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بنك الأسئلة
بنك الأسئلة
QUESTION BANK OF
Dr. MOHAMED YAHIA
:بنـــــــــــــــــــك أسئـــــــــــــلة
محمد يحيــــــــى.د
PHYSIOLOGY – MICROBIOLOGY – BIOCHEMISTRY –
PATHOLOGY – PHARMACOLOGY - ANATOMY
CHAPTER 1
1168 Question
PRETEST PHYSIOLOGY
CARDIOVASCULAR SYSTEM
1. Which of the following is part of the reflex response to an increase in arterial
pressure?
3. Venous Return:
a) Is increased on standing
b) Decreases by deep inspiration
c) Is decreased by venoconstriction
d) When increased, activates Bainbridge reflex
e) When increased, increases end-systolic volume
5. In a normal ECG:
a) 10 mL
b) 30 mL
c) 50 mL
d) 120 mL
e) 140 Ml
a) 5%
b) 10%
c) 30%
d) 50%
e) 80%
a) SA Node
b) AV Node
c) Bundle of His
d) Bundle of branches
e) Purkinje fibers
a) Capillaries
b) Pulmonary vein
c) Small arteries
d) Inferior Vena Cava
e) Arterioles
a) Systemic capillaries
b) Veins
c) Arteries
d) The spleen
e) The heart
12. Cardiac Output (in liters per minute) divided by the heart rate (in beats per
minute) equals to:
a) Cardiac Index
b) Cardiac Efficiency
c) Mean Arterial Pressure
d) Stroke Volume
e) Blood Velocity
13. The segment of the vascular bed responsible for local regulation of blood flow
in most tissues is:
a) Distributing arteries
b) Large veins
c) Capillaries
d) Venules
e) Arterioles
a) Isometric relaxation
b) Isotonic relaxation
c) Isovolumetric contraction
d) Isovolumetric relaxation
e) Atrial contraction
a) Tachycardia
b) Increased stroke volume
c) Stimulation of vasomotor center
d) Vasoconstriction
e) Decreased arterial blood pressure
18. A drug that increases the heart rate from 70 to 100 beats per minute could
be:
a. Blood volume
b. Central venous pressure
c. Pulmonary capillary wedge pressure
d. Left ventricular end-diastolic volume
e. Left ventricular end-diastolic pressure
21. The highest blood flow per gram of left ventricular myocardium would occur
23. Which of the following would result from a regurgitant aortic valve in a
nonfailing heart?
26. Which of the following is true of the electrical activity of cardiac muscle?
c. A decrease in contractility
d. An increase in heart rate
e. A decrease in coronary blood flow
a. Arteriolar tone
b. Venous tone
c. Myocardial contractility
d. Heart rate
e. Capillary permeability
33. Propagation of the action potential through the heart is fastest in the
a. SA node
b. Atrial muscle
c. AV node
d. Purkinje fibers
e. Ventricular muscle
34. Closure of the aortic valve occurs at the onset of which phase of the cardiac
cycle?
a. Isovolumetric contraction
b. Rapid ejection
c. Protodiastole
d. Isovolumetric relaxation
e. Rapid filling
35. Which one of the following is most likely to be observed in a patient with
untreated atrial fibrillation?
36. Normal splitting of the second heart sound (S 2 ) into two components is
increased during inspiration because
37. Which of the following statements about the third heart sound (S 3 ) is
correct?
a. 0.1
b. 0.2
c. 0.3
d. 0.6
e. 0.9
39. Sustained elevation of cardiac output will occur with which of the following
conditions?
a. Hypertension
b. Aortic regurgitation
c. Anemia
d. Third-degree heart block
e. Cardiac tamponade
a. Mitral stenosis
b. Mitral regurgitation
c. Atherosclerosis
d. Aortic regurgitation
e. Tachycardia
a. Heart rate
b. PR interval
c. Ventricular contractility
d. Ejection fraction
e. Cardiac output
43. During the cardiac cycle, closure of the aortic valve occurs at:
a) Atrial contraction
b) Atrial depolarization
c) Ventricular repolarization
d) SA node depolarization
e) Ventricular contraction
a. Stroke volume
b. Diastolic pressure
c. Venous compliance
d. Pulmonary arterial resistance
e. Total peripheral resistance
a. Exercise
b. Increased body temperature
c. Exposure to high altitude
d. Increased intracranial pressure
e. Hemorrhage
52. When flow through the mitral valve is restricted by mitral stenosis,
a. Ventricular contractility
b. Mean blood pressure
c. Total peripheral resistance
d. Ejection fraction
e. Coronary blood flow
57. Which one of the following correctly describes an event that normally occurs
during the PR interval?
58. Which one of the following will be observed in a patient with aortic
regurgitation?
a) The lungs
b) Glomus bodies
c) Aortic arch
d) Carotid sinus
e) Medulla
a) Neural reflexes
b) Myogenic autoregulation
c) An increase in PO2
d) A decrease in H+ concentration
e) Synthesis of ATP
a) Causes tachycardia
b) Makes the prepotential more horizontal
c) Decreases the rate of potassium efflux in the sino-atrial node
d) Prolongs the refractory period
e) Shortens the duration of the cardiac cycle
a. Primarily permeable to Na +
b. Primarily permeable to Ca 2+
c. Primarily permeable to K +
d. Primarily permeable to Cl −
e. Equally permeable to Na + and K +
a. Is primarily permeable to Na +
b. Is opened by membrane depolarization
c. Is opened by vagal nerve stimulation
d. Is primarily permeable to K +
e. Is closed by norepinephrine
69. An exercise stress test to rule out ischemic heart disease is positive if
a. Venous compliance
b. Heart rate
c. Ventricular contractility
d. Total peripheral resistance
e. Coronary blood flow
71. The constriction of a blood vessel to one-half of its resting diameter would
increase its resistance to blood flow by a factor of
a. 2
b. 4
c. 8
d. 12
e. 16
72. During aerobic exercise, blood flow remains relatively constant within
a. The skin
b. The heart
c. The brain
d. The skeletal muscles
e. The kidneys
a. Tachycardia
b. Hypertension
c. Hemorrhage
d. Aortic stenosis
e. Heart failure
74. Sudden standing evokes the baroreceptor reflex. Which one of the following
will be greater after a person suddenly stands up than it was before the person
stood?
a. Heart rate
b. Myocardial contractility
c. Total peripheral resistance
d. Venous compliance
e. Cardiac output
77. Which one of the following organs has the highest arteriovenous O 2
difference under normal resting conditions?
a. Brain
b. Heart
c. Skeletal muscle
d. Kidney
e. Stomach
78. The percentage of the total cardiac output distributed to any single organ is
most dependent on
79. At which of the following sites does the blood flow lose the greatest amount of
energy?
a. Mitral valve
b. Large arteries
c. Arterioles
d. Capillaries
e. Venules
a. Heart
b. Aorta
c. Distributing arteries and arterioles
d. Capillaries
e. Venules and veins
82. Which of the following will be lower than normal in a patient with an
abnormally high intracranial pressure?
a. Ventricular contractility
b. Heart rate
c. Mean blood pressure
d. Stroke volume
e. Total peripheral resistance
85. The distribution of blood among the various organs of the body is regulated
by regulating the resistance of the
a. Arteries
b. Arterioles
c. Precapillary sphincters
d. Postcapillary venules
e. Veins
88. Which of the following is the most important in determining the total
peripheral resistance?
a) a)Blood viscosity
b) Concentration of plasma protein
c) Arteriolar diameter
d) Cardiac Output
e) Metabolic autoregulation
89. Which of the following substances will be most likely to dilate systemic
arterioles:
a) Endothelin
b) ADH
c) Histamine
d) Noreadrenaline
e) Aldosterone
a) An increased afterload
b) A high end-diastolic volume
c) An increased heart rate
d) Parasympathetic stimulation
e) Ca2+ channel blockers
94. Which one of the following will increase if massaging the neck stretches the
carotid sinus baroreceptor?
RESPIRATORY SYSTEM
1. The physiological dead space:
5. Dennervation of carotid and aortic bodies leads to all the following except:
a) Oxygen
b) Carbon dioxide
c) Carbon monoxide
d) Nitrous oxide
e) Nitrogen
a) For the same partial pressure a unit of blood carries the same amount of O2
and CO2
b) High PCO2 favors O2 binding to hemoglobin
c) Metabolic acidosis reduces PCO2
d) Oxygenation of hemoglobin increases the affinity of hemoglobin to CO2
e) Per unit volume of arterial blood there is more O2 than CO2
10. The residual volume can be calculated by subtracting the expiratory reserve
volume from:
a) Vital Capacity
b) Inspiratory capacity
c) Functional residual capacity
d) Total lung capacity
e) Alveolar ventilation
a) PO2
b) pH of arterial blood
c) PCO2
d) Body temperature
e) % saturation of hemoglobin
a) Alkalosis
b) Hypocapnia
15. All the following are expected to decrease airway resistance except:
a) Atropine
b) Adrenaline
c) Parasympathetic stimulation
d) Sympathetic stimulation
e) Shifting from nose to mouth breathing
16. Which one of the following would increase in obstructive, but not in
restrictive, lung disease?
a. Vital capacity
b. Maximum breathing capacity
c. FEV 1
d. Functional residual capacity
e. Breathing frequency
18. Which one of the following will decrease in a person with ventilation-
perfusion (V/Q) abnormalities?
a. Anion gap
b. Arterial pH
c. Arterial carbon dioxide tension
d. Alveolar-arterial (A-a) gradient for oxygen
e. Alveolar ventilation
19. Which one of the following is higher at the apex of the lung than at the base
when a person is standing?
a. V/Q ratio
b. Blood flow
c. Ventilation
d. Pa CO 2
e. Lung compliance
20. In areas of the lung with lower than normal V/Q ratios, the
23. Surfactant:
a. Anemia
b. Carbon monoxide poisoning
c. A low V/Q ratio
d. Hypoventilation
e. Right-to-left shunt
a. Dissolved CO 2
b. Carbonic acid
c. Carbaminohemoglobin
d. Bicarbonate
e. Carboxyhemoglobin
27. Peripheral and central chemoreceptors may both contribute to the increased
ventilation that occurs as a result of
e. An increase in arterial Ph
30. Which one of the following components of a pulmonary function test will be
closest to normal in a patient with restrictive lung disease?
a. FEV 1
b. MVV
c. FVC
d. FEV 1 /FVC
e. TLC
32. When the respiratory muscles are relaxed, the lungs are at
33. Which one of the following is the most likely cause of a high arterial P CO 2 ?
a) Beta-adrenergic blockers
b) Muscarinic cholinergic agonists
c) Breathing at higher lung volumes
d) Leukotrienes
e) Histamine
The answer is: C
a) Increased compliance
b) Decreased work of breathing
c) Reduced surface tension of fluid in the alveoli
d) Decreased compliance
e) Asthma
a) Venoarterial shunts
b) Pulmonary edema
c) Carbon monoxide poisoning
d) Anemia
e) Methemoglobinemia
The answer is: D
a) Polycythemia
b) Hyperventilation
c) Increased cardiac output
d) Shift of hemoglobin dissociation curve to the left
e) Increase formation of fetal hemoglobin
39. At the end of maximal expiration the volume of air in the lungs is:
a) FRC - RV
b) IRV + RV
c) FRC - TV
d) TLC - VC
e) VC – ERV – IRV
The answer is: D
41. Because the small airways produce a small fraction of the airway resistance,
their obstruction is difficult to detect. Which one of the following changes is
indicative of small rather than large airway obstruction?
46. Which of the following would normally be less in the fetus than in the
mother?
a. Pa CO 2
b. Pulmonary vascular resistance
c. Affinity of hemoglobin for oxygen
d. Pa O 2
e. Arterial hydrogen ion concentration
a. Metabolism
b. pH
c. Temperature
d. Oxygen
e. 2,3-DPG
a. Pa O 2 increases
b. Pa CO 2 decreases
c. Arterial pH decreases
d. Alveolar ventilation increases
e. Blood lactate level increases
50. Pulmonary alveoli are kept dry by factors that include the
51. In which one of the following conditions will the diffusing capacity of the lung
increase?
53. Which of the following will return toward normal during acclimatization to
high altitude?
56. In an acclimatized person at high altitudes, oxygen delivery to the tissues may
be adequate at rest because of
a. Lung compliance
b. Airway diameter
c. Elastic work of breathing
d. Resistive work of breathing
e. Anatomic dead space
58. During a normal inspiration, more air goes to the alveoli at the base of the
lung than to the alveoli at the apex of the lung because
a. Metabolic acidosis
b. Exercise
c. Hypoxemia
d. Anemia
e. Carbon monoxide poisoning
62. Which one of the following characteristics is the most similar between the
pulmonary and skeletal muscle capillaries?
64. Which one of the following will be greater than normal in a patient with a
low V/Q ratio?
a. Pa CO 2
b. Pa O 2
c. A-a gradient
d. Oxygen dissolved in blood
e. Oxygen combined with hemoglobin
65. Which one of the following contributes to the normal difference between the
alveolar and arterial oxygen tension (A-a) gradient?
a. FEV 1
b. FVC
c. FEV 1 /FVC
d. MVV
e. V/Q ratio
69. Which one of the following gases diffuses across the alveoli-capillary
membrane by a diffusion-limited transport process?
a. Oxygen
b. Nitrogen
c. Carbon dioxide
d. Carbon monoxide
e. Nitrous oxide (N 2 O)
a. Pregnancy
b. Sleep
c. Morphine administration
d. Exercise
e. Metabolic alkalosis
71. A person ascends to the top of a mountain where the atmospheric pressure is
below normal. Which one of the following blood gases was drawn from the
person at the top of the mountain?
PO2 P CO 2
a. 50 30
b. 60 40
c. 80 50
d. 100 40
e. 120 30
73. A patient with reduced VC, FRC, and RV is found to have a normal pH. A
tentative diagnosis of diffuse interstitial fibrosis is made. Which of the following
characteristics are consistent with this disease?
GIT
1. The physiological actions of CCK include:
2. The enzymes produced by the exocrine pancreas include the following except:
a) Proelastase
b) DNase
c) Amylase
d) Enteropeptidase
e) Lipase
a) Vagal stimulation
b) Acetylcholine
c) Secretin
d) CCK
e) Atropine
The answer is: E
4. The jejunum is the main site for absorption of the following except:
a) Glucose
b) Amino acids
c) Fatty acids
d) Bile salts
e) Water
5. A tumor producing large amounts of the intestinal hormone GIP may result
in:
a) Hyperglycemia
b) Hypoglycemia
c) Diarrhea
d) Intestinal colic
e) Hyperacidity in the stomach
a. H 2 receptor antagonist
b. Proton pump inhibitor
c. Anticholinergic
d. Antacid
e. Beta blocker
a. Stomach
b. Duodenum
c. Jejunum
d. Ileum
e. Colon
a. Gastrin
b. Somatostatin
c. Histamine
d. Enterogastrone
e. Acetylcholine
a. Dopamine
b. Vasoactive intestinal peptide
c. Somatostatin
d. Substance P
e. Acetylcholine
13. Which one of the following statements best describes water and electrolyte
absorption in the GI tract?
14. Hypokalemic metabolic acidosis can occur with excess fluid loss from the
a. Stomach
b. Ileum
c. Colon
d. Pancreas
e. Liver
17. After a cholecystoctomy, patients may have problems with fat-rich foods
becuase:
20. The hormone involved in the initiation of the migrating motor complex is
a. Gastrin
b. Motilin
c. Secretin
d. Cholecystokinin
e. Enterogastrone
a. Intragastric volume
b. Intraduodenal volume
c. Fat content of duodenum
d. Osmolality of duodenum
e. Acidity of duodenum
23. Which one of the following processes applies to the proximal stomach?
a. Accommodation
b. Peristalsis
c. Retropulsion
d. Segmentation
e. Trituration
24. After secretion of trypsinogen into the duodenum, the enzyme is converted
into its active form, trypsin, by
a. Enteropeptidase
b. Procarboxypeptidase
c. Pancreatic lipase
d. Previously secreted trypsin
e. An alkaline Ph
25. The major mechanism for absorption of sodium from the small intestine is
a. Na + -H + exchange
b. Cotransport with potassium
c. Electrogenic transport
d. Neutral NaCl absorption
e. Solvent drag
28. Dietary fat, after being processed, is extruded from the mucosal cells of the
gastrointestinal tract into the lymphatic ducts in the form of
a. Monoglycerides
b. Diglycerides
c. Triglycerides
d. Chylomicrons
e. Free fatty acids
29. Gas within the colon is primarily derived from which one of the following
sources?
a. Vitamin B 6
b. Vitamin K
c. Thiamine
d. Riboflavin
e. Folic acid
33. Which one of the following statements about the colon is correct?
36. Which one of the following statements about small intestine crypt cells is
correct?
37. Which of the following sugars is absorbed from the small intestine by
facilitated diffusion?
a. Glucose
b. Galactose
c. Fructose
d. Sucrose
e. Lactose
40. Which one of the following statements about the process of vitamin B 12
absorption is correct?
a. In humans, intrinsic factor is secreted from chief cells of the gastric gland
b. Vitamin B 12 binds preferentially to intrinsic factor in the stomach
41. Patients may experience nausea and a sense of early satiety following
42. Which one of the following statements about bile acids is correct?
a. A H 1 receptor antagonist
b. A proton pump inhibitor
c. A cholinergic receptor antagonist
d. An antacid
e. A CCK B receptor antagonist
45. The delivery of chyme into the proximal small intestine will
46. A person is found to have increased basal and maximal acid outputs,
decreased serum calcium levels, and microcytic anemia. Inflammation in which
area of the gastrointestinal tract would explain these findings?
a. Colon
b. Jejunum
c. Duodenum
d. Gallbladder
e. Stomach
47. Which one of the following statements best describes water and electrolyte
absorption in the gastrointestinal tract?
a. Most water and electrolytes derive from the oral intake of fluids
b. The small and large intestines have similar absorptive capacities
c. Net secretion of potassium occurs from the ileum
d. Osmotic equilibration of chyme occurs in the duodenum
e. Cholera toxin inhibits sodium-coupled nutrient transport
48. The paracrine secretion responsible for inhibiting gastric acid secretion is
a. Histamine
b. Enterogastrone
c. Somatostatin
d. Pepsin
e. Enterooxyntin
49. A medical student presents to the emergency room with a two-day history of
severe vomiting and orthostatic hypotension. What kind of metabolic
abnormalities would you expect?
51. Which one of the following statements about bile acids is correct?
53. The transport protein responsible for entry of glucose into the intestinal
enterocyte is called
a. Glut-2
b. Glut-5
c. SGLT1
d. SGLT2
e. SGLT5
54. Short-chain fatty acid absorption occurs almost exclusively from the
a. Stomach
b. Duodenum
c. Jejunum
d. Ileum
e. Colon
55. Which one of the following statements about medium-chain fatty acids is
correct?
Endocrine system
1. A tumor that produces large amounts of catecholamines can be detected by
examining the urine for:
a) K+
b) Uric acid
c) Choline
d) VMA
e) Calcium
a) Cortisol
b) TRH
c) CRH
d) Vasopressin
e) TSH
3. A ten year old boy has high levels of the growth hormone. He is likely to
develop:
a) Acromegaly
b) Hyperglycemia
c) Mental retardation
d) Muscle atrophy
e) Hyperkalaemia
a) It is inhibited by T4
b) It is increased in cold weather
c) It is increased in Grave's disease
d) It is increased in TRH
e) Has no marked diurnal rhythm
a) Stimulation of melanocytes
b) Increased secretion of aldosterone
c) Induction of growth of the adrenal gland
d) Induction of secretion of adrenomedullins
e) Feedback inhibition of CRH
a) Moderate hyperglycemia
b) Sodium natriuresis
c) Oedema
d) Alkalosis
e) Increased rennin secretion
a) Hypopigmentation
b) Good appetite
c) Hypoglycemia
d) Obesity
e) Hypertension
a) Hypotension
b) Protein depletion
c) Hypoglycemia
d) Dry thick skin
e) Increased body hair
15. Calcitonin:
a) Diabetes mellitus
b) Diabetes insipidus
c) Hypervitaminosis D
d) Tetany
e) Hypothyroidism
20. True statements regarding atrial natriuretic hormone (ANH) include that it
23. The following can be observed in a patient who has Grave's disease
(hyperthyroidism):
a) Growth hormone
b) Prolactin
c) Adrenocorticotrophic hormone
d) Melanocyte stimulating hormone
e) Luteinizing hormone
a. Hyperglycemia
b. Exercise
c. Somatostatin
d. Hypothermia
e. Free fatty acid
27. The source of estrogen and progesterone during the last seven months of
pregnancy is the
a. Ovary
b. Placenta
c. Corpus luteum
d. Anterior pituitary
e. Posterior pituitary
28. The source of estrogen and progesterone during the first two months of
pregnancy is the
a. Ovary
b. Placenta
c. Corpus luteum
d. Anterior pituitary
e. Posterior pituitary
29. Which one of the following hormones is secreted by the posterior pituitary
gland?
a. Cortisol
b. Corticosterone
c. Dehydroepiandrosterone
d. Progesterone
e. Pregnenolone
33. Compared with the resting state, during prolonged exercise, the caloric needs
of skeletal muscle are met by
34. Iodides are stored in the thyroid follicles mainly in the form of
a. Thyroxine
b. Thyroglobulin
c. Monoiodotyrosine
d. Diiodotyrosine
e. 3,5,3′-triiodothyronine
35. Almost all of the active thyroid hormone entering the circulation is in the
form of
a. Triiodothyronine
b. Thyroxine
c. Thyroglobulin
d. Thyrotropin
e. Long-acting thyroid stimulator (LATS)
a. Bound to albumin
b. Bound to prealbumin
c. Bound to globulin
d. As a glucuronide
e. Unbound
a. Estrogen
b. Progesterone
c. LH
d. FSH
e. Prolactin
39. Which of the following is a correct statement about the production of human
sperm?
42. The following factors have a direct marked effect on the adrenal cortex to
stimulate the secretion of aldosterone except:
a) Angiotensin III
b) Angiotensin II
c) Hyperkalemia
d) Hypernatremia
e) High levels of ACTH
a) Parathyroid hormone
b) Calcitonin
c) Growth hormone
d) Prolactin
e) Active vitamin D
44. If a patient dies of hypercalcemia, the most likely cause would be:
46. The hormone involved in the ejection of milk from a lactating mammary
gland is
a. Prolactin
b. FSH
c. LH
d. Growth hormone
e. Oxytocin
a) Gluconeogenic
b) Ketogenic
c) Protein anabolic
d) Diuretic
e) Vasoconstrictive
48. The main effect of somatostatin secreted by the D cells of the islets of
Langerhans appears to be:
49. Factors that act on the cells of the adrenal gland to cause secretion of
aldosterone include:
a) Renin
b) Angiotensinogen
c) Angiotensin I
d) Atrial natriuretic peptide (ANP)
e) Potassium ions
52. Plasma levels of calcium can be increased most rapidly by the direct action of
parathyroid hormone on the
a. Kidney
b. Intestine
c. Thyroid gland
d. Bones
e. Skeletal musculature
53. Correct statements about human growth hormone include which of the
following?
a. Hypertension
b. Hyperkalemia
c. Decreased extracellular fluid volume
d. Increased concentrating ability of the kidney
e. Increased hematocrit
a. Phosphate
b. Sodium
c. Calcium
d. Potassium
e. Calcitonin
a. Anorexia
b. Increased basal metabolic rate
c. Bradycardia
d. Increased weight gain
e. Decreased sweating
a. Adipose tissue
b. Cardiac muscle
c. Skeletal muscle
d. The brain
e. The uterus
a. Tachycardia
b. Increased metabolic rate
c. Heat intolerance
d. Sleepiness
e. Decreased body mass index
a. Days 6 and 8
b. Days 10 and 12
c. Days 14 and 16
d. Days 18 and 20
e. Days 22 and 24
e. Hyperglycemia
70. The uptake of triglycerides into adipose tissue from plasma lipoproteins
a) Melatonin
b) Acetylcholine
c) Beta endorphin
d) Inhibin
e) Somatomedins
a) Estradiol
b) Testosterone
c) Calcium
d) Oxytocin
e) A or B
79. The hormone primarily responsible for development of ovarian follicles prior
to ovulation is
a. Chorionic gonadotropin
b. Estradiol
c. Follicle-stimulating hormone
d. Luteinizing hormone
e. Progesterone
81. Melatonin
84. Progesterone
a. Gastrin
b. Enterooxyntin
c. Somatostatin
d. Motilin
e. Secretin
a. Müllerian-inhibiting substance
b. Androstenedione
c. Dihydrotestosterone
d. Testosterone
e. Androsterone
89. Which one of the following statements about growth and development is
correct?
a. Secretin
b. Cholecystokinin
c. Motilin
d. Vasoactive intestinal polypeptide
e. Glucagon
a. Secretin
b. Somatostatin
c. Gastrin
d. VIP
e. Motilin
92. Which one of the following hormones initiates a biological effect by activation
of cell membrane receptors?
a. Progesterone
b. Estrogens
c. Cortisol
d. Epinephrine
e. Thyroxine
93. Which one of the following hormones interacts with a cytoplasmic receptor,
then localizes in the nucleus and directs protein and nucleotide synthesis?
a. Thyrotropin-releasing hormone
b. Epinephrine
c. Luteinizing hormone
d. Cortisol
e. Insulin
a. Oxytocin
b. Progesterone
c. Estradiol
d. Insulin
e. Prolactin
97. Insulin regulates glucose transport into muscle and fat cells via which glucose
transporter?
a. GLUT-1
b. GLUT-2
c. GLUT-3
d. GLUT-4
e. GLUT-5
a. Diarrhea
b. Polyuria
c. Metabolic alkalosis
d. Euphoria
e. Hyperphagia
a. Hypertension
b. Hypoglycemia
c. Dry skin
d. Lethargy
e. Bradycardia
e. Increase gluconeogenesis
102. The signs and symptoms of a patient with primary adrenal insufficiency
include
a. Pallor
b. Low ACTH levels
c. High cortisol levels
d. Hyperkalemia
e. Hypertension
104. Which one of the following statements about atrial natriuretic factor is
correct?
105. A patient is diagnosed with acromegaly. Patients with this disease typically
have
a. Decreased gluconeogenesis
b. Hypoglycemia
c. Insulin resistance
d. Decreased protein synthesis
e. Decreased lipolysis
a. Estrogens
b. Progesterone
c. Dopamine
d. FSH
e. LH
107. A woman tests positive for pregnancy. In order for the pregnancy to
proceed uneventfully, which of the following must occur?
a. Dry skin
b. Bradycardia
c. Insomnia
d. Loss of fine motor skills
e. Satiety
a. Hypokalemia
b. Angiotensin I
c. Decreased renal afferent arteriole pressure
d. Increased parasympathetic nerve activity
e. Decreased sodium delivery to the distal convoluted tubule
a. Hyperglycemia
b. Arginine
c. Vagal stimulation of the pancreas
d. Insulin
e. Somatostatin
114. Which one of the following conditions experienced by pregnant women may
be due to the effects of pregnancy?
115. Which one of the following is associated with prolonged fasting (3 or more
days)?
a. Decreased lipolysis
b. Increased urinary excretion of nitrogen
c. Decreased gluconeogenesis
d. Increased glucose utilization by the brain
e. Increased secretion of insulin
RENAL SYSTEM
1. Which of the following is true about renal blood flow?
5. For those substances that are actively reabsorbed or secreted, the highest limit
of the amount that can be transported per unit time by the kidney tubules:
a) Is dependent on aldosterone
b) Is increased by ADH
c) Has the largest percentage of total water reabsorbed
d) Is facilitated by sodium reabsorption
e) Independent of osmotic difference across the tubules
8. The anion gap will increase with an increase in the plasma concentration of
a. Sodium
b. Potassium
c. Chloride
d. Bicarbonate
e. Lactate
10. Sodium reabsorption from the distal tubule will be increased if there is an
increase in
11. ADH will be released from the posterior pituitary when there is a decrease in
a. Plasma Na + concentration
b. Plasma volume
c. Plasma K + concentration
d. Plasma pH
e. Plasma Ca 2+ concentration
a. 400 mL
b. 200 mL
c. 100 mL
d. 50 mL
e. 25 Ml
14. Na + is reabsorbed from the basolateral surface of the renal epithelial cells by
a. Na/H exchange
b. Na-glucose cotransport
c. Na-K pump
d. Facilitated diffusion
e. Solvent drag
15. Which of the following is most likely to cause an increase in the glomerular
filtration rate?
a) Macula densa
b) Mesangial cells
c) Intercalated cells
d) Afferent arteriole
e) Interstitial cells
18. The tonicity of urine as it enters the renal collecting duct is:
a) Isotonic
b) Hypotonic or isotonic, but never hypertonic
c) Hypotonic
d) Hypertonic
e) Hypertonic or isotonic, but never hypotonic
20. The following factors when increased, they will increase the glomerular
filteration rate except:
a) Erythropoietin
b) Angiotensin II
c) Prostaglandins
d) ADH
e) Calcitrol
a. Extracellular bicarbonate
b. Red blood cell bicarbonate
c. Red blood cell hemoglobin
d. Plasma proteins
e. Plasma phosphate
25. If a substance appears in the renal artery but not in the renal vein,
26. Destruction of the supraoptic nuclei of the brain will produce which of the
following changes in urinary volume and concentration? (Assume that fluid
intake equals fluid loss.)
27. Which one of the following returns closest to normal during chronic
respiratory acidosis?
a. Alveolar ventilation
b. Arterial P CO 2
c. Arterial P O 2
d. Plasma concentration of bicarbonate
e. Arterial concentration of hydrogen ion
28. The pH of the tubular fluid in the distal nephron can be lower than that in
the proximal tubule because
a. A greater sodium gradient can be established across the wall of the distal
nephron than across the wall of the proximal tubule
b. More buffer is present in the tubular fluid of the distal nephron than in the
proximal tubule
c. More hydrogen ion is secreted into the distal nephron than into the proximal
tubule
d. The brush border of the distal nephron contains more carbonic anhydrase than
that of the proximal tubule
e. The tight junctions of the distal nephron are less leaky to solute than those of
the proximal tubule
a. Alkalosis
b. Acidosis
c. Increased secretion of HCO 3 −
d. Increased secretion of H +
e. Increased excretion of Na +
31. Sodium reabsorption in the proximal tubules from the luminal surface is
marked by all of the following except:
a) Plasma (H+)
b) Plasma volume
c) Plasma sodium concentration
d) Plasma potassium concentration
e) Plasma calcium concentration
33. The following is true about glucose reabsorption in the renal tubules:
35. The effective renal plasma flow, which equals the clearance of PAH, is less
than the true renal plasma flow because
b. The plasma entering the renal vein contains a small amount of PAH
c. The cortical and medullary collecting ducts are able to reabsorb some PAH
d. The calculated clearance of PAH depends on the urinary flow rate
e. The measured value of the plasma PAH concentration is less than the actual
PAH concentration
36. Most of the glucose that is filtered through the glomerulus undergoes
reabsorption in the
a. Proximal tubule
b. Descending limb of the loop of Henle
c. Ascending limb of the loop of Henle
d. Distal tubule
e. Collecting duct
37. Glomerular filtration rate (GFR) and renal blood flow (RBF) will both be
increased if
38. A man drinks 2 L of water to replenish the fluids lost by sweating during a
period of exercise. Compared with the situation prior to the period of sweating,
41. Which of the following substances will be more concentrated at the end of the
proximal tubule than at the beginning of the proximal tubule?
a. Glucose
b. Creatinine
c. Sodium
d. Bicarbonate
e. Phosphate
a. Glomerular filtrate
b. Proximal tubule
c. Loop of Henle
d. Cortical collecting tubule
e. Distal collecting duct
43. The electrically neutral active transport of sodium from the lumen of the
kidney occurs in the
a. Proximal tubule
b. Descending limb of the loop of Henle
c. Ascending limb of the loop of Henle
d. Cortical collecting duct
e. Medullary collecting duct
45. Decreasing the resistance of the afferent arteriole in the glomerulus of the
kidney will decrease
46. If GFR increases, proximal tubular reabsorption of salt and water will
increase by a process called glomerulotubular balance. Contributions to this
process include
a. Beta-adrenergic agonists
b. Prostaglandins
c. Aldosterone
d. Stimulation of the macula densa
e. Increased pressure within the afferent arterioles
48. Patients with renal insufficiency develop very high plasma concentrations of
urea (uremia) because of
a) Plasma pH
b) Glomerular fileration rate
c) Reabsorption of potassium by the proximal tubules
d) Red blood cell production
e) Phosphate excretion
a. Metabolic acidosis
b. Diarrhea
c. Adrenal insufficiency
d. Hypovolemia
e. Hyperosmotic extracellular fluid
54. The ability of the kidney to excrete a concentrated urine will increase if
a. Hyperaldosteronism
b. Hyperventilation
c. Persistent diarrhea
d. Renal failure
e. Diabetes
58. Which one of the following comparisons between the distal nephron and the
proximal tubule is correct?
59. An increase in the concentration of NaCl in the intraluminal fluid with the
ascending limb of the loop of Henle causes the macula densa to release
a. ADH
b. Aldosterone
c. Adenosine
d. Renin
e. Angiotensinogen
a. Hypoaldosteronism
b. Hyperventilation
c. Hypokalemia
d. Hypovolemia
e. Hypercalcemia
61. The Glomerular Filteration Rate (GFR) can be calculated by all of the
following except:
a) PAH clearance
b) Creatinine clearance
c) Urea clearance
d) Inulin clearance
e) Formula using plasma creatinine concentration
62. The transport of glucose across the luminal membrane in the proximal part
of the renal tubule is:
63. The following contributes to the high osmolarity of the renal medulla:
64. The restriction of protein to pass through the filtration membrane is due to:
65. The following hormones act on the proximal tubules of the kidney:
a) ADH
b) Aldosterone
c) 25 hydroxy cholecalciferol
d) Angiotensin II
e) Dihydrotestosterone
a) Hypotonic
b) Hypertonic
c) Has the same sodium concentration as the filtrate
d) Has a volume that is 20% of the filtrate
e) Has very low inulin concentration following inulin administration
68. The clearance of a substance was found to be less than that of inulin. This
substance is:
72. The segment of the nephron that contributes most to potassium excretion
when dietary potassium is altered is:
73. The ability of the kidney to excrete a concentrated urine will increase if:
a. ACTH
b. Chloride
c. Sodium
d. Hydrogen
e. Potassium
75. In which one of the following situations is urinary flow less than normal?
a. Diabetes insipidus
b. Diabetes mellitus
c. Sympathetic stimulation
d. Increased renal arterial pressure
e. Infusion of mannitol
a. Bicarbonate
b. Plasma proteins
c. Hemoglobin
d. Phosphates
e. Lactate
a. Proximal tubule
b. Thin descending limb of Henle’s loop
c. Thick descending limb of Henle’s loop
d. Distal convoluted tubule
e. Cortical collecting duct
78. Which one of the following values will be above normal in a diabetic patient
with a blood glucose concentration of 600 meq/L?
a. Urine flow
b. Intracellular volume
c. Plasma sodium concentration
d. Arterial pH
e. Alveolar P CO 2
79. Which one of the following will be increased in a patient suffering from
persistent diarrhea?
a. Hydrogen
b. Ammonium
c. Potassium
d. Sodium
e. Urea
82. Which one of the following conditions causes a higher than normal plasma
bicarbonate concentration?
a. Volume depletion
b. Renal failure
c. Hypoxemia
d. Diarrhea
e. Hypoaldosteronism
83. Which one of the following substances causes renal blood flow to decrease?
a. Nitric oxide
b. Bradykinin
c. Prostaglandins
d. Adenosine
e. Dopamine
a. Atropine
b. Epinephrine
c. Glucagon
d. Lactic acid
e. Isotonic saline
86. Which one of the following blood-gas values is consistent with metabolic
acidosis?
