulin resistance

  Excess fat can cause insulin resistance.

14

Which one of the following is NOT a method of gradation of skeletal muscle contraction?


  Twitch summation.

  Motor unit recruitment.

  Stimulating various portions of each motor unit.

  Varying the number of motor units stimulated.

  Varying the frequency at which a motor unit is stimulated.

15

With respect to segmented neutrophil granulocytes which one of the following is CORRECT?


  They undergo cell division in response to infection.

  They have a lifespan in the circulation of 7 to 10 days

  The role they play is most specifically related to allergic responses.

  They are in the cell lineage of the main type of cell that produces antibodies.

  They are normally the predominant white cell in the blood.

16

With respect to beta thalassaemia minor which one of the following is CORRECT?


  Progeny of affected subjects can be born without thalassaemia.

  There is a reduced Haemoglobin A2 percentage in red cells.

  The mean red blood volume normalises with iron medication.

  The diagnosis is excluded by demonstration of subnormal iron stores.

  The primary abnormality is deficient haem synthesis.

17

The triad of subnormal serum iron, low normal serum transferrin, and high normal serum ferritin best correlates with:


  Low dietary iron content.

  High dietary iron content.

  Inflammation.

  Liver damage from iron overload.

  Mild blood loss.

18

The posterior wall of the inguinal canal is formed throughout by the


  External oblique muscle.

  Internal oblique muscle.

  Transversus abdominus muscle.

  Conjoint tendon.

  Fascia transversalis.

19

The arterial supply to the stomach is derived from the


  Superior mesenteric artery.

  Inferior mesenteric artery.

  Coeliac trunk.

  Marginal artery.

  Superior rectal artery.

20

The hilum of the spleen is directly related to the


  Left kidney.

  Stomach.

  Diaphragm.

  Tail of the pancreas.

  Duodenal-jejeunal flexure.

21

The accessory pancreatic duct drains into


  The main pancreatic duct.

  The second part of the duodenum proximal to the ampulla of Vater.

  The second part of the duodenum distal to the ampulla of Vater.

  The duodenal-jejeunal flexure.

  None of the above.

22

Below the arcuate line the posterior rectus sheath is


  Formed by the aponeuroses of external oblique and internal oblique muscle.

  Formed by the aponeuroses of internal oblique and transversus abdominus muscle.

  Formed only by the aponeurosis of transversus abdominus muscle.

  Formed by all of the aponeuroses of the muscles of the anterior abdominal wall.

  Not present.

23

In portal hypertension alternative venous drainage is provided via sites of portosystemic anastomosis including the


  Stomach.

  Duodenum.

  Porta hepatic.

  Anterior abdominal wall.

  Sigmoid colon.

24

Which one of the following is an anabolic pathway in metabolism?


  Glucose conversion to pyruvate.

  Acetyl-CoA conversion to palmitate.

  Alanine transamination to pyruvate.

  Citrate transport from mitochondria to cytosol followed by conversion to acetyl- CoA and oxaloacetic acid.

  Pyruvate conversion to lactate during the Cori Cycle.

25

Identify the one CORRECT statement.


  The first Law of Thermodynamics is not applicable to living systems.

  The average energy consumed by Australian adults is about 20MJ per day.

  The Carbon Cycle and the Krebs Cycle are different names for the same events.

  Resting humans radiate about 250 Watts.

  The change in free energy for glucose oxidation is the same whether it occurs in human metabolism or in a bomb calorimeter.

26

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


  Glycogen is captive in the liver and only available for liver metabolism.

  Glycogen is physically located in granules that form as a consequence of the water-insoluble nature of glycogen.

  Glycogen can polymerise to a limit size of approximately 100 glucose units.

  Glycogen has a branched helical molecular structure.

  Glycogen breaks down to glucose-6-phosphate via the intermediate formation of UDP-glucose.

27

The obese mouse achieves normal weight in the experiment illustrated below. Although a number of the following statements may be correct, indicate the one that is supported by the evidence of the experiment. [PICTURE HERE]


  The obese gene is dominant to normal wild type.

  Leptin always suppresses hunger.

  Leptin is a peptide hormone.

  Leptin is made by adipose tissue.

  Normal weight can be achieved by obese (Ob/Ob) mice when provided with leptin.