Pa CO2 HCO3- pH
(mmHg) (mM)
a. 25 30 7.7
b. 35 20 7.3
c. 40 25 7.4
d. 50 30 7.1
e. 60 20 7.1
a. Volume depletion
b. Diuretic therapy
c. Administration of insulin
d. Metabolic alkalosis
e. Stimulation of adrenal medulla
88. Which one of the following substances is less concentrated at the end of the
proximal tubule than at the beginning of the proximal tubule?
a. Creatinine
b. Hydrogen
c. Chloride
d. Phosphate
e. Sodium
89. What percentage of the filtered load of sodium is reabsorbed by the proximal
tubule?
a. 15%
b. 25%
c. 45%
d. 65%
e. 95%
a. Heart failure
b. Renal failure
c. Diuretic therapy
d. Diabetes mellitis
e. Diabetes insipidus
a. Aldosterone
b. Parathyroid hormone
c. Norepinephrine
d. Vasopressin
e. Angiotensin
a. Vasopressin
b. Atrial natriuretic hormone
c. Norepinephrine
d. Insulin
e. Aldosterone
93. Which one of the following will produce the greatest increase in potassium
secretion?
94. A decrease in the concentration of NaCl in the intraluminal fluid causes the
juxtaglomerular apparatus to release
a. ADH
b. Aldosterone
c. Adenosine
d. Renin
e. Angiotensinogen
95. Which one of the following will be observed in a patient with chronic renal
failure?
a. 5% of body mass
b. 10% of body mass
c. 20% of body mass
d. 40% of body mass
e. 60% of body mass
97. Which one of the following signs of renal failure is caused by the loss of a
hormone produced by the kidney?
a. Edema
b. Hypertension
c. Anemia
d. Uremia
e. Acidosis
BRS PHYSIOLOGY
CARDIOVASCULAR SYSTEM
1. A 53-year-old woman is found, by arteriography, to have 50% narrowing of
her left renal artery. What is the expected change in blood flow through the
stenotic artery?
A. Decrease to 1⁄2
B. Decrease to 1⁄4
C. Decrease to 1⁄8
D. Decrease to 1 ⁄ 16
E. No change
(A) Aorta
(B) Central vein
(C) Pulmonary artery
(D) Right atrium
(E) Renal artery
(F) Renal vein
(A) increased pulse pressure because the contractility of the ventricle is increased
(B) increased pulse pressure because total peripheral resistance (TPR) is
decreased
(C) increased pulse pressure because compliance of the veins is decreased
(D) decreased pulse pressure because the contractility of the ventricle is
increased
(E) decreased pulse pressure because TPR is decreased
11. The ventricles are completely depolarized during which isoelectric portion of
the electrocardiogram (ECG)?
(A) PR interval
(B) QRS complex
(C) QT interval
(D) ST segment
(E) T wave
12. In which of the following situations is pulmonary blood flow greater than
aortic blood flow?
(A) decreased firing rate of the pacemaker in the sinoatrial (SA) node
(B) decreased firing rate of the pacemaker in the atrioventricular (AV) node
14. An acute decrease in arterial blood pressure elicits which of the following
compensatory changes?
17. During exercise, total peripheral resistance (TPR) decreases because of the
effect of
21. The greatest pressure decrease in the circulation occurs across the arterioles
because
(A) α 1 Receptors
(B) β 1 Receptors
(C) β 2 Receptors
(D) Muscarinic receptors
25. During which phase of the cardiac cycle is aortic pressure highest?
(A) Na +
(B) K+
(C) Ca 2+
(D) Cl −
(E) Mg 2+
28. Carbon dioxide (CO 2 ) regulates blood flow to which one of the following
organs?
(A) Heart
(B) Skin
(C) Brain
(D) Skeletal muscle at rest
(E) Skeletal muscle during exercise
29. Cardiac output of the right side of the heart is what percentage of the cardiac
output of the left side of the heart?
(A) 25%
(B) 50%
(C) 75%
(D) 100%
(E) 125%
30. The physiologic function of the relatively slow conduction through the
atrioventricular (AV) node is to allow sufficient time for
31. Blood flow to which organ is controlled primarily by the sympathetic nervous
system rather than by local metabolites?
(A) Skin
(B) Heart
(C) Brain
(D) Skeletal muscle during exercise
(A) α 1 Receptors
(B) β 1 Receptors
(C) β 2 Receptors
(D) Muscarinic receptors
(E) Nicotinic receptors
34. During which phase of the cardiac cycle is ventricular volume lowest?
36. Which of the following substances crosses capillary walls primarily through
water-filled clefts between the endothelial cells?
(A) O2
(B) CO 2
(C) CO
(D) Glucose
(A) α 1 Receptors
(B) β 1 Receptors
(C) β 2 Receptors
(D) Muscarinic receptors
41. Which of the following agents or changes has a negative inotropic effect on
the heart?
42. The low-resistance pathways between myocardial cells that allow for the
spread of action potentials are the
(A) Aldosterone
(B) Angiotensin I
(C) Angiotensinogen
(D) Antidiuretic hormone (ADH)
(E) Atrial natriuretic peptide
44. During which phase of the cardiac cycle does the mitral valve open?
(A) 14 mL
(B) 37 mL
(C) 55 mL
(D) 92 mL
(E) 140 Ml
RESPIRATORY SYSTEM
1. Which of the following lung volumes or capacities can be measured by
spirometry?
(A) Coronary
(B) Pulmonary
(C) Cerebral
(D) Muscle
(E) Skin
4. Which of the following statements about this patient is most likely to be true?
7. Which volume remains in the lungs after a tidal volume (TV) is expired?
(A) Trachea
(B) Largest bronchi
(C) Medium-sized bronchi
(D) Smallest bronchi
(E) Alveoli
10. A 49-year-old man has a pulmonary embolism that completely blocks blood
flow to his left lung. As a result, which of the following will occur?
11. In the hemoglobin–O 2 dissociation curves shown above, the shift curve from
left to right could be caused by
(A) increased pH
(B) decreased 2,3-diphosphoglycerate (DPG) concentration
(C) strenuous exercise
(A) increased P 50
(B) increased affinity of hemoglobin for O 2
(C) impaired ability to unload O 2 in the tissues
(D) increased O 2 -carrying capacity of hemoglobin
(E) decreased O 2 -carrying capacity of Hemoglobin
14. Compared with the systemic circulation, the pulmonary circulation has a
15. Compared with the apex of the lung, the base of the lung has
(B) J receptors
(C) lung stretch receptors
(D) medullary chemoreceptors
(E) carotid and aortic body chemoreceptors
18. If an area of the lung is not ventilated because of bronchial obstruction, the
pulmonary capillary blood serving that area will have a P O 2 that is
19. In the transport of CO 2 from the tissues to the lungs, which of the following
occurs in venous blood?
(A) Hypoventilation
(B) Right-to-left cardiac shunt
(C) Anemia
(D) Carbon monoxide poisoning
(E) Ascent to high altitude
22. A 38-year-old woman moves with her family from New York City (sea level)
to Leadville Colorado (10,200 feet above sea level). Which of the following will
occur as a result of residing at high altitude?
(A) Hypoventilation
(B) Arterial P O 2 greater than 100 mm Hg
(C) Decreased 2,3-diphosphoglycerate (DPG) concentration
(D) Shift to the right of the hemoglobin–O 2 dissociation curve
(E) Pulmonary vasodilation
(F) Hypertrophy of the left ventricle
(G) Respiratory acidosis
23. The pH of venous blood is only slightly more acidic than the pH of arterial
blood because
26. Which person would be expected to have the largest A–a gradient?
GIT
1. Which of the following substances is released from neurons in the GI tract and
produces smooth muscle relaxation?
(A) Secretin
(B) Gastrin
(C) Cholecystokinin (CCK)
(D) Vasoactive intestinal peptide (VIP)
(E) Gastric inhibitory peptide (GIP)
(D) Ileum
(E) Colon
6. A 49-year-old male patient with severe Crohn’s disease has been unresponsive
to drug therapy and undergoes ileal resection. After the surgery, he will have
steatorrhea because
(A) Secretin
(B) Gastrin
(C) Cholecystokinin (CCK)
(D) Vasoactive intestinal peptide (VIP)
(E) Gastric inhibitory peptide (GIP)
(A) glycerol
(B) galactose
(C) leucine
(D) bile acids
(E) vitamin B 12
(F) vitamin D
(A) Secretin
(B) Gastrin
(C) Cholecystokinin (CCK)
(D) Vasoactive intestinal peptide (VIP)
(E) Glucose-dependent insulinotropic peptide (GIP)
14. Which of the following is true about the secretion from the exocrine
pancreas?
15. Which of the following substances must be further digested before it can be
absorbed by specific carriers in intestinal cells?
(A) Fructose
(B) Sucrose
(C) Alanine
(D) Dipeptides
(E) Tripeptides
18. A patient with a duodenal ulcer is treated successfully with the drug
cimetidine. The basis for cimetidine’s inhibition of gastric H + secretion is that it
(A) Secretin
(B) Gastrin
(C) Cholecystokinin (CCK)
(D) Vasoactive intestinal peptide (VIP)
(E) Gastric inhibitory peptide (GIP)
ENDOCRINE SYSTEM
1. A 41-year-old woman has hypocalcemia, hyperphosphatemia, and decreased
urinary phosphate excretion. Injection of parathyroid hormone (PTH) causes an
increase in urinary cyclic adenosine monophosphate (cAMP). The most likely
diagnosis is
(A) Dopamine
(B) Growth hormone–releasing hormone (GHRH)
(C) Somatostatin
(D) Gonadotropin-releasing hormone (GnRH)
(E) Thyroid-stimulating hormone (TSH)
(F) Oxytocin
(G) Testosterone
(A) Sleep
(B) Stress
(C) Puberty
(D) Somatomedins
(E) Starvation
(F) Hypoglycemia
(A) Aldosterone
(B) Androstenedione
(C) Cortisol
(D) Dehydroepiandrosterone
(E) Testosterone
(A) Blood prolactin levels are too low for milk production to occur
(B) Human placental lactogen levels are too low for milk production to occur
(C) The fetal adrenal gland does not produce sufficient estriol
(D) Blood levels of estrogen and progesterone are high
(E) The maternal anterior pituitary is suppressed
14. Which of the following would be expected in a patient with Graves’ disease?
(A) Triiodothyronine (T 3 )
(B) Thyroxine (T 4 )
(C) Diiodotyrosine (DIT)
(D) Thyroid-stimulating hormone (TSH)
(E) Iodide (I – )
(A) 1,25-Dihydroxycholecalciferol
(B) Progesterone
(C) Insulin
(D) Parathyroid hormone (PTH)
(E) Gonadotropin-releasing hormone (GnRH)
18. The source of estrogen during the second and third trimesters of pregnancy
is the
(A) Triiodothyronine (T 3 )
(B) Thyroxine (T 4 )
(C) Diiodotyrosine (DIT)
(D) Thyroid-stimulating hormone (TSH)
(E) Iodide (I – )
22. A 39-year-old man with untreated diabetes mellitus type I is brought to the
emergency room. An injection of insulin would be expected to cause an increase
in his
23. Which of the following results from the action of parathyroid hormone
(PTH) on the renal tubule?
(D) Interaction with receptors on the luminal membrane of the proximal tubular
cells
(E) Decreased urinary excretion of cyclic adenosine monophosphate (cAMP)
24. Which step in steroid hormone biosynthesis occurs in the accessory sex target
tissues of the male and is catalyzed by 5α-reductase?
25. Which of the following pancreatic secretions has a receptor with four
subunits, two of which have tyrosine kinase activity?
(A) Insulin
(B) Glucagon
(C) Somatostatin
(D) Pancreatic lipase
(A) 46 XY genotype
(B) Testes
(C) Elevated serum testosterone
(D) Lack of uterus and cervix
(E) Lack of menstrual cycles
RENAL SYSTEM:
1. Secretion of K + by the distal tubule will be decreased by
2. Subjects A and B are 70-kg men. Subject A drinks 2 L of distilled water, and
subject B drinks 2 L of isotonic NaCl. As a result of these ingestions, subject B
will have a
A 45-year-old woman develops severe diarrhea while on vacation. She has the
following arterial blood values:
❖ pH = 7.25
❖ P co2 = 24 mm Hg
❖ [HCO 3 – ] = 10 mEq/L
❖ Venous blood samples show decreased blood [K + ] and a normal anion gap.
(A) Mannitol
(B) D 2 O alone
(C) Evans blue
(D) Inulin and D 2 O
(E) Inulin and radioactive albumin
10. Compared with a person who ingests 2 L of distilled water, a person with
water deprivation will have a
11. Which of the following would cause an increase in both glomerular filtration
rate (GFR) and renal plasma flow (RPF)?
(A) Hyperproteinemia
(B) A ureteral stone
(C) Dilation of the afferent arteriole
(D) Dilation of the efferent arteriole
(E) Constriction of the efferent arteriole
❖ pH = 7.52
❖ PCO 2 = 20 mm Hg
❖ [HCO 3 – ] = 16 mEq/L
Which of the following statements about this patient is most likely to be correct?
(A) He is hypoventilating
(B) He has decreased ionized [Ca 2+ ] in blood
(C) He has almost complete respiratory compensation
(D) He has an acid–base disorder caused by overproduction of fixed acid
(E) Appropriate renal compensation would cause his arterial [HCO 3 – ] to
increase
13. Which of the following would best distinguish an otherwise healthy person
with severe water deprivation from a person with the syndrome of inappropriate
antidiuretic hormone (SIADH)?
(A) Hypoparathyroidism
(B) Treatment with chlorothiazide
(C) Treatment with furosemide
(D) Extracellular fluid (ECF) volume expansion
(E) Hypermagnesemia
15. A patient arrives at the emergency room with low arterial pressure, reduced
tissue turgor, and the following arterial blood values:
❖ pH = 7.69
❖ [HCO 3 – ] = 57 mEq/L
❖ PCO 2 = 48 mm Hg
Which of the following responses would also be expected to occur in this patient?
(A) Hyperventilation
(B) Decreased K + secretion by the distal tubules
(C) Increased ratio of H 2 PO 4 – to HPO 4 –2 in urine
(D) Exchange of intracellular H + for extra- cellular K +
16. A woman has a plasma osmolarity of 300 mOsm/L and a urine osmolarity of
1200 mOsm/L. The correct diagnosis is
17. Which of the following substances has the highest renal clearance?
18. A woman runs a marathon in 90°F weather and replaces all volume lost in
sweat by drinking distilled water. After the marathon, she will have
(A) Exercise
(B) Alkalosis
(C) Insulin injection
(D) Decreased serum osmolarity
(E) Treatment with β-agonists
(A) Diarrhea
(B) Chronic renal failure
(C) Ethylene glycol ingestion
(D) Treatment with acetazolamide
(E) Hyperaldosteronism
(F) Salicylate poisoning
23. Which set of arterial blood values describes a heavy smoker with a history of
emphysema and chronic bronchitis who is becoming increasingly somnolent?
(A) 7.65 48 45
(B) 7.50 15 20
(C) 7.40 24 40
(D) 7.32 30 60
(E) 7.31 16 33
24. Which set of arterial blood values describes a patient with partially
compensated respiratory alkalosis after 1 month on a mechanical ventilator?
(A) 7.65 48 45
(B) 7.50 15 20
(C) 7.40 24 40
(D) 7.32 30 60
(E) 7.31 16 33
25. Which set of arterial blood values describes a patient with chronic renal
failure (eating a normal protein diet) and decreased urinary excretion of NH 4 +
?
(A) 7.65 48 45
(B) 7.50 15 20
(C) 7.40 24 40
(D) 7.32 30 60
(E) 7.31 16 33
(A) 7.65 48 45
(B) 7.50 15 20
(C) 7.40 24 40
(D) 7.32 30 60
(E) 7.31 16 33
27. Which set of arterial blood values describes a patient with a 5-day history of
vomiting?
(A) 7.65 48 45
(B) 7.50 15 20
(C) 7.40 24 40
(D) 7.32 30 60
(E) 7.31 16 33
28. A person who takes an aspirin (salicylic acid) overdose is treated in the
emergency room. The treatment produces a change in urine pH that increases
the excretion of salicylic acid. What was the change in urine pH, and what is the
mechanism of increased salicylic acid excretion?
شيت الجامعة
CARDIOVASCULAR SYSTEM
1. Which of the following is part of the reflex response to an increase in arterial
pressure?
skin
kidneys
a) Is increased on standing
c) Is decreased by venoconstriction
c) Bradycardia
a) Internodal pathways
d) Interventricular septum
e) AV node
14. Protodiastole:
a) 10 mL
b) 30 mL
c) 50 mL
d) 120 mL
e) 140 mL
b) Right Atrium
c) Pulmonary Artery
d) Pulmonary Vein
e) Left Ventricle
a) 5%
b) 10%
c) 30%
d) 50%
e) 80%
a) SA Node
b) AV Node
c) Bundle of His
d) Bundle of branches
e) Purkinje fibers
b) Heart
c) Kidney
d) Brain
e) Skin
24. With a mixed venous oxygen content of 110 ml/L and an arterial oxygen
content of 150 ml/L an oxygen uptake of 280 ml/min, the cardiac output is:
a) 5 liters/ min
b) 6 liters/ min
c) 7 liters/ min
d) 8 liters/ min
e) 9 liters/ min
25. The pulmonary valve closes when the pressure in the right ventricle is about:
a) 0 mmHg
b) 15 mmHg
c) 30 mmHg
d) 50 mmHg
e) 120 mmHg
a) Capillaries
b) Pulmonary vein
c) Small arteries
e) Arterioles
a) Systemic capillaries
b) Veins
c) Arteries
d) The spleen
e) The heart
b) An increased after-load
c) Parasympathetic stimulation
e) Venodilation
29. During the cardiac cycle, closure of the aortic valve occurs at:
b) Neural control
d) Natural leakiness to K+
d) From the left ventricle is more than from the right ventricle
a) Atrial contraction
b) Atrial depolarization
c) Ventricular repolarization
d) SA node depolarization
e) Ventricular contraction
33. Cardiac Output (in liters per minute) divided by the heart rate (in beats per
minute) equals to:
a) Cardiac Index
b) Cardiac Efficiency
d) Stroke Volume
e) Blood Velocity
34. The segment of the vascular bed responsible for local regulation of blood flow
in most tissues is:
a) Distributing arteries
b) Large veins
c) Capillaries
d) Venules
e) Arterioles
a) Isometric relaxation
b) Isotonic relaxation
c) Isovolumetric contraction
d) Isovolumetric relaxation
e) Atrial contraction
37. In the heart, within physiological limits the force of contraction is directly
proportional to the:
a) Pacemaker activity
b) AV nodal delay
d) Respiratory rate
e) Vagal stimulation
d) Of Ca2+ influx
e) Is more permeable to K+
a) Tachycardia
d) Vasoconstriction
b) Iso-volumetric contraction
c) Iso-volumetric relaxation
d) Ventricular filling
e) Atrial systole
increased
increased
42. The work done by the right ventricle is much less than that done by the left
ventricle because its:
a) Wall is thinner
c) Preload is less
d) Afterload is less
43. The following are not signs of pure right ventricular failure:
c) Pulmonary oedema
d) Hepatomegally
e) Sacral oedema
44. The blood vessel responsible for local regulation of blood flow in most tissues
is:
a) Distributing arteries
b) Large veins
c) Capillaries
d) Venules
e) Arterioles
a) Fever
c) Atropine
d) Hypothyroidism
e) Adrenaline
47. A drug that increases the heart rate from 70 to 100 beats per minute could
be:
e) Digitalis
a) Blood volume
b) Pulmonary pressure
c) End-diastolic volume
d) A systolic murmur
b) An increased afterload
c) Parasympathetic stimulation
a) Parasympathetic stimulation
b) Generalized vasodilation
c) Severe hemorrhage
d) Aortic stenosis
e) Heart failure
d) Venodilation
a) In hypovolaemia
b) By sympathetic stimulation
b) A reflex brachycardia
e) A patient stands up
a) Exposure to heat
b) Parasympathetic stimulation
e) Venoconstriction
58. Which of the following is the most important in determining the total
peripheral resistance?
a)Blood viscosity
c) Arteriolar diameter
d) Cardiac Output
e) Metabolic autoregulation
c) Reflex vasoconstriction
d) Venoconstriction
e) Tachycardia
d) Increased on standing up
a) The lungs
b) Glomus bodies
c) Aortic arch
d) Carotid sinus
e) Medulla
a) Neural reflexes
b) Myogenic autoregulation
c) An increase in PO2
d) A decrease in H+ concentration
e) Synthesis of ATP
68. The following are expected to increase the cardiac output except:
a) Eating
b) Adrenaline Infusion
e) Pregnancy
71. A drug that increases the heart rate from 70 to 100 beats per minute could
be:
c) Are capable of pacemaker activity at an intrinsic rate of 100 beat per minute
a) Causes tachycardia
b) Increased K+ efflux
d) Decreased K+ efflux
a) Medium-size arteries
b) Small veins
c) Capillaries
d) Venules
e) Arterioles
e) Ensure that the right and left arterial pressure are equal
a) Exposure to cold
c) Hypothyroidism
e) Muscular exercise
a) Heart rate
b) Myocardial contractility
e) Cardiac output
a) Atrial contraction
b) Atrial depolarization
c) Ventricular depolarization
d) SA node depolarization
e) Ventricular contraction
a) Atrial contraction
b) Atrial depolarization
c) Ventricular repolarization
d) SA node depolarization
e) Ventricular contraction
b) The second heart sound is due to opening of the aortic and pulmonary
valves
d) The first heart sound occurs at the beginning of the isovolumetric relaxation
phase
a) 0.10 sec
b) 0.15 sec
c) 0.30 sec
d) 0.45 sec
e) 0.60 sec
volume
volume
the ventricles
a) Atrial muscles
b) Bundle of His
c) Ventricular muscles
d) Purkinje fibers
e) AV nodal fibers
b) Body temperature
d) End-systolic volume
e) Number of impulses that reach the muscle cell per unit time
a) During protodiastole
b) The rate of cardiac muscle contraction is always set by nerves to the heart
skeletal muscles
97. Which of the laws explain the relationship between vessel wall tension and
vessel radius:
a) Poiseuille's Law
b) Ohm's Law
c) Starling's Law
d) LaPlace's Law
e) Reynold's Law
a) Large arteries
b) Arterioles
c) Venules
d) Capillaries
e) Large veins
99. Which of the following substances will be most likely to dilate systemic
arterioles:
a) Endothelin
b) ADH
c) Histamine
d) Noreadrenaline
e) Aldosterone
a) Parasympathetic stimulation
b) Generalized vasodilation
c) Sympathetic stimulation
d) Venodilation
e) Heart failure
e) During bradycardia
a) Stroke volume
b) Heart rate
a) Parasympathetic inhibition
d) Sympathetic stimulation
e) End-systolic volume
a) Sympathetic stimulation
b) Venodilation
c) Fever
d) Anemia
e) Exercise
e) In hypothyroidisim
a) An increased afterload
d) Parasympathetic stimulation
115. The blood vessels responsible for exchange between plasma & interstitial
fluid are:
a) Distributing arteries
b) Large veins
c) The capillaries
d) The venules
e) Arterioles
b) AV nodal fibers
c) Purkinje fibers
118. The most important function of the Starling mechanism in the heart is:
b) An increased afterload
c) Parasympathetic stimulation
e) Venodilation
RESPIRATORY SYSTEM
1. The physiological dead space:
b) Hypoventilation
c) Arteriovenous shunt
d) Pulmonary edema
e) Polycythemia
a) Two atmospheres
5. The partial pressure of oxygen in the alveoli is expected to be least affected by:
b) Respiratory quotient
c) PCO2 in alveoli
d) Hemoglobin concentration
e) Barometric pressure
d) Decrease PaO2
d)Liver
b) Kidney
c) Cardiac muscle
d) Skin
e) Brain
a) PaO2 is low
c) PaCO2 is high
b) Respond to changes in pH
11. Surfactant:
becomes smaller
c) Recoil force of the chest is greater than the recoil force of the lung
17. Dennervation of carotid and aortic bodies leads to all the following except:
18. Exchange of which of the following gases across the respiratory membrane is
normally diffusion limited:
a) Oxygen
b) Carbon dioxide
c) Carbon monoxide
d) Nitrous oxide
e) Nitrogen
21. With respect to oxygen and carbon dioxide transport in the blood:
a) For the same partial pressure a unit of blood carries the same amount of O2
and CO2
chemoreceptors
24. At the end of inspiration at sea level the PO2 in the anatomic dead space is
approximately:
a) 150 mmHg
b) 100 mmHg
c) 160 mmHg
d) 95 mmHg
arterial blood
chemoreceptors
a) Beta-adrenergic blockers
d) Leukotrienes
e) Histamine
27. Compared to normal arterial blood, normal mixed venous blood has:
a) Increased compliance
d) Decreased compliance
e) Asthma
29. For a normal Hb-O2 dissociation curve, the most correct relationship is:
chemoreceptors
a) Venoarterial shunts
b) Pulmonary edema
d) Anemia
e) Methemoglobinemia
33. At which of the following points is the intrapleural pressure closest to zero:
e) Mid-normal expiration
34. Regarding the vital capacity, all of the following are correct except:
a) Polycythemia
b) Hyperventilation
36. At the end of maximal expiration the volume of air in the lungs is:
a) FRC - RV
b) IRV + RV
c) FRC - TV
d) TLC - VC
e) VC – ERV - IRV
37. At the end of expiration at sea level the PO2 in the anatomic dead space is
approximately:
a) 150 mmHg
b) 100 mmHg
c) 160 mmHg
d) 40 mmHg
e) 130 mmHg
c) During inspiration the recoil tendencies of both the lungs and chest
increases
d) At the end of normal expiration the recoil tendency of the chest is slightly
40. A person whose anatomic dead space is 100 mL breathes 12 times per minute
with a tidal volume of 400 mL. His pulmonary ventilation is:
a) 1.2 liters
b) 2.4 liters
c) 3.6 liters
d) 4.8 liters
e) 6.0 liters
b) PCO2 is decreasing
a) 3 liters
b) 4 liters
c) 5 liters
d) 6 liters
e) 7 liters
43. The residual volume can be calculated by subtracting the expiratory reserve
volume from:
a) Vital Capacity
b) Inspiratory capacity
e) Alveolar ventilation
44. The volume of air that describes the lung's ability to eliminate carbon dioxide
is:
a) Tidal volume
b) Pulmonary ventilation
c) Vital capacity
d) Alveolar ventilation
d) Bronchial asthma
b) Alveolar ventilation
a) 250 ml
b) 350 ml
c) 400 ml
d) 500 ml
e) 550 ml
a) Surfactant deficiency
b) Lung fibrosis
d) Pulmonary edema
e) Pulmonary congestion
50. The most likely cause of hypoxic hypoxia together with hypercapnia is:
c) Veno-arterial shunt
d) Hypoventilation
51. Which of the following is correct regarding blood in the pulmonary trunk:
a) PO2 of 60 mmHg
c) PCO2 of 40 mmHg
a) PO2
b) pH of arterial blood
c) PCO2
d) Body temperature
e) % saturation of hemoglobin
d) Apneustic center
e) Pneumotaxic center
a) Alkalosis
b) Hypocapnia
a) 10 ml
b) 25 ml
c) 50 ml
d) 4 ml
e) 15 ml
a) Pulmonary edema
b) Hypoventilation
c) Severe anemia
d) Radiation
e) Convection
58. Which type of hypoxia in which there is a greater than normal atrial-mixed
venous partial pressure difference and relatively normal arterial oxygen
concentration:
a) Hypoxic hypoxia
b) Anemic hypoxia
c) Stagnant hypoxia
d) Histotoxic hypoxia
a) Veno-arterial shunt
b) Diffusion impairment
c) Anemia
d) Cyanide poisoning
60. The PCO2 is an alveolus which is ventilated but not perfused is about:
a) 0.3 mmHg
b) 46 mmHg
c) 40 mmHg
d) 5 mmHg
e) 7 mmHg
a neglible level
b) In the absence of surfavtant alveoli with small radii collapse into alveoli
inspiration
d) In normal lungs surface tension is responsible for 20% of the recoil force of
the lung
b) The P50 is the percent saturation of hemoglobin with oxygen when PO2 is
50 mmHg
c) The normal P50 of arterial blood is higher than that of venous blood
300 mmHg. The partial pressure of O2 in the air is saturated with water vapour
at 37oC at this altitude is expected to be about:
a) 45 mmHg
b) 55 mmHg
c) 60 mmHg
d) 65 mmHg
e) 62 mmHg
65. Which of the following parameters is lower in the elderly than in young
adults?
a) Residual volume
b) Vital capacity
c) Lung compliance
66. Surfactant:
67. At the end of normal exporation all the following are correct except:
b) Reduced FEV1
69. The following parameters are higher in the elderly than young adults:
a) Vital capacity
70. The approximate dead space of a normal adult man breathing through a tube
that is 50 cm long and 6mm in diameter is:
a) 200 ml
b) 300 ml
c) 150 ml
d) 250 ml
e) 350 ml
b) Transection of the brain stem between the pons and medulla combined with
bilateral vagotomy
72. All the following are expected to decrease airway resistance except:
a) Atropine
b) Adrenaline
c) Parasympathetic stimulation
d) Sympathetic stimulation
GASTROINTESTINAL SYSTEM
2. The component parts of the myenteric plexus of the enteric nervous system
include the following except:
a) Sensory neurons
b) Interneurons
c) Motor neurons
d) Synapses
b) Lysozymes
c) Immunoglobulins
d) Platelets
e) Chloride
b) Killing bacteria
c) Digestion of proteins
d) Facilitation of speech
e) Digestion of lipids
a) Is partially voluntary
6. The enzymes produced by the exocrine pancreas include the following except:
a) Proelastase
b) DNase
c) Amylase
d) Enteropeptidase
e) Lipase
a) Vagal stimulation
b) Acetylcholine
c) Secretin
d) CCK
e) Atropine
a) Sympathetic activation
b) Secretin
c) CCK
d) Bile salts
e) Atropine
9. The jejunum is the main site for absorption of the following except:
a) Glucose
b) Amino acids
c) Fatty acids
d) Bile salts
e) Water
a) Absorption of water
b) Absorption of sodium
c) Absorption of chloride
d) Absorption of calcium
e) Absorption of potassium
a) Mainly viruses
c) Has haustrae
15. Which of the following is likely to fail to reduce secretion of hydrochloric acid
in the stomach:
a) A H2 receptor blocker
16. A tumor producing large amounts of the intestinal hormone GIP may result
in:
a) Hyperglycemia
b) Hypoglycemia
c) Diarrhea
d) Intestinal colic
b) The bile stored in the gall bladder contains secondary bile acids
18. A plain X-Ray film of the abdomen of a normal healthy man is expected to
show some gas in all the following except:
a) Stomach
c) Small intestine
d) Transverse colon
e) Rectum
19. The component parts of the myenteric plexus of the enteric nervous system
includes the following except:
a) Sensory neurons
b) Interneurons
c) Motor neurons
d) Synapses
20. The secretion of the exocrine pancreas is increased by the following except:
a) Vagal stimulation
b) Acetylcholine
c) Secretin
d) CCK
e) Noradrenaline
a) Glucose
b) Amino acids
c) Fatty acids
d) Vitamin B12
e) Water
a) Absorption of iron
25. Micelles:
d) Are "flickering clusters" of cholesterol and fatty acids coated with bile salts
and 2 mono-glycerides
lymphatic system
26. The neurons of the intrinsic enteric nervous system do NOT perform the
following functions:
27. The part of the gastrointestinal tract that is NOT affected by disorders of the
myenteric plexus of the intrinsic nervous system:
a) Anal canal
b) Rectum
c) Caecum
d) Oesophagus
e) Pharynx
28. A patient who undergoes the following operation will NOT survive without
parenteral feeding:
a) Total oesophagectomy
b) Total gastrectomy
d) Total oroclocolectomy
29. After a cholecystoctomy, patients may have problems with fat-rich foods
becuase:
30. Diseases that reduce pancreatic enzyme secretions do NOT usually decrease
the digestion and absorption of:
a) Animal proteins
b) Plant proteins
c) Plant lipids
d) Sucrose
e) Starch
d) Absorption of sodium
e) Absorption of phosphates
a) Secretin
b) VIP
c) Bile salts
d) Atropine
e) Paraympathetic stimulation
b) Lysozymes
c) Immunoglobulins
d) Pepsin
e) Chloride
a) Digestion of sucrose
b) Digestion of phospholipids
c) Ability to speak
e) Absorption of chloride
a) A deep breath
b) Ca2+ deficiency
c) Macrocytic anemia
d) Malnutrition
a) Digestive enzymes
c) Stercobilinogen
d) CCK
e) Taurocholic acid
a) Alkaline phosphatase
b) K+
c) Cholesterol
d) CCK
e) Water
a) Water
b) Cellulose
c) Bacteria
d) Calcium salts
e) Glycogen
a) Chymotrypsinogen
b) Prolestase
c) Lactase
d) Alpha-amylase
e) Phospholipase
44. GIT hormones with a major effect on the stomach include the following
except:
a) Gastrin
b) Secretin
c) GIP
d) Neurotensin
e) CCK
a) Starch
b) Cholesterol esters
c) Albumin
d) Galactose
e) Lactose
49. The average daily amount of fluid that passes through the pylorus in a
healthy adult is about:
a) 2 liters
b) 9 liters
c) 6 liters
d) 8 liters
e) 12 liters
a) Ca2+
b) Alcohol
c) Glucose
e) Fe2+
a) CCK
b) Secretin
c) Vagal stimulation
e) Entropeptidase
a) The stomach absorbs 55% of dietary iron due to the presence of HCl
d) The amount of iron absorbed changes according to body stores and rate of
erythropoiesis
kidney
a) Isozyme
b) IgA
c) Lactoferrin
d) Intrinsic factor
e) Hydrogen ions
d) Severe exercise
e) Bad smell
fasting
58. The duodenum and jejunum are the main site for absorption of the following
except:
a) Glucose
b) Vitamin C
c) Fat-soluble vitamins
d) Bile salts
e) Iron
59. The mucosal cells of the human colon perform the following functions:
c) Absorption of Na+
e) Digestion of cellulose
60. It is true to say the following about the motility of the gastrointestinal system:
motor complex
61. Secretion of the acinar cells within the exocrine pancreas is not increased by:
a) Secretin
b) CCK
c) Parasympathetic stimulation
d) Bicarbonate ions
e) Acetylcholine
RENAL SYSTEM
1. Which of the following is true about renal blood flow?
vasomotor tone
b) Production of renin
8. For those substances that are actively reabsorbed or secreted, the highest limit
of the amount that can be transported per unit time by the kidney tubules:
c) Secreted
d) Reabsorbed
a) Macula densa
b) Mesangial cells
c) Intercalated cells
d) Afferent arteriole
e) Interstitial cells
11. The tonicity of urine as it enters the renal collecting duct is:
a) Isotonic
c) Hypotonic
d) Hypertonic
d) Venodilation
13. In a healthy adult man the glomerular filteration rate is expected to be:
a) 225 ml/min
b) 325 ml/min
c) 125 ml/min
d) 25 ml/min
e) 180 ml/min
14. The following factors when increased, they will increase the glomerular
filteration rate except:
15. A substance that is used to measure renal plasma flow should be:
b) Easily reabsorbed
c) Highly secreted
e) Decreased when the fluid flow at the site of the macula densa is decreased
a) Erythropoietin
b) Angiotensin II
c) Prostaglandins
d) ADH
e) Calcitrol
18. Sodium reabsorption in the proximal tubules from the luminal surface is
marked by all of the following except:
b) Sodium-hydrogen exchanger
c) Na-K pump
d) Solvent drag
e) Obstruction of ureters
a) Plasma (H+)
b) Plasma volume
21. The following is true about glucose reabsorption in the renal tubules:
glucose filtered
d) It is reduced with metabolic inhibitors that reduce the activity Na/K ATPase
a) Is dependent on aldosterone
b) Is increased by ADH
23. The Glomerular Filteration Rate (GFR) can be calculated by all of the
following except:
a) PAH clearance
b) Creatinine clearance
c) Urea clearance
d) Inulin clearance
) a Glutamine
b) Glycine
c) Leucine
d) Alanine
26. The transport of glucose across the luminal membrane in the proximal part
of the renal tubule is:
a) 25 ml/minute
b) 50 ml/minute
c) 125 ml/minute
d) 225 ml/minute
e) 250 ml/minute
28. The following contributes to the high osmolarity of the renal medulla:
d) Aldosterone
29. The restriction of protein to pass through the filtration membrane is due to:
b) The size of the spaces between the cells of the epithelial layer
30. The following hormones act on the proximal tubules of the kidney:
a) ADH
b) Aldosterone
c) 25 hydroxy cholecalciferol
d) Angiotensin II
e) Dihydrotestosterone
a) Hypotonic
b) Hypertonic
33. The clearance of a substance was found to be less than that of inulin. This
substance is:
b) Actively reabsorbed
c) Secreted
d) Is absent in children
38. The segment of the nephron that contributes most to potassium excretion
when dietary potassium is altered is:
d) Distal tubule
39. The ability of the kidney to excrete a concentrated urine will increase if:
a) An osmotic diuresis
d) A substance that has a clearance less than that of inulin must be reabsorbed
by the tubules
43. Which of the following substances is more concentrated at the end of the
proximal tubule than at the beginning:
a) Glucose
b) Potassium
c) Bicarbonate
d) Creatinine
e) Sodium
44. The bicarbonate: carbonic acid ration of the plasma that corresponds to pH
7.4 equals:
a) 1:1
b) 5:1
c) 10:1
d) 15:1
e) 20:1
a) Plasma pH
e) Phosphate excretion
ENDOCRINE SYSTEM
1. A tumor that produces large amounts of catecholamines can be detected by
examining the urine for:
a) K+
b) Uric acid
c) Choline
d) VMA
e) Calcium
a) Cortisol
b) TRH
c) CRH
d) Vasopressin
e) TSH
3. A ten year old boy has high levels of the growth hormone. He is likely to
develop:
a) Acromegaly
b) Hyperglycemia
c) Mental retardation
d) Muscle atrophy
e) Hyperkalaemia
c) Hypervolaemia
b) Release of insulin
c) Lipogenesis
c) Intolerance to cold
e) Constipation
a) Growth hormone
b) Prolactin
c) Adrenocorticotrophic hormone
e) Luteinizing hormone
10. The most sensitive regulatory mechanism of ADH secretion is dependent on:
b) Renin-angiotensin system
c) Hypothalamic osmoreceptors
12. All the following is true about control of secretion of TSH except:
a) It is inhibited by T4
d) It is increased in TRH
a) Stimulation of melanocytes
b) Exercise
c) Reduce weight
b) Inhibition of gluconeogenesis
c) Inhibition of ketogenesis
d) Reduction of extracellular K+
16. The following factors have a direct marked effect on the adrenal cortex to
stimulate the secretion of aldosterone except:
a) Angiotensin III
b) Angiotensin II
c) Hyperkalemia
d) Hypernatremia
a) Parathyroid hormone
b) Calcitonin
c) Growth hormone
d) Prolactin
e) Active vitamin D
18. If a patient dies of hypercalcemia, the most likely cause would be:
myosin
e) Hypo-osmolality
a) Moderate hyperglycemia
b) Sodium natriuresis
c) Oedema
d) Alkalosis
a) Hypopigmentation
b) Good appetite
c) Hypoglycemia
d) Obesity
e) Hypertension
a) Hypotension
b) Protein depletion
c) Hypoglycemia
b) Vagal stimulation
c) Amino acids
d) GIP
e) Gastrin
23. Calcitonin:
a) Diabetes mellitus
b) Diabetes insipidus
c) Hypervitaminosis D
d) Tetany
e) Hypothyroidism
25. A ten year old boy has high levels of growth hormone. He is likely to develop:
a) Acromegaly
b) Hyperglycemia
c) Mental retardation
d) Muscle atrophy
e) Hyperkalemia
a) Melatonin
b) Acetylcholine
c) Beta endorphin
d) Inhibin
e) Somatomedins
a) Estradiol
b) Testosterone
c) Calcium
d) Oxytocin
e) A or B
28. Testosterone action on target cells below the neck leads to increases on which
of the following?
a) Spermatogenesis
b) Prostate size
c) Penile size
a) Gluconeogenic
b) Ketogenic
c) Protein anabolic
d) Diuretic
e) Vasoconstrictive
32. The main effect of somatostatin secreted by the D cells of the islets of
Langerhans appears to be:
33. Factors that act on the cells of the adrenal gland to cause secretion of
aldosterone include:
a) Renin
b) Angiotensinogen
c) Angiotensin I
e) Potassium ions
b) Hypertension
c) Hyperglycemia
syndrome
e) Immunosuppression
c) Is inhibited by chlorpromazine
d) Is stimulated by bromocriptine
شيت المجلس
224 صفحة Dr. MOHAMED YAHIA 0900987639
QUESTION BANK OF Dr. MOHAMED YAHIA
5. A drug that increases the heart rate from 70 to 100 beats per minute could be:
a. a B1 adrenergic receptor antagonist
b. a cholinergic receptor antagonist
c. a cholinergic receptor agonist
d. a B2 adrenergic receptor agonist
e. a non-cholinergic, non-adrenergic agonist
6. Body water
a. is about 60 liters
b. can be measured by inulin dilution
c. is found mainly intra-cellularly
d. has solutes osmotic pressure of about 400 mosm/l
e. loss of 5% causes symptoms & signs of dehydration
d. protein
e. calcium
14. The most sensitive regulatory mechanism of ADH secretion is dependent on:
a. The volume receptors
b. Rennin- angiotensin system
c. Hypothalamic osmoreceptors
d. Renal glomerulotubular feedback
19. If a patient dies of hypocalcaemia, the most likely cause would be:
a. excessive bleeding
b. loss of normal smooth muscles contractility
c. uncontrolled contraction of skeletal muscles
d. failure of the SA node to generate impulses
e. hypo-osmolality
20. Which of the following is true about the glomerular filtration (GFR):
a. the rate of filtration is about 180 liters /day
b. GFR= about 250 ml/min
c. its composition is similar to that of plasma
d. water, electrolytes pass by diffusion
e. organic molecules up to 80 D can pass in the glomerular filtrate
24. The dorsal column tracts of the spinal cord serve the following modalities
a. Pain
b. crude touch
c. ticle& itch
d. sexual sensations
e. proprioception
29. The concentration of the following is higher in the extracellular fluid than in the
intracellular fluid:
a. Ca++
b. H+
c. K+
d. Mg++
e. Protein
31. Regarding the role of the kidney in regulation of acid base balance. The following is
true:
a. The kidney maintains the urine pH at constant levels
b. Increased titrable acidity increases sodium re-absorption
c. Increased excretion of NH4+ increases Hco3- loss in urine
d. Increased urine pH increases secretion of NH3
e. Titrable acidity increases five folds in metabolic acidosis
36. What is the chief factor in producing sensation of heat on palpation of an acute
abscess?
a. Increased metabolism in the tissues around the abscess
b. Increased rate of destruction of micro-organisms
c. Increased blood flow through the skin
d. Increased metabolism of the epidermis
e. Increased body temperature
37. In a polymorph white blood cell what is the cytoplasmic organelle that destroys
the bacterium:
a. Lysosome
b. Mitochondrion
c. Phagocytic vacuole
d. Phagosome
e. Pinocytic vacuole
42. The distal ileum is the main site for absorption of:
a. Glucose
b. vitamin C
c. fat soluble vitamins
d. bile salts
e. iron
44. Which receptors are most effective in mediation of secretion of HCL in the
stomach?
a. PG2 receptors
b. H2 receptors
c. adrenergic B2 receptors
d. cholinergic muscarinic receptors
e. gastrin receptors
47. On measuring the osmolarity of urine in a normal subject, it was found to be 1000
mosm/L. in this subject we expect the following:
a. ADH is secreted
b. 30% of water is reabsorbed in the proximal tubules
c. 20% of filtered fluid is reabsorbed in the ascending limb of the loop of Henle
d. the thick part of the loop of Henle became permeable to water
e. glucose reabsorption is inhibited
50. The movement of fluid from the capillaries to the interstitial space is increased by
the following EXCEPT:
a. lymphatic obstruction
b. arteriolar constriction
c. blockage of veins
d. increased proteins in the interstitial fluid
e. histamine
57. A patient with D.U is treated successfully with the drug omeprazol, the basis for
cimetidine inhibition of gastric H+ secretion is that it:
a. blocks muscarinic receptors on parietal cells
b. blocks H2 receptors at parietal cells
c. increases intracellular cyclic adenosine monophosphate (CAMP) levels
d. blocks H+, K+ adenosine triphosphate (ATPase)
e. enhances the action of acetylecholine (ACh) on parietal cells
60. Which of the following inhibits the secretion of growth hormone by the anterior
pituitary?
a. Hypoglycemia
b. Starvation
c. Sleep
d. Stress
e. Somatomedins
b. hypokalaemia
c. hyperosmolerity
d. hypernatraemia
e. administration of an inhibitor of angiotensin converter enzyme (ACE)
63. Which of the following results from the action of parathyroid hormone (PTH) on
the renal tubule?
a. inhibition of 1 alpha hydroxylase
b. stimulation of Ca+2reabsorption in the distal tubule
c. decreased urinary excretion of cyclic adenosine monophosphate (AMP)
d. stimulation of phosphate reabsorption in the proximal tubules
e. interaction with receptors on the luminal membrane of the proximal tubular
cells
d. pulmonary
e. coronary
69. A lesion of the chorda tympani nerve would most likely result in:
a. impaired olfactory function
b. impaired vestibular function
c. impaired auditory function
d. impaired taste function
e. nerve deafness
73. In which of the following is pulmonary blood flow greater than aortic blood flow?
a. normal adult
b. fetus
c. left-to-right ventricular shunt
74. Carbon dioxide (Co2) regulates blood to which of the following organs?
a. heart
b. skin
c. brain
d. skeletal muscle at rest
e. skeletal muscle during exercise
76. Cardiac output of the right side of the heart is what percentage of the cardiac
output of the left heart?
a. 25%
b. 50%
c. 75%
d. 100%
e. 125%
81. Complete transection of the spinal cord at T1 would most likely result in:
a. loss of stretch reflexes below the lesion
b. temporary loss of coordination proprioception below the lesion
c. permanent loss of voluntary control micturition
d. permanent loss of consciousness above the lesion
e. non of the above
82. Repolarization:
a. is due to active transport K+ out of the cell
b. is partly due to influx of Cl-
c. is usually much quicker than depolarization
d. coincides with the relaxation phase of the muscle twitch in skeletal muscles
e. is due to Ca2+ influx in cardiac muscle
84. A skeletal muscle cell requires ATP for the following except:
a. to provide energy for the power stroke of myosin
b. the release of myosin head from actin
c. the reuptake of Ca2+ by the sarcoplasmic reticulum
d. the transport of Na+ to the ECF
e. the release of Ca2+ from the sarcoplasmic reticulum
85. The interaction of the parasympathetic and sympathetic nervous systems in the
control of heart rate:
a. is an example of reciprocal innervations
b. determines the range of control of the heart rate
c. works predominantly through muscarinic receptors
d. enables dual control of ventricular muscle contraction
e. all of the above are correct
87. Acetylcholine:
a. Is blocked by propanolol.
b. Is blocked by curare in the autonomic ganglion.
c. Is the neurotransmitter at all sites that are blocked by atropine.
d. Is secreted by postganglionic sympathetic to sweat glands.
e. Is degraded by the enzyme COMT.
91. The average daily amount of fluid that passes through the pylorus in a healthy
adult is about:
a. 2 -3litres
b. 9-10 litres
c. 5-6 litres
d. 8-10 litres
e. 10-12 litres
a. Ca2+
b. Alcohol
c. Glucose
d. aromatic aminoacids
e. Fe2+
99. Tripling the resting heart rate of a healthy young adult during heavy exercise:
a. is achieved by activation of the sympathetic nerves
b. a decrease in cholinergic discharge at the sinoatrial node
c. occurs as a result of withdrawal of normal parasympathetic activity
d. occurs as a result of the Bainbridge reflex
e. is primarily due to an increase in venous returns
101. All the following is true about control of secretion of TSH, except:
a. It is inhibited by T4
b. It is increased in cold weather
c. It is increased in Grave’s disease
d. It is increased by TRH
e. Has no marked diurnal rhythm
103. Which of the following factors has a directly stimulates the secretion of
aldosterone from adrenal corex:
a. angiotensin I
b. hypotension
c. hyperkalemia
d. hyponatraemia
e. ACTH
a. is determined by LH
b. is longer in young women
c. is dependent on the duration of the proliferative phase
d. depends on the life span of the corpus luteum
e. decreases with age
117. The following is true about the generator potential of a sensory receptor
a. it is immediately propagated
b. cannot be summated
c. is a form of local potential
d. obeys the all or non law
e. is transmitted to the axon
128. In the physiology of the heart: One of the following is not true:
a. Total de-enervation of the heart result in heart rate of 105 beats/min.
b. Vagal stimulation decreases the heart rate
c. The A.V. node is innervated by the Rt.vagus nerve
d. Stimulation of B-adrenergic receptors has a positive inotropic effect.
e. The resting membrane potential of the S.A node is –50 nv
129. Regarding the anti-diuretic hormone ADH: One of the following is not true:
a. Is stored in the anterior pituitary
b. Action is on the distal and collecting tubules
c. Deficiency causes diabetes insipidus
d. Is produced by the posterior pituitary
e. Has a vasopressor effect
132. Prolactin:
a. is a glycoprotein
b. causes milk ejection
c. is mainly controlled by inhibitory hormone from hypothalamus
d. causes milk formation during pregnancy
e. estimulate secretion of oestrogen from the ovaries
134. The increased excitability of nerve and muscle associated with plasma calcium
is due to:
a. increased entry of calcium into synaptic knob at neuromuscular junction
b. increased release of acetylcholine into synaptic junction
c. decreased potassium efflux
d. increased entry of sodium through voltage gated sodium channels
e. opening of chemically gated channels for sodium
b. hypertension
c. hypokalaemia
d. metabolic acidosis
e. respiratory alkalosis
144. The jejunum is the main site for absorption of the following except:
a. glucose
b. amino acids
c. fatty acids
d. bile salts
e. water
d. severe exercise
e. cerebellar lesions
149. Micelles:
a. are emulsified fat globules in the duodenum
b. are packets of pro-enzymes found in pancreatic acinar cells.
c. are dead enterocytes leaving the tips of villi.
d. are micro structures of cholesterol and fatty acids coated with bile salts
e. are the triglyceride particles formed by enterocytes and transported in the
lymphatic system.
151. Platelets:
a. normal count is about 4000/mm3
b. have a life span of 30 days
c. contain clotting factors
d. secret prostacyclin
e. has receptors for protein C
153. Neutrophils:
a. contain heparin
177. During the cardiac cycle, closure of the aortic valve occurs at:
a. the end of the isovolumetric contraction
b. the beginning of rapid ejection phase
c. the beginning of isometric relaxation
d. the end of systole
e. the end of rapid filling phase
183. A patient in the A& E department with profuse hemorrhage from a severed
limb artery will have increased:
a. sodium excretion
b. sympathetic nerve activity
c. vagal activity
d. arteriolar diameter in skin
e. water excretion
190. Inferior wall MI will be picked by which of the following ECG leads:
a. V1 – V3
b. II, III, avf
c. RV4, RV5
d. I, AVL, V4, V6
e. V1 – V6
194. The transport of glucose across the luminal membrane in the proximal part of
the renal tubules:
a. is through insulin dependent glucose transporters
b. cannot take place against concentration gradient
c. is not affected by Na+ -K+ pump inhibitors
d. is a co-transport with sodium
e. is decreased in diabetes mellitus
204. Increased sympathetic discharge in the renal nerves will result in:
a. dilatation of the afferent and constriction of the efferent arterioles
b. decreased secretion of renin
c. decreased renal blood flow (RBF)
d. an increase in the GFR
e. renal excretion of sodium and water
209. The receptors for the following hormones are present in the cell membrane
except:
a. growth hormone
b. aldosterone
c. insulin
d. thyroid stimulating hormone
e. catecholamines
210. Acromegaly:
a. is due to excess growth hormone secretion in children
b. may result in diabetes mellitus
c. is characterized by hypertension
d. results in taller individuals
e. may result from increased number of growth hormone receptors
214. The physiological significance of amino acids stimulating both insulin and
glucagon secretion is:
a. entry of amino acids into cells
b. protein synthesis
c. avoiding hypokalaemia
d. avoiding hypoglycemia
e. gluconeogenesis in liver
217. Partial pressure of oxygen is less in alveoli compared to atmosphere due to:
a. high partial pressure of nitrogen.
b. low partial pressure of CO2.
c. presence of carbon monoxide.
d. the dead space.
e. water vapor.
218. In a patient with shortness of breath after a chest stab wound the following can
be expected
a. FEV1 is high.
b. FVC is low.
c. PEFR is normal.
d. Total lung capacity is high.
e. Anatomical dead space is low.
222. In a diabetic patient the pH was found to be 7.3, PaCO2 was found to be 46
mmHg and his HCO3- normal, fasting blood sugernorma; he is suffering from
a. respiratory alkalosis.
b. metabolic alkalosis.
c. metabolic acidosis.
d. diabetic ketoacidosis.
e. respiratory acidosis.
d. Stimulation of chemoreceptors.
e. Voluntary respiration.
227. In left sided pleural effusion the intrapleural pressure in that side will be
a. -2.5 mmHg at quiet expiration.
b. More than that in the right side.
c. -6 mmHg in quiet inspiration.
d. Can reach -30 in forced inspiration.
e. More effective in lung expansion.
234. In hypoxia the glomus cells of the carotid bodies are stimulated due to:
a. increased calcium.
b. increased dopamine.
c. closure of potassium channels
d. exocytosis of granules.
e. depolarization of nerve fibres.
235. In bone:
a. Osteoclasts are thought to be responsible for bone resorption.
b. A normal calcium content depends on mechanical stress being applied to the
bone
c. The width of the epighyseal plate is an indication of the rate of growth.
d. Strontium ions can replace some of the calcium ions
e. All of the above are true.
242. The most important factor regulating blood flow through exercising muscles
is:
a. Systemic blood pressure
b. Venous tone
c. Vasodilator metabolites
d. Sympathetic over activity
e. Parasympathetic control
243. The morphological layer of the articular cartilage most responsible for the
resistance to shear stress is:
a. Superficial zone
b. middle(transitional) zone
c. Radial zone
d. Tide mark
e. Zone of calcified cartilage
CHAPTER 2
262 صفحة Dr. MOHAMED YAHIA 0900987639
QUESTION BANK OF Dr. MOHAMED YAHIA
285 Question
PRETEST MICROBIOLOGY
VIROLOGY
1. An HIV-positive patient asks you if you can tell him the chances of him
progressing to symptomatic AIDS. Which one of the following tests would be
most useful?
2. Which of the following viruses causes an acute febrile rash and produces
disease in immunocompetent children but has been associated with transient
aplastic crises in persons with sickle cell disease?
a. Rubeola
b. Varicella-zoster
c. Parvovirus
d. Rubella
e. Herpes simplex
3. The latest and most effective therapy for AIDS patients includes
azidothymidine (AZT), dideoxyinosine (DDI), and saquinavir or similar agents.
Use of these three drugs would inhibit which of the following viral processes?
a. RNase, DNase
b. gp120 formation
c. p24 antibody expression
d. All membrane synthesis
e. Reverse transcriptase, protease
4. An HIV-positive patient prior to being treated with AZT, DDI, and saquinavir
has a CD4 lymphocyte count and an HIV RNA viral load test done. Results are
as follows:
5. This HIV-positive patient with a viral load of 750,000 copies of HIV RNA/ml
and a total CD4 count of 50 is at an increased risk for a number of infectious
diseases. For which of the following diseases is the patient at no more added risk
than an immunocompetent host?
a. Pneumocystic pneumonia
b. Mycobacterial disease
c. Kaposi’s sarcoma
d. Pneumococcal pneumonia
e. Herpes simplex virus
8. Delta hepatitis only occurs in patients who also have either acute or chronic
infection with hepatitis B virus. The delta agent is
a. Amantadine
b. Rimantadine
c. Vidarabine
d. Ribavirin
e. Acyclovir
10. Echoviruses are cytopathogenic human viruses that mainly infect the
a. Respiratory system
b. Central nervous system
c. Blood and lymphatic systems
d. Intestinal tract
e. Bladder and urinary tract
11. The most sensitive test for the diagnosis of herpes simplex (HSV) meningitis
in a newborn infant is
a. Coronavirus
b. Reovirus
c. Rhinovirus
d. Enterovirus
e. Respiratory syncytial virus
13. Mumps virus accounts for 10 to 15% of all cases of aseptic meningitis in the
United States. Infection with mumps virus
14. The serum of a newborn infant reveals a 1:32 cytomegalovirus (CMV) titer.
The child is clinically asymptomatic. Which of the following courses of action
would be advisable?
15. A 3-year-old child presents at the physician’s office with symptoms of coryza,
conjunctivitis, low-grade fever, and Koplik’s spots. The causative agent of this
disease belongs to which group of viruses?
a. Adenovirus
b. Herpesvirus
c. Picornavirus
d. Orthomyxovirus
e. Paramyxovirus
16. One of the most common sexually transmitted diseases that may lead to
cervical carcinoma is caused by which of the following viruses?
a. Cytomegalovirus
b. Papillomavirus
c. Epstein-Barr virus
d. Herpes simplex virus
e. Adenovirus
17. Which virus is the leading cause of the croup syndrome in young children
and, when infecting mammalian cells in culture, will hemabsorb red blood cells?
a. Group B coxsackievirus
b. Rotavirus
c. Parainfluenza virus
d. Adenovirus
e. Rhinovirus
19. Kuru is a fatal disease of certain New Guinea natives and is characterized by
tremors and ataxia; Creutzfeldt-Jakob disease (CJD) is characterized by both
ataxia and dementia. These diseases are thought to be caused by
a. Slow viruses
b. Cell wall–deficient bacteria
c. Environmental toxins
d. Prions
e. Flagellates
21. Meningitis is characterized by the acute onset of fever and stiff neck. Aseptic
meningitis may be caused by a variety of microbial agents. During the initial 24 h
of the course of aseptic meningitis, an affected person’s cerebrospinal fluid is
characterized by
22. What serologic test can be used to determine whether a patient with HDV is
an HBV carrier?
a. HBsAg
b. HBc IgM
c. HBeAg
d. HBs IgM
e. HBs IgG
23. A nurse develops clinical symptoms consistent with hepatitis. She recalls
sticking herself with a needle approximately 4 months before after drawing
blood from a patient. Serologic tests for HBsAg, antibodies to HBsAg, and
hepatitis A virus (HAV) are all negative; however, she is positive for IgM core
antibody. The nurse
a. Measles (rubeola) and German measles (rubella) are caused by the same virus
b. Incubation time is approximately 3 to 4 weeks
c. Vesicular rashes are characteristic
d. Onset is abrupt with cough, coryza, and fever
e. Specific antibody in the serum does not prevent disease
a. Mumps
b. Infectious mononucleosis
c. Congenital rubella
d. Aseptic meningitis
e. Rabies
26. Hepatitis D virus (delta agent) is a defective virus that can replicate only in
cells already infected with which of the following viruses?
a. Hepatitis A virus
b. Epstein-Barr virus
c. Hepatitis G virus
d. Hepatitis B virus
e. HIV
a. Parvovirus
b. Adenovirus
c. Epstein-Barr virus
d. Respiratory syncytial virus
e. Varicella-zoster virus
a. Hepatitis C virus
b. Herpes simplex virus
c. Listeria monocytogenes
d. Coxsackievirus
e. Parvovirus
30. Which of the following procedures or clinical signs is most specific for the
diagnosis of infectious mononucleosis caused by the Epstein-Barr virus?
31. An infant, seen in the ER, presents with a fever and persistent cough.
Physical examination and a chest x-ray suggest pneumonia. Which of the
following is most likely the cause of this infection?
a. Rotavirus
b. Adenovirus
c. Coxsackievirus
d. Respiratory syncytial virus
e. Rhinovirus
32. An obstetrician sees a pregnant patient who was exposed to rubella virus in
the eighteenth week of pregnancy. She does not remember getting a rubella
vaccination. The best immediate course of action is to
33. Mad Cow Disease has been highly publicized in Great Britain. This disease,
which is similar to scrapie, is caused by
a. A prion
b. A virus
c. Rickettsiae
d. An autoimmune reaction
e. A bacterium with a defective cell wall
34. A patient has all the gastrointestinal symptoms of infection with hepatitis A
virus (HAV), yet all the tests for HAV-IgG and HAV-IgM are nonreactive. A
possible cause of this infection is
35. A 70-year-old nursing home patient refused the influenza vaccine and
subsequently developed influenza. She died of acute pneumonia 1 week after
contracting the “flu.” The most common cause of acute postinfluenzal
pneumonia is
a. Legionella
b. Listeria
c. Staphylococcus aureus
d. Klebsiella
e. Escherichia coli
a. Measles
b. Parvovirus
c. Rubella
d. Human herpesvirus type 6
e. Norwalk virus
37. Which one of the following viruses may be human tumor virus?
43. Paramyxoviruses are most commonly associated with which of the following
diseases?
a. Fifth disease
b. Rubella
c. Croup
d. Tonsillitis
e. Otitis media
a. Rectal polyps
b. Prostate cancer
c. Condyloma acuminatum
d. Hepatic carcinoma
e. Carcinoma of the lung
a. DNase activity
b. RNA-dependent RNA polymerase activity
c. RNA isomerase activity
d. RNA-dependent DNA polymerase activity
e. Integration activity
47. Which one of the following viruses would be most likely to establish a latent
infection?
a. Adenovirus
b. Measles virus
c. Influenza virus
d. Parvovirus
e. Coxsackievirus group B
a. Hepatitis A
b. Hepatitis B
c. Rabies
d. Poliomyelitis
e. Infectious mononucleosis
a. Dengue fever
b. St. Louis encephalitis
c. Infectious mononucleosis
d. Hepatitis
e. HIV infection
51. Hepatitis C (HCV) is usually a clinically mild disease, with only minimal
elevation of liver enzymes. Hospitalization is unusual. Which one of the following
statements best characterizes HCV?
52. Which of the following markers is usually the first viral marker detected
after hepatitis B infection?
a. HBeAg
b. HBsAg
c. HBcAg
d. Anti-HBc
e. HbeAb
53. Which of the following may be the only detectable serological marker during
the early convalescent phase of HBV infection (window phase)?
a. HBeAg
b. HBsAg
c. HBcAg
d. Anti-HBc
e. HbeAb
54. Which one of the following markers is closely associated with HBV infectivity
and DNA polymerase activity?
a. HBeAg
b. HBsAg
c. HBcAg
d. Anti-HBc
e. HBeAb
55. Which of the following is found within the nuclei of infected hepatocytes and
not usually in the peripheral circulation?
a. HBeAg
b. HBsAg
c. HBcAg
d. Anti-HBc
e. HbeAb
56. Which one of the following viruses is the leading cause of congenital
malformations?
a. Rabies
b. Rhinovirus
c. Cytomegalovirus
d. Respiratory syncytial virus
e. Mumps
57. Orchitis, which may cause sterility, is a possible manifestation of which of the
following?
a. Rabies
b. Rhinovirus
c. Cytomegalovirus
d. Respiratory syncytial virus
e. Mumps
a. Rabies
b. Rhinovirus
c. Cytomegalovirus
d. Respiratory syncytial virus
e. Mumps
59. Which of the following causes a fatal encephalitis for which a vaccine is
available?
a. Rabies
b. Rhinovirus
c. Cytomegalovirus
d. Respiratory syncytial virus
e. Mumps
60. Traditional vaccination for the common cold is virtually impossible because
there are multiple serotypes of which one of the following viruses?
a. Rabies
b. Rhinovirus
c. Cytomegalovirus
d. Respiratory syncytial virus
e. Mumps
a. Cytomegalovirus
b. Rotavirus
c. Varicella-zoster virus
d. Adenovirus
e. Papillomavirus
62. Excluding influenza, which one of the following viruses is a common cause of
acute respiratory disease?
a. Cytomegalovirus
b. Rotavirus
c. Varicella-zoster virus
d. Adenovirus
e. Papillomavirus
63. Human warts are not only cosmetically unsightly but may lead to cancer of
the cervix. They are caused by which one of the following viruses?
a. Cytomegalovirus
b. Rotavirus
c. Varicella-zoster virus
d. Adenovirus
e. Papillomavirus
64. A vaccine is available for one of the most common causes of infantile
gastroenteritis. However, it has recently been recalled. The virus is
a. Cytomegalovirus
b. Rotavirus
c. Varicella-zoster virus
d. Adenovirus
e. Papillomavirus
65. A child has mononucleosis-like symptoms yet the test for mononucleosis and
the EBV titers are negative. One of the causes of heterophile negative
mononucleosis is
a. Cytomegalovirus
b. Herpes simplex virus
c. Varicella-zoster virus
d. Adenovirus
e. Coxsackievirus
66. Malaise and fatigue with increased “atypical” lymphocytes and a reactive
heterophil antibody test is most commonly caused by
a. Toxoplasma
b. Borrelia burgdorferi
c. Epstein-Barr virus
d. Parvovirus
e. Rubella virus
67. Lethargy, malaise, and fatigue are observed in a patient 2 weeks after eating
raw hamburger at a restaurant. The most likely infectious cause is
a. Toxoplasma
b. Cytomegalovirus
c. E. coli
d. Salmonella
e. Clostridium
a. Cytomegalovirus
b. B. burgdorferi
c. Epstein-Barr virus
d. Lymphogranuloma venereum
e. Herpes simplex virus
69. This virus may be detected by the polymerase chain reaction (PCR) in a
variety of cells of patients with nasopharyngeal carcinoma.
a. Measles
b. Mumps
c. Rubella
d. Parvovirus
e. Epstein-Barr virus
Questions 70–74
Assume you are asked by a resident what the most appropriate specimen is for
the detection of a particular virus.
a. Cervical tissue
b. Synovial fluid
c. Blood
d. Skin
71. Cytomegalovirus
a. Cervical tissue
b. Synovial fluid
c. Blood
d. Skin
e. Cerebrospinal fluid
72. Enterovirus
a. Cervical tissue
b. Synovial fluid
c. Blood
d. Skin
e. Cerebrospinal fluid
a. Cervical tissue
b. Synovial fluid
c. Blood
d. Skin
e. Cerebrospinal fluid
a. Cervical tissue
b. Synovial fluid
c. Blood
d. Stool
e. Cerebrospinal fluid
75. Which of the following is transmitted by the fecal-oral route; can be acquired
from shellfish; and often causes acute jaundice, diarrhea, and liver function
abnormalities?
a. Rotavirus
b. Adenovirus 40/41
c. Norwalk virus
d. Astrovirus
e. Hepatitis A virus
76. Which of the following is the second most common cause of pediatric
gastroenteritis? Unlike other similar viruses, this virus causes only
gastroenteritis.
a. Rotavirus
b. Adenovirus 40/41
c. Norwalk virus
d. Astrovirus
e. Hepatitis A virus
77. Which of the following is the most common cause of pediatric gastroenteritis?
It is difficult to grow in cell culture but can be detected easily by immunologic
methods (ELISA).
a. Rotavirus
b. Adenovirus 40/41
c. Norwalk virus
d. Astrovirus
e. Hepatitis A virus
a. Rotavirus
b. Adenovirus 40/41
c. Norwalk virus
d. Astrovirus
e. Hepatitis A virus
a. Rotavirus
b. Adenovirus 40/41
c. Norwalk virus
d. Astrovirus
e. Hepatitis A virus
80. IgM antibody to the viral particle is the method of choice for laboratory
diagnosis of which one of the following hepatitis viruses?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E
81. This virus belongs to the family of flaviviruses and its reservoir is strictly
human. Transmission is blood-borne so the blood supply is routinely screened
for this virus.
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E
82. Vaccination for this hepatic disease is with viral surface antigen and usually
provides immunity.
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E
83. This hepatitis virus is a calicivirus. The reservoir is in pigs, and humans
acquire it via the fecal-oral route.
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E
a. Measles virus
b. Influenza virus
c. Respiratory syncytial virus
d. Parainfluenza virus
e. Adenovirus
a. Measles virus
b. Influenza virus
c. Respiratory syncytial virus
d. Parainfluenza virus
e. Adenovirus
a. Epstein-Barr virus
b. Cytomegalovirus
c. HHV-6
d. Parvovirus
e. Norwalk virus
BACTERIOLOGY
1. A patient with a peptic ulcer was admitted to the hospital and a gastric biopsy
was performed. The tissue was cultured on chocolate agar incubated in a
microaerophilic environment at 37°C for 5 to 7 days. At 5 days of incubation,
colonies appeared on the plate and were curved, Gram negative rods, oxidase-
positive. The most likely identity of this organism is
a. Campylobacter jejuni
b. Vibrio parahaemolyticus
c. Haemophilus influenzae
d. Helicobacter pylori
e. Campylobacter fetus
a. Exotoxin liberator
b. Endotoxin assembly
c. Flagella synthesis
d. Capsule formation
e. IgA protease synthesis
a. Vibrio cholerae
b. Corynebacterium diphtheriae
c. Pseudomonas
d. Listeria monocytogenes
e. Brucella
a. Mycoplasma pneumonia
b. Pneumococcal pneumonia
c. Staphylococcal pneumonia
d. Influenza
e. Legionellosis
5. Based on the information given, which of the following laboratory tests would
most rapidly assist you in making the diagnosis?
a. Cold agglutinins
b. Viral culture
c. Complement fixation (CF) test
d. Gram stain of sputum
e. Culture of sputum
6. The following laboratory data were available within 2 days: cold agglutinins—
negative; complement fixation (M. pneumoniae)—1:64; viral culture—pending,
but negative to date; bacterial culture of sputum on blood agar and
MacConkey’s agar—normal oral flora. In order to confirm the diagnosis, which
of the following procedures could be ordered to achieve a specific and sensitive
diagnosis?
8. The class of antibiotics known as the quinolones are bactericidal. Their mode
of action on growing bacteria is thought to be
10. A sputum sample was brought to the laboratory for analysis. Gram stain
revealed the following: rare epithelial cells, 8 to 10 polymorphonuclear
leukocytes per high-power field, and pleomorphic Gram-negative rods. As the
laboratory consultant, which of the following interpretations should you make?
a. A foul-smelling discharge
b. A black exudate in the wound
c. An exquisite susceptibility to penicillin
d. A heme-pigmented colony formation
e. Severe neurologic symptoms
13. Virtually all prokaryotic cells (bacteria, both Gram-positive and Gram
negative) contain peptidoglycan as well as specific enzymes for its synthesis. All
of the following statements concerning Gram-positive and Gram-negative
bacteria are true except
14. A 30-year-old male patient was seen by the emergency service and reported a
2-week history of a penile ulcer. He noted that this ulcer did not hurt. Which one
of the following conclusions/actions is most valid?
15. The laboratory reports that the Venereal Disease Research Laboratory
(VDRL) test performed on the above patient is reactive at a dilution of 1:4 (4
dils). The patient also reports to you that he has recently been diagnosed with
hepatitis A. Which one of the following actions would be most appropriate?
16. In the above patient, which one of the following test combinations for syphilis
is most appropriate?