28

Which one of the following statements is CORRECT with respect to this structure? [PICTURE HERE]


  Well cooked foods with polymers of this structure can have a glycaemic index close to or equal to 100.

  Even well cooked polymers of this structure will have a glycaemic index close to or equal to zero.

  Digestion of these polysaccharides begins in the mouth by the action of salivary amylase.

  The pancreas produces ß-amylase to digest such polymers.

  The pancreas produces a-amylase to digest such polymers.

29

Which one of the following statements is CORRECT with respect to fat digestion?


  Bile secretion is not relevant to fat digestion.

  Triacylglycerols are absorbed intact into gut mucosal cells and packaged into chylomicrons.

  Triacylglycerols are absorbed intact into gut mucosal cells and packaged into VLDL lipoproteins.

  Dietary triacylglycerols are absorbed into intestinal mucosal cells only after breakdown to free fatty acids and monoacylglycerols.

  Fat digestion commences in the stomach due to non-enzymic acid catalysed hydrolysis (the same process used for centuries to make soap from animal fats).

30

Which one of the following statements is CORRECT with respect to nutritional diseases due to lack of vitamins?


  Wernicke-Korsakoff syndrome in alcoholics is attributed to niacin deficiency.

  Scurvy is a vitamin-A deficiency disease.

  Osteomalacia and rickets are riboflavin deficiency diseases.

  Beriberi is a vitamin-D deficiency disease.

  Pellagra is a niacin deficiency disease.

31

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


  Succinate dehydrogenase is part of respiratory complex II located in mitochondrial membranes.

  The reaction occurs before succinyl-CoA synthesis in the conventional direction of the TCA cycle.

  The reaction has malate as the product.

  The forward reaction is highly unfavourable due to formation of the high energy compound FADH2.

  The reaction also produces GTP (not included above).

32

Which one of the following statements describing events in oxidative phosphorylation is CORRECT?


  The transfer of electrons from NADH to O2 involves passage through four separate respiratory complexes.

  The respiratory chain can pump 10 H+ across the inner mitochondrial membrane when one NADH is oxidised.

  The reduction of NAD+ to NADH involves the transfer of one electron.

  Only two separate respiratory complexes are involved as electrons flow from FADH2 to oxygen.

  Complex II is the only respiratory complex with copper as an electron carrier.

33

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


  CYP 2E1 is also known as aromatase and modifies steroid hormones.

  CYP 2E1 is active in the microsomal ethanol oxidising system.

  CYP 2E1 has codeine as a substrate and poor metabolisers of codeine lack this activity.

  CYP 2E1 is induced to high levels by the direct action of dioxin on liver DNA.

  CYP 2E1 is commonly the first to act when a novel toxin is encountered due to continuous high activity and the widest substrate affinity of all P450 types.

34

Which one of the following statements about triacyglycerols (TAGs) is CORRECT?


  TAGs are stored as a single oily droplet in individual adipose cells.

  On a dry weight for weight basis, the oxidation of TAGs provides about four times as much energy as the oxidation of carbohydrates.

  Most frequently TAGs contain only one type of fatty acid.

  TAGs are made only by animals, not plants.

  TAGs are soluble in water.

35

Select the one CORRECT statement about dietary protein.


  Dietary protein will be preferentially used for energy, not structural purposes, when total dietary energy is below daily needs.

  100 grams of a typical dietary protein contains 26 grams of nitrogen.

  The most significant nitrogen rich excretion product in humans is uric acid.

  Based on Australian recommended intake a typical 70kg male would be expected to remain in nitrogen balance on a daily diet with 35 grams of good quality protein.

  Corn protein is among the most nutritious of proteins from plant sources as judged by Net Protein Utilization (a value that gives an index of nutritional value).

36

Select the one cluster of symptoms that suggests a primary cause other than excessive alcohol consumption.


  Neurological disturbance, jaundice and altered breath.

  Eosphageal varices, male feminisation and liver pathology.

  Portal hypertension, ascites and hand tremor.

  Hypogonadism, muscle wasting and oedema.

  Dementia, diarrhoea and dermatitis.

37

Select the one CORRECT statement with respect to type 1 diabetes.


  In type 1 diabetes, plasma levels of C peptide are raised.

  In most cases, the onset of type 1 diabetes occurs after the age of 35 years.