17. Assume that the patient absolutely denied any contact, sexual or otherwise,
with a person who had syphilis. Assume also that both the RPR and the FTA Abs
were positive on this patient. Which one of the following tests could be used to
show that this patient probably does not have syphilis?
a. VDRL
b. Quantitative RPR
c. Treponema pallidum immobilization (TPI) test
d. Frei test
e. MHTP test
18. A 55-year-old man who is being treated for adenocarcinoma of the lung is
admitted to a hospital because of a temperature of 38.9°C (102°F), chest pain,
and a dry cough. Sputum is collected. Gram’s stain of the sputum is
unremarkable and culture reveals many small Gram-negative rods able to grow
only on a charcoal yeast extract agar. This organism most likely is
a. Klebsiella pneumoniae
b. Mycoplasma pneumoniae
c. Legionella pneumophila
d. Chlamydia trachomatis
e. S. aureus
19. A patient was hospitalized after an automobile accident. The wounds became
infected and the patient was treated with tobramycin, carbenicillin, and
clindamycin. Five days after antibiotic therapy was initiated, the patient
developed severe diarrhea and pseudomembranous enterocolitis. Antibiotic-
associated diarrhea and the more serious pseudomembranous enterocolitis can
be caused by
a. Clostridium sordellii
b. Clostridium perfringens
c. Clostridium difficile
d. S. aureus
e. B. fragilis
20. A child comes to an emergency room because of an infected dog bite. The
wound is found to contain small Gram-negative rods. The most likely cause of
infection is
a. E. coli
b. H. influenzae
c. Pasteurella multocida
d. Brucella canis
e. Klebsiella rhinoscleromatis
23. A patient complained to his dentist about a draining lesion in his mouth. A
Gram’s stain of the pus showed a few Gram-positive cocci, leukocytes, and many
branched Gram-positive rods. The most likely cause of the disease is
a. Actinomyces israelii
b. Actinomyces viscosus
c. C. diphtheriae
d. Propionibacterium acnes
e. S. aureus
24. A man who has a penile chancre appears in a hospital’s emergency service.
The VDRL test is negative. The most appropriate course of action for the
physician in charge would be to
25. Fever of unknown origin in a farmer who raises goats would most likely be
caused by which of the following organisms?
a. Brucella melitensis
b. Clostridium novyi
c. T. pallidum
d. Histoplasma capsulatum
e. Mycobacterium tuberculosis
27. S. aureus causes a wide variety of infections, ranging from wound infection to
pneumonia. Treatment of S. aureus infection with penicillin is often complicated
by the
28. Symptoms of C. botulinum food poisoning include double vision, in- ability to
speak, and respiratory paralysis. These symptoms are consistent with
29. In people who have sickle cell anemia, osteomyelitis usually is associated with
which of the following organisms?
a. Micrococcus
b. Escherichia
c. Pseudomonas
d. Salmonella
e. Streptococcus
a. Erythromycin
b. Ciprofloxacin
c. Ampicillin
d. Pepto-Bismol
e. Campylobacter antitoxin
31. A hyperemic edema of the larynx and epiglottis that rapidly leads to
respiratory obstruction in young children is most likely to be caused by
a. K. pneumoniae
b. M. pneumoniae
c. Neisseria meningitidis
d. H. influenzae
e. H. hemolyticus
a. Proteus mirabilis
b. Streptococcus faecalis
c. Staphylococcus epidermidis
d. S. aureus
e. E. coli
Questions 33–35
A 70-year-old female patient was readmitted to a local hospital with fever and
chills following cardiac surgery at a major teaching institution. Blood cultures
were taken and a Gram-positive coccus grew from the blood cultures within 24
hours. Initial tests indicated that this isolate was resistant to penicillin.
a. Streptococcus pneumoniae
b. Neisseria
c. Group A streptococcus
d. Enterococcus
e. Group B streptococcus
34. Further testing revealed that the isolate possessed the group D antigen, was
not β-lactamase-positive, but was resistant to vancomycin. The most likely
identification of this isolate is
a. Enterococcus faecalis
b. Enterococcus durans
c. Enterococcus cassiflavus
d. S. pneumoniae
e. Enterococcus faecium
a. Gentamicin
b. Gentamicin and ampicillin
c. Ciprofloxacin
d. Rifampin
e. No available treatment
36. Diphtheria toxin is produced only by those strains of C. diphtheria that are
a. Glucose fermenters
b. Sucrose fermenters
c. Lysogenic for β-prophage
d. Of the mitis strain
e. Encapsulated
37. The patient described in the case above most likely has
38. Culture of the menstrual fluid in the case cited would most likely reveal a
predominance of
a. S. aureus
b. S. epidermidis
c. C. perfringens
d. C. difficile
e. Gardnerella vaginalis
39. The most characteristic finding not yet revealed in the case just presented
would be
a. Travel to Vermont
b. Recent exposure to rubella
c. A retained tampon
d. Heavy menstrual flow
e. A meal of chicken in a fast-food restaurant
40. A 2-year-old infant is brought to the emergency room with hemolytic uremic
syndrome and thrombocytopenia. Which one of the following bacteria would
most likely be isolated from a stool specimen?
a. Shigella
b. Salmonella
c. Aeromonas
d. E. coli 0157/H7
e. Enterobacter
41. E. coli causes disease by a variety of different methods. Which one of the
following E. coli types is characterized by the presence of LT (heat-labile) and
ST (heat-stable) proteins?
a. Enteroinvasive (EIEC)
b. Enterotoxigenic (ETEC)
c. Enterohemorrhagic (EHEC)
d. Enteropathogenic (EPEC)
e. Enterohemolytic (EHEEC)
42. Yersinia pestis, the causative agent of plague, is enzootic in the United States
west of the one-hundredth meridian. Human plague can be bubonic or
pneumonic. The primary epidemiologic difference between the two clinical forms
of plague is
43. Recently, there have been sensational media reports of patients infected with
invasive, “flesh-eating” bacteria that spread rapidly through the tissues. This
necrotizing fasciitis is usually caused by
a. S. aureus
b. Group A streptococci
c. Micrococcus
d. Bacillus cereus
e. Clostridium tetani
44. The most effective noninvasive test for the diagnosis of Helicobacter
associated gastric ulcers is
45. A 9-year-old child is brought to the emergency room with the chief complaint
of enlarged, painful axillary lymph nodes. The resident physician also notes a
small, inflamed, dime-sized lesion surrounding what appears to be a small
scratch on the forearm. The lymph node is aspirated and some pus is sent to the
laboratory for examination. A Warthin-Starry silver impregnation stain reveals
many highly pleomorphic, rod-shaped bacteria. The most likely cause of this
infection is
a. Y. pestis
b. Yersinia enterocolitica
c. Mycobacterium scrofulaceum
d. B. canis
e. Bartonella henselae
46. If a quellung test was done on the following bacterial isolates, which one
would you expect to be positive?
a. S. pneumoniae
b. Enterobacter
c. Haemophilus parainfluenzae
d. C. diphtheriae
e. N. gonorrhoeae
a. Tetanus
b. Botulism
c. Bacillary (Shigella) dysentery
d. Diphtheria
e. Disseminated intravascular coagulation
48. A 2-year-old child was admitted to the hospital with acute meningitis. The
Gram stain revealed Gram-positive short rods, and the mother indicated that the
child had received “all” of the meningitis vaccinations. What is the most likely
cause of the disease?
a. N. meningitidis, group A
b. N. meningitidis, group C
c. Listeria
d. S. pneumoniae
e. H. influenza
50. Rheumatic fever (RF) is a disease seen in children and young adults. Which
one of the following statements best typifies the disease?
51. The fermentation patterns for four strains of Gram-negative cocci are given
below (strains C and D grow on plain nutrient agar). Which of these strains is
likely to cause venereal disease in humans?
a. a. Strain A + + −
b. b. Strain B − + −
c. c. Strain C − − −
d. d. Strain D + + +
a. Penicillin
b. Ampicillin
c. Erythromycin
d. Vancomycin
e. Ceftriaxone
a. Penicillin
b. Ampicillin
c. Erythromycin
d. Vancomycin
e. Ceftriaxone
a. Penicillin
b. Ampicillin
c. Erythromycin
d. Vancomycin
e. Ceftriaxone
a. Penicillin
b. Ampicillin
c. Erythromycin
d. Vancomycin
e. Ceftriaxone
a. Penicillin
b. Ampicillin
c. Erythromycin
d. Vancomycin
e. Ceftriaxone
60. C. diphtheriae may be difficult to isolate from the nasopharynx without the
use of special media. The medium of choice is
61. S. aureus has a distinctive appearance on which one of the following media?
b. It produces toxin that blocks protein synthesis in an infected cell and carries a
lytic bacteriophage that produces the genetic information for toxin production
c. It produces at least one protein toxin consisting of two subunits, A and B, that
cause severe spasmodic cough usually in children
d. It has capsules of polyglutamic acid, which is toxic when injected into rabbits
e. It secretes exotoxin that has been called “verotoxin” and “Shiga-like toxin”;
infection is mediated by specific attachment to mucosal membranes
64. Brucella is pathogenic for humans and animals. Which one of the following
statements best characterizes this organism?
a. It has capsule of polyglutamic acid, which is toxic when injected into rabbits
b. It synthesizes protein toxin as a result of colonization of vaginal tampons
c. It causes spontaneous abortion and has tropism for placental tissue due to the
presence of erythritol in allantoic and amniotic fluid
d. It secretes two toxins, A and B, in large bowel during antibiotic therapy
e. It has 82 polysaccharide capsular types; capsule is antiphagocytic; type 3
capsule (b-d-glucuronic acid polymer) most commonly seen in infected adults
Questions 65–69
66. Influenza can be treated; therefore, specific detection of the virus becomes
much more important. Which of the following would be best for detection of
influenza?
67. Legionnaires’ disease is most rapidly diagnosed by which one of the following
procedures?
69. Bordetella bronchitis, sometimes called whooping cough, can best be detected
by which of the following procedures?
70. Which of the following is the predominant organism on skin commonly seen
as a blood culture contaminant?
a. α-hemolytic streptococci
b. Lactobacillus
c. S. epidermidis
d. Escherichia coli
e. B. fragilis
71. Which of the following is the predominant flora of the mouth that is the
major cause of dental caries?
a. α-hemolytic streptococci
b. Lactobacillus
c. S. epidermidis
d. E. coli
e. B. fragilis
72. The bowel contains many microorganisms but the most prevalent bacterium
is
a. α-hemolytic streptococci
b. Lactobacillus
c. S. epidermidis
d. E. coli
e. B. fragilis
73. Which of the following is the most prevalent microorganism in the vagina
that may also be protective?
a. α-hemolytic streptococci
b. Lactobacillus
c. S. epidermidis
d. E. coli
e. B. fragilis
a. Toxoplasma
b. Cryptosporidium
c. Candida
d. Cryptococcus
e. Pneumocystis
a. Candida albicans
b. Cryptococcus
c. Paracoccidioides brasiliensis
d. Histoplasma capsulatum
e. Aspergillus fumigates
a. Acremonium
b. Nocardia
c. Actinomyces
d. Pseudallescheria (Petriellidium)
e. Madurella
a. Aspergillus
b. Candida
c. Wangiella
d. Cryptococcus
e. Blastomyces
a. Wound infection
b. Urinary tract infection
c. Invasive aspergillosis causing thrombosis and infarction
d. Thrush
e. Superficial rash
9. Human infection with the beef tapeworm, Taenia saginata, usually is less
serious than infection with the pork tapeworm, T. solium, because
a. Plasmodium falciparum
b. Plasmodium vivax
c. Trypanosoma gambiense
d. Wuchereria bancrofti
e. Schistosoma mansoni
a. Microsporidium
b. Cryptosporidium
c. Pneumocystis
d. Blastocystis
e. Blastomyces
BRS MICROBIOLOGY
BACTERIOLOGY:
(A) Acetyltransferase
(B) Neuraminidases
(C) Oxidases
(D) Penicillin-binding proteins
(E) Phosphotransferases
(A) E. coli
(B) Mycobacteria
(C) Neisseria
(D) Salmonella
(E) Shigella
(A) Prophage
(B) Virulent phage
(C) Temperate phage
(D) Filamentous phage
(A) Heterotrophs
(B) Obligate anaerobes
(C) Aerobes
(D) Facultative anaerobes
(E) Autotrophs
(A) Capsule
(B) Lipopolysaccharide
(C) Common pili
(D) O-specific side chain
(E) Teichoic acid
(A) Heterotrophs
(B) Obligate anaerobes
(C) Aerobes
(D) Facultative anaerobes
(E) Autotrophs
15. Bacteria capable of growth in a high salt concentration are best isolated in
which of the following media?
(A) Heterotrophs
(B) Obligate anaerobes
(C) Aerobes
(D) Facultative anaerobes
(E) Autotrophs
(A) Transformation
(B) Conjugation
(C) Transduction
(D) Transcription
(E) Recombination
22. The exchange of allelic forms of genes is involved in which of the following
processes?
(A) Transformation
(B) Conjugation
(C) Transduction
(D) Transcription
(E) Recombination
(A) Transformation
(B) Conjugation
(C) Transduction
(D) Transcription
(E) Recombination
(F) Translation
(C) PBPs
(D) Pili
(E) Protein secretion systems
(A) Deletion
(B) Frameshift
(C) Insertion
(D) Nonsense
(E) Nucleotide substitution
26. A 21-year-old male college student who had complained of headache and
feeling feverish the night before is brought this morning to the emergency
department (ED) when his roommate was unable to rouse him. He had been well
until yesterday. Vital signs include fever (39.8°C/103.1°F), tachycardia, and
hypotension (BP 70/55). Remarkable on physical examination is petechial rash
(purpuric in areas) and nuchal rigidity with positive Kernig and Brudzinski
signs. CSF is cloudy with high protein and low glucose. Intracellular, red
diplococci are seen on Gram stain. What is the most likely genus?
(A) Staphylococcus
(B) Streptococcus
(C) Chlamydia
(D) Mycobacterium
(E) Neisseria
27. A 24-year-old female presents with dysuria, as well as urinary urgency and
frequency. A urine dipstick test is positive for both leukocyte esterase and
nitrites. What genus or family is noted for the production of nitrites?
(A) Escherichia
(B) Staphylococcus
(C) Streptococcus
(D) Vibrio
28. What rapid test commonly used on Gram- negative rods rules out
Enterobacteriaceae if positive?
(A) Catalase
(B) Coagulase
(C) Oxidase
(D) Chitinase
(E) Urease
29. A patient presents with rapid onset severe respiratory symptoms. Chest
radiographs show a hemorrhagic lymphadenitis. The isolation of chains of fairly
large, aerobic Gram-positive rods, some of which have started to sporulate from
a patient with this presentation, should raise a major concern of which
organism? (You should be able to answer this question from the genus alone,
although a question might also mention that it was nonmotile.)
(A) Actinomyces
(B) Chlamydophila
(C) Mycobacterium avian-intracellulare (MAI or MAC)
(D) Nocardia
31. A female patient with a new genital lesion presents to your sexually
transmitted disease clinic. She is homeless, has no health insurance, and is an
intravenous drug user. You suspect syphilis. Which of these techniques would be
most appropriate to demonstrate treponemes?
(E) Electrophoresis
32. The CSF from a 2-week-old infant with meningitis shows rods with tumbling
motility. These bacteria are found to be Gram-positive and do not form spores.
What is the most likely agent?
(A) Actinomyces
(B) Bacillus
(C) Clostridium
(D) Corynebacterium
(E) Listeria
33. Both a 53-year-old farmer and his 21-year old son present in August with
fever, myalgia, and malaise, which they came down with within a few hours of
each other. The son had been home in southern Minnesota for only 3 weeks to
help field train two new hunting dogs. You ask about potential tick bites, and the
son did have one on him, which was quite engorged. Platelets and granulocytes
are low in each man’s blood. You ask one of your experienced techs to do a
Giemsa stain on a thick blood smear. He calls, reporting clusters of cells
resembling raspberries in granulocytes, even though nothing grows in any of the
blood cultures. You realize that the blood cultures you set up will not grow and
that you have two patients who have infections with a tick-borne obligate
intracellular parasite of granulocytes. What genus does the organism belong to?
35. An 83-year-old who still lives in her own home has developed pneumonia
following influenza. The Gram stain of her sputa is shown. What is the most
likely agent?
37. A 14-month-old boy is brought in by his parents with fever, fussiness and
lethargy, and apparent headache. On examination, the neck is stiff. His parents
have not allowed his routine childhood vaccines. Very short Gram negative rods
are seen in the CSF, so antibiotics are immediately started. The organism grows
on chocolate agar but not blood agar. No one else in the family is ill. What is the
most likely causative agent?
38. A healthy 7-year-old boy who has not traveled outside the United States is
brought in by his parents in June with signs of meningitis. No bacteria are seen
in the Gram stain of the CSF, and no bacterial capsule material is present as
determined by a series of latex particle agglutination tests standard to the
diagnosis of meningitis. The CSF glucose level is slightly low, protein is near
normal, and white cell count is less than 500 cells/microL, mainly lymphocytes.
What is the most likely causative agent?
(B) Enterovirus
(C) Mycoplasma pneumoniae
(D) Mycobacterium tuberculosis
(E) Treponema pallidum
39. In any case, a clue indicating that the causative organism is an obligate
intracellular pathogen transmitted by an arthropod bite should lead you to
which of the following groups of organisms?
(A) Chlamydiae
(B) Enterobacteriaceae
(C) Rickettsias including Anaplasma and Ehrlichia
(D) Spirochetes including Borrelia burgdorferi
40. A 36-year-old man presents with focal central nervous system signs. Imaging
shows a brain abscess. The dominant organism is an anaerobe normally found as
part of the oral flora. Which of the following best fits that description?
(A) Nocardia
(B) Actinomyces
(C) Mycobacterium
(D) Pseudomonas aeruginosa
41. A 23-year-old man who has recently started working on a sheep farm in Nova
Scotia develops pneumonia shortly after helping with lambing. His cough
produces little sputum, and a saline-induced sputum sample shows no
predominant organism either with Gram stain or with acid-fast stain. It is
established that he acquired the pneumonia from parturition products from the
sheep. Which agent is most likely to be the cause of his pneumonia?
42. A 3-year-old girl presents with difficulty breathing and will not lie down to be
examined. You suspect acute bacterial epiglottitis and examine the child’s
epiglottis, which is highly inflamed. Which vaccine are you most likely to find
that the child is missing?
(A) Diphtheria
(B) Neisseria meningitidis
(C) Polio
(D) Streptococcus pneumoniae (conjugate vaccine)
(E) Haemophilus influenza
43. A 22-year-old man with cystic fibrosis presents with fever and increasing
dyspnea. A Gram-negative organism is found in unusually high numbers in the
pulmonary mucus. Which virulence factor is most important in colonization and
maintenance of the organism in the lungs?
(A) Exotoxin A
(B) Pyocyanin (blue-green pigment)
(C) Polysaccharide slime
(D) Endotoxin
44. From the above case, exotoxin A of the causative agent most closely
resembles the action of which other microbial toxin?
45. A 36-year-old man who immigrated to the United States 15 years ago and
lived in a crowded resettlement camp before coming to the United States
presents with a cough that has been bothering him for several weeks. He has also
lost 10 pounds. A gamma interferon release blood test is positive. Which of the
following factors is known to be most important in triggering the granulomatous
reaction to wall off and contain the infection?
47. A 23-year-old woman presents with mild gastroenteritis a few days after
having a variety of sushi at a party. There is no blood or pus in the stool. Which
causative agent is most likely to have caused this illness?
49. A patient who had surgery to put in a pace- maker and who states he felt fine
for the first 2 months now presents 3 months postoperatively with complaints of
malaise and increasing fatigue. He is running a low-grade fever, tires easily, and
has worsening heart murmurs. Which of the following staphylococcal organisms
causes subacute bacterial endocarditis that generally occurs 2 months or more
after heart surgery?
50. A previously healthy 6-month-old boy presents with upper body weakness.
He cannot hold his eyes open, pupils do not react, and he cannot hold his head
up. What is the proper treatment?
(A) Send him home on amoxicillin and clindamycin (to stop the toxin production
quickly)
(B) Give him a dose of equine anti-botulinum immunoglobulin
(C) Offer monitored supportive care with antibiotics and human anti-botulinum
immunoglobulin
(D) Offer monitored supportive care with human anti-botulinum
immunoglobulin
(E) Offer monitored supportive care with no antibiotics and no antitoxin
51. A 78-year-old man presents with a high fever, cough producing a blood-
tinged sputum, and difficulty breathing. Sputum shows an organism consistent
with Streptococcus pneumoniae. What is the most important virulence factor?
(A) Endotoxin
(B) A phospholipase allowing Streptococcus pneumoniae to escape the
phagosome quickly
(C) Polypeptide capsule
(D) Polysaccharide capsule
53. A 45-year-old man who recently returned from Africa has been febrile for
several days and now presents with abdominal pain. His blood cultures grow out
Salmonella typhi. What was the most likely source of his infection?
54. A 4-day-old infant girl now showing signs of sepsis is brought to the
emergency department. She was preterm (33 weeks) and born at home to her 16-
year-old mom after 22 hours of labor following the rupture of the membranes. A
friend helped the mother deliver the baby. What is the best description for the
agent most likely causing the sepsis if it was acquired during labor but prior to
delivery? All organisms in the answer choices are Gram-positive, catalase
negative cocci found in pairs or short chains.
(A) Nonhemolytic organisms found as part of the normal fecal flora; resistant to
bile and optochin; carries a high level of drug resistance
(B) Alpha-hemolytic diplococci sensitive to both bile and optochin
(C) Beta-hemolytic cocci in chains and carrying Lancefield’s Group B antigen
(D) Alpha-hemolytic cocci in chains; resistant to bile and optochin
55. A 62-year-old woman presents with signs of a gastric ulcer. She does not
regularly take nonsteroidal anti-inflammatory agents. Which characteristic
appears to play a central role in the organism’s ability to survive transit of the
lumen to colonize the stomach?
56. A 54-year-old man develops a pyogenic infection along the suture line after
knee surgery. The laboratory gives a preliminary report of a beta-hemolytic,
catalase- positive, coagulase-positive, Gram- positive coccus. The most likely
causative agent is
VIROLOGY:
1. Clinical viral disease
(A) Caliciviruses
(B) Flaviviruses
(C) Papillomaviruses
(D) Parvoviruses
3. Amantadine inhibits
(A) Adenoviruses
(B) Papovaviruses
(C) Paramyxoviruses
(D) Polioviruses
7. An 8-year-old boy is brought to your office by his mother. He has had a slight
fever and a sore throat for the past 2 days. He has eight ulcerative lesions in his
mouth, three vesicular lesions on his left hand, and five similar lesions on his
right foot. The most probable cause of his disease is
8. A 16-year-old boy presents at your office with a sore throat, fever, and
enlarged lymph nodes. His tonsils are enlarged, the pharynx is inflamed, and
splenomegaly is observed. He complains of severe fatigue. Confirmation of the
causative agent is best done by observing
(A) CMV
(B) HSV
(C) Parvovirus
(D) Rubella virus
11. A 4-year-old girl is brought to your rural clinic office by her mother who
states the child has a runny nose, barking cough, and a sore throat. Your
examination indicates respiration is labored. None of her three siblings is sick.
The most probable viral cause of her symptoms is
(A) Adenovirus
(B) Influenza virus
(C) Parainfluenza virus
(D) RSV
14. A mother brings her 18-month-old son to your office. She was called by her
day care center who reported he had vomited twice during the morning and had
diarrhea as well. She noted he had a slight fever the past 2 days and had not been
very hungry. The most likely cause of his illness is
(A) Adenovirus
(B) Astrovirus
(C) Norovirus
(D) Rotavirus
15. A vaccine is available for protection against the disease observed in review
question 8. The immunizing agent(s) for this vaccine is a(n)
17. On September 17, a 22-year-old male college student appears at the Student
Health Clinic complaining of moderate headache, nausea, and vomiting. His
temperature is 38.5°C/101°F and his physical examination shows stiffness in the
neck. What is the most likely viral cause of the symptoms?
(A) CMV
(B) Enterovirus
(C) EBV
(D) HSV type 1
18. Knowing the genotype of the causative virus is important for determining the
treatment of chronic
MYCOLOGY
1. A florist presents with a subcutaneous lesion on the hand, which she thinks
resulted from a jab wound she received while she was making a sphagnum moss-
wire frame for a floral wreath. The nodule has ulcerated and not healed despite
use of antibacterial cream, and a new nodule is forming above the original lesion.
What is most likely to be an appropriate treatment for this infection?
2. Although hard to find in the above mentioned nodule, what form would be
present in the tissue?
3. A patient presents with paranasal swelling and bloody exudate from both his
eyes and nares, and he is nearly comatose. Necrotic tissue in the nasal turbinates
show nonseptate hyphae consistent with Rhizopus, Mucor, or Absidia (phylum
Zygomycota, class Phycomycetes). What is the most likely compromising
condition underlying this infection?
(A) AIDS
(B) Ketoacidotic diabetes
(C) Neutropenia
(D) B-cell defects
(E) Chronic sinusitis
4. A patient presents with a circular, itchy, inflamed skin lesion that is slightly
raised; it is on his left side where his dog sleeps next to him. His dog has had
some localized areas of hair loss. The patient has no systemic symptoms. What
would you expect to find in a KOH of skin scrapings?
(A) Aspergillus
(B) Cryptococcus
(C) Candida
(D) Malassezia
(E) Rhizopus
(A) Pseudohyphae
(B) Hyphae
(C) Mycelium
(D) Septum
(E) Yeast
(A) Aspergillus
(B) Candida
(C) Cryptococcus
(D) Malassezia
(E) Sporothrix
(A) Coenocyte
(B) Hypha
(C) Mycelium
(D) Septum
(E) Yeast
(A) Amphotericin B
(B) Griseofulvin
(C) Ketoconazole
(D) Miconazole
(E) Nystatin
10. A 15-year-old dirt-bike rider visiting southern California the first time has
developed pneumonia. The causative organism has environmental form that
consists of hyphae that break up into arthroconidia, which become airborne.
What is the agent?
(A) Amphotericin B
(B) Fluconazole
(C) Griseofulvin
(D) Echinocandins
(E) Nystatin
12. A patient has splotchy hypopigmentation on the chest and back with only
slight itchiness. What is most likely to be seen on a KOH mount of the skin
scraping?
13. A patient has a dry, scaly, erythematous penis. Skin scales stained with
calcofluor white show fluorescent blue-white yeasts and a few pseudohyphae.
What is the causative agent of this dermatophytic look-alike?
(A) Candida
(B) Trichosporon
(C) Trichophyton
(D) Malassezia
(E) Microsporum
14. A recent immigrant from rural Brazil presents with a swollen face and
extremely poor dental hygiene, including loss of an adult tooth, which appears to
be the focus of the current infection. There are two open ulcers on the outside of
the swollen cheek. Small yellow “grains” are seen in one of the ulcers. Gram
stain shows purple- staining fine filaments. What is the most likely disease?
15. A patient who is a recent immigrant from a tropical, remote, rural area with
no medical care is now working with a group of migrant crop harvesters. He has
a large, raised, colored, cauliflower-like ankle lesion. Darkly pigmented, yeastlike
sclerotic bodies are seen in the tissue biopsy. Which of the following is the most
likely diagnosis?
16. A premature baby, now 4 days old, has developed a white coating on her
buccal mucosa extending onto her lips. It appears to be painful. What is the most
likely causative agent?
(A) Actinomyces
(B) Aspergillus
(C) Candida
(D) Fusobacterium
(E) Microsporum
17. Which of the following stains allows differentiation of fungus from human
tissue by staining the fungus a pink-red color?
18. A normally healthy 8-year-old boy from Florida is visiting friends on a farm
in Iowa during the month of July. He presents on July 28 with a fever, cough,
and lower respiratory symptoms (no upper respiratory tract symptoms). He has
been ill for 4 days. His chest sounds are consistent with pneumonia, so a chest
radiograph is obtained. The radiograph shows small, patchy infiltrates with hilar
adenopathy. His blood smear shows small, nondescript yeast forms inside
monocytic cells. What is the most likely causative agent?
19. Which of the following is a polyene antifungal agent used for many life-
threatening fungal infections?
(A) Amphotericin B
(B) Griseofulvin
(C) Itraconazole
(D) Miconazole
(E) Nystatin
20. A logger undergoing chemotherapy for cancer has developed pneumonia and
skin lesions. Biopsy of the skin lesions demonstrates the presence of large yeasts
with thick cell walls and broad-based buds. What is the most likely causative
agent?
(A) Coenocyte
(B) Hypha
(C) Mycelium
(D) Septum
(E) Yeast
(A) Aspergillus
(B) Cryptococcus
(C) Candida
(D) Malassezia
(E) Sporothrix
23. Which of the following features differentiates fungal cells from human cells?
PARASITOLOGY
1. A biology graduate student who recently visited a tropical region of Africa
presents with new visual impairment and the sensation that something is moving
in her eye. She tells you that she is concerned because she had been warned
about eye disease transmitted by black flies. When in Africa, she was in a river
area, and despite her best efforts she received a lot of black fly bites. She also has
some subcutaneous nodules. If her infection was acquired by black fly bite, what
is the most likely causative agent?
2. A woman who imports food from Mexico and spends several months per year
in rural Mexico had to have a compound leg fracture pinned and set in Mexico
and has returned 3 days later. She now has signs of acute appendicitis and is
taken to surgery in Houston. When her appendix is removed, it is found to
contain a light-colored, 20.5-cm-long roundworm as well as bile-stained, knobby
eggs consistent with Ascaris. How did she acquire this infection?
3. A patient whose major source of protein is smoked and cooked fish develops
what appears to be pernicious anemia. What parasite is noted for causing a look-
alike vitamin B 12 anemia in certain genetically predisposed infected
individuals?
4. Which of the following protozoans is free living and is such that acquisition
does not generally indicate fecal contamination?
(A) Acanthamoeba
(B) Dientamoeba fragilis
(C) Entamoeba histolytica
(D) Entamoeba coli
(E) Giardia
11. What roundworm is transmitted by filariform larvae that are found in the
soil and penetrate the skin?
12. How is Clonorchis sinensis (Chinese liver fluke) most likely transmitted to
humans?
13. A 48-year-old subsistence farmer from rural Brazil dies of heart failure. His
autopsy shows a greatly enlarged heart. What was the vector for the most likely
infectious agent that may have been responsible for his death?
14. A 16-year-old man who recently returned from camping in Canada presents
with fatty diarrhea and acute abdominal pain following many meals. How does
the most likely agent cause the diarrhea?
CHAPTER 3
241 Question
PRETEST BIOCHEMISTRY
METABOLISM
1. A child develops chronic diarrhea and liver inflammation in early infancy
when the mother begins using formula that includes corn syrup. Evaluation of
the child demonstrates sensitivity to fructose in the diet. Which of the following
glycosides contains fructose and therefore should be avoided when feeding or
treating this infant?
a. Sucrose
b. Oaubain
c. Lactose
d. Maltose
e. Streptomycin
a. Amylose
b. Lactose
c. Cellulose
d. Maltose
e. Glycogen
a. Oxaloacetate
b. Glycerol
c. Alanine
d. Pyruvate
e. Lactate
a. NADH
b. NAD +
c. FADH
d. FAD +
e. NADPH
6. Following a fad diet meal of skim milk and yogurt, an adult female patient
experiences abdominal distention, nausea, cramping, and pain followed by a
watery diarrhea. This set of symptoms is observed each time the meal is
consumed. A likely diagnosis is
a. Steatorrhea
b. Lactase deficiency
c. Maltose deficiency
d. Sialidase deficiency
e. Lipoprotein lipase deficiency
7. Asians and Native Americans may flush and feel ill after drinking small
amounts of ethanol in alcoholic beverages. This reaction is due to genetic
variation in an enzyme that metabolizes the liver metabolite of alcohol, which is
a. Methanol
b. Acetone
c. Acetaldehyde
d. Hydrogen peroxide
e. Glycerol
a) Pyruvate kinase
b) Phosphoglycerate kinase
c) Triose phosphate isomerase
d) Aldolase
e) Glyceraldehyde-3-phosphate dehydrogenase
a. Pyruvate kinase
b. Pyruvate carboxylase
c. Hexokinase
d. Phosphoglycerate kinase
e. Fructose-1,6-bisphosphatase
10. During the first week of a diet of 1500 calories per day, the oxidation of
glucose via glycolysis in the liver of a normal 59-kg (130-lb) woman is inhibited
by the lowering of which one of the following?
a. Citrate
b. ATP
c. Fatty acyl CoA
d. Ketone bodies
e. Fructose-2,6-bisphosphate
12. A newborn begins vomiting after feeding, becomes severely jaundiced, and
has liver disease. Treatment for possible sepsis is initiated, and the urine is found
to have reducing substances. A blood screen for galactosemia is positive, and
lactose-containing substances are removed from the diet. Lactose is toxic in this
case because
13. Which one of the following enzymes catalyzes phosphorylation with the use of
inorganic phosphate?
a. Hexokinase
b. Phosphofructokinase
c. Glyceraldehyde-3-phosphate dehydrogenase
d. Phosphoglycerate kinase
e. Pyruvate kinase
a. Galactose-1-phosphate
b. Glucose-6-phosphate
c. Uridine diphosphoglucose
d. Fructose-6-phosphate
e. Uridine diphosphogalactose
a. Progesterone
b. Glucagon
c. Aldosterone
d. Epinephrine
e. Thyroxine
f. Growth hormone
g. Insulin
h. Glucocorticoids
18. The key regulatory enzyme of the pentose phosphate pathway is positively
regulated by
19. The activity of pyruvate carboxylase is dependent upon the positive allosteric
effector
a. Succinate
b. AMP
c. Isocitrate
d. Citrate
e. Acetyl CoA
20. Which of the following explains why individuals with hyperlipidemia and/or
gout should minimize their intake of sucrose and high fructose syrups?
23. Which one of the following compounds is common to both the oxidative
branch and the nonoxidative branch of the pentose phosphate pathway?
a. Xylulose-5-phosphate
b. Glucose-6-phosphate
c. Glyceraldehyde-3-phosphate
d. Fructose-6-phosphate
e. Ribulose-5-phosphate
24. A Nigerian medical student studying in the United States develops hemolytic
anemia after taking the oxidizing antimalarial drug pamaquine. This severe
reaction is most likely due to
a. CO 2 is consumed
b. Inorganic phosphate is consumed
c. Acetyl CoA is utilized
d. ATP is generated
e. GTP is generated
a. Citrate → α-ketoglutarate
b. α-ketoglutarate → succinate
c. Succinate → fumarate
d. Fumarate → malate
e. Malate → oxaloacetate
a. Acetyl CoA
b. Lactate
c. Acetaldehyde
d. Citrate
e. Oxaloacetate
28. Citrate has a positive allosteric effect on which one of the following enzymes?
a. Pyruvate kinase
b. Acetyl CoA carboxylase
c. Phosphofructokinase
d. Fatty acid synthetase
e. Enolase
a. Succinyl CoA
b. Malate
c. Fumarate
d. Oxaloacetate
e. Citrate
30. The entry point into the citric acid cycle for isoleucine, valine, and the
product of odd-chain fatty acids is
a. Fumarate
b. Pyruvate
c. Oxaloacetate
d. Citrate
e. Succinyl CoA
31. A child has ingested cyanide from her parents’ garage and is rushed to the
emergency room. Which of the following components of the citric acid cycle will
be depleted first in this child?
a. NAD + cofactor
b. Citrate synthase
c. Aconitase
d. Citrate production
e. Acetyl coenzyme A (CoA) production
33. Oxidative degradation of acetyl coenzyme A (CoA) in the citric acid cycle
gives a net yield of which of the following chemicals?
a. Fluoroacetate
b. Fluorouracil
c. Aerobic conditions
d. Arsenic
e. Malic acid
35. In the pathway leading to biosynthesis of acetoacetate from acetyl CoA in the
liver, the immediate precursor of acetoacetate is which of the following
substances?
a. 3-hydroxybutyrate
b. Acetoacetyl CoA
c. 3-hydroxybutyryl CoA
d. Mevalonic acid
e. 3-hydroxy-3-methylglutaryl CoA
36. A child presents with low blood glucose (hypoglycemia), enlarged liver
(hepatomegaly), and excess fat deposition in the cheeks (cherubic facies). A liver
biopsy reveals excess glycogen in hepatocytes. Deficiency of which of the
following enzymes might explain this phenotype?
a. α-1,1-glucosidase
b. α-1,1-galactosidase
c. α-1,4-glucosidase
d. α-1,4-galactosidase
e. α-1,6-galactosidase
38. A man goes on a hunger strike and confines himself to a liquid diet with
minimal calories. Which of the following would occur after 4 to 5 h?