  Type 1 diabetes accounts for the majority of cases of diabetes mellitus.

  In the early stages of type 1 diabetes, the islets are usually infiltrated with CD8+ and CD4+ lymphocytes.

  Patients with autoimmune adrenalitis are less likely to develop type 1 diabetes.

38

A patient who is taking propranolol for migraine prophylaxis presents at a general practice clinic suffering from a severe allergic reaction after eating crayfish involving hypotension and bronchospasm. Which of the following statements concerning adrenaline is CORRECT?


  Adrenaline should not be administered to this patient because it would exacerbate the hypotension.

  Adrenaline will be relatively ineffective at treating both the hypotension and the bronchospasm because of the propranolol.

  Adrenaline will be effective in treating the hypotension, but relatively ineffective at treating the bronchospasm.

  The actions of adrenaline will be unaffected by the propranolol.

  Adrenaline should not be administered to this patient because it would exacerbate the bronchospasm.

39

With regard to the early development of the kidney which one of the following statements on development of the mesonephros is CORRECT?


  Mesonephros regresses at 8-9 weeks.

  From the mesonephros dilute urine drains down the ureter.

  Mesonephros contains about 400 primitive tubules at any one time.

  Mesonephros develops after the metanephros.

  Mesonephros becomes the definitive kidney after induction by the ureteric bud.

40

Which of these statements concerning control of water and electrolyte secretion through the Enteric Nervous System is NOT CORRECT?


  Major secretomotor transmitters are Acetylcholine and Vasoactive Intestinal Peptide.

  Enteric reflexes act to return fluid to the lumen of the small intestine.

  Enteric reflexes controlling transmucosal fluid exchange are prominent in the stomach.

  Enteric secretomotor reflexes are under central, sympathetic, inhibitory control.

  Mucosal secretion and blood flow are locally co-ordinated.

41

Which of these statements concerning neuronal control of intestinal muscle is NOT CORRECT?


  Emptying of the stomach is regulated by neural and hormonal feed-back from the small intestine.

  The major transmitters of enteric muscle motor neurons are acetylcholine (excitatory) and noradrenaline (inhibitory).

  Enteric reflexes can switch intestinal motility between mixing and propulsive modes.

  The vagus nerves have both excitatory and inhibitory effects on gastric motility.

  Without the enteric nervous system, there is a life-threatening loss of control of intestinal motility.

42

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.

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

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

  Microaerophilic Gram positive rods, e.g., Lactobacillus spp.

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

43

Indicate the CORRECT statement regarding the intestinal microbiota:


  The gastrointestinal microbiota of humans plays an essential role in digestion and nutrition.

  Commensal bacteria seldom causes infections at extra-intestinal sites.

  Antibiotic-associated diarrhoea is caused by the overgrowth of susceptible bacteria, such as Escherichia coli.

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

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

44

Which one of the following statements regarding arachidonic acid metabolites is CORRECT?


  Thromboxane is a vasoconstrictor synthesised predominantly in endothelial cells.

  Prostacyclin (PGI2) inhibits mucus secretion and increases gastric acid secretion in the stomach.

  All of the leukotrienes are potent bronchoconstrictors.

  Prostaglandin E2 synthesis in the hypothalamus causes an increase in body temperature.

  Lipoxygenase converts arachidonic acid to prostaglandins.

45

Which of the following is CORRECT?


  Reflux esophagitis is due to Barrett’s esophagus.

  Gastritis may be associated with H.pylori infection.

  Helicobacter pylori polyps are associated with non-steroidal anti-inflammatory drug use.

  Celiac disease is associated with villous atrophy in the large intestine.

  Meckel’s diverticulum is associated with the presence of ectopic squamous epithelium.

46

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


  Adenomatous polyp.

  Hamartomatous polyp.

  Hyperplastic polyp.

  Inflammatory polyp.

  Sessile polyp.

47

Adenocarcinoma of the large bowel:


  Does not invade tissue.

  Does not obstruct the lumen.

  May be staged using the Duke's staging system.

  Is not associated with ulceration or bleeding.

  Does not spread to other organs.

48

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:


  The use of intravascular contrast agents.

  Thickness of tissue.

  Density of tissue.

  Composition of atoms in the tissues.

  The type of X-ray film.

49

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


  Intravascular contrast agents contain calcium atoms to increase absorption of Xrays.

  Radioisotope scanning relies on detection of thermal radiation using an infra red camera.

  Ultrasound relies on reflection of the ultrasound beam to generate images.

  The Doppler effect is used to measure the density of tissue.

  Magnetic resonance can be used in patients with cardiac pacemakers because it does not use ionizing radiation.

50

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


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

  Hepatic sinusoidal endothelial cells have no boundary with the Space of Disse.

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

  Hepatic sinusoidal endothelial cells rest on a basement membrane.

  Hepatic sinusoidal endothelial cells cannot promote hepatic stellate cell activation in response to injury.

51

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


  Kupffer cells have cytoplasmic extensions called macropodia.

  Kupffer cells lack phagocytic activity.

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

  Kupffer cells lack cyclo-oxygenase activity and do not release prostaglandins when activated.

  Kupffer cells stretch across the sinusoidal lumen.

52

Which one of the following statements concerning haemochromatosis is CORRECT?


  Haemochromatosis may result in an emphysema.

  Haemochromatosis decreases the risk of diabetes by lowering blood glucose.

  Haemochromatosis is associated with an increased risk of hepatocellular carcinoma.

  Haemochromatosis may be a secondary complication of primary adrenal cancer.

  Haemochromatosis is more likely to occur in females.

53

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


  Fulminant hepatitis is associated with a normal bleeding profile.

  Fulminant hepatitis can be associated with hepatitis B virus infection.

  Fulminant hepatitis can be associated with hepatomegaly.

  Fulminant hepatitis can be associated with chronic renal failure.

  Fulminant hepatitis is associated with normal levels of bilirubin.

54

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


  Following extensive liver injury, regeneration is initiated by the division of biliary epithelial cells.

  Hepatic regeneration results in decreased numbers of binucleate hepatocytes.

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

  Hepatic regeneration results in liver cell plates that are one cell-thick.

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

55

Which one of the following statements concerning the location and function of podocytes found in the renal corpuscle is CORRECT?


  Podocytes are located on the outer surface of the glomerular capillaries and provide part of the filtration barrier in the form of the slit membrane.

  Podocytes are a sensory structure that forms part of the wall of the distal convoluted tubule and are found adhering to the renal corpuscle between the afferent and efferent arterioles.

  Podocytes are squamous cells forming the outer surface of the renal corpuscle around Bowman's space.

  Podocytes are modified smooth muscle cells in the wall of the afferent and efferent arterioles that release the enzyme renin.

  Podocytes are located between the base of the loops of the glomerular capillaries to help stabilize the glomerular structure.

56

Which one of the following combinations characterises the nephrotic syndrome?


  Heavy haematuria and heavy proteinuria.

  Oedema and heavy proteinuria.

  Poor tissue turgor and hypertension.

  Poor tissue turgor and renal calculi (stones).

  Circulatory acidosis and low pH urine.

57

In normal anatomy which one of the following are observed on the posterior abdominal wall?


  The lumbar vessels run anterior to the psoas major.

  The kidneys are retroperitoneal viscera and lie on the psoas major.

  The thoracolumbar fascia gives origin to the rectus abdominus muscle.

  The psoas minor is a constant structure present in every individual.

  Peritoneal reflections pass as mesenteries to surround intraperitoneal viscera.

58

Which one of the following statements about metabolic responses to prolonged starvation is CORRECT?


  The urea cycle is up-regulated.

  There is increased synthesis of ketone bodies in the liver.

  The plasma level of fatty acids decreases.

  Gluconeogenesis maintains blood glucose at 5.5 mM or above.

  The rate of degradation of proteins increases with time.

59

Which of the following statements is/are CORRECT? A) There is only one known hormone that stimulates food intake. B) Hormonal signals that inhibit food intake are made in the gut, the adipocytes and the islets of Langerhans. C) Some food intake-inhibitory signals act via activation of the Vagus nerve. D) The Vagus nerve communicates with the hypothalamus via projections from the nucleus of the tractus solitarius (NTS).