39. After a meal, blood glucose enters cells and is stored as glycogen, particularly
in the liver. Which of the following is the donor of new glucose molecules in
glycogen?
a. UDP-glucose-1-phosphate
b. UDP-glucose
c. UDP-glucose-6-phosphate
d. glucose-6-phosphate
e. glucose-1-phosphate
40. Which of the following statements about the structure of glycogen is true?
41. Which of the following steps is involved in the generation of glucose from
lipolysis?
42. McArdle’s disease causes muscle cramps and muscle fatigue with increased
muscle glycogen. Which of the following enzymes is deficient?
a. Hepatic hexokinase
b. Muscle glycogen synthetase
c. Muscle phosphorylase
d. Muscle hexokinase
e. Muscle debranching enzyme
a. Amylo-(1,4 → 1,6)-transglycosylase
b. Phosphorylase
c. Phosphorylase kinase
d. Amylo-1,6-glucosidase
e. Glucose-6-phosphatase
44. A child with a large head, multiple fractures, and blue scleras (whites of the
eyes) is evaluated for osteogenesis imperfecta (166200). One study involves
labeling of collagen chains in tissue culture to assess their mobility by gel
electrophoresis. Amino acids labeled with radioactive carbon 14 are added to the
culture dishes in order to label the collagen. Which of the following amino acids
would not result in labeled collagen?
a. Serine
b. Glycine
c. Aspartate
d. Glutamate
e. Hydroxylserine
45. Liver aminotransferases, which are also called transaminases, catalyze the
transfer of α-amino groups from many different amino acids to α-ketoglutarate.
The intermediate produced is deaminated back to α-ketoglutarate with the
formation of ammonium ion. The structure of α-ketoglutarate is shown below.
What is the intermediate produced?
a. Aspartate
b. Alanine
c. Oxaloacetate
d. Glutamate
e. Pyruvate
a. In the cytosol
b. In the mitochondrial matrix
c. In the mitochondrial matrix and the cytosol
d. Only in lysosomes
e. In peroxisomes
47. A newborn becomes progressively lethargic after feeding and increases his
respiratory rate. He becomes virtually comatose, responding only to painful
stimuli, and exhibits mild respiratory alkalosis. Suspicion of a urea cycle
disorder is aroused and evaluation of serum amino acid levels is initiated. In the
presence of hyperammonemia, production of which of the following amino acids
is always increased?
a. Glycine
b. Arginine
c. Proline
d. Histidine
e. Glutamine
a. Threonine
b. Tyrosine
c. Thiamine
d. Tryptophan
e. Tyramine
a. L -dihydroxyphenylalanine (dopa)
b. Dopamine
c. Norepinephrine
d. Epinephrine
e. Phenylalanine
a. Threonine
b. Methionine
c. Glutamine
d. Lysine
e. Alanine
a. Serine
b. Sulfhydryl
c. Tyrosine
d. Acetyl coenzyme A (CoA)
e. Carboxyl
54. Which one of the following hormones is derived most completely from
tyrosine?
a. Glucagon
b. Thyroxine
c. Insulin
d. Prostaglandins
e. Endorphins
55. A newborn develops jaundice (yellow skin and yellow scleras) that requires
laboratory evaluation. Which of the following porphyrin derivatives is
conjugated, reacts directly, and is a major component of bile?
a. Bilirubin diglucuronide
b. Stercobilin
c. Biliverdin
d. Urobilinogen
e. Heme
f. Bilirubin
g. Urobilin
56. Which of the following porphyrins gives stools their characteristic brown
color?
a. Biliverdin
b. Urobilinogen
c. Heme
d. Stercobilin
e. Urobilin
lipoproteins. What is the correct ordering of these particles from the lowest to
the highest density?
58. A 3-year-old child is brought into the ER while you are on duty. She is cold
and clammy and is breathing rapidly. She is obviously confused and lethargic.
Her mother indicates she has accidentally ingested automobile antifreeze while
playing in the garage. Following gastrointestinal lavage and activated charcoal
administration, one of the treatments you immediately initiate involves
a. Phosphatidyl serine
b. Sphingomyelin
c. Phosphatidyl glycerol
d. Phosphatidyl choline
e. Phosphatidyl ethanolamine
a. Membrane lipids
b. Anti-inflammatory steroids
c. Blood proteins
d. Stored carbohydrates
e. Nucleotide metabolism
a. Multifactorial inheritance
b. Variable activities of abnormal enzyme in different patient tissues
c. Deficiency of a hydrolytic enzyme
d. Abnormalities of sphingolipid synthesis
e. Accumulation of ceramide-containing lipids
a. Oleic acid
b. Arachidonic acid
c. Linoleic acid
d. Palmitic acid
e. Palmitoleic acid
64. It has been noted that infants placed on extremely low-fat diets for a variety
of reasons often develop skin problems and other symptoms. This is most often
due to
a. Lactose intolerance
b. Glycogen storage diseases
c. Antibody abnormalities
d. Deficiency of fatty acid desaturase greater than ∆ 9
e. Deficiency of chylomicron and VLDL production
67. Which one of the following apolipoproteins is synthesized in the liver as part
of the coat of very-low-density lipoproteins (VLDLs)?
a. AI
b. B48
c. CII
d. B100
e. E
a. Very-low-density lipoproteins
b. High-density lipoproteins
c. Chylomicrons
d. Chylomicron remnants
e. Adipocyte lipid droplets
69. Which of the following statements correctly describes the enzyme thiokinase?
70. A 15-year-old boy has a long history of school problems and is labeled as
hyperactive. His tissues are puffy, giving his face a “coarse” appearance. His IQ
tests have declined recently and are now markedly below normal. Laboratory
studies demonstrate normal amounts of sphingolipids in fibroblast cultures with
increased amounts of glycosaminoglycans in urine. Which of the following
enzyme deficiencies might explain the boy’s phenotype?
a. Hexosaminidase A
b. Glucocerebrosidase
c. α- L -iduronidase
d. α-galactocerebrosidase
e. β-gangliosidase A
71. Leukocyte samples isolated from the blood of a newborn infant are
homogenized and incubated with ganglioside GM 2 . Approximately 47% of the
expected normal amount of N-acetylgalactosamine is liberated during the
incubation period. These results indicate that the infant
72. Most of the reducing equivalents utilized for synthesis of fatty acids can be
generated from
73. During fatty acid metabolism in humans, coenzyme A (CoA) is different from
acyl carrier protein (ACP) in which one of the following ways?
75. Which one of the following compounds is a key intermediate in the synthesis
of both triacylglycerols and phospholipids?
a. CDP-choline
b. Phosphatidate
c. Triacylglyceride
d. Phosphatidylserine
e. CDP-diacylglycerol
76. Which of the following is not used in the synthesis of fatty acids?
a. Cobalamin (vitamin B 12 )
b. NADPH
c. AMP
d. FADH 2
e. HCO 3
77. A 45-year-old man has a mild heart attack and is placed on diet and
mevastatin therapy. Which of the following will be a result of this therapy?
80. When the liver is actively synthesizing fatty acids, a concomitant decrease in
β oxidation of fatty acids is due to
81. A 4-year-old girl presents in the clinic with megaloblastic anemia and failure
to thrive. Blood chemistries reveal orotic aciduria. Enzyme measurements of
white blood cells reveal a deficiency of the pyrimidine biosynthesis enzyme
orotate phosphoribosyltransferase and abnormally high activity of the enzyme
aspartate transcarbamoylase. Which one of the following treatments will reverse
all symptoms if carried out chronically?
a. Blood transfusion
b. White blood cell transfusion
c. Dietary supplements of phosphoribosylpyrophosphate (PRPP)
d. Oral thymidine
e. Oral uridine
82. In most patients with gout as well as those with Lesch-Nyhan syndrome,
purines are overproduced and overexcreted. Yet the hypoxanthine analogue
allopurinol, which effectively treats gout, has no effect on the severe neurological
symptoms of Lesch-Nyhan patients because it does not
a. Lesch-Nyhan syndrome
b. Gout
c. Xanthine oxidase hyperactivity
d. Carbamoyl phosphate synthase deficiency
e. Purine overproduction secondary to Von Gierke’s disease
84. Which one of the following contributes nitrogen atoms to both purine and
pyrimidine rings?
a. Aspartate
b. Carbamoyl phosphate
c. Carbon dioxide
d. Glutamine
e. Tetrahydrofolate
88. Which base derivative can serve as a precursor for the synthesis of two of the
other base derivatives shown?
a. Aspartate transcarbamoylase
b. Hypoxanthine-guanine phosphoribosyl transferase (HGPRT) 5-fluorouracil
c. Thymidylate synthase
d. Ribose-phosphate pyrophosphokinase
e. Xanthine oxidase
a. 5-methyl thymidine
b. Ara C
c. Ribose phosphate
d. 5-phosphoribosylpyrophosphate (PRPP)
e. 5-fluorouracil
a. Ara C
b. Allopurinol
c. Ribose phosphate
d. 5-phosphoribosylpyrophosphate (PRPP)
e. 5-FU
a. Cytosine
b. Guanosine
c. Thymidine
d. Thymidylate
e. Cytidylate
NUTRITION
94. A deficiency of vitamin B 12 causes
a. Cheilosis
b. Beriberi
c. Pernicious anemia
d. Scurvy
e. Rickets
a. Night blindness
b. Osteomalacia
c. Rickets
d. Osteogenesis imperfecta
e. Osteopetrosis
96. Which of the following vitamins would most likely become deficient in a
person who develops a completely carnivorous lifestyle?
a. Thiamine
b. Niacin
c. Cobalamin
d. Pantothenic acid
e. Vitamin C
a. Decarboxylation
b. Acetylation
c. Dehydrogenation
d. Reduction
e. Oxidation
a. Hydroxylations
b. Carboxylations
c. Decarboxylations
d. Dehydrations
e. Deaminations
a. Riboflavin
b. Pantothenate
c. Thiamine
d. Cobamide
e. Pyridoxamine
a. Choline
b. Ethanolamine
c. Thiamine
d. Serine
e. Glycine
104. Both acyl carrier protein (ACP) of fatty acid synthetase and coenzyme A
(CoA)
a. Thiamine pyrophosphate
b. Lipoamide
c. ATP
d. NADH
e. FADH
106. Which one of the following cofactors must be utilized during the conversion
of acetyl CoA to malonyl CoA?
a. Thiamine pyrophosphate
b. Acyl carrier protein (ACP)
c. NAD 1
d. Biotin
e. FAD
110. A term infant is born at home and does well with breast-feeding. Two days
later, the mother calls frantically because the baby is bleeding from the umbilical
cord and nostrils. The most likely cause is
113. A 3-month-old boy presents with poor feeding and growth, low muscle tone
(hypotonia), elevation of blood lactic acid (lactic acidemia), and mild acidosis
(blood pH 7.3 to 7.35). The ratio of pyruvate to lactate in serum is elevated, and
there is decreased conversion of pyruvate to acetyl coenzyme A in fibroblasts.
Which of the following compounds might be considered for therapy?
a. Pyridoxine
b. Thiamine
c. Free fatty acids
d. Biotin
e. Ascorbic acid
114. A homeless person is brought into the emergency room with psychotic
imagery and alcohol on his breath. Which of the following compounds is most
important to administer?
a. Glucose
b. Niacin
c. Nicotinic acid
d. Thiamine
e. Riboflavin
115. Which of the following vitamins becomes a major electron acceptor, aiding
in the oxidation of numerous substrates?
a. Vitamin B 6
b. Niacin
c. Riboflavin
d. Thiamine
e. Vitamin B 1
a. Pyridoxine
b. Lipoamide
c. Niacin
d. Thiamine
e. Riboflavin
117. A 2-year-old child presents with chronic cough and bronchitis, growth
failure, and chronic diarrhea with light-colored, foul-smelling stools. A
deficiency of which of the following vitamins should be considered?
a. Vitamin A
b. Vitamin C
c. Vitamin B 1
d. Vitamin B 2
e. Vitamin B 6
118. Pantothenic acid is important for which of the following steps or pathways?
a. Pyruvate carboxylase
b. Fatty acid synthesis
c. Pyruvate carboxykinase
d. Gluconeogenesis
e. Glycolysis
GENETICS:
1. Which of the following statements regarding a double-helical molecule of DNA
is true?
b. 3′ to 5′ DNA polymerase
c. Okazaki fragments
d. Replication and immediate crossover of the leading strand
e. Lack of RNA primer on one of the strands
4. A child presents with severe growth failure, accelerated aging that causes
adult complications such as diabetes and coronary artery disease, and
microcephaly (small head) due to increased nerve cell death. In vitro assay of
labeled thymidine incorporation reveals decreased levels of DNA synthesis
compared to controls, but normal-sized labeled DNA fragments. The addition of
protein extract from normal cells, gently heated to inactivate DNA polymerase,
restores DNA synthesis in the child’s cell extracts to normal. Which of the
enzymes used in DNA replication is likely to be defective in this child?
a. Primase
b. DNA ligase
c. DNA gyrase
d. RNA polymerase III
e. Reverse transcriptase
11. Which of the following statements correctly describes the recombinant DNA
tool known as plasmids?
a. A pyrophosphate group
b. A 1′ base linked to a pentose sugar
c. A 5′-phosphate group linked to a pentose sugar
d. A 3′-phosphate group linked to a pentose sugar
e. A terminal triphosphate
13. Human cells have a finite lifespan and this contributes to the aging process.
Stem cells and neoplastic cells have indefinite life spans. The reason for these
observations is that chromosomes in a cell get progressively shorter with each
cell division because the telomere sequences at the ends of the chromosomes get
shorter with each cell division. The chromosomes in stem cells and neoplastic
cells do not generally shorten with each cell division. The enzyme utilized by
stem cells and neoplastic cells to lengthen the telomeres is which of the following?
a. DNA helicase
b. topoisomerase
c. telomerase
d. DNA polymerase delta
e. DNA polymerase alpha
a. It is semiconservative.
b. It occurs during G1 in the cell cycle.
c. Inactive genes are replicated first.
d. It starts with the synthesis of Okazaki fragments.
16. The leading strand of DNA in the replication fork is synthesized by which one
of the following mechanisms?
18. Which is the most correct sequence of events in gene repair mechanisms in
patients without a mutated repair process?
a. DNA ligase
b. Primase
a. The DNA polymerase uses an RNA primer but does not degrade it
b. The DNA polymerase contains an RNA molecule that serves as template for
DNA synthesis
c. The DNA polymerase must cross-link the 5′ and 3′ termini
d. The DNA polymerase has a σ subunit that facilitates binding to repetitive
DNA
e. The DNA polymerase does not use an RNA template or primer
23. The removal of introns and subsequent self-splicing of adjacent exons occurs
in some portions of primary ribosomal RNA transcripts. The splicing of introns
in messenger RNA precursors is
a. Transcribes repressor
b. Initiates transcription
c. Codes for RNA polymerase
d. Regulates termination
e. Translates specific proteins
a. It differs from that found in bacterial cells in that histones are present
b. It may contain hundreds of copies of genes for different types of ribosomal
RNAs
c. It synthesizes 5S ribosomal RNA
d. It synthesizes 60S and 40S ribosomal subunits
e. It synthesizes all ribosomal RNA primary transcripts
30. Which one of the following statements correctly describes the synthesis of
mammalian messenger RNA (mRNA)?
32. Which one of the following binds to specific nucleotide sequences that are
upstream of the start site of transcription?
a. RNA polymerase
b. Primase
c. Helicase
d. Histone protein
e. Restriction endonuclease
a. Golgi apparatus
b. Smooth endoplasmic reticulum
c. Free polysomes
d. Nucleus
e. Rough endoplasmic reticulum
a. Zero
b. One
c. Two
d. Three
e. Four
36. The hydrolytic step leading to the release of a polypeptide chain from a
ribosome is catalyzed by
a. Stop codons
b. Peptidyl transferase
c. Release factors
d. Dissociation of ribosomes
e. UAA
40. Which of the following is required for certain types of eukaryotic protein
synthesis but not for prokaryotic protein synthesis?
a. Ribosomal RNA
b. Messenger RNA
c. Signal recognition particle
d. Peptidyl transferase
e. GTP
BRS BIOCHEMISTRY
METABOLISM
1. A 47-year-old obese man complains of having to get out of bed three times a
night to urinate (polyuria), being constantly thirsty (polydipsia), and eating more
often (polyphagia). The patient is diagnosed with insulin resistant diabetes
mellitus (type 2). If the patient’s symptoms are due to a problem at the level of
the glucose transporter, which one of the tissues indicated below will be most
affected?
(A) RBCs
(B) Small intestine
(C) Muscle
(D) Brain
(E) Liver
(A) Lactate formation occurs when the NADH/ NAD + ratio is high.
(B) The liver preferentially converts lactate into carbon dioxide and water.
(C) The heart preferentially converts lactate into glucose.
(D) Lactate formation is less likely to be found in the eye, testes, and RBCs than
in other tissues.
(E) The intracellular pH is typically increased when lactate is produced
3. A 36-year-old woman is training for her first marathon, and her coach has her
keeping a pace that allows her to stay below her anaerobic threshold. By
avoiding anaerobic muscle glycolysis, the pyruvate produced in the muscle does
not accumulate because it is converted to which one of the following?
(A) Ethanol
(B) Lactic acid
(C) Acetyl CoA
(D) Alanine
(E) OAA
in the liver, which one of the following is the most important in allowing the liver
to maintain a normal blood glucose level?
(A) Citrate
(B) ATP
(C) Fructose 2,6-bisphosphate
(D) Glucose 6-phosphate
(E) Acetyl CoA
6. Emergency medical services are called to the scene of a diabetic patient who
has collapsed and is in a confused state. The patient uses an insulin pump, which
appears to have malfunctioned. The patient’s blood sugar is found to be 12
mg/dL, and the squad is having difficulty getting intravenous access to
administer intravenous glucose. On the way to the hospital, the squad
administers an intramuscular injection of glucagon. Which one of the following
statements is true regarding the use of glucagon?
7. A 33-year-old triathlete is admitted to the hospital after he spent the whole day
training. He looks ill and complains of diffuse weakness, fatigue, and myalgia.
Laboratory tests are sent for analysis, and his lactate level is elevated, creatinine
is elevated (suggesting acute renal failure), creatine kinase is 76,000, and urine
tests positive for myoglobin. You determine he has rhabdomyolysis and treat
him with aggressive intravenous hydration. The basis for the elevated lactate is
which one of the following?
(A) An increase in ATP due to the lack of oxygen for the muscle
(B) An increase in NADH due to the lack of oxygen for the muscle
(C) A defect in the M form of lactate dehydrogenase
(D) A defect in the H form of lactate dehydrogenase
(E) A defect in the B form of muscle aldolase
9. A biochemistry graduate student isolates all the enzymes of the TCA cycle and
adds OAA and acetyl CoA, including the appropriate energy precursors,
cofactors, and water. Which of the following will not be a direct product of his
experiment?
(A) ATP
(B) GTP
(C) NADH
(D) CO 2
(E) FADH 2
10. A 24-year-old woman presents with diarrhea, dysphagia, jaundice, and white
transverse lines on the fingernails (Mee lines). The patient is diagnosed with
arsenic poisoning, which inhib- its which one of the following enzymes?
11. A 3-year-old boy presents to the pediatric clinic with the symptoms of
hypotonia, lactic acidosis, and seizures. After an extensive workup, he is
diagnosed with PDHC deficiency, an X-linked recessive disorder. Which one of
the following cofactors is not required by this enzyme to convert pyruvate to
acetyl CoA?
(A) Thiamine
(B) Lipoic acid
(C) Pantothenate
(D) Niacin
(E) Ascorbic acid
12. A 3-year-old boy presents to the emergency room after having a generalized
tonic-clonic seizure. The child has a history of epilepsy, ataxia, and lactic
acidosis. When questioned, the parents state that their child was born with a rare
metabolic disease, pyruvate carboxylase deficiency. Which one of the following
metabolites is this child unable to produce effectively?
(A) Pyruvate
(B) Alanine
(C) Acetyl CoA
(D) Oxaloacetate
(E) Acetoacetate
(A) 1 mole
(B) 2 moles
(C) 4 moles
(D) 8 moles
(E) 0 moles
14. A newborn is found to have fasting hypoglycemia. The nursery staff begins
overnight feeds by nasogastric tube because they find that the child has
consistently low blood sugars. A liver biopsy and molecular studies demonstrate
an absence of glycogen synthase. The normal function of this enzyme is to do
which of the following?
(A) Remove glucose residues one at a time from glycogen in the liver
(B) Remove glucose residues one at a time from glycogen in muscles
(C) Transfer glucose from UDP-glucose to the nonreducing end of a glycogen
primer
(D) Hydrolyze a-1,6 bonds of glycogen
(E) Function as a glucosyl 4:6 transferase
storage can endure the 28-day race. The activity of muscle glycogen synthase in
resting muscles is increased by the action of which of the following?
(A) Epinephrine
(B) Glucagon
(C) Insulin
(D) Phosphorylation
(E) Fasting and starvation
18. A patient had large deposits of liver glycogen, which, after an overnight fast,
contained shorter than normal branches. A defective form of which of the
following could cause this abnormality?
19. A sprinter is trying to optimize his performance. He has calculated that, even
under anaerobic conditions, his glycogen stores will supply him with enough
energy to last the race. What would the energy difference be between using
glucose from a dietary source versus relying solely on glucose from glycogen
stores as fuel for his race?
20. Which one of the following occurs in an individual who is rested and has
fasted for 12 hours?
23. A 41-year-old woman presents with severe, sharp epigastric abdominal pain
that radiates to her back and with nausea and vomiting. Laboratory results
indicate a serum triglyceride level of 5000 mg/dL. She is diagnosed with
pancreatitis, in part owing to her elevated serum triacyl- glycerol levels. To form
triacylglycerol from diacylglycerol, which of the following compounds is also
required?
(A) Glycerol
(B) Glycerol 3-phosphate
(C) Fatty acyl CoA
(D) Acetyl CoA
(E) Malonyl CoA
24. An 18-year-old woman presents with xanthomas on her eyelids and is found
to have a rare genetic deficiency of lipoprotein lipase. She is diagnosed with type
I hyperlipidemia. In this disorder, chylomicrons are abnormally elevated in the
serum. In which cell or tissue does triacyl- glycerol packaging into chylomicrons
occur?
(A) The thoracic duct carries a substantial volume of lymph and triglycerides
from the enteric circulation to the venous system.
(B) Triacylglycerol is primarily stored in the liver.
(C) In the intestinal cell, glucose is converted to triacylglycerol by phosphatidic
acid.
(D) In adipose cells, triacylglycerol is converted to VLDL.
(E) Somatostatin has no role in the treatment of chylothorax in children.
26. An 18-year-old obese woman maintains a sedentary lifestyle and eats a high-
fat, high carbohydrate diet. Maintenance of this diet and lifestyle has led to
lipogenesis and obesity. Which of the following statements correctly describes an
aspect of lipogenesis?
(A) The primary source of carbons for fatty acid synthesis is glycerol.
(B) Fatty acids are synthesized from acetyl CoA in the mitochondria.
(C) Fatty acid synthesis and esterification to glycerol to form triacylglycerols
occurs primarily in muscle cells.
(D) The fatty acyl chain on the fatty acid synthase complex is elongated two
carbons at a time.
(E) NADP + , which is important for fatty acid synthesis, is produced by the
pentose phosphate pathway.
27. A 45-year-old man presents with multiple gunshot wounds to the abdomen
requiring an emergent laparotomy, jejunectomy, and colectomy. After surgery,
he is placed on intravenous nutrition (i.e., TPN). Which of the following
compounds should be a component of TPN?
382 صفحة Dr. MOHAMED YAHIA 0900987639
QUESTION BANK OF Dr. MOHAMED YAHIA
(A) Palmitate
(B) Linoleate
(C) Phosphatidic acid
(D) Glycerol
(E) Glucose
28. A 16-year-old girl presents with extreme slenderness. Her body weight is
35% below expected. She feels as though she is obese and severely restricts her
food intake. She is diagnosed with anorexia nervosa. In this patient, breakdown
of fatty acids is required to provide energy. Before being oxidized, fatty acids are
activated in the cytosol to form which of the following?
(A) ATP
(B) CoA
(C) Fatty acyl CoA
(D) Carnitine
(E) Malonyl CoA
29. After surgical resection of part of her small intestine, a 40-year-old woman
presents with chronic foul-smelling diarrhea and weight loss. She is diagnosed
with short bowel syndrome. In this syndrome, fat cannot be properly absorbed,
so long-chain fatty acids are mobilized from adipose tissue to generate energy for
cell survival. The initiating substrate for fatty acid oxidation is which of the
following?
30. An infant is born with a high forehead, abnormal eye folds, and deformed ear
lobes and shows little muscle tone and movement. After multiple tests, he is
diagnosed with Zellweger syndrome, a disorder caused by peroxisome
malformation. What type of fatty acid would you expect to accumulate in
patients with Zellweger syndrome?
31. A 4-month-old infant presents with a seizure. His mother reports that her
infant has been irritable and lethargic over the past several days. The infant is
found to be profoundly hypoglycemic and have low ketones. Short-chain
dicarboxylic acids are found to be elevated in the serum. The most likely enzyme
deficiency is which of the following?
(A) Apo A
(B) Apo B
(C) Apo C-II
(D) Apo D
(E) Apo E
34. A 40-year-old Hispanic woman with a body mass index of 34 presents with
acute right upper quadrant pain, nausea, and vomiting after eating a meal rich
in lipids. She is diagnosed with having cholelithiasis and is placed on a bile salt
analog that is used to inhibit the formation of cholesterol gallstones. Which of the
following is an example of a bile salt?
(A) HMG-CoA
(B) Mevalonate
(C) Squalene
(D) Lanosterol
(E) Chenocholic acid
35. An 8-year-old boy presents with orange- colored tonsils, a very low HDL
level, and an enlarged liver and spleen and is diagnosed with Tangier disease.
Which of the following statements best describes HDL?
36. A 40-year-old man presents with chest pain that radiates to his left jaw and
shoulder. He is diagnosed with a myocardial infarction and is prescribed a statin
medication. Statins are competitive inhibitors of HMG-CoA reductase, which
converts HMG-CoA to which of the following?
(A) Mevalonate
(B) Isopentenyl pyrophosphate
(C) Geranyl pyrophosphate
(D) Farnesyl pyrophosphate
(E) Cholesterol
37. A 45-year-old woman presents with oily, foul-smelling stool, which appears to
be due to an obstruction of the bile duct. Which of the following statements
correctly describes bile salts?
38. A 55-year-old woman presents with crushing substernal chest pain and
shortness of breath. A coronary artery is occluded owing to an athero- sclerotic
plaque, and a high myocardial infarct is diagnosed. High serum HDL levels are
protective against the development of atherosclerosis because HDL does which of
the following?
39. A 30-year-old man presents with weakness in his right upper and lower
extremities. He is diagnosed with an acute middle cerebral artery stroke
secondary to atherosclerosis. Genetic studies show that he has familial
hypercholesterolemia, type II, a disorder caused by a deficiency of LDL
receptors. Which of the following statements best describes patients with type II
familial hypercholesterolemia?
(A) After LDL binds to the LDL receptor, the LDL is degraded extracellularly.
(B) The number of LDL receptors on the surface of hepatocytes increases.
(C) Cholesterol synthesis by hepatocytes increases.
(D) Excessive cholesterol is released by LDL.
(E) The cholesterol level in the serum decreases.
41. A 25-year-old woman presents with a low red blood cell count, corneal
opacities, and kidney insufficiency. She is diagnosed with LCAT deficiency.
LCAT is involved in which of the following processes?
(A) Cystathionine
(B) Valine
(C) Phenylalanine
(D) Tyrosine
(E) Methionine
(A) CPS II
(B) Glutaminase
(C) Argininosuccinate lyase
(D) Asparagine synthetase
(E) Urease
44. A 55-year-old man suffers from cirrhosis of the liver. He has been admitted
to the hospital several times for hepatic encephalopathy. His damaged liver has
compromised his ability to detoxify ammonia. Which of the following amino
acids can be used to fix ammonia and thus transport and store ammonia in a
nontoxic form?
(A) Aspartate
(B) Glutamate
(C) Serine
(D) Cysteine
(E) Histidine
(A) Oxaloacetate
(B) Citrate
(C) a-Ketoglutarate
(D) Fumarate
(E) Succinyl CoA
46. A 2-year-old girl was seen in the emergency room for vomiting and tremors.
Laboratory tests revealed a plasma ammonium ion concentration of 195 mM
(normal, 11- to 50 mM) and serum elevation of arginine. Two days later, after
stabilization, ammonia and arginine levels were normal. You conclude that this
patient may have a defect in which of the following enzymes?
(A) CPS I
(B) CPS II
(C) Ornithine transcarbamoylase
(D) Arginase
(E) Argininosuccinate lyase
acetyl CoA carboxylase. The patient is functionally deficient in which one of the
following cofactors?
(A) Tetrahydrobiopterin
(B) Tetrahydrofolate
(C) Biotin
(D) Methylcobalamin
(E) Pyridoxal phosphate
48. A new test is developed that can nonradioactively ‘‘label’’ compounds in the
human body. As a physician with a background in the new field of metabolomics,
you assess a 21-year-old with classic PKU. The patient is fed phenylalanine with
a label in the phenyl ring, and a 24-hour urine sample is collected. Which of the
following compounds would you expect to contain the greatest amount of label in
this urine sample?
(A) Tyrosine
(B) Tryptophan
(C) Epinephrine
(D) Phenylketone
(E) Acetate
NUTRITION
50. A 57-year-old alcoholic man with chronic pancreatitis is admitted to the
hospital for treatment. The absorption of which one of the following vitamins
may be affected with pancreatitis?
(A) Niacin
(B) Cobalamin
(C) Folic acid
(D) Vitamin C
(E) Vitamin E
52. A 32-year-old woman presents to the physician with extreme fatigue and
vague neurologic complaints. On examination, it is found that she has decreased
positional and vibrational sense, and her complete blood count reveals a
megaloblastic anemia. She relates a history of gastric resection 4 years ago for
severe stomach ulcers. Which vitamin deficiency does this represent?
(A) Vitamin C
(B) Vitamin D
(C) Vitamin K
(D) Vitamin B 12
(E) Folate
53. A 75-year-old chronic alcoholic man presents to the emergency room after
being found unconscious on the floor of his home. On examination, he is found to
have a distended abdomen consistent with ascites. Which of the following
functions of the liver has been compromised to lead To the finding of abdominal
ascites?
54. A 45-year-old alcoholic man walks into the emergency room with a clumsy,
wide-based gait and appears confused. He has pronounced nystagmus, and
laboratory tests are significant for a metabolic acidosis and a serum blood
alcohol level of 0.13. This patient should most probably be treated with IV fluids
containing which of the following?
(A) Thiamine
(B) Riboflavin
(C) Niacin
(D) Pantothenic acid
(E) Biotin
(A) Marasmus
(B) Anorexia nervosa
(C) Bulimia
(D) Kwashiorkor
(E) Cachexia
GENETICS
56. A 23-year-old man presents to his family physician with a painless swelling of
his testicles. An ultrasound is suspicious for a neoplasm, and a biopsy confirms
the presence of cancer. He is referred to an oncologist, who begins treatment
with the topoisomerase inhibitor etoposide. The normal function of this enzyme
is to do which of the following?
57. A 33-year-old homosexual man is recently diagnosed with HIV. His CD4 + T-
cell count is dramatically decreased, and he has a high HIV viral load. He is
referred to an infectious disease clinic where they begin him on a nucleoside
analog. Certain nucleoside analogs inhibit DNA synthesis because they lack
which of the following properties required for normal DNA polymerization?
(A) A 5 0 -phosphate
(B) A 3 0 -hydroxyl
(C) A 7-methyl G modification
(D) A poly(A) tail
(E) A consensus sequence
59. A 37-year-old immigrant from Thailand develops fevers, night sweats, weight
loss, and a blood-tinged cough. He present to the emergency room, where an
infectious disease doctor is consulted and immediately prescribes a multidrug
regimen that includes rifampin. Rifampin inhibits which one of the following
types of enzymes?
60. Two couples present to the emergency room with severe nausea, vomiting,
and diarrhea. One of the patients admits that she had a dinner party and served
a salad containing mushrooms she had picked during a hike in the forest earlier
that day. Inhibition of which enzyme or process explains the clinical
manifestations of a-amanitin poisoning seen in these patients?
61. A 23-year-old diabetic woman reports having fevers and dysuria. Physical
examination reveals costovertebral tenderness, and her urinary analysis shows
the presence of bacteria in her urine. Her physician suspects a complicated
urinary tract infection and begins a 5-day course of ciprofloxacin. Such
quinolone antibiotics inhibit which one of the following enzymes?
(A) Poly(A) RNA is the initial transcript produced, which is subsequently spliced
to mRNA.
(A) tRNA
(B) rRNA
(C) hnRNA
(D) mRNA
(E) snRNP
66. A 14-year-old African American girl with sickle cell anemia presents with
extreme pain in her chest and legs. A peripheral smear shows sickling of her red
blood cells, and her reticul cyte count is 6.7%. She is diagnosed with an acute
pain crisis secondary to microvascular occlusion from sickled erythrocytes.
Sickle cell anemia is caused by a mutation that results in one amino acid being
replaced by another, which results from which of the following?
67. A 53-year-old man sees his family physician with concerns that his skin is
‘‘bronzing.’’ He is found to have diabetes as well as an elevated ferritin level (a
sign of iron overload). The physician suspects hemochromatosis and confirms the
diagnosis with genetic testing. It is found that the patient’s DNA carries a
mutation in which tyrosine is substituted for cysteine at position 282 (C282Y)
within the HFE gene. What word below best describes this type of mutation?
(A) Silent
(B) Missense
(C) Nonsense
(D) Frameshift
(E) Deletion
68. A 43-year-old woman, who has recently had difficulty getting up and out of a
chair and finds going up stairs to be troublesome, is referred to a rheumatologist
for her progressive weakness. A full rheumatologic workup reveals anti–Jo-1
antibodies, indicating that the patient likely has polymyositis. The physician
explains to the patient that she has autoantibodies directed against histidinyl-
tRNA synthetase (the Jo-1 antigen). Which of the following best describes a
property of this protein?
70. A 27-year-old man is seen by his physician for a week-long cough, sore
throat, and difficulty swallowing. He is diagnosed with diphtheria, which has
reactivated because of waning immunity. One way in which diphtheria toxin
leads to cell death is through the inhibition of eEF-2. Which statement best
explains the function of eEF-2?
71. A third-year medical student joins a laboratory that studies gene regulation.
The laboratory uses bacteria to study gene expression and metabolic regulation
after exposure to toxic com- pounds. The goal is to generalize the observations
seen in prokaryotic cells in response to the toxins and to compare the response to
eukaryotic cells. Which of the following statements is true regarding prokaryotic
and eukaryotic genomes?
73. One colony of bacteria is split into two Petri plates: one plate with growth
medium containing glucose and all 20 amino acids and one medium with one
sugar (lactose) and one nitrogen source (NH 4 + ). Which of the following
statements is correct concerning the cells growing in the second medium?
(A) cAMP levels will be lower than cells growing in the presence of glucose.
(B) CAP protein (cAMP-binding protein) will be bound to the lac promoter.
(C) The lac repressor will be bound to the lac operator.
(D) RNA polymerase will not bind to the trp promoter.
(E) Attenuation of transcription of the trp operon will increase.
74. Gene transcription rates and mRNA levels were determined for an enzyme
that is induced by glucocorticoids. Compared with untreated levels,
glucocorticoid treatment caused a 10-fold increase in the gene transcription rate
and a 20-fold increase in both mRNA levels and enzyme activity. These data
indicate that a primary effect of glucocorticoid in this assay is to decrease which
of the following?
75. An 8-year-old boy of Ashkenazi Jewish descent presents with bone pain and
easy bruising. His parents have no known history of serious medical ailments. He
is found to have hepatosplenomegaly (enlarged liver and spleen), anemia, and an
Erlenmeyer flask deformity of his distal femur. Which of the following is true for
this patient?
(A) The likelihood of another, to be born, sibling being affected with the disease
is 50%.
(B) At least one person in every generation of his pedigree is likely to be affected.
(C) His disease will only affect males.