  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 about obesity is/are CORRECT? A) Obesity results from eating too much and not exercising enough. B) Identical twin studies suggest that 30-50% of the variance of body weight is genetically determined. C) Of the 5 gene abnormalities identified that lead to massive obesity, three are involved in the production or function of Melanocyte Stimulating Hormone (a MSH). D) The CB-1 (endocannabinoid receptor) inhibits food intake when activated.


  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 digestion of food is/are CORRECT? A) Trypsin is an endopeptidase. B) Triglycerides are digested by lipases. C) Carboxypeptidase is an exopeptidase. D) Bile acids (salts) are essential for triglyceride breakdown.


  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 the absorption of food is/are CORRECT? A) Chylomicrons are formed in the intestinal lumen. B) Glucose is absorbed by primary active transport in the small intestine. C) Chylomicron formation depends upon bile salts. D) Glucose absorption is achieved by cotransport 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.

63

Which of the following statements related to the pancreas and its secretions is/are CORRECT? A) Glucagon is secreted from ß cells of the pancreas. B) a amylase digests starches only from molecular ends to monosaccharides. C) Insulin is secreted from a cells of the pancreas. D) a amylase breaks down 1-4 glucosidic linkages.


  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 malabsorption is/are CORRECT? A) Bile salts are essential for the absorption of fat soluble vitamins. B) Calcium problems in fat malabsorption are due completely to poor Vitamin D absorption. C) Coagulation problems can be causally linked to disorders of fat absorption. D) Triglyceride digestion requires bile salts to proceed.


  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 malabsorption is/are CORRECT? A) Protein (amino acid) malabsorption is usually due to failure of protein digestion. B) Absorption of calcium takes place predominantly in the terminal ileum. C) Lack of pancreatic amylase leads to severe carbohydrate malabsorption. D) Disease of the terminal ileum may cause problems with calcium absorption.


  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 malabsorption is/are CORRECT? A) Iron malabsorption is usually due to mucosal defects. B) Lactose and galactose may accumulate in the intestinal lumen in lactase deficiency. C) Calcium malabsorption may occur with long standing bile acid deficiency. D) Parathyroid hormone directly stimulates intestinal calcium absorption.


  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 sodium and water absorption by the small intestine is/are CORRECT? A) Sodium absorption is increased by prostaglandin. B) A high pH stimulates sodium and water absorption. C) Sodium absorption is stimulated by increased free cytosolic calcium. D) Sodium absorption is inhibited by cholera toxin.


  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.

68

Which of the following statements related to the causation of diarrhoea is/are CORRECT? A) Excess somatostatin may cause diarrhoea. B) Increased cyclic AMP levels in intestinal cells stimulates Cl- secretion. C) Increased transit time in the small intestine may cause diarrhoea. D) Increased intestinal cell cytosolic Ca++ causes diarrhoea.


  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.

69

Which of the following statements related to liver metabolic function is/are CORRECT? A) Synthesis of blood clotting factors by the liver is Vitamin K dependent. B) Blood clotting factors are synthesised by the liver. C) Albumin is synthesised by the liver. D) Fibrinogen synthesis by the liver depends upon Vitamin K.


  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.

70

Which of the following statements related to abnormal liver function and bilirubin is/are CORRECT? A) Conjugation of bilirubin is defective in premature infants. B) Unconjugated bilirubin is excreted in the urine. C) Unconjugated bilirubin is converted to soluble bilirubin by ultra violet light. D) Failure of conjugation of bilirubin is the primary defect leading to jaundice in hepato cellular disease.


  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 acute jaundice and liver is/are CORRECT? A) Oedema due to a low plasma albumin is common in acute hepato cellular jaundice. B) Plasma albumin is low in acute hepato cellular jaundice. C) Electrolyte disturbances are common in acute hepato cellular jaundice. D) Albumin synthesis is impaired in acute hepato cellular 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.

72

Which of the following statements related to liver dysfunction is/are CORRECT? A) Transaminases are usually markedly raised in chronic liver dysfunction. B) Portal-systemic venous anastomosis is common in chronic liver disease. C) In chronic liver dysfunction plasma bilirubin is unconjugated. D) A low plasma albumin may be the only plasma abnormality 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.

73

Which of the following statements related to the glomerulus and glomerular filtration is/are CORRECT? A) GFR is decreased by efferent arteriole constriction. B) Substances with MW > 2000 are not filtered by the glomerulus. C) Glomerular capillary pressure is about 70-80 mmHg. D) Glomerular filtration rate increases if plasma albumin is low.