(D) The probability that the patient’s unaffected siblings will be heterozygous
carriers is 67%.
76. A 2-year-old boy with Down syndrome requires intubation in the intensive
care unit due to difficulty breathing. He is afflicted with congenital heart disease
associated with the disease, and he dies shortly after admission. What is the most
common genetic cause of Down syndrome?
77. A 30-year-old woman presents to her obstetrician for her 6-month pregnancy
examination. The patient has already had one son born with Edwards syndrome,
who died after 1 week of life. She is concerned about the fate of the current
pregnancy because after her first child was born she was seen by a clinical
geneticist who told her that she is a mosaic for trisomy 18. Which of the
following statements is true for this patient?
78. A 50-year-old woman presents with spleen enlargement and a decreased red
blood cell count. She is diagnosed with chronic myelogenous leukemia (CML), a
blood cell cancer in which a portion of chromosome 9 is aberrantly attached to
chromosome 22. CML thus serves as a paradigm for other blood cell cancers, as
an example of which of the following?
(A) Karyotyping
(B) Phenotype characterization
(C) DNA sequencing
(D) Amniocentesis
(E) Chorionic villus sampling
80. A woman is pregnant with her fourth child. She has had an uneventful
pregnancy and is offered amniocentesis. Cytogenetic analysis performed on
amniotic fluid reveals 47,XY,+21.Which of the following statements is true of
amniocentesis?
diagnosed with the disease. However, he never develops signs of elevated serum
iron levels or organ toxicity. Which of the following terms best describes this
patient’s disease?
(A) p 2
(B) q 2
(C) 2pq
(D) p
(E) q
CHAPTER 4
905 Question
BRS PATHOLOGY
(D) Fibrinoid
(E) Liquefactive
The answer is: A
5. A 45-year-old woman is investigated for hypertension and is found to have
enlargement of the left kidney. The right kidney is smaller than normal.
Contrast studies reveal stenosis of the right renal artery. The size change in the
right kidney is an example of which of the following adaptive changes?
(A) Aplasia
(B) Atrophy
(C) Hyperplasia
(D) Hypertrophy
(E) Metaplasia
The answer is: B
6. A 56-year-old man recovered from a myocardial infarction after his
myocardium was entirely “saved” by immediate thrombolytic therapy. If it had
been possible to examine microscopic sections of his heart during his ischemic
episode, which of the following would be the most likely cellular change to be
found?
(A) Karyolysis
(B) Karyorrhexis
(C) Pyknosis
(D) Swelling of the endoplasmic reticulum
The answer is: D
7. A 64-year-old woman presents with fever, chills, headache, neck stiffness,
vomiting, and confusion. The Kernig sign (passive knee extension eliciting neck
pain) and Brudzinski sign (passive neck flexion eliciting bilateral hip flexion) are
both positive. Examination of the cerebrospinal fluid reveals changes consistent
with bacterial meningitis, and brain imaging demonstrates a localized abscess.
Which of the following types of necrosis is most characteristic of abscess
formation?
(A) Caseous
(B) Coagulative
(C) Enzymatic
(D) Fibrinoid
(E) Liquefactive
The answer is: E
8. A 20-year-old man presents with yellowing of the sclerae, skin, and oral
mucosa. Which of the following accumulations underlies these findings?
(A) Bilirubin
(B) Hemosiderin
(C) Lead
(D) Melanin
(E) Silver
The answer is: A
9. A 45-year-old man is referred because of a recent diagnosis of hereditary
hemochromatosis. Which of the following is a correct statement about this
disorder?
(A) Damage to organs results from abnormal deposition of lead
(B) It can progress to liver cirrhosis, diabetes mellitus, and skin pigmentation
(C) Most cases are due to spontaneous mutations
(D) Skin hyperpigmentation is due to bilirubin accumulation
(E) The TIBC is characteristically increased
The answer is: B
10. A 60-year-old woman with breast cancer and widespread bony metastases is
found to have calcification of multiple organs. The calcifications are best
described as
(A) dystrophic with decreased serum calcium.
(B) dystrophic with increased serum calcium.
(C) metastatic with decreased serum calcium.
(D) metastatic with increased serum calcium.
The answer is: D
11. A 56-year-old man dies 24 hours after the onset of substernal chest pain
radiating down his left arm to the ulnar aspect of his fingertips. Which of the
following morphologic myocardial findings is an indicator of irreversible injury?
(A) Cell blebs
(B) Depletion of glycogen
(C) Mitochondrial swelling
(D) Myelin figures
(E) Pyknotic nuclei
The answer is: E
12. A 72-year-old man presents with a 3-day history of progressively worsening
productive cough, fever, chills, and signs of toxicity. Prominent physical findings
include signs of consolidation and rales over the right lung base. Sputum culture
is positive for Streptococcus pneumoniae. An intra-alveolar exudate filling the
alveoli of the involved portion of the lung is present. Which of the following types
of inflammatory cells is most likely a prominent feature of this exudate?
(A) Basophils
(B) Eosinophils
(C) Lymphocytes
(D) Monocytes–macrophages
(E) Neutrophils
The answer is: E
(A) C5a
(B) Fucosyl transferase
(C) β 2 -Integrin
(D) P-selectin
(E) TNF-α
The answer is: A
17. A 26-year-old African-American woman has bilateral hilar adenopathy, and
radiography reveals multiple reticular densities in both lung fields. A
bronchoscopic biopsy reveals granulomatous inflammation with multiple giant
cells of the Langhans type and no evidence of caseous necrosis. Which of the
following is the most likely diagnosis?
(A) Aspergillosis
(B) Coccidioidomycosis
(C) Histoplasmosis
(D) Sarcoidosis
(E) Tuberculosis
The answer is: D
18. A 70-year-old man presents with the sudden onset of left-sided weakness,
spasticity, and hyperactive and pathologic reflexes. The most serious
consequences of this disorder are the result of damage to which of the following
cell types?
(A) Labile cells
(B) Multipotent adult progenitor cells
(C) Permanent cells
(D) Stable cells
The answer is: C
19. Within minutes of a bee sting, a 23-year-old woman develops generalized
pruritus and hyperemia of the skin, followed shortly by swelling of the face and
eyelids, dyspnea, and laryngeal edema. This reaction is mediated by
(A) antigen-antibody complexes.
(B) cytotoxic T cells.
(C) IgA antibodies.
(D) IgE antibodies.
(E) IgG antibodies.
The answer is: D
20. A 25-year-old woman with membranous glomerulonephritis receives a
kidney transplant. The donor is her HLA-matched sister. She does well initially,
but after several weeks, there is a progressive increase in serum creatinine.
Assuming that this represents acute cellular rejection, an infiltrate with which of
the following types of inflammatory cells is most likely to be a prominent finding
on renal biopsy?
(A) Eosinophils
(B) Lymphocytes
(C) Mast cells
(D) Monocytes-macrophages
(E) Neutrophils
The answer is: B
21. A 20-year-old woman presents with malar rash, arthralgias, low-grade fever,
and high titer antibodies to double-stranded DNA and to the Sm (Smith) antigen.
Which of the following forms of hypersensitivity is the primary mechanism of
the abnormalities found in this disorder?
(A) Type I (immediate or anaphylactic) hypersensitivity
(B) Type II (antibody-mediated or cytotoxic) hypersensitivity
(C) Type III (immune complex-mediated disorders) hypersensitivity
(D) Type IV (cell-mediated) hypersensitivity
The answer is: C
22. An HIV-positive intravenous drug user is suspected of having active
tuberculosis, and a tuberculin (Mantoux) intradermal skin test is performed.
After 48 hours, 10 cm of induration is observed. Which of the following are
involved in this form of hypersensitivity reaction?
(A) B cells and antibodies
(B) Basophils and IgE
(C) Immune complexes and complement
(D) Plasma cells and IgM
(E) T cells and macrophages
The answer is: E
23. A 24-year-old woman who had previously been uneventfully transfused
receives a blood transfusion during surgery and shortly thereafter develops
itching, generalized urticaria, laryngeal edema, and dyspnea with wheezing
respiration. She has a past history of recurrent upper respiratory tract infections
and frequent episodes of diarrhea. Laboratory studies are most likely to reveal
decreased concentrations of which of the following immunoglobulins?
(A) IgA
(B) IgD
(C) IgE
(D) IgG
(E) IgM
The answer is: A
24. A 54-year-old woman who has been diagnosed with early-stage breast cancer
undergoes surgery for a lumpectomy to remove a small tumor detected by
mammography. The pathology report confirms the early stage of the cancer and
further comments on the fact that there is significant desmoplasia in the
surrounding tissue. The term desmoplasia refers to
PRETEST PATHOLOGY
1. A 59-year-old man is found to have a 3.5-cm mass in the right upper lobe of
his lung. A biopsy of this mass is diagnosed as a moderately differentiated
squamous cell carcinoma. Workup reveals that no bone metastases are present,
but laboratory examination reveals that the man’s serum calcium levels are 11.5
mg/dL. This patient’s paraneoplastic syndrome is most likely the result of the
ectopic production of which of the following substances?
a. Parathyroid hormone
b. Parathyroid hormone-related peptide
c. Calcitonin
d. Calcitonin-related peptide
e. Erythropoietin
a. Caseous necrosis
b. Coagulative necrosis
c. Fat necrosis
d. Fibrinoid necrosis
e. Liquefactive necrosis
a. Endothelial cells
b. Fibroblasts
c. Lymphocytes
d. Mast cells
e. Neutrophils
laden cells within the alveoli. Which of the following is the cell of origin of these
“heart failure cells”?
a. Endothelial cells
b. Eosinophils
c. Lymphocytes
d. Macrophages
e. Pneumocytes
a. Neutrophils
b. Eosinophils
c. Monocytes
d. Lymphocytes
e. Plasma cells
6. A 37-year-old man presents with a cough, fever, night sweats, and weight loss.
A chest x-ray reveals irregular densities in the upper lobe of his right lung.
Histologic sections from this area reveal groups of epithelioid cells with rare
acid-fast bacilli and a few scattered giant cells. At the center of these groups of
epithelioid cells are granular areas of necrosis. What is the source of these
epithelioid cells?
a. Bronchial cells
b. Fibroblasts
c. Lymphocytes
d. Monocytes
e. Pneumocytes
7. A 47-year-old man presents with pain in the midportion of his chest. The pain
is associated with eating and swallowing food. Endoscopic examination reveals
an ulcerated area in the lower portion of his esophagus. Histologic sections of
tissue taken from this area reveal an ulceration of the esophageal mucosa that is
filled with blood, fibrin, proliferating blood vessels, and proliferating fibroblasts.
Mitoses are easily found, and most of the cells have prominent nucleoli. Which of
the following statements best describes this ulcerated area?
b. Dysplastic epithelium
c. Granulation tissue
d. Squamous cell carcinoma
e. Noncaseating granulomatous inflammation
a. Active hyperemia
b. Acute congestion
c. Nonpalpable purpura
d. Passive hyperemia
e. Petechial hemorrhage
a. Fibrinogen
b. Prostacyclin
c. Thrombomodulin
d. Thromboplastin
e. Thromboxane
11. Assuming that the levels of all of the other coagulation factors are within
normal limits, which of the following laboratory findings is most consistent with
an individual who is not taking any medication but has a familial deficiency of
coagulation factor VII?
a. Prolonged Normal
b. Normal Prolonged
c. Shortened Normal
d. Normal Shortened
e. Shortened Prolonged
12. Ten minutes after being stung by a wasp, a 30-year-old man develops
multiple patches of red, irregular skin lesions over his entire body. These lesions
(urticaria) are pruritic, and a new crop of lesions develops the next day. Which
one of the following statements correctly describes an important component of
the pathomechanism of this immune response?
شيت الجامعة
1. An example of a tissue or organ composed of Permenant Parenchymal cells is:
a) Liver
b) Bone Marrow
c) Small Intestinal Mucosa
d) Heart
e) Renal Tubules
. The type of necrosis that occurs in Peripancreatic tissue in Acute Pancreatitis
is:
a) Liquefaction
b) Fat
c) Coagulation
d) Gummatous
e) Fibrinoid
3. Change of Columnar Epithelium of the Bronchi into Mature Squamous
Epithelium is called:
a) Metaplasia
b) Dysplasia
c) Hyperplasia
d) Neoplasia
e) Hypertrophy
4. Metastatic Calcification:
a) Is due to hypercalcemia
b) Is due to hypocalcemia
c) Occurs in Necrotic Tissue
d) Occurs at sites of Chronic Inflammation
e) Is due to malignancy
5. Which of the following is a feature of Irreversible Cell Injury:
a) Glycogen stores are depleted
10. The presence of Columnar Epithelium with Goblet cells in the Lower
Oesophagus is most consistent with:
a) Dysplasia
b) Hyperplasia
c) Carcinoma
d) Ischaemia
e) Metaplasia
13. Which of the following cellular changes is most likely to present irreversible
cellular injury:
a) Epithelial dysplasia
b) Cytoplasmic fatty metamorphosis
c) Nuclear pyknosis
d) Atrophy
e) Anaerobic Glycolysis
15. Which of the following is the most likely pathologic alteration following
occlusion of the left middle cerebral artery by a sterile thrombus:
a) Cerebral softening from liquefactive necrosis
b) Pale infarction with coagulative necrosis
c) Predominantly the loss of glial cells
d) Recovery of damaged neurons if the vascular supply is re-established
e) Wet gangrene with secondary bacterial infection
17. Which of the following type of necrosis is most commonly associated with
ischaemic injury:
a) Coagulation Necrosis
b) Liquefaction Necrosis
c) Caseous Necrosis
d) Fat Necrosis
e) Gangrenous Necrosis
e) -antitrypsin
23. The enzymes responsible for liquefaction in an abscess are derived mainly
from:
a) Tissue
b) Serum
c) Lymph
d) Neutrophils
e) Lymphocytes
24. Each of the following is an example of hyperplasia except:
a) Enlargement of one kidney after surgical removal of the other kidney
b) Changes in the thyroid gland in response to increased demand for thyroid
hormones
c) Changes in breast tissue during pregnancy
d) Enlargement of lymph nodes during a viral infection
e) Enlargement of skeletal muscles after weight training
e) -antitrypsin
a) Can be physiological
b) Is a precancerous condition
c) Is reversible
d) Is due to excess hormone stimulation
e) Can be associated with hypertrophy
40. Digestion of tissue with soap formation and calcification is characteristic of:
a) Coagulation Necrosis
b) Caseous Necrosis
c) Fibrinoid Necrosis
d) Liquefaction Necrosis
e) Enzymatic Fat Necrosis
41. All of the following findings represent changes seen within cells that
represent reversible cellular injury, except:
a) Fatty change in hepatocytes
b) Neuronal cell swelling
c) Skeletal muscle fiber anaerobic glycolysis
d) Renal tubular cell nuclear pyknosis
e) Kupffer cell iron deposition
42. Which is most likely to happen following a stroke with loss of blood supply to
a lobe of the brain:
44. Which of the following cellular changes represents the best evidence for
irreversible cellular injury:
a) Epithelial dysplasia
b) Cytoplasmic fatty metamorphosis
c) Nuclear pyknosis
d) Atrophy
e) Anaerobic glycolysis
45. The presence of differentiated columnar epithelium with goblet cells in lower
esophagus is consistent with:
a) Dysplasia
b) Hyperplasia
c) Carcinoma
d) Ischemia
e) Metaplasia
49. Which of the following tissues is most likely to be least affected by Ischemia:
a) Skeletal muscle
b) Small intestinal epithelium
c) Retina
d) Myocardium
e) Hippocampus
50. An amputated foot of a diabetic will most likely show:
a) Neoplasia
b) Gangrenous Necrosis
c) Coagulopathy
d) Hemosiderosis
e) Caseation
52. Which of the following types of necrosis is grossly opaque & "chalk" white:
a) Coagulation necrosis
b) Liquefaction
c) Caseous necrosis
d) Fat necrosis
e) Gangrenous necrosis
c) Both A and B
d) Neither A nor B
e) Ischemia
59. The loss of individual cell through fragmentation of individual cell nucleus is
best described as:
a) Coagulative Necrosis
b) Mitochondrial Poisoning
c) Phagocytosis
d) Apoptosis
e) Liquefaction
60. The light brown perinucleur pigment seen in an old man muscle fiber is:
a) Hemosidrin
b) Lipofuscin
c) Glycogen
d) Melanin
e) Calcium
61. Hypertensive Enlargement of the heart is a form of:
a) Fatty infiltration
b) Hypoplasia
c) Glycogen storage
d) Hypertrophy
e) Hyperplasia
62. Gangrene of the big toe in a 60 year old female is most likely associated with:
a) Diabetes Mellitus
b) Temporal Arteritis
c) AIDS
d) Type III Hypersensitivity
e) Carcinoma of the Bronchus
64. Two days after myocardial infarction, histology of the heart will show:
a) Fibroblasts and Collagen
b) Granulation Tissue
c) Necrotic Muscle & Neutrophils
d) Granulamatous Inflammation
e) Aneurysmal Dilation
b) Swollen mitochondria
c) Pyknotic Nucleus
d) Dilated Endoplasmic
e) Cell surface blebs
d) Both A and B
e) Both B and C
a) Karyolysis
b) Karyorrhecsis
c) Cytoplasmic Basophilia
d) Pyknosis
e) Loss of RNA
78. Which of the following is most likely associated with Caseation Necrosis:
a) Diabetic Gangrene
b) Gas Gangrene
c) Myocardial Infarction
d) Inpissated Pus
e) Splenic Infarction
82. Squamous Metaplasia can occur in all of the following sites except:
a) Nose
b) Salivary Gland Ducts
c) Jejunum
d) Renal Pelvis
e) Gall Bladder
d) A & C
e) All of the above
88. A common manifestation of sublethal cell injury seen in organs such as the
heart and liver is:
a) Glycogen accumulation
b) Fatty change
c) Calcium deposition
d) Apoptosis
e) Deposition of Amyloid
89. In the process of necrosis, a reduction in the size of the nucleus and a
condensation of nuclear material is known as:
a) Karyolysis
b) Pyknophrasia
c) Karyorrhexis
d) Pyknosis
e) Metachromasia
c) Capillary Dilation
d) Increased Intracellular Fluid
e) Increased Extracellular Fluid
99. Multinucleated Giant Cells of the foreign body type origin from:
a) Nuclear Division of Granulocytes
b) Atypical Regeneration of Epithelium
c) Megakaryocytes
d) Fusion of Macrophages
e) Multiplication of Nuclei Surrounding Fibrocytes
108. Which of the following is the most efficient killer of bacteria in neutrophils:
a) Spontaneous dismutation of O2 to H2O
b) Conversion of H2O2 to HOCl by Myeloperoxiase
c) Oxidative metabolism giving rise to OH and O2
d) Hyrolyzing Bacterial Coated with Lysozyme
e) Action of Hydrolytic Enzymes
111. Fever and Leukocytes in which most leukocytes are neutrophils typical of:
a) Acute Bacterial Infection
b) Acute Viral Infection
c) Chronic Viral Infection
d) Parasitemia
e) Foreign Body Giant Cell Reaction
112. Epitheloid Cells and Langerhans Giant Cells in granulomas are derived
from:
a) Neutrophils
b) Eosinophils
c) Mast Cells
d) Macrophage
e) Lymphocytes
113. Prostaglandins are formed from Arachidonic Acid through the action of
which enzyme pathway?
a) Cyclooxygenase
b) Lipoxygenase
c) Myeloperoxidase
d) Phospholipase A
e) Glutathione Reductase
e) Staphylococcal Infection
119. The first inflammatory cell to show at the site of acute inflammation is the:
a) Monocyte
b) B-lymphocyte
c) T-lymphocyte
d) Neutrophils
e) Mast cell
d) Bradykinin
e) Complement C5a
122. A biopsy of a region of acute inflammation would most likely reveal all of
the following except:
a) Fibrinous exudate
b) Neutrophils
c) Edema
d) Necrosis
e) Fibrous connective tissue
124. Following an attack of chest infection for three days, a patient becomes very
ill and his chest x-rays shows a 3cm rounded density. He is most likely having:
a) Hypertrophic scar
b) Abscess formation
c) Regeneration
d) Bronchogenic carcinoma
e) Progression to chronic inflammation
125. Which of the following cells is the most important in the development of
tuberculous granuloma:
a) Macrophages
b) Fibroblast
c) Neutrophil
d) Mast Cell
e) Platelet
127. Which of the following mediators are predominantly responsible for pain in
acute inflammation:
a) Complement C3b and IgG
b) Interleukin-1 and tumour necrosis factor
c) Histamine and Serotonin
d) Prostaglandin and Bradykinin
e) Leukotriene and E-selectin
128. Which of the following cell types is most likely to be most characteristic of a
foreign body reaction:
a) Mast cell
b) Eosinophil
c) Giant cell
d) Neutrophils
e) Plasma cell
c) Both A and B
d) Neither A nor B
e) Granuloma
e) Chronic Bronchitis
142. The high protein content of the inflammatory exudates is mainly due to:
a) Protein released from dead tissue
b) Production of protein by inflammatory cells
c) Increased capillary permeability
d) Increased capillary hydrostatic pressure
e) Increased blood flow in the site of inflammation
150. The most important factor in the formation of acute inflammatory exudates
is:
a) Increased Hydrostatic Pressure
b) Increased Blood Flow
c) Chemotaxis
d) Increased Vascular Permeability
e) Lymphatic Obstruction
152. Infertility and short stature in a woman with a 45x karyotype are typical of:
a) Rlinefelter Syndrome
b) Turner Syndrome
c) Down Syndrome
d) Achondroplasia Dwarfism
e) Cystic Fibrosis
c) Cystic Fibrosis
d) Diabetes
e) Rheumatic Heart Disease
163. The primary role of which of the following in the closure of wounds healing
by second intention:
a) Neutrophils
b) Connective Tissue
c) Macrophages
d) Granulation Tissue
e) Granuloma
164. The process of regeneration:
a) Does not restore prior function
b) Invariability leads to scar formation
c) Refers to healing by proliferation of stromal elements
d) Occurs in tissues composed of labile and stable cells
e) Is synonymous with repair
e) Glucocorticoids
166. Repair of which of the following involves regeneration and connective tissue
repair:
a) Bone fracture
b) Renal tubular necrosis
c) Both A and B
d) Neither A nor B
168. Neurogenic, Septic and Cardiogenic shock are all characterized by:
a) Equal prognosis if untreated
b) Need for blood transfusion
c) Peripheral vasodilation at onset
d) Normal blood volume at early stage
e) Progression to irreversible shock
170. Following a hypotensive shock which lasted for hours, which of the
following tissues is most likely to withstand the ischemia:
a) Skeletal muscle
b) Small Intestinal Epithelium
c) Retina
d) Myocardium
e) Hippocampus
c) Polycythenia
d) Dissiminated Carcinomatosis
e) High level of antithrombin III
179. The following are associated with DIC except:
a) Widespread deposition of fibrin with microcirculation
b) Consumption of coagulation factors
c) Haemorrhagic diathesis (Bleeding Tendency)
d) Thrombocytosis (Increased Platelet Count)
e) Activation of Plasminogen
187. A detached intravascular solid, liquid or gas carried to a site distant from its
point of origin is most associated with:
a) Ascites
b) Petechiae
c) Infarction
d) Emboli
e) Hematoma
d) Adrenal Glands
e) Intestine
191. Which of the following is most significant in the diagnosis of early acute
myocardial infarction:
a) ESR
b) ASO titre
c) Troponin
d) LDH
e) Total CK
192. Which of the following is not a major risk factor for atherosclerosis:
a) Family history
b) Hyperlipidemia
c) Physical inactivity
d) Diabetes
e) Hypertension
193. Organs which are less susceptible than others to infarction because of a dual
blood supply include:
a) Liver and Lungs
b) Liver and Kidney
c) Lung and Spleen
d) Spleen and Kidney
e) Pancreas and Lung
b) Plasma cells
c) Macrophages
d) Both A & B
e) Both A & C
201. Of the following histopathologic finding, the one best indicates that a
neoplasm is malignant is:
a) Pleomorphism
b) Atypia
c) Invasion
d) Increased Nuclear/Cytoplasmic Ratio
e) Necrosis
d) Giardia Lamblia
e) Staphylococcus aureus
203. Which of the following complications is most likely to occur in a 76 year old
woman who has a swollen leg followed by fracture of femoral trochanter and
who has been immobilized:
a) Gangrenous Necrosis of the Foot
b) Haematoma of the Thigh
c) Disseminated Intravascular Coagulation (DIV)
d) Pulmonary Thromboembolism
e) Soft Tissue Sarcoma
c) Complement C5a
d) Histamine
e) Thromboxane
207. Which of the following cellular process is most likely to occur in the
myocardium of a patient with myocardial infarction who is being treated with
fibrinolytic agents:
a) Apoptosis
b) Free Radical Injury
c) Fatty Changes
d) Accumulation of Lipofuscin
e) Accumulation of Amyloid
208. Which of the following will predict a better prognosis for breast cancer:
a) The tumor is small in size
b) No metastasis are found in sampled lymph node
c) Numerous mitosis are seen
d) Tumor shows mild hyperchromatism
e) Tumor cells show marked pleomorphism
d) Hypoalbuminemia
e) Cancer of the Stomach
215. Which of the following malignant tumors has the best prognosis:
a) Hepatocellular Carcinoma
b) Renal Cell Carcinoma
c) Basal Cell Carcinoma
d) Squamous Cell Carcinoma of Cervix
e) Squamous Cell Carcinoma of Skin
d) Diptheria
e) Measles
d) Berger's Disease
e) Tubular immunoflorescence
226. All of the following are true of renal cell carcinoma except:
a) The tumor cells secrete erythropoietin
b) It originates from the glomeruli
c) The tumor cells are rich in glycogen
d) The tumor cell is often associated with polycythemia
227. One of the following is not true about amoebic liver abscess:
a) There is Neutrophilia
b) The patient is febrile
c) Jaundice is always present
d) The right lobe of the liver is commonly involved
e) Metronidazole is used for treatment
229. The Chemical Carcinogen, Alfatoxin B1, derived from a fungus which may
contaminate peanuts, most commonly induces:
a) Transitional Cell Carcinoma of the Lung
b) Adenocarcinoma of the Rectum
c) Hepatocellular Carcinoma
d) Squamous Cell Carcinoma of the Skin
e) Renal Cell Carcinoma
b) Sarcoidosis
c) Schistosoma manson infection
d) Tuberculosis
e) Cerebral Malaria
242. In Amoebiasis:
a) Condylomata Lata is a feature
b) Granuloma Formulation is characteristic
c) The small intestine is always involved
d) The perianal skin may be affected
e) There is an intense infiltration in the lesions by polymorphs
c) Inflammatory Reaction
d) Fibrosis
e) Increased Cellular Enzymes in the Blood
245. One of the following is not true about bilharzial portal hypertension:
a) Splenomegaly is of the congestive type
b) Iron deficiency anemia is a complication
c) Periportal fibrosis is the cause
d) There is an increased incidence of hepatocellular carcinoma
e) Hepatic failure is not an early complication
e) Sarcoid Granulomas
e) A Cuff of Lymphocytes
254. The following are not features of the primary focus in pulmonary
tuberculosis except:
a) Usually undergoes cavitation
b) Commonly occurs in the apex of the lung
c) May give rise to miliary tuberculosis
d) Is known as Assman's Focus
e) Is a common cause of haemoptysis
c) Stool Culture
d) Urine Culture
e) Peritoneal Fluid Culture
269. Which of the following is not used for diagnosis of Typhoid Fever:
a) Blood Culture
b) Widal
c) Stool Culture
d) VDRL
270. The activation of chemical procarcinogen requires activation by:
a) Neuropeptidases
b) Dismutases
c) Collagenase
d) P450 dependent Oxygenase
e) Alkaline Phosphotase
272. Exposure to UV light will give rise to which of the following tumours:
a) Hepatocellular Carcinoma
b) Basal Cell Carcinoma
c) Squamous Cell Carcinoma
d) Both A and C
e) Both B and C
273. Who of the following is more likely to develop Squamous Cell Carcinoma of
the Skin:
a) Sudanese
b) Nigerians
c) Kenyans
d) Scandinavian living in Zimbabwe
e) Bantu South African
275. Which of the following is used for screening of food handlers for Typhoid:
a) Blood Culture
b) Stool Culture
c) Widal
d) Sputum Culture
282. Which of the following can give rise to Nitrosamins when ingested:
a) Fresh Vegetable
b) Citric Fruits
c) Preserved Food
d) Biscuits
e) Beef
283. Individuals with Sickle Cell Trait are resistant to Malaria because:
a) They have low hemoglobin
b) Anopheles mosquito does not bite them
c) Their red blood cells sickle when parasitized and are removed by spleen
d) Their red blood cells contain antiparasite antibodies
e) None of the Above
b) Urinary Schistosomiasis
c) Tuberculoid Leprosy
d) Sarcoidosis
e) Tertiary Syphilis
291. Which of the following is not true about Syphilitic Primary Chancre:
a) Occurs commonly on external genitalia
b) Contains treponema pallidum spiroecele
c) Has a dense plasma cell infiltrate
d) Does not heal spontaneously
e) Occurs 3 weeks after contact with an infected individual
b) Oesophageal Varices
c) Markedly Disturbed Liver Function
d) Coput Medusa
e) All of the Above
c) Typhoid Fever
d) Urinary Schistosomiasis
e) Portal Hypertension
a) -Interferon
b) TNF-
c) IL-4
d) Both A and B
e) Both A and C
d) Widal Test
e) Bone Marrow Smear
310. Which of the following statements is not true about Unconjugated Bilirubin:
a) It is Protein Bound
b) It is Water Insoluble
c) It is Excreted in Urine
d) Can cross the Blood-Brain Barrier
e) It is increased in Hemolytic Anemia
319. All of the following are thought to be related to the capacity for tumor cells
to invade except:
a) Elaboration of Type IV Collagenase
b) Expression of Laminin Receptors
c) Mitotic Rate
d) Production of Proteases
321. Which of the following is the best candidate as the origin of a Metastatic
Neoplasm in the Liver:
a) Carcinoma in situ of the uterine cervix
b) Adenocarcinoma of the cecum
322. The most important enzyme system for the Metabolic Activation of
Chemical Carcinogens is:
a) Glutathione Reductase
b) Cytochrome-P450-dependednt Monooxygenases
c) Epoxide Hydrolase
d) UDP-Glucuronic Acid Transferase
c) Kvein Test
d) Mantoux Test
e) Lepromin Test
d) -Interferon
e) IgM
337. Which of the following clinical patterns of Leprosy is associated with a well
developed cell mediated response:
a) Lepromatous Leprosy
b) Tuberculoid Leprosy
c) Borderline Leprosy
d) Indeterminate Early Stage
e) Borderline Lepromatous
d) Tumors
e) None of the Above
351. Under Polarized Light, Amyloid Stained with Congo Red appears:
a) Pink
b) Blue
c) Vacuoles
d) Apple Green Birifringence
e) Granulated
e) Leishmania Test
b) B6 Deficiency
c) Folate Deficiency
d) A and B
e) B and C
366. Causes of Iron Deficiency Anemia include all of the following except:
a) Peptic Ulcers
b) Hemorrhoids
c) Low Dietary Iron
d) Intra-Vascular Hemolysis
e) Menorrhagia
d) Ig E
e) Ig D
b) Head Surgery
T c) Hypocalcemia
d) Hypokalemia
e) Chronic Renal Failure
c) Adrenal Ectomy
T d) Pituitary Tumors
e) Meningo-Coccal Septicemia
a) Breast Carcinoma
b) Carcinoma of the Pancreas
c) Fibroadenoma of the Breast
T d) Bronchogenic Carcinoma
e) Carcinoma of the Cervix Uteri
397. Which of the following tumors is likely to rise because of loss of Tumor
Suppressor Gene:
a) Infiltrating Ductal Carcinoma of Breast
b) Small Cell Anaplastic Carcinoma of the Lung
c) Retinoblastoma of the Eye
d) Cerebral Astrocytomy
e) Chronic Myeloid Leukemia
398. Which of the following is most likely to be found in a 30 year old female who
has SLE:
a) Severe Atherosclerosis
b) Glomerular Immune Deposits
c) Amyloid Deposition
T d) Vascular Chronic Inflammation
e) Anti-Glomerular Basement Membrane Antibody
شيت المجلس
1. A cell consistently seen in an abscess contents:
a. Histocytes
b. Lymphocytes
c. Neutrophil
d. Multinucleated giant cell
e. Plasma cell
7. One of the following seriously interferes with healthy and repair of damaged
tissue:
a. age
b. sex
c. hypertension
d. immobilization
e. diabetes mellitus
9. Prostaglandin are:
a. products of arachidonic acid metabolism
b. inhibited by aspirin
c. inhibited by azothioprins
d. vasodilatation
e. important in the formation of mucus barrier in the stomach
11. The following statements are true about malignant neoplasm Except:
a. infiltrate adjacent tissue
b. can metastasis
c. cause loss of weight
d. majority occur in children
e. some secrete ectopic hormone
14. One of the following is not valuable in reporting an incisional biopsy from a
malignant tumor:
a. histological type of tumor
b. histological grading of tumor
c. extension of tumor to the lines of surgical excision
d. presence of necrosis
e. presence of vascular invasion
16. Surgical staging contributes least to the management and prognosis of cancer of:
a. the breast
b. the bowel
c. the brain
d. the uterine cervix
e. the urinary bladder
22. The best established factor promoting the migration of epidermal cells in wound
healing is:
a. high concentration of vit. C in the exudates
b. loss of contact inhibition
c. raised local temperature
d. secretion of local mitosis regulators (chalones)
e. secretion of wound hormones (trephones)
25. Viruses have been implicated in the pathogenesis of the following human tumors
except:
a. nasopharyngeal carcinoma
b. Hodgkins disease
c. colonic carcinoma
d. hepatocellular carcinoma
e. cervical carcinoma
29. One of the following is not true with raised intracranial pressure:
a. leads to systemic hypertension
b. is associated with bradycardia
c. leads to papilledema
d. may cause brain stem hemorrhage
e. may lead to pulmonary edema
a. anaplasia
b. aplasia
c. dysplasia
d. heteroplasia
e. metaplasia
33. Major risk factors associated with development of coronary and generalized
atherosclerosis included all the following Except:
a. cigarette smoking
b. elevated high-density lipoproteins (HDL) levels
c. diabetes mellitus
d. hypertension
e. hypercholesterolaemia
34. Disorders that predispose to thrombosis include all the following Except:
a. pancreatic carcinoma
b. pregnancy
c. vitamin K deficiency
d. sickle cell anemia
e. severe burns
39. congenital malformations are associated with all of the following conditions
Except:
a. fetal chromosomal abnormalities
b. maternal thalidomide use
c. rubella infection in the first 8 weeks of pregnancy
d. cytomegalovirus infection in the second trimester of pregnancy
e. heavy cigarette smoking throughout pregnancy
40. Malignancies that commonly occur in children younger than 5 years of age
include all of the following Except:
a. Leukaemia
b. Wilmstumor
c. Retinoblastoma
d. Rhabdomyosarcoma
e. Osteosarcoma
41. All of the following conditions increase in incidence with obesity Except:
hypertension
a. diabetes mellitus
b. hyperlipidemia
c. rheumatoid arthritis
d. gall stones
42. All of the following statements are true about iron as a nutrient Except:
a. daily requirements are greater for young women than for young men
b. normally most dietary iron is not absorbed
c. in Western World deficiency in adult males is often due to gastro-intestinal
blood loss
d. deficiency causes a drop in the transferin iron-binding capacity
e. deficiency causes abnormal mitochondrial and cytochrome function
43. Immediate consequences of a first ischemic cardiac event include all of the
following Except:
a. angina pectoris
b. sudden death without infarction
c. trans-mural infarction
d. cardiac rupture
e. no symptoms
45. All of the following statements about disseminate intravascular coagulation are
true Except:
a. the disorder is characterized by wide-spread thrombosis
b. the disorder is characterized by wide-spread hemorrhage
c. it most often present as a primary (idiopathic) condition
d. the brain is the organ most often involved
e. the disorder is associated with muci-secretary adenocarcinoma
46. Cancer patients receiving medical treatment often develop eosophigitis from all of
the following Except:
a. antibiotic toxicity
b. viral infection
c. chemotherapeutic agent toxicity
d. radiation
e. fungal infection
50. Which of the following is the most confirmative feature of malignancy in size
a. progressive increase in size
b. infiltration of adjacent tissue
c. presence of metastasis
d. cellular pleomorphism
e. mitotic activity
51. In acute inflammation vasodilatation is the main cause of one of the following
cardinal signs:
a. Pain
b. Swelling
c. Redness
d. Hotness
e. Loss of function
55. Hypoxia is an important and common cause of cell injury and death. Which of the
following is the commonest cause of hypoxia:
a. Ischemia
b. pneumonia
c. anemia
d. CO poisoning
e. high attitude
56. The following are true about the functions of the cytoskeleton Except:
a. intracellular transport for organelles and molecules
b. maintenance of basic cell structure
c. production of intracellular energy
d. cell mobility
e. conveying all cell and cell-extracellular matrix signals to the nucleus
b. inhibited by aspirin
c. inhibited by azothioprens
d. are vasodilators
e. increase vascular permeability
59. The following conditions are associated with acquired defects in leukocyte
function, which one is most frequently seen:
a. thermal injury
b. diabetes mellitus
c. hemodialysis
d. leukemia
e. sepsis
64. Which of the listed categories of shock rank first as a cause of death in intensive
care units:
a. cardiogenic shock
b. hypovolemic shock
c. septic shock
d. neurogenic shock
e. anaphylactic shock
66. Hepatitis A
a. is the most common type of viral hepatitis
b. is spread by the fecal–oral route
c. has a carrier state
d. virus causes direct damage to the liver
e. caused by DSRNA virus
68. The following statements about the hepatitis B virus are correct:
a. the whole virus is called the Dane particle
b. the virus replicates in the blood stream
c. HBsAg is produced by replication in nucleus
d. HBcAg is formed in the liver cell cytoplasm
e. the damage caused by it is the result of an immunological reaction to the
virus
d. tissue culture
e. serum slopes
d. ribanvirin
e. marboran
88. The diagnostic test for homozygous SS disease (sickle cell anemia) is:
a. sickling test
b. peripheral film examination for sickle cells
c. reticulocyte count
d. Hb electrophoresis
e. urine examination for urobiliogen
89. A 20 years old man had pain around his Rt.knee, x-ray showed an osteolytic
lesion extending to subchondral bone. To diagnose GCT (Giant Cell Tumor) the
microscopic picture would show:
a. small round cells with indistinct cell boundary
b. spindle cells and giant cells
c. giant cells and plenty of cartilage cells
d. fibroblast and lymphocytes
e. reactive bone
92. The following are common causes of paraplegia in T.B. spine EXCEPT:
a. compression caused by necrotic bone
b. abscess formation compressing the cord
c. disc prolapse
d. vascular occlusion due to inflammatory process
e. cord may be stretching over the apex of kyphos deformity
93. The following mechanisms are used by some parasites to evade attack by the
immune system EXCEPT:
a. antigenic disguise
b. development of capsules
c. resistance to ability of macrophage in killing
d. immunosuppression
e. antigenic variation
97. The following are known complications of sickle cell anemia EXCEPT:
a. aplastic crisis
b. hemolytic crisis
c. sequestration crisis
d. osteomyelitis
e. acute salpingitis
d. endothelial damage
e. formation of platelet aggregates
99. In severe injuries a patient with pelvic fracture may lose blood in the range of:
a. 1-4 units
b. 2-4 units
c. 2-6 units
d. 2-3 units
e. 1-3 units
103. The most effective method for reducing the incidence of nosocomial infection
is:
a. laminar flow rooms
b. wearing surgical masks
c. immunization
d. giving antibiotics
e. hand washing
e. Diabetic angiopathy
105. In complete obstructive of the common bile duct the following is true except.
a. Increased direct serum bilirubin.
b. Increased indirect serum bilirubin.
c. Increased serum alkaline phosphatase .
d. Presence of uroblinogen in the urine.
e. Presence of bilirubin in the urine.