  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 the proximal tubule is/are CORRECT? A) Carbonic anhydrase is in the luminal membrane of the proximal tubule. B) Na+-H+ countertransport takes place in the proximal tubule. C) Paracellular reabsorption of sodium and water take place in the proximal tubule. D) Renin directly stimulates Na+-H+ countertransport 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.

75

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. B) 15-30% of water filtered is reabsorbed in the loop of Henle. C) Na+ concentration at end of the loop of Henle is about 100 mmol/l. D) 15-30% of Na+ filtered is reabsorbed in 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.

76

Which of the following statements related to the collecting tubule and/or duct is/are CORRECT? A) Permeability to water of the collecting tubule and duct is increased by ADH. B) H+ is secreted down an electrochemical gradient in the collecting tubule. C) Na+ absorption is increased by aldosterone in the collecting tubule. D) Net H+ secretion is greater in the collecting tubule than 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.

77

Which of the following statements related to the collecting tubule and/or duct is/are CORRECT? A) Aldosterone decreases K+ secretion by the collecting tubule. B) HCO3- in lumen of the collecting tubule increases H+ excretion by the kidney. C) Aldosterone decreases H+ secretion by the collecting tubule. D) There can be net K+ reabsorption in the distal nephron.


  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

In the kidney which of the following statements related to JGA or the cortical diluting segment is/are CORRECT? A) The efferent arteriole is more sensitive to circulating angiotensin II than the afferent arteriole. B) Low NaCl at macula densa ? dilatation of efferent arteriole. C) NO may modulate and control TG feedback. D) Renin secretion from the afferent arteriole controls TG 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.

79

Which of the following statements related to the renin angiotensin aldosterone system is/are CORRECT? A) ACTH is a major stimulus for aldosterone release. B) A high NaCl at the macula densa causes renin release. C) Aldosterone has an immediate effect increasing Na+-K+ ATPase. D) A high NaCl at the macula densa causes afferent arteriole constriction.


  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 acid base is/are CORRECT? A) H2PO4 - is a major titratable acid in urine. B) NH4 + in the urine is the major excretory mechanism of an acid load. C) Organic acids contribute to titratable acid in urine. D) pH = pK + log - 3 2 3 HCO H CO


  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 water balance and urine concentration is/are CORRECT? A) Impairment of urine concentrating ability is an early sign of renal insufficiency. B) Concentrating ability is reduced by thiazide diuretics. C) Too little vasopressin causes hypernatraemia. D) Vasopressin decreases water permeability of 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.

82

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.


  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 diuretics is/are CORRECT? A) Furosemide binds to the NaCl cotransporter. B) Hyperkalaemic alkalosis may occur with diuretic therapy. C) Furosemide inhibits the diluting ability of the kidney. D) Hypokalaemic alkalosis is a common side effect of diuretic therapy.


  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 proteinuria is/are CORRECT? A) Proteinuria is always due to increased glomerular filtration of protein. B) Microalbuminuria is an early sign of renal vascular damage. C) The filtration fraction of albumin is about 0.5%. D) The amount of albumin filtered may be many times greater than the amount in the 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.

85

Which of the following statements related to hypotension and acute renal failure is/are CORRECT? A) A urine osmolality < 400 but > 200 mosmol in a hypotensive patient suggests that acute tubular necrosis has occurred. B) A urine creatinine <10 times plasma level in an oliguric patient suggests that the problem is probably reversible. C) A urine sodium < 30 mmol/litre in an oliguric patient suggests that the process is probably reversible. D) There is usually no glomerular filtration in a person with acute tubular necrosis.


  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 hypotension and acute renal failure is/are CORRECT? A) Afferent arteriolar constriction causes increased GFR. B) The afferent arteriole is more sensitive to angiotensin II than the efferent arteriole. C) The AT2 receptor is the receptor by which angiotensin II has most of its action. D) Efferent arteriolar constriction causes increased filtration fraction.


  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 chronic liver 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.


  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 chronic liver failure is/are CORRECT? A) 1,25 dihydroxy Vit D is deficient in chronic renal failure. B) Protein restriction will cause a fall in blood urea. C) Plasma parathyroid hormone is usually elevated in patients with chronic renal failure. D) Protein restriction in chronic renal failure is important to reduce the proton load requiring 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.