108. In acute inflammation which one of the following events occurs first?
a. increased vascular permeability
b. leukocyte cellular parementation
c. chemotaxispavementation
d. vasodilatation
e. leukocyte cellular aggregation
109. Which of the following conditions is not associate with defects in leukocyte
function:
a. diabetes mellitus
b. sepsis
c. hemodialysis
d. leukemia
e. leishmaniasis
120. Serum analysis for drug concentration is necessary for monitoring treatment
with:
a. chloramphenicol
b. ampiclox
c. gentamycin
d. fucidic acid
e. clavulonic acid
121. All of the following organisms are associated with hospital wound infection
EXCEPT:
a. Staphylococcus aureus
b. Coliforms
c. Β-hemolytic streptococci
d. d-hemolytic streptococci
e. clostridium perfringens
124. The best test for investigating long-term diabetic control in type 2 diabetes is:
a. fasting plasma glucose
b. GTT
c. Plasma insulin
d. Hb A1C
e. pancreatic β-cell antibodies
125. The metabolic response after major surgery includes which of the following?
a. hypoglycemia
b. water deficit
c. hyperkalemia
d. tendency to ketosis
e. saline responsive metabolic alkalosis
126. Which of the following microorganisms the ATE surgeon can have vaccine
for:
a. hepatitis A virus
b. hepatitis B virus
c. hepatitis C virus
d. HIV virus
e. Rubella virus
132. In hypovolemic shock the most appropriate intravenous solution to give is:
a. 5% dextrose in water
b. dextrose saline
c. dextran
d. ringer's lactate solution
e. Darrow's solution
e. renal tubules
151. In acute inflammation the main means (way) of increased escape of plasma
from capillaries and venules is:
a. fenestration of basement membrane
b. gaps between endothelia cells produced by active contraction of cells
c. necrosis of short stretch of the wall
d. reduction of charges on muco-polysaccharides receptors in the basement
membrane
e. transfer throughout endothelial cells by enlarged pinocytotic vesicles
152. The gross texture and resilience of a given tumor are largely influenced by:
a. degree of malignancy
b. type of epithelium present
c. presence or absence connective tissue stroma
153. The involution of the thymus that occurs with aging is an example of the
process of programmed cell death, best described as:
a. pyknosis
b. karyorexia
c. apoptosis
d. karyolysis
e. pinocytosis
167. The presence of calcification in the soft tissue of the upper arm following
severe blunt trauma is best described as:
a. metaplasia
b. hyperplasia
c. hypertrophy
d. dystrophy
e. dysplasia
b. venous occlusion
c. epididmoorchits
d. occlusion of the cremastric artery
e. thrombosis of the pampino form plexus
175. In intestinal obstruction with vomiting the most grave sequale is:
a. dehydration
b. hemo-concentration
c. hypokalemia
d. hyponatremia
e. hypocalcemia
c. pleural effusion
d. pancreatic necrosis
e. occurrence of a pseudo cyst
183. A 59old male is found to have a 3.5-cm mass in the right upper lobe of his
lung a biopsy of this mass is diagnosed as moderately differentiated squamous cell
carcinoma. Work up reveal no bone metastasis, but laboratory examination
revealed calcium level of 11.5 mg/dL, this patient paraneoplastic syndrome is
most likely the result of ectopic production of:
a. parathyroid hormone
b. parathyroid hormone related peptide
c. calcitonin
d. calcitonin related peptide
e. erythropiotin
186. Which one of the following is the most common congenital heart defect that
cause an initial left-to-right shunt:
a. tetraology of fallot
b. coarctation of the aorta
c. ventricular septal defect
d. atrial septal defect
e. patent ductusarteriosus
187. An elderly patient who was waiting for a thoracotomy became acutely short of
breath, hypotensive with elevated jugular venous pressure and muffled heart
sound. This triad of signs is most suggestive of:
a. chronic pericarditis
b. chronic pericardial effusion
c. cardiac tamponade
d. dissecting aortic aneurysm
e. right heart failure
188. Which one of the listed substances is secreted by malignant plasma cells in
individuals with multiple myeloma and is the osteoclast-activating factor (OAF)
that produces the characteristic lytic bone lesion?
a. interleukin 1
b. interleukin 6
c. tumor necrosis factor β
d. transforming growth factor β
e. platelet-derived growth factor
189. A 7-year-old boy accidentally inhales small peanut-which lodges in one of his
bronchi. A CXR showed mediastinal shifting towards the site of obstruction. The
best description for the lung changes that result from this obstruction is:
a. absorptive atelectasis
b. compression atelectasis
c. contraction atelectasis
d. patchy atelectasis
e. hyaline membrane disease
190. Histologic sections of lung tissue from an individual with adult respiratory
distress syndrome (ARDS) are most likely to reveal:
a. angioinvasive infiltrates of pleomorphic lymphoid cells
195. An 18-year-old woman presents with abdominal pain localized to the right
lower quadrant, nausea and vomiting, mild fever an elevation of the peripheral
leukocyte count to 17.000. examination of the surgically resected appendix is
most likely to reveal:
a. an appendix with a normal appearance
b. neutrophils within the muscular walled
c. lymphoid hyperplasia and multinucleated giant cells within the muscular
walled
196. A 44-year-old male presents with sudden of severe right upper quadrant
(RUQ), abdominal pain, temper hepatomegaly and hematemesis. These symptoms
are suggestive of Budd-Chiari syndrome, a disorder that is caused by:
a. obstruction of common bile duct
b. obstruction of intrahepatic sinusoids
c. thrombosis of hepatic artery
d. thrombosis of hepatic vein
e. thrombosis of portal vein
197. The combination of episodic elevation of serum transamenase level along with
fatty change in hepatocytes is most suggestive of infection with:
a. hepatitis A virus
b. hepatitis B virus
c. hepatitis C virus
d. hepatitis D virus
e. hepatitis E virus
198. Which one of the following tumors is most likely to be associated with
primary sclerosing cholangitis:
a. adenocarcinoma of gall bladder
b. adenocarcinoma of pancreas
c. cholangiocarcinoma
d. hepatoblastoma
e. hepatocellular carcinoma
a. metaphyseal region
b. diaphsysis
c. epiphysis
d. area around entrance of the nutrient artery
e. medullary cavity
202. Which one of the listed abnormalities is most likely to produce a spinal cord
lesion that destroys both bone and the disk space (cartilage):
a. metastatic carcinoma
b. multiple myeloma
c. non-Hodgkin's lymphoma
d. syringomyelia
e. tuberculosis
205. A young man who developed systemic fungal infection was advised to avoid
antifungal agents with renal toxicity because he has history of renal disease.
Which of the following drugs should be avoided?
a. 5-fluocytosine
b. Amphotericin B
c. Ketocorazole
d. Mycostatin
e. Vonconazole
c. Chlamydia trachomatis
d. Trichomorasvaginalis
e. Group B streptococci
211. Which of the following organisms can produces an exotoxin that causes
myocarditis and pseudomembrane at the throat?
a. Corynebacteriumdiphtheriae
b. Streptococcus pyogenes
c. Bordetelia pertussis
d. Salmonella typhi
e. b and c only
212. Which of the following organisms is associated with the clinical condition
called pseudomembranous enterocolitis following long abuse of antibiotics?
a. Staphylococcus aureus
b. Bacillus cereus
c. Clostridium difficile
d. Pseudomonas aerugenosa
e. Group B hemolytic streptococcui
213. Which of the following organisms is the most recovered in hospital acquired
infections?
a. E. coli
b. S. aureus
c. Streptococcus pneumoniae
d. Mycoplasma pneumonia
e. Pseudomonas aerugenosis
219. The most likely hazard for both health personnel and patients in a dialysis
unities:
a. malaria
b. syphilis
c. hepatitis B
d. typhoid fever
e. herpes virus
220. Soil contaminated wound will most likely change oxidation reduction
potential leading to growth of:
a. Escherichia coli
b. Clostridium spp
c. Staph aureus
d. Pseudomonas aeruginosa
e. Streptococcus faecalis
221. The most common virulence factor found in the gram-negative enteric
organisms is:
a. endotoxin
b. exotoxin
c. H-antigen
d. K-antigen
e. heavy capsule
223. Several organisms considered commensals are causing disease nowadays. This
is mainly due to:
a. misuse of antibiotics
b. increased poverty
c. increased incidence of diabetes
d. increased immunocompromised patients
e. development of new strains
224. The organism of which of the following diseases is unable to produce spores?
a. Gasgangrene
b. anthrax
c. diphtheria
d. pseudomembraneous
e. tetanus
228. A drug that causes a false increase of serum creatinine in Sudan is:
a. fansidar
b. flagyl
c. cephalexin
d. mycostatin
e. suramin
b. strawberry gallbladder
c. primary biliary cirrhosis
d. severe fatty change of liver
e. glycogen storage disease
235. The antibody molecule that is transferable through the placenta is:
a. IgG
b. IgA
c. IgM
d. IgD
e. IgE
237. The effector phase of the adaptive immune response is the phase when:
a. foreign antigen is first recognized
b. a clone of lymphocytes is expanded
c. expanded lymphocytes are differentiated
d. foreign antigen is eliminated by antibody
e. all above
238. HIV infects immune cells through which of the following cell-surface
molecules:
a. CD3
b. CD8
c. CD40
d. CD5
b. tuberculoid leprosy
c. lepromatous leprosy
d. SLE
e. acute poststreptococcal glomerulonephritis
244. IgM + IgD are simultaneously expressed as antigen receptors on the follwing
cell:
a. macrophage
b. T lymphocyte
c. B lymphocyte
d. plasma cell
e. epithelial cell
250. Several types of immunologic rejection reactions can occur following organ
transplantation. The rejection reaction that is caused by the presence of preformed
antibodies in the recipient is referred to as:
a. acute
b. hyper acute
c. chronic immediate
d. accelerated
251. prevention of and recovery from cancer may involve all of the following
EXCEPT:
a. natural killer (NK) cells
b. macrophages
c. cytotoxic T cells
d. suppressor T cells
e. tumor – specific antibody
252. Which of the following procedures gives the most sensitive measure of
antibody?
a. precipitation
b. agglutination
c. radial immunodiffusion
d. radioimmunoassay
e. immunoelectrophoresis
254. Regarding the p53 protein, one of the following statements is incorrect:
a. it is transcription factor
b. it is found only in cells that have undergone malignant transformation
c. it is a regulator of apoptosis
d. it suppresses cell division
e. a mutation of p53 in the primary defect in the Li Fraumeni syndrome
e. b & c only
262. H. pylori can survive in the gastric mucosa because of the following EXCEPT:
a. urease activity generates ammonia which neutralizes gastric acid
b. possessing flagella sustains motility of the organism
c. microaerophilic conditions of the mucus gel
d. curved and spiral shape of the organism
e. nature of the stomach chyme
264. Which of the following is best for preparing skin before surgery:
a. 80% alcohol
b. 5% chlorine (hypochlorite)
c. Tincture iodine
d. Iodophor
e. Hydrogen peroxide
274. The following are true about Blood which is to be used for transfusion except:
276. The healing of an incised wound is associated with the following EXCEPT:
a. a lag phase
b. a demolition phase
c. a proliferative phase
d. a contractile phase
e. B maturation phase
280. The following coagulation factors are generated in the liver except:
a. Factor II
b. Factor VII
c. Factor VI
d. Factor IX
e. Factor X
283. Gall stones are not associated with the following diseases:
a. contraceptive pills
b. cirrhosis of the liver
c. hereditary spherocytosis
d. obesity
e. raised serum triglycerides
287. The metabolic effects following a severe injury include the following except:
a. respiratory alkalosis
b. accelerated gluconeogenesis
c. mobilization of fat stores
d. decreased aldosterone secretion
e. protein catabolism
289. When using an autoclave to sterilize surgical drapes and instruments the
following are essential except:
a. the load should be tightly packed
b. the containers in which the loads are packed should be pervious to steam
c. air should be completely removed from the chamber prior to the admission of
steam
d. a vacuum must be made at the end of the cycle
e. an adequate indication of autoclave efficiency should be included in the load
294. The following are the chemical mediators involved in acute inflammation:
a. complement
b. histamine
c. prostaglandins
d. bradykinin
e. lymphokine
295. Antibodies may be detected in vitro by the following except:
a. Precipitation
b. complement fixation
c. ELISA
d. lymphocyte transitiontest
e. RIA(radio-immunoassay)
300. Necrosis dose not occurs as a concomitant feature of chronic inflammation in:
a. leprosy
b. tuberculosis
c. syphilis
d. actinomycosis
e. coccidiomycosis
305. General factors predisposing to wound infection do not include the following
except:
a. uncontrolled diabetes
b. hypogammaglobulinaemia
c. low platelet count
d. agranulocytopenia
e. eosinophilia
309. The findings of the following substances in excessive quantities in the blood
may be due to the presence of a specific type of tumor except:
a. Noradrenaline
b. 5-hydroxytryptemine
c. carcinoembryonic antigen
d. prostaglandins
e. calcium
311. Exfoliative cytology is useful for the diagnosis of in the following except:
a. CA uterus
b. broncnial cancer
c. multiple myeloma
d. cervical cancer
e. vesical cancer
315. The following infection is not associated with the development of cancer:
a. clostridial infections
b. HSV infection
c. EBV infection
d. HIV infection
e. schistosomiasis
317. Pure water depletion in the surgical patient does not follow:
a. reduced intake of water
b. dysphagia
c. severe diarrhea
d. persistent fever
e. the development of diabetes insipidus.
b. calcaneum
c. scaphoid
d. capitulum
e. femoral head
321. The part of an immunoglobulin molecule that passes biological functions but
no antibody function is:
a. CHI domain
b. CL domain
c. fab end
d. FC end
e. Both CHI and CL
323. Which of the following cells is primarily responsible for antigen processing
and presentation?
a. basophil
b. neutrophil
c. NK cell
d. eosinophil
e. macrophage
325. The MHC (HLA) class of molecules that is found on all nucleated cells of the
body and is necessary cytotoxic T cell function is class:
a. I
b. II
c. III
d. I & II
e. II & III
331. An adjuvant:
a. is an immunogen
b. is an activator of macrophages
c. may be a soluble complex of aluminum and calcium salts
d. enhances quick release of immunogen from site of injection
e. is formed of pure water
332. The following is not a property of an immunogen:
a. large size molecule
b. foreingerness
c. complex molecule e.g. protein
334. The basis for Mycobacterium tuberculosis virulence is largely due to:
a. Production of exotoxin
b. Presence of lipids in cell wall
c. Presence of wax in cell wall
d. Multiplication within macrophages
e. Presence of mycolic acid
340. In tetanus:
a. active immunity is produced by giving human antitoxin immunoglobulin
b. the disease caused by gram negative anaerobic bacilli
c. the longer the incubation period the better is the prognosis
d. benzyl penicillin is the drug of choice
e. the disease is caused by the endotoxin of colestridiumtetani
344. Actinomycosis
a. is a bacterial disease
b. causative agent is commensal in the mouth
c. pus contains sulphur granules composed of filaments
d. is a nosocomial infection
e. can be controlled by an effective vaccine
d. flucloxacillin
e. penicillin
348. The Epstein-Barr virus (EBV) has a proven positive association with the
following conditions:
a. carcinoma of the cervix
b. infectious mononucleosis
c. human T-cell lymphoma
d. Burkitt's lymphoma
e. undifferentiated nasopharyngeal carcinoma
349. Poliovirus
a. selectively attacks the motor neuron cells in the anterior horn of the spinal
cord
b. is most readily isolated from the feces of the infected subjects
c. occurs in the three different types
d. produces neurological signs in the majority of those infected
e. gains entry to the central nervous system across the blood-brain barrier
e. aspergillusfumigatus
354. Which of the following organisms causes a urinary tract infection resistant to
the majority of antibiotics:
a. Proteus mirabilis
b. Klebsiella spp.
c. Staphylococcus saprophyticus
d. Pseudomonas aeruginosa
e. Enterococcus faecalis
357. Urinary tract infection caused by Pseudomonas aeruginosa is best treated with.
a. Cloxacillin
b. Vancomycin
c. Kanamycin
d. Piperacillin
e. Gentamicin
362. A 65 year old man suffered a massive myocardial infarction that was
complicated by shock and prolonged hypotension. On arrival in the emergency
department he was found to have focal neurological signs in addition to features
consistent with low-output cardiac failure. Despite the best efforts of the medical
team he died the next day. At autopsy the most likely change you would expect to
see in a brain would be:
a. Acute hemorrhagic change
b. Coagulative necrosis
c. Granulomatous change
d. Lacunar infarct
e. Liquefactive necrosis
363. A skin biopsy from an anorexic 16 year old girl showed cellular atrophy.
During atrophy:
a. The cell disappears
b. Cellular organelles swell
c. Cell size decreases
d. Cell size increases
e. Protein synthesis increases
364. A 35 year old man is a habitual smokerIf a biopsy is taken from the respiratory
tract in this man. the epithelium of respiratory tract is most likely to show:
a. Mucous hyperplasia
b. Smooth muscle hyperplasia
c. Squamous cell anaplasia
d. Squamous cell hypertrophy
e. Stratified squamous metaplasia
365. Apoptotic cells usually exhibit distinctive morphological features. Which one
of the following morphological features is usually seen in pure apoptosis ?
a. Cellular swelling
b. Chromatin condensation
c. Early disruption of the plasma membrane
d. Nuclear stabilization
e. Phagocytosis of apoptotic bones by neutrophils
366. A healthy 26 year old man fractured his right tibia In a road traffic accident.
His right leg was stabilized in a plaster cast. The cast was removed from his leg
after 8 weeks of immobilization. Which of the following changes is most likely to
have taken place in his gastrocnemius muscle after this time?
a. Decrease in the number of muscle fibers
b. Decrease in the number of nerve fibers
c. Increase in the number of fast fibers
d. Increase in the mitochondrial content
e. Increase in the number of satellite cells
367. A 73-years old woman with long-standing hypertension and aortic stenosis
died suddenly one morning . An autopsy was performed on her body. At autopsy
her heart weighed 540 g. The size of her heart is most likely to be the result of
which of the following processes involving the myocardial fibers?
a. Fatty degeneration
b. Fatty infiltration
c. Hyperplasia
d. Hypertrophy
e. Edema
368. Metaplasia is reversible change in which one adult cell type (epithelial or
mesenchymal) is replaced by another adult cell type. In which of the following
situations is the process of epithelial metaplasia most likely to have occurred?
a. Acute myocardial infarction
b. Lactation following pregnancy
c. Tanning of the skin following sunlight exposure
d. Urinary obstruction due to an enlarged prostate
e. Vitamin A deficiency
369. A 55 year old woman with chronic atrial fibrillation suddenly developed an
acute abdomen and was rushed to the emergency department at emergency
laparoscopy most of the small bowel loops were dusky to purple red in color. Her
mesenteric veins were patent the most probable underlying pathological process
is:
a. Coagulative necrosis
b. Dry gangrene
c. Gas gangrene
d. Liquefactive gangrene
e. Wet gangrene
371. Which of the following cells is an example of a permanent cell, on the basis of
classification according to regenerative ability?
a. Acinar cell of the pancreas
b. Colonic mucosal cell
c. Erythrocyte
d. Hepatocyte
e. Osteocyte
373. You are looking at a histopathology slide that shows changes associated with
cell injury which of the following cell changes associated with injury is most
likely to be accompanied by disruption of the cell membrane?
a. Apoptosis
b. Cloudy swelling
c. Coagulative necrosis
d. Hydropic change
e. Pyknosis
d. Macrophages
e. Neutrophils
375. A lump was excised and sent for histo-pathological examination. The histo-
pathologist reported seeing what appeared to bean abnormal amount and
arrangement of normal tissue than is appropriate or normal for the area in which
the tissue arises. This is best described as:
a. Carcinosarcoma
b. Embryonal tumor
c. Hamartoma
d. Mixed tumor
e. Teratoma
377. Which of the following terms best describes the passage of leukocytes through
the blood vessel wall?
a. Diapedesis.
b. Euperiporesis
c. Migration
d. Phagocytosis
e. Pavement
378. A 16 year old boy with a 1 day history of sore throat was seen by his GP. On
physical examination the most prominent finding was a pharyngeal purulent
exudates. Which of the following types of inflammation does this boy have?
a. Acute inflammation
b. Abscess formation
c. Chronic inflammation
d. Granulomatous inflammation
e. Resolution of inflammation
d. Mast cell
e. Platelet
383. Which of the following terms best describes the unidirectional migration of
leucocytes towards a target?
a. Chemotaxis
b. Diapedesis
c. Endocytosis
d. Margination
e. Meiosis
384. What is the origin of the cells of the mononuclear phagocyte system?
a. Bone marrow
b. Liver
c. Lymph nodes
d. Thymus
e. Spleen
386. A 26-year-old woman with blood group type A Rh-negative is pregnant with
her second child. Her first child is Rh- positive and the father is also Rh- positive.
The second child most likely to be at risk of developing:
a. An autoimmne disease
b. ABO incompatibility
c. Drug-induced hemolytic anemia
d. Neutropenia
e. Hemolytic disease of the newborn
387. A 25-year-old man with persistent low-grade fever and cough had a blood
smear which showed a marked increase in the number of cells with a large bi-
lobed nucleus which of the following cell types was seen in the smear?
a. Basophils
b. Eosinophils
c. Lymphocytes
d. Monocytes
e. Neutrophils
388. Which of the following white blood cells will be the predominant cell type
seen under the microscope if a blood smear Is made from a normal healthy
individual?
a. Basophils
b. Eosinaphils
c. Lymphocytes
d. Monocytes
e. Neutrophils
390. Arachidonic acid is one of the essential fatty acids required by most mammals.
It isessential for the synthesis of which of the following mediators of
Inflammation ?
a. Bradykinin
b. Interferon gamma
c. Interleukin-l
d. Prostaglandins
e. Tumor necrosis factor
391. Which one of the following is a primary function of the Kupffer cells in the
liver?
a. Protein synthesis
b. Recycling of old red blood cells
c. Secretion of mucus
d. Storage of fat-soluble vitamins
392. A healthy 45-year-old woman has a routine health checkShe has no chest pain
cough or fever A chest X-ray is taken however which shows a peripheral coin
lesion 2.5cm in diameter in the right mid-lung field which of the following
biological characteristics would best distinguish this lesion as a neoplasm rather
than a granuloma?
a. Necrosis
b. Rapid increase in size
c. Recurrence following excision
d. Sensitivity to radiation or chemotherapy
e. Uncontrolled (autonomous) growth
393. A 76 year old man with back painwas diagnosed with metastatic prostatic
carcinoma involving the lumbar spine. High serum levels of which of the
following tumor markers will aid the diagnosis of prostatic carcinoma?
a. Acid phosphatase
b. Alkaline phosphatase
c. Alpa-fetoprotien
d. CEA
e. PSA
396. Which of the following features is taken into account when staging a cancer?
a. Basophilia
b. Local invasion
c. nuclear/ cytoplasmic ratio
d. Number of mitotic figures
e. Pleomorphism
397. A 60 year old woman with suspected carcinoma cervix is seen by the
gynaecologist. The most reliable and easy method to confirm the diagnosis is:
a. Blood culture
b. Colposcopy
c. Laparotomy
d. Pap smear
e. Ultrasound
398. Which of the following Is the most common primary malignant tumor of the
thyroid ?
a. Anaplastic carcinoma
b. Follicular carcinoma
c. Large-cell carcinoma
d. Medullary carcinoma
e. Papillary carcinoma
400. In which of the following sites is a tumor morelikely to occur in adults than in
children?
a. Bone
b. Central nervous system
c. Kidney
d. Lung
e. Soft t issue
401. Which of the following sites in newborns most commonly gives rise to tumors
derived from all three germ-cell layers?
a. Central nervous system
b. Mediastinum
c. Ovaries
d. Sacrococcygeal area
e. Testis
402. Which of the following is the most common predisposing factor for
adenocarcinoma of the esophagus?
a. Exposure to nitrosamines
b. Gastro-esophageal reflux disease
c. Human papilloma virus infection
d. Smoking
e. Tylosispalmaris
403. Which of the following structures is found in Gram negative bacteria but not
in Gram-positive bacteria?
a. Capsule
b. Cell wall
c. Cytoplasmic membrane
d. Endospore
e. Outer membrane
404. A 21 year old woman who had been feeling unwell since returning from a
holiday trip to India, presented to the emergency department on day 16 after the
onset of fever. She had a positive Widel test. The most likely organism
responsible for the fever is:
a. Bacteroidesfragilis
b. Escherichia coli
c. Klebsiellaspecies
d. Mycobacterium tuberculosis
e. Salmonella typhi
408. A 6 year old child is brought to the emergency department by his parents
complaining of earache. On examination, there is greenish pus discharging from
his right ear. Which of the following organisms ismost likely to be responsible for
this child's ear infection?
a. Klebsiellaspecies
b. Pseudomonas aeruginosa
c. Staphylococcus aureus
d. Streptococcus pyogenes
e. Streprococcuspneumoniae
e. Staphylococcus aureus
410. A 22 year old medical student presented In the emergency department with
sore throat and lymphadenopathy. Her peripheral smear shows atypical
lymphocytes. What is the most probable infectious cause for this patient' s clinical
presentation?
a. Cytomegalovirus
b. Epstein- Barr virus
c. Herpes Simplex virus
d. HIV
e. Mycobacterium tuberculosis
411. Demineralized bone matrix, which is a clinically useful bone graft substitute
or enhancer, exerts its effectiveness by what mechanism:
a. Cytokine activity
b. Creation of hyperosmotic environment
c. Calcium stimulation of stem cells
d. Structural mechanical support
e. Exogenous recombinant bone morphogenetic protein activity
413. The most documented association between cancer & virus is in the case of:
a. Human immunodeficiency virus
b. Human papilloma virus
c. Pox virus
d. Herpes simplex virus
e. Vericella virus
415. One of the following not associated with malignant transformation of cells:
a. Asbestos filters
b. Chronic malaria
c. Nitrosamines
d. U.V light
e. Human papilloma virus
b. Gravid uterus
c. Cardiac muscle hypertension
d. Proliferative endometrium following menstruation
e. Endemic goiter
419. A visualization by the electron microscope, the structure most likely not to be
a cytoplasmic organelle is (are):
a. Lysosome
b. Golgi complex
c. Desmosomes
d. Endoplasmic reticulum
e. Microbodies
423. The primary mechanism by which aspirin its effectiveness is direct inhibition
of:
a. Cyclooxygenase
b. Lipoxygenase
c. Phospholipase
d. Leukotrines
e. Thromboxane A2
428. Which one of the following clinical signs is most important of severe
dehydration:
a. Tachycardia
b. Decreased voiding
c. Thirst
d. Reduced skin turgor
e. Dry Axillary fold
c. Prostaglandin
d. Cyclic AMP
e. ACTH
432. Which are of the following of vascular endothelial changes that allow
increased fluid permeability:
a. Cytoplasm transcytosis of the fluid
b. Gaps in basement membrane
c. Increase number of phagolysomes
d. Endothelial gaps due to endothelial cell contraction
e. Fluid escapes without morphological changes
d. Bacteria
e. Rickettsia
436. A 60 years old hypertensive male presented with a pulsating abdominal mass.
A CTscan revealed an abdominal aneurysm. The most likely cause is:
a. High blood pressure on arterial wall
b. Old syphilis
c. Atherosclerosis
d. Endarteritis oblitertans of vasa vasorum
e. Chlamydia infection
437. After 2 weeks in hospital following a facture of her Lt. femur a 76 years old
woman now has Lt. leg swollen below the knee. There is pain on movement of the
leg. Which of the following complications is most likely to occur after these
events:
a. Gangrenous necrosis of the foot
b. Hematoma
c. DIC
d. Pulmonary thrombo-embolism
e. Soft tissue sarcoma
438. Which of the following infectious agents induce the transformation tissue
macrophages to epitheloid cells:
a. Mycobacterium leprae
b. Pseudomonas aerouginosa
c. Cytomegalovirus
d. Giardia lamblia
e. Treponemapallidum
441. A 43 years old male complained of mild burning epigastric pain following
meals for 3 years. Endoscopy & biopsy from the lower esophagus was done which
showed presence of columnar epithelium with goblet cells. Which one of the
following mucosal alteration is represendted by these findings:
a. Dysplasia
b. Hyperplasia
c. Carcinoma
d. Ischemia
e. Metaplasia
442. Generation of which of the following substances within the cells is most likely
to reduce the number of free radicals:
a. Glutathione peroxidase
b. Caspase
c. Hydrogen peroxide
d. NADPH oxidase
e. Meyloperoxidase
443. Which of the following cellular changes represent irreversible cellular injury:
a. Dysplasia
b. Fatty changes
c. Nuclear pyknosis
d. Atrophy
e. Anaerobic glycolysis
445. A 40 years old woman has a sudden onset of severe abdominal pain. Physical
examination & investigations showed acute pancreatitis with increased serum
lipase. Which of following cellular changes is most likely to accompany these
findings:
a. Coagulative necrosis
b. Dry gangrene
c. Fat necrosis
d. Apoptosis
e. Liquifactive necrosis
d. Colonic adenocarcinoam
e. Ovarian teratoma
449. Dysplasia:
a. Is irreversible
b. Occurs in ulcerative colitis
c. May progress into metaplasia
d. Is associated with invasion of basement membrane
e. Is usually seen in the uterine endo-cervix
452. The following tumor rarely metastasized but locally very destructive:
a. Sequamous cell carcinoma of the bladder
b. Basal cell carcinoma
c. Carcinoid tumor in the stomach
d. Glioblastoma
e. Hemangioma
453. Apoptosis:
a. Require energy
b. Occurs in helicobacter pylori infection
c. Is a cause of inflammation
d. Is reversible
e. Is monogenic
b. Hyperkalemia
c. Hypernatremia
d. Hypoglycemia
e. Decrease level of fatty acids in the plasma
457. A CSF profile that consist of elevated PMNL, depressed glucose & elevated
protein suggests:
a. Brain abscess
b. Encephalitis
c. Fungal meningitis
d. Viral meningitis
e. Untreated bacterial meningitis
458. The pathological specimen where Aspergillus heads can be seen directly in:
a. Sputum
b. Ear swab
c. Biopsy
d. CSF
e. Nail clipping
460. Which one of the following organisms can resist intracellular killing by
phagocytes:
a. Mycobacterium tuberculosis
b. Streptococcus pneumoniae
c. Haemophilusinflauenzae
d. Staphylococcus saprophyticus
e. Campylobacter jejunei
461. When cultured on chocolate blood agar under appropriate conditions colonies
of helicobacter pylori appear after:
a. 1-2 days
b. 2-3 days
c. 4-6 days
d. 7 days
e. 8 days
464. Maximum duration to keep peripheral lines to prevent blood stream infection
is:
a. 24 hours
b. 48 hours
c. 72 hours
d. 7 days
e. 10 days
CHAPTER 5
174 Question
PRETEST
PHARMACOLOGY
a. Intravenous
b. Inhalational
c. Oral
d. Sublingual (SL)
e. Intramuscular
2. The pharmacokinetic value that most reliably reflects the amount of drug
reaching the target tissue after oral administration is the
a. Biliary tract
b. Kidneys
c. Lungs
d. Feces
e. Milk
a. Sulfoxide formation
b. Nitro reduction
c. Ester hydrolysis
d. Sulfate conjugation
e. Deamination
7. A 19-year-old male being treated for leukemia develops fever. You give agents
that will cover bacterial, viral, and fungal infections. Two days later, he develops
acute renal failure. Which drug was most likely responsible?
a. Vancomycin
b. Ceftazidime
c. Amphotericin B
d. Acyclovir
a. Ketoconazole
b. Amphotericin B
c. Fluconazole
d. Nystatin
a. Isoniazid
b. Rifampin
c. Pyrazinamide
d. Ethambutol
e. Vitamin B 6
13. A patient with AIDS is treated with a combination of agents, which includes
zidovudine. What is the mechanism of action of zidovudine?
15. A 30-year-old male with a two-year history of chronic renal failure requiring
dialysis consents to transplantation. A donor kidney becomes available. He is
given cyclosporine to prevent transplant rejection just before surgery. What is
the most likely adverse effect of this drug?