89

Which of the following statements related to abnormal liver function and bilirubin is/are CORRECT? A) Conjugated bilirubin is carried in plasma bound to albumin. B) Unconjugated bilirubin is toxic to neural tissue. C) Gilberts disease is associated with neurological symptoms. D) Conjugation of bilirubin may be defective in Gilberts disease.


  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 liver dysfunction is/are CORRECT? A) An impaired coagulation mechanism is often present in acute liver dysfunction. B) In chronic liver dysfunction bilirubin is conjugated. C) In acute liver failure bilirubin is conjugated. 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.

91

Which of the following statements related to liver metabolic function is/are CORRECT? A) Aldosterone is metabolized by the liver. B) The liver synthesises glucagon. C) The liver synthesizes glucose from proteins. D) The liver synthesises bilirubin.


  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 about volume of distribution is/are CORRECT? A) A drug that binds strongly to plasma proteins will be likely to have a small volume of distribution. B) Volume of distribution can be calculated by dividing the amount of drug in the body by the concentration of drug in the plasma. C) Volume of distribution may be one or two orders of magnitude greater than total body water. D) Volume of distribution depends on the dose and route of administration 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.

93

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 intravenous injection. B) A bolus intravenous injection is often used when a rapid onset of drug action is required. C) For most drugs, the steady state concentration of drug in plasma achieved following a long term intravenous infusion is proportional to the rate of administration. D) Drugs administered intravenously typically show complete (i.e. 100%) bioavailability.


  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 regarding the behaviour of drugs following oral administration is/are CORRECT? A) 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. B) Basic drugs such as morphine tend to be well absorbed from the stomach following oral administration. C) The bioavailability of drugs following oral administration is affected by the extent to which they are absorbed from the gastrointestinal tract and undergo first pass hepatic metabolism. 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.

95

Which of the following statements regarding the half life of drugs is/are CORRECT? A) The half life of a drug is a useful guide in the choice of dosing frequency. 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 liver disease may increase 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.

96

Which of the following statements regarding the pharmacokinetic behaviour of drugs is/are CORRECT? A) Drugs that distribute slowly exhibit a higher peak concentration than would be predicted for a rapidly distributing drug. B) Drugs that are eliminated according to zero order kinetics would not be expected to give steady state levels of drug in plasma. C) Drugs that are eliminated solely by glomerular filtration would likely exhibit first order elimination kinetics. D) Drugs that distribute slowly are generally regarded as conforming to a one compartment pharmacokinetic model.


  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 the behaviour of partial agonists is/are CORRECT? A) Partial agonists always cause smaller maximal responses than full agonists acting at the same receptors. B) Partial agonists always have to be administered at higher doses than full agonists for an equivalent effect. C) Partial agonists may lose their effectiveness entirely after receptor desensitization has occurred. D) Partial agonists act at a different receptor from full agonists.


  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 competitive antagonists is/are CORRECT? A) Competitive antagonists bind to the same site as agonists thereby preventing the agonist from binding. B) Antagonism by a competitive antagonist can always be overcome by increased agonist concentration. C) Competitive antagonists have little or no ability to activate the receptor when bound. D) Competitive antagonist have higher affinity than the agonist for the receptor.


  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 types of drugs would inhibit the increase in cardiac contractile force in response to adrenaline and to histamine? A) An agonist that mediates a decrease in contractile force by activating adenosine receptors. B) A competitive antagonist of the ß1-adrenoceptor. C) An inhibitor of the opening of cardiac L-type calcium channels. D) A competitive antagonist of the histamine H2 receptor.


  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

Which of the following statements is/are true regarding enzymes levels in alcoholic cirrhosis and acute alcoholic hepatitis. A) Lactate dehydrogenase (LD) level is not elevated in alcoholic hepatitis or acute alcoholic cirrhosis. B) Gamma Glutaryl Transferase (GGT) is usually not elevated by liver pathologies other than acute alcoholic hepatitis. C) All liver enzyme levels in plasma are generally higher in advanced cirrhosis. D) Both alcoholic cirrhosis and acute alcoholic hepatitis may be associated with pancreatitis (i.e alcohol consumption predisposes to pancreatitis).


  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.