17. Ampicillin and amoxicillin are in the same group of penicillins. Which of the
following statements best characterizes amoxicillin?
18. A 60-year-old male with AIDS develops a systemic fungal infection that is
treated with fluconazole. What is the mechanism of action of fluconazole?
21. A 36-year-old female with a chronic UTI treated with ciprofloxacin is not
responsive to the antibiotic. Which of the following agents that she might have
been taking for other reasons would decrease the effectiveness of ciprofloxacin?
a. An antacid
b. An antihistamine
c. A nonsteroidal anti-inflammatory
d. An anxiolytic
e. A multivitamin not containing iron
22. A 20-year-old male with herpes simplex of the lips is treated with famciclovir.
What is the mechanism of action of famciclovir?
a. Cross-linking of DNA
b. Strand breakage of DNA
c. Inhibition of viral DNA synthesis
d. Inhibition of nucleotide interconversions
e. Inhibition of a viral kinase
a. INH
b. Streptomycin
c. Rifampin
d. Pyrizinamide
e. Ethambutol
a. Azathioprine
b. Cyclosporine
c. 5-fluorouracil (5-FU)
d. Cyclophosphamide
e. Vincristine
25. The phase of the cell cycle that is resistant to most chemotherapeutic agents
and requires increased dosage to obtain a response is the
a. M phase
b. G 2 phase
c. S phase
d. G 0 phase
e. G 1 phase
a. Cyclophosphamide
b. 5-FU
c. Methotrexate
d. Prednisone
e. Thioguanine
a. Thioguanine
b. Busulfan
c. Bleomycin
d. Vincristine
e. Tamoxifen
a. Cyclophosphamide
b. Methotrexate
c. Tamoxifen
d. 5-FU
e. Doxorubicin
a. N-acetyl- L -cysteine
b. Vitamin K
c. Penicillamine
d. Leucovorin
e. Deferoxamine
30. Cardiotoxicity limits the clinical usefulness of which one of the following
antitumor antibiotics?
a. Dactinomycin
b. Doxorubicin
c. Bleomycin
d. Plicamycin
e. Mitomycin
31. Binding to the enzyme dihydrofolate reductase is the mechanism of action for
a. Procarbazine
b. Paclitaxel
c. Methotrexate
d. Ifosfamide
e. Cladribine
33. The tumor that is least susceptible to cell-cycle-specific (CCS) anti- cancer
agents is
34. A 32-year-old cancer patient, who has smoked two packs of cigarettes a day
for 10 years, presents a decreased pulmonary function test. Physical examination
and chest x-rays suggest preexisting pulmonary disease. Of the following drugs,
which is best not prescribed?
a. Vinblastine
b. Doxorubicin
c. Mithramycin
d. Bleomycin
e. Cisplatin
a. Mercaptopurine (6-MP)
b. 5-FU
c. Bleomycin
d. Busulfan
e. Vincristine
a. Interferon α
b. Aldesleukin
c. Muromonab-CD3
d. Sargramostim
e. Filgrastim
37. A 50-year-old female with rheumatoid arthritis has developed erosions in her
wrist bones. Which of the following agents should be administered?
a. Allopurinol
b. Asparaginase
c. Methotrexate
d. Streptozocin
e. 6-MP
f. Azathioprine
g. Pentostatin
h. Leucovorin
i. Bacille Calmette-Guérin (BCG) vaccine
a. Allopurinol
b. Asparaginase
c. Methotrexate
d. Streptozocin
e. 6-MP
f. Azathioprine
g. Pentostatin
h. Leucovorin
i. BCG vaccine
39. A 34-year-old male with Hodgkin’s disease is treated with the adriamycin,
bleomycin, vinblastine, and decarbazine (ABVD) regimen. What is the
mechanism of action of vinblastine?
40. A 60-year-old male with hematuria is found to have a small localized tumor
of the bladder that is diagnosed as a carcinoma. Which of the following agents
should be given intravesicularly?
a. Allopurinol
b. Asparaginase
c. Methotrexate
d. Streptozocin
e. 6-MP
f. Azathioprine
g. Pentostatin
h. Leucovorin
i. BCG vaccine
41. A 45-year-old female has a bone marrow transplant for treatment of ovarian
cancer. Cyclosporine is given as an immunosuppressant. What is the mechanism
of action of cyclosporine?
42. A young adult patient with acute granulocytic leukemia, treated with a
combination of cytarabine and thioguanine, is no longer responsive to the
therapy. The nonresponsiveness of the patient is thought to be due to
thioguanine. What is the mechanism of resistance to thioguanine?
a. Decreased uptake
b. Increased efflux
c. Increased alkaline phosphatase activity
d. Increased production of trapping agents
e. Increased DNA repair
43. A 45-year-old male has an insulinoma. Which of the following agents is the
treatment of choice?
a. Cyclophosphamide
b. Carboplatin
c. Vincristine
d. Streptozocin
e. Bleomycin
a. An alkylating agent
b. An antimetabolite
c. A plant alkaloid
d. An antibiotic
e. A hormonal agent
45. A 41-year-old female is treated for endometrial cancer with tamoxifen. Of the
following, how is tamoxifen classified?
a. An alkylating agent
b. An antimetabolite
c. A plant alkaloid
d. An antibiotic
e. A hormonal agent
46. A 35-year-old female is being treated for cervical cancer with cisplatin. Of
the following, how is cisplatin classified?
a. An alkylating agent
b. An antimetabolite
c. A plant alkaloid
d. An antibiotic
e. A hormonal agent
47. A 16-year-old male treated for acute lymphocytic leukemia develops severe
lumbar and abdominal pain. His serum amylase is markedly elevated. Which of
the following agents most likely caused these findings?
a. 6-MP
b. Asparaginase
c. Doxorubicin
d. Methotrexate
e. Vincristine
48. A 60-year-old female treated for breast cancer develops leucopenia and
severe stomatitis and oral ulcerations. Which of the following agents most likely
caused these findings?
a. 5-FU
b. Paclitaxel
c. Cyclophosphamide
d. Tamoxifen
e. Carboplatin
a. 6-MP
b. Methotrexate
c. Cyclophosphamide
d. Doxorubicin
e. Carmustine
50. A 45-year-old female treated for ovarian cancer develops difficulty hearing.
Which of the following agents most likely caused these findings?
a. Paclitaxel
b. Doxorubicin
c. Bleomycin
d. 5-FU
e. Cisplatin
51. Of the many types of adrenergic receptors found throughout the body, which
is most likely responsible for the cardiac stimulation that is observed following
an intravenous injection of epinephrine?
a. α 1 -adrenergic receptors
b. α 2 -adrenergic receptors
c. β 1 -adrenergic receptors
d. β 2 -adrenergic receptors
e. β 3 -adrenergic receptors
a. Timolol
b. Nadolol
c. Pindolol
d. Acebutolol
e. Labetalol
a. Tacrine
b. Edrophonium
c. Neostigmine
d. Pyridostigmine
e. Ambenonium
a. Diazoxide
b. Isofluorphate
c. Tubocurarine
d. Nicotine
e. Pilocarpine
a. Parkinson’s disease
b. Bronchial asthma
c. Depression
d. Hypertension
e. Premature labor
56. The skeletal muscle relaxant that acts directly on the contractile mechanism
of the muscle fibers is
a. Gallamine
b. Baclofen
c. Pancuronium
d. Cyclobenzaprine
e. Dantrolene
a. Hypertension
b. Cardiac arrhythmia
c. Asthmatic attacks
d. Respiratory depression
e. Hypersensitivity
58. All of the following drugs are used topically in the treatment of chronic wide-
angle glaucoma. Which of these agents reduces intraocular pressure by
decreasing the formation of the aqueous humor?
a. Timolol
b. Echothiophate
c. Pilocarpine
d. Isofluorphate
e. Physostigmine
59. The cholinomimetic drug that is useful for treating postoperative abdominal
distention and gastric atony is
a. Acetylcholine (ACh)
b. Methacholine
c. Carbachol
d. Bethanechol
e. Pilocarpine
a. Pancuronium
b. Succinylcholine
c. Diazepam
d. Baclofen
e. Nicotine
a. Dicyclomine hydrochloride
b. Cyclopentolate hydrochloride
c. Ipratropium bromide
d. Methscopolamine bromide
e. Trihexyphenidyl hydrochloride
a. Edrophonium chloride
b. Ambenonium chloride
c. Malathion
d. Physostigmine salicylate
e. Pyridostigmine bromide
65. The skeletal muscles that are most sensitive to the action of tubocurarine
are the
a. Epinephrine
b. NE
c. Isoproterenol
d. Diphenhydramine
e. Atropine
68. A 60-year-old male with congestive heart failure (CHF) is treated with
dobutamine. Select the mechanism of action of dobutamine.
a. α-adrenergic agonist
b. α-adrenergic antagonist
c. β-adrenergic agonist
d. β-adrenergic antagonist
e. Mixed α and β agonist
f. Mixed α and β antagonist
69. A 58-year-old male with angina is treated with atenolol. Select the mechanism
of action of atenolol.
a. α-adrenergic agonist
b. α-adrenergic antagonist
c. β-adrenergic agonist
d. β-adrenergic antagonist
e. Mixed α and β agonist
f. Mixed α and β antagonist
70. A 75-year-old female with CHF is treated with carvedilol. Select the
mechanism of action of carvedilol.
a. α-adrenergic agonist
b. α-adrenergic antagonist
c. β-adrenergic agonist
d. β-adrenergic antagonist
a. α-adrenergic agonist
b. α-adrenergic antagonist
c. β-adrenergic agonist
d. β-adrenergic antagonist
e. Mixed α and β agonist
f. Mixed α and β antagonist
a. Metoprolol
b. Dopamine
c. Isoproterenol
d. Epinephrine
e. Albuterol
a. Propranolol
b. Methylphenidate
c. Prazosin
d. Guanethidine
e. Atropine
74. Of the following structures, which does not respond to β-adrenergic receptor
stimulation?
75. A 16-year-old male treated for bronchial asthma develops skeletal muscle
tremors. Which of the following agents may be responsible for this finding?
a. Ipratropium
b. Zileuton
c. Beclomethasone
d. Cromolyn
e. Salmeterol
76. Of the following, which will not be blocked by atropine and scopolamine?
a. Bradycardia
b. Salivary secretion
c. Bronchoconstriction
d. Skeletal muscle contraction
e. Miosis
77. Which of the following agents should a patient take for a stuffy, runny nose?
a. Oxymetazoline
b. Albuterol
c. Clonidine
d. Terbutaline
e. Metoprolol
78. A 65-year-old male has a blood pressure of 170/105 mmHg. Which of the
following would be effective in lowering this patient’s blood pressure?
a. Methylphenidate
b. Terbutaline
c. Dobutamine
d. Pancuronium
e. Prazosin
f. Scopalamine
a. Methylphenidate
b. Terbutaline
c. Dobutamine
d. Pancuronium
e. Prazosin
f. Scopalamine
81. Which of the following agents might mask the hypoglycemia in treated
diabetics?
a. An α-adrenergic agonist
b. An α-adrenergic antagonist
c. A β-adrenergic agonist
d. A β-adrenergic antagonist
e. A cholinergic agonist
f. A cholinergic antagonist
85. In a patient who has had attacks of paroxysmal atrial tachycardia, an ideal
prophylactic drug is
a. Adenosine
b. Procainamide
c. Lidocaine
d. Nifedipine
e. Verapamil
87. A 59-year-old female with mild CHF is treated with furosemide. What is its
primary mechanism of action?
88. A positive Coombs’ test and hemolytic anemia may follow the administration
of which antihypertensive drug?
a. Methyldopa
b. Clonidine
c. Guanabenz
d. Prazosin
e. Captopril
89. Which of the following is an antiarrhythmic agent that has relatively few
electrophysiologic effects on normal myocardial tissue but suppresses the
arrhythmogenic tendencies of ischemic myocardial tissues?
a. Propranolol
b. Procainamide
c. Quinidine
d. Lidocaine
e. Disopyramide
90. A 59-year-old male with a history of rheumatic heart disease is found to have
atrial fibrillation (AF), for which he is treated with digoxin. Treatment with
digoxin converts his AF to a normal sinus rhythm and most likely results in a
decrease in which of the following?
91. A 65-year-old female receives digoxin and furosemide for CHF . After several
months, she develops nausea and vomiting. Serum K + is 2.5 mEq/L.
Electrocardiogram (EKG) reveals an AV conduction defect. What cellular effect
is causing these new findings?
a. Increased intracellular K +
b. Increased intracellular cyclic guanosine 5′-monophosphate (cGMP)
c. Increased intracellular Ca 2+
d. Increased intracellular norepinephrine
92. Which of the following drugs recommended for the lowering of blood
cholesterol inhibits the synthesis of cholesterol by blocking 3-hydroxy-3-
methylglutaryl–coenzyme A (HMG-CoA) reductase?
a. Lovastatin
b. Probucol
c. Clofibrate
d. Gemfibrozil
e. Nicotinic acid (NA)
93. The EKG of a patient who is receiving digitalis in the therapeutic dose range
would be likely to show
a. The combination will not lower cholesterol more than either agent alone
b. The combination causes elevated very-low-density lipoprotein (VLDL)
c. Cholestyramine inhibits gastrointestinal (GI) absorption of simvastatin
d. Simvastatin is a direct antagonist of cholestyramine
95. In a hypertensive patient who is taking insulin to treat diabetes, which of the
following drugs is to be used with extra caution and advice to
the patient?
a. Hydralazine
b. Prazosin
c. Guanethidine
d. Propranolol
e. Methyldopa
a. Propranolol
b. Nitroglycerin
c. Sodium nitroprusside
d. Nifedipine
e. Isosorbide dinitrate
97. A 47-year-old male is seen in the medicine clinic with recently diagnosed
mixed hyperlipidemia. An antihyperlipidemic is administered that favorably
affects levels of VLDL, low-density lipoprotein (LDL), and high- density
lipoprotein (HDL) and inhibits cholesterol synthesis. This drug is:
a. Lovastatin
b. Colestipol
c. Niacin
d. Probucol
e. Neomycin
992. Drugs that block the catecholamine uptake process (e.g., cocaine, tri- cyclic
antidepressants, and phenothiazines) are apt to block the antihypertensive action
of which of the following drugs?
a. Propranolol
b. Guanethidine
c. Prazosin
d. Hydralazine
e. Diazoxide
a. Neomycin
b. Lovastatin
c. Cholestyramine
d. Gemfibrozil
101 A 64-year-old male with arteriosclerotic heart disease (AHD) and CHF who
has been treated with digoxin complains of nausea, vomiting, and diarrhea. His
EKG reveals a bigeminal rhythm. The symptoms and EKG findings occurred
shortly after another therapeutic agent was added to his regimen. A drug-drug
interaction is suspected. Which agent was involved?
a. Lovastatin
b. Hydrochlorothiazide
c. Phenobarbital
d. Nitroglycerin
e. Captopril
a. Release of histamine
b. Production of local prostaglandins
c. Release of platelet-derived growth factor (PDGF)
d. Production of NO
e. Ca channel blockade
a. Type I
b. Type IIa, IIb
c. Type III
d. Type IV
e. Type V
a. Propranolol
b. Captopril
c. Verapamil
d. Dobutamine
e. Nitroglycerin
105. Angiotensin converting enzyme (ACE) inhibitors are associated with a high
incidence of which of the following adverse reactions?
a. Hepatitis
b. Hypokalemia
c. Agranulocytosis
d. Proteinuria
e. Hirsutism
a. Aminocaproic acid
b. Dipyridamole
c. Factor IX
d. Protamine
e. Vitamin K
107 Patients with genetically low levels of N-acetyltransferase are more prone to
develop a lupus erythematosus–like syndrome with which of the following
drugs?
a. Propranolol
b. Procainamide
c. Digoxin
d. Captopril
e. Lidocaine
a. K+
b. Ca 2+
c. Phenytoin
d. Fab fragments of digoxin antibodies
e. Magnesium (Mg 2+ )
a. Hydralazine
b. Minoxidil
c. Diazoxide
d. Sodium nitroprusside
e. Nifedipine
a. Adenosine
b. Digoxin
c. Propranolol
d. Phenylephrine
e. Edrophonium
116. A 42-year-old male with an acute MI is treated with alteplase. What is the
mechanism of action of alteplase?
a. Atenolol
b. Transdermal nitroglycerin
c. Amlodipine
d. Amyl nitrite
a. α-adrenergic activity
b. Phosphodiesterase activity
c. Phosphorylation of light chains of myosin
d. Norepinephrine release
e. cGMP
a. K+
b. Cl −
c. Ca 2+
d. Na +
e. Mg 2+
122. A 47-year-old female comes to the emergency department (ED) with severe
crushing chest pain of one hour’s duration. Electrocardiogram and blood
chemistries are consistent with a diagnosis of acute MI. Streptokinase is chosen
as part of the therapeutic regimen. What is its mechanism of action?
123. Of the following agents, which is best avoided in a patient with a history of
chronic congestive heart failure (CHF)?
a. Hydrochlorothiazide
b. Amiloride
c. Mannitol
d. Ethacrynic acid
e. Spironolactone
a. Collecting duct
b. Ascending limb of the loop of Henle
c. Descending limb of the loop of Henle
d. Proximal tubule
e. Distal convoluted tubule
125. Of the following agents, which is best avoided when a patient is being
treated with an aminoglycoside?
a. Metolazone
b. Triamterene
c. Furosemide
d. Spironolactone
e. Acetazolamide
a. Acetazolamide
b. Chlorothiazide
c. Ethacrynic acid
d. Chlorthalidone
e. Spironolactone
127 A reduction in insulin release from the pancreas may be caused by which of
the following diuretics?
a. Triamterene
b. Chlorothiazide
c. Spironolactone
d. Acetazolamide
e. Amiloride
a. Guanethidine
b. Acetazolamide
c. Chlorothiazide
d. Ethanol
e. Indomethacin
130. Conservation of K ions in the body occurs with which of the following
diuretics?
a. Furosemide
b. Hydrochlorothiazide
c. Triamterene
d. Metolazone
e. Bumetanide
132. Which of the following diuretics could be added to the therapeutic regimen
of a patient who is receiving a direct vasodilator for the treatment of
hypertension?
a. Acetazolamide
b. Triamterene
c. Spironolactone
d. Mannitol
e. Hydrochlorothiazide
133. A patient develops acute gout following treatment with which of the
following?
a. Acetazolamide
b. Allopurinol
c. Triamterene
d. Spironolactone
e. Furosemide
124. A patient with nephrogenic diabetes insipidus is best treated with which of
the following?
a. Hydrochlorothiazide
b. Triamterene
c. Furosemide
d. Spironolactone
e. Acetazolamide
135. Which of the following is unlikely to cause a drug-drug interaction with the
thiazides?
a. Adrenal corticosteroids
b. Anticoagulants (oral)
c. Aminoglycosides
d. Uricosuric agents
e. Insulin
136. Of the following diuretic agents, which would be least likely to indirectly
cause an increased binding of digoxin to cardiac tissue sodium– potassium–
adenosine triphosphatase (Na + ,K + ,ATPase)?
a. Hydrochlorothiazide
b. Furosemide
c. Amiloride
d. Acetazolamide
e. Metolazone
a. Hydrochlorothiazide
b. Triamterene
c. Spironolactone
d. Acetazolamide
e. Amiloride
139. Of the following, which adverse reaction is not associated with furosemide?
a. Hyperglycemia
b. Tinnitus
c. Fluid and electrolyte imbalance
d. Hypotension
e. Metabolic acidosis
140. A 35-year-old male has renal stones and increased calcium (Ca) in the urine
that is associated with normal serum Ca and parathyroid hormone levels. Which
of the following agents could be used to treat this patient?
a. Furosemide
b. Acetazolamide
c. Triamterene
d. Hydrochlorothiazide
e. Vasopressin
BRS PHARMACOLOGY
(A) Potency
(B) Intrinsic activity
(C) Therapeutic index
(D) Efficacy
(E) Bioavailability
6 . Which of the following is the term used to describe the elimination rate via
metabolism catalyzed by alcohol dehydrogenase when the enzyme is saturated?
7 . A 69-year-old woman is being treated in the intensive care unit for presumed
staphylococcal sepsis. To avoid problems with possible resistance, she is
empirically given IV vancomycin while waiting for the culture results to come
back. Vancomycin is a renally excreted drug. The patient’s routine laboratory
work-up reveals a creatinine value of 3.2, indicating acute renal failure. What
specific considerations will have to be made with regard to adjustments of the
prescribed medication?
8 . Glucuronidation reactions
10 . A 43-year-old man who was recently fired from a well-paying job decides to
commit suicide and ingests a jarful of his antiseizure medication, phenobarbital.
His wife finds him at home sleeping, but notices that he has diminished
breathing, low body temperature, and skin reddening. She brings him to the ER,
where he is appropriately diagnosed with barbiturate overdose. The patient is
given bicarbonate to alkalinize his urine. How does alkalinization of urine with
bicarbonate help to overcome the toxic effects of Phenobarbital in this situation?
15 . If the oral dosing rate of a drug is held constant, what will be the effect of
increasing the bioavailability of the preparation?
(A) Bioavailability
(B) Volume of distribution
(C) Clearance
(D) Half-life
19. A 35-year-old diabetic woman presents to the emergency room with signs and
symptoms of urinary tract infection, including fever, dysuria, and bacteriuria.
Given that she is diabetic, she is admitted for treatment with intravenous
ciprofloxacin. What is the mechanism of this drug?
(A) Cyclophosphamide
(B) Melphalan
(C) Carmustine
(D) Thiotepa
(E) Streptozocin
21. A 73-year-old woman with breast cancer and history of congestive heart
failure is placed on a chemotherapy regimen that includes the use of
methotrexate (MTX) after her mastectomy. This agent’s activity is related to its
ability to do what?
22. A 53-year-old man presents with changes in bowel frequency and pencil-thin
stools with occasional bright red blood in the stool. A further work-up, including
computed tomography (CT) scanning of the chest, abdomen, and pelvis,
demonstrates lesions consistent with metastasis in the liver. His therapy will
likely include which of the following chemotherapeutic agents?
(A) Carmustine
(B) Fluorouracil
(C) Leuprolide
(D) Temozolamide
(E) Tamoxifen
26. A world-class cyclist was diagnosed with metastatic testicular cancer with
lesions in both his lung and brain. He forgoes the standard treatment for his
condition because he learns one of the drugs typically used for his condition
could ultimately compromise his pulmonary function. Which of the following is
included in the standard regimen and is associated with his feared complication?
(A) Cisplatin
(B) Busulfan
(C) Aminoglutethimide
(D) Bleomycin
(E) Cyclophosphamide
27. A 35-year-old otherwise healthy man presents with fullness in the inguinal
region with swelling of the ipsilateral leg. A computed tomography (CT) scan
demonstrates several confluent enlarged lymph nodes. Biopsy specimens
demonstrate malignant CD20 + B cells. A diagnosis of diffuse B-cell lymphoma is
made. Which of the following biologics will likely be given to the patient?
(A) Traztuzumab
(B) Rituxan
(C) Dactinomycin
(D) l-Asparaginase
(E) Interferon-a
(A) Anastrozole
(B) Rituximab
(C) Imatinib
(D) Gefitinib
(E) Amifostine
29. A 37-year-old man presents with changes in Bowel habits for the last several
months. He comPlains of small stool caliber alongwith occasional blood in his
stools. Colonoscopy reveals the diagnosis of colon adenocarcinoma. Further
work-up demonstrates that there are metastatic lesions in His liver. The
oncologist recommends the use of becacizamab. This agent
(A) Thalidomide
(B) Cisplatin
(C) Thioguanine
(D) Temozolomide
(E) Mercaptopurine
(A) Anastrozole
(B) Leuprolide
(C) Tamoxifen
(D) Mitotane
(E) Prednisone
32. A 56-year-old woman with a significant smoking history was diagnosed with
small-cell lung cancer 2 years ago and was successfully treated. Now on follow-
up computed tomography (CT) scan there are several new pulmonary nodules,
and the oncologist elects to begin second-line chemotherapy with a DNA
topoisomerase I inhibitor. Which of the following is such an agent?
(A) Ciprofloxacin
(B) Etoposide
(C) Vinorelbine
(D) Teniposide
(E) Irinotecan
(A) Thromboembolism
(B) Bowel perforation
(C) Aplastic anemia
(D) Myelosuppression
(E) Hypotension
CHAPTER 6
497 Question
PRETEST ANATOMY
Canal of Nuck
Ligament of the ovary or proper ligament of the ovary
Round ligament of the uterus
Round ligament of the uterus and the ligament of the ovary or proper ligament of
the ovary
Suspensory ligament of the ovary
3. Parts of some human skeletal remains are brought to you as coroner of a rural
community. The pelvis is complete, yet the individual bones of the pelvis, the
ilium, ischium, and pubis have just started to fuse together. The subpubic angle
you estimate at 60°and the pelvic brim has a distinctive heart shaped
appearance. On the basis of this information, you guess the remains are of which
of the following?
3-year-old male
4-year-old female
14-year-old male
30-year-old female
80-year-old male
Puborectalis muscle
Obturator internus muscle
Pubococcygeus muscle
Superficial transverse perineal muscle
Piriformis muscle
5. When one touches the upper medial thigh or scrotum of most young males, the
testicles are pulled upwards towards the external inguinal ring. This is called the
cremasteric reflex. The efferent limb of the cremasteric reflex is provided by
which of the following?
7. You deliver a full-term baby boy who is healthy and receives an Apgar score
of 9 out of 10. You do note that his scrotum is rather large compared to his penis
and when he cries and strains, the scrotum gets even bigger. You palpate for
testes and epididymides and think both are present and don’t feel any abnormal
structures. You tell the parents the newborn has which of the following?
Cryptorchidism
Direct inguinal hernia
Varicocele
Hydrocele
Klinefelter’s syndrome
8. A 6-year-old boy badly bruised his perineum on the horizontal bar of his
bicycle as he was learning to ride a bike. Blood extended into his scrotum, and
onto the anterior abdominal wall from 3 in. below his umbilicus to just anterior
to his anus, but did not pass into his thigh. Which anatomical layers most likely
explain the distribution of extravasated blood?
Bulbourethral glands
Epididymis
Prostate
Seminal vesicles
Testis
11. A rectal cancer that occurs within the anal canal penetrates the mucosa and
basement membrane. Which nodes would you most likely harvest at the same
time you removed the cancerous growth to send to pathology to determine if
there has been metastasis?
12. In the male, the homologue of the vaginal artery is which of the following?
Obturator artery
Internal pudendal artery
Middle rectal artery
Umbilical artery
Inferior vesical artery
13. A 24-year-old woman seeking assistance for apparent infertility has been
unable to conceive despite repeated attempts in 5 years of marriage. She reveals
that her husband fathered a child in a prior marriage. Although her menstrual
periods are fairly regular, they are accompanied by extreme lower back pain.
The lower back pain during menstruation experienced by this woman probably
is referred from the pelvic region. The pathways that convey this pain sensation
to the central nervous system involve which of the following?
14. The body of the uterus tends to wander within the pelvic cavity. However the
cervix of the uterus tends to remain fairly firmly in place most of the time.
Which of the following would be found immediately inferior to the left cardinal
(lateral cervical) ligament?
15. The most important measurement of the pelvic outlet, indicating the
SMALLEST dimension, is the transverse midplane diameter. It is measured
between which of the following?
Ischial spines
Ischial tuberosities
Uterine artery
Ureter
Urinary bladder
Urethra
Kidney
18. Which of the following arteries may occasionally arise as a branch of the
external iliac artery or inferior epigastric artery instead of as a branch of the
internal iliac artery?
19. A couple comes to your office because they have been unable to conceive a
child after 1 year of trying. You examine the man and notice a darkish mass and
fullness of the left scrotum/spermatic cord compared to the smaller right
scrotum/spermatic cord. You suggest he follow up with an urologist because you
suspect which of the following?
20. Which of the following is one of the roles of the sympathetic chain in the
pelvis?
Bladder contraction
Cutaneous function (sudomotor, vasomotor, pilomotor)
Erection in males
Erection in both male and female
21. Both the autonomic and vascular systems need to function properly for
successful male sexual function. Which of the following statements concerning
erection, emission, and ejaculation in the male is correct?
22. Which of the following locations is optimal for fertilization of an ovulated egg
by sperm to occur?
Broad ligament
Mesosalpinx
Mesovarium
Suspensory ligament of the ovary
24. Pap smears are the collection of cells from the uterine cervix to look for
cytological evidence of transformation to cancerous forms, most typically due to
a viral infection. While most women do not report any discomfort associated
with the collection of cervical cells, a few women do. To which of the following
somatic areas does the uterine cervix refer pain to?
Epigastric region
Medial thigh and buttock
Inguinal and pubic regions, anterior labia majora, medial thigh
Lateral leg and perineum
Subcostal and umbilical regions
25. Episiotomies are performed to control tearing that can occur during a
vaginal delivery. When performing a mediolateral episiotomy, an OB- GYN will
likely cut through several structures of the perineum. What perineal structures
must be sutured back together following a typical mediolateral episiotomy?
26. Which anatomical region or structure does not drain into the superficial
inguinal lymph nodes and thus should be EXCLUDED from your differential
diagnosis list?
Penis
Scrotum
Testicles
Anus
Epididymides
27. What would you tell your patient regarding how to perform a pudendal
nerve block and an advantage to performing the injection transvaginally versus
injecting through perineal skin?
The pudendal nerve serves the skin around the anterior/lateral entrance of the
vagina; the nerve wraps around the ischial spine, which is used as landmark;
transvaginal administration is less painful since the upper portion of the vagina
has fewer pain receptors
The pudendal nerve serves the skin around the posterior/lateral entrance of the
vagina; the nerve wraps around the ischial spine, which is used as a landmark;
transvaginal administration is less painful since the upper portion of the vagina
has fewer pain receptors
The pudendal nerve serves the skin around the anterior/lateral entrance of the
vagina; the nerve wraps around the ischial tuberosity, which is used as
landmark; transvaginal administration is less painful since the upper portion of
the vagina has fewer pain receptors
The pudendal nerve serves the skin around the posterior/lateral entrance of the
vagina; the nerve wraps around the ischial tuberosity, which is used as a
landmark; transvaginal administration is less painful since the upper portion of
the vagina has fewer pain receptors
BRS ANATOMY
2. A 17-year-old boy suffers a traumatic groin injury during a soccer match. The
urologist notices tenderness and swelling of the boy’s left testicle that may be
produced by thrombosis in which of the following veins?
Sciatic nerve
Internal pudendal artery
Superior gluteal nerve
Inferior gluteal artery
Posterior femoral cutaneous nerve
4. A 22-year-old woman receives a deep cut in the inguinal canal 1 in. lateral to
the pubic tubercle. Which of the following ligaments is lacerated within the
inguinal canal?
Mesosalpinx
Round ligament of the uterus
Rectouterine ligament
Ovarian artery
Ovarian ligament
Uterine tube
Ureter
Round ligament of the uterus
Piriformis
Sphincter urethrae
Obturator internus
Levator ani
Sphincter ani externus
Pelvic diaphragm
Colles fascia
Superficial perineal fascia
Deep perineal fascia
Perineal membrane
Bulbourethral glands
Crus of penis
Bulb of vestibule
Spongy urethra
Great vestibular gland
Anterior lobe
Middle lobe
Right lateral lobe
Left lateral lobe
Posterior lobe
15. A 37-year-old man is suffering from carcinoma of the skin of the penis.
Cancer cells are likely to metastasize directly to which of the following lymph
nodes?
16. A 42-year-old woman who has had six children develops a weakness of the
urogenital diaphragm. Paralysis of which of the following muscles would cause
such a symptom?
Sphincter urethrae
Coccygeus
Superficial transversus perinei
Levator ani
Obturator internus
17. A 43-year-old man has a benign tumor located near a gap between the
arcuate pubic ligament and the transverse perineal ligament. Which of the
following structures is most likely compressed by this tumor?
Perineal nerve
Deep dorsal vein of the penis
Superficial dorsal vein
Posterior scrotal nerve
Deep artery of the penis
19. A 22-year-old man has a gonorrheal infection that has infiltrated the space
between the inferior fascia of the urogenital diaphragm and the superficial
perineal fascia. Which of the following structures might be inflamed?
20. A 39-year-old man is unable to expel the last drops of urine from the urethra
at the end of micturition because of paralysis of the external urethral sphincter
and bulbospongiosus muscles. This condition may occur as a result of injury to
which of the following nervous structures?
Pelvic plexus
Prostatic plexus
Pudendal nerve
Pelvic splanchnic nerve
Sacral splanchnic nerve
21. A 21-year-old marine biologist asks about her first bimanual examination,
and it is explained to her that the normal position of the uterus is
22. After his bath but before getting dressed, a 4-year-old boy was playing with
his puppy. The boy’s penis was bitten by the puppy, and the deep dorsal vein was
injured. The damaged vein
23. A 62-year-old man is incapable of penile erection after rectal surgery with
prostatectomy. The patient most likely has a lesion of which of the following
nerves?
Perineum
Lower part of the vagina
External genitalia
Ovary
Lower part of the anterior abdominal wall
25. A sexually active adolescent presents with an infection within the ischiorectal
fossa. Which of the following structures is most likely injured?
Vestibular bulb
Seminal vesicle
Greater vestibular gland
Inferior rectal nerve
Internal pudendal artery
Levator ani
Sphincter urethrae
Uterosacral ligament
Ovarian ligament
Arcuate pubic ligament
28. A 16-year-old boy presents to the emer- gency department with rupture of
the penile urethra. Extravasated urine from this injury can spread into which of
the following structures?
Scrotum
Ischiorectal fossa
Pelvic cavity
Testis
Thigh
29. A 23-year-old woman visits her obstetrician for an annual checkup. During
vaginal examination, which of the following structures may be palpated?
30. A 53-year-old bank teller is admitted to a local hospital for surgical removal
of a benign pelvic tumor confined within the broad ligament. There is a risk of
injuring which of the following structures that lies in this ligament?
Ovary
Proximal part of the pelvic ureter
Terminal part of the round ligament of the uterus
Uterine tube
Suspensory ligament of the ovary
31. A 72-year-old man comes to his physician for an annual checkup. Which of
the following structures is most readily palpated during rectal examination?
Prostate gland
Epididymis
Ejaculatory duct
Ureter
Testis
32. A 48-year-old college football coach under- goes a radical prostatectomy for
a malignant tumor in his prostate. Following surgery, he is incapable of
achieving an erection. Which of the following nerves is most likely damaged
during the surgery?
34. A 32-year-old patient with multiple fractures of the pelvis has no cutaneous
sensation in the urogenital triangle. The function of which of the following nerves
is most likely to be spared?
Ilioinguinal nerve
Iliohypogastric nerve
Posterior cutaneous nerve of the thigh
Pudendal nerve
Genitofemoral nerve
38. A woman is delivering a breech baby. The obstetrician decides that it is best
to perform a mediolateral episiotomy. Which of the following structures should
the obstetrician avoid incising?
Vaginal wall
Superficial transverse perineal muscle
Bulbospongiosus
Levator ani
Perineal membrane
39. During pelvic surgery, a surgeon notices severe bleeding from the artery that
remains within the true pelvis. Which of the following arteries is most likely to be
injured?
Iliolumbar artery
Obturator artery
Uterine artery
Internal pudendal artery
Inferior gluteal artery
lumbosacral plexus and remains within the abdominal or pelvic cavity. To which
of the following nerves should he pay particular attention?
Ilioinguinal nerve
Genitofemoral nerve
Lumbosacral trunk
Femoral nerve
Lateral femoral cutaneous nerve
Ischiocavernosus muscles
Superficial transverse perineal muscles
Levator ani
Sphincter urethrae
Bulbospongiosus
43. A 49-year-old woman has a large mass on the pelvic brim. Which of the
following structures is most likely compressed by this mass when crossing the
pelvic brim?
44. A 26-year-old man comes to a hospital with fever, nausea, pain, and itching
in the perineal region. On examination by a urologist, he is diagnosed as having
infected bulbourethral (Cowper) glands. Which of the following structures is/are
affected by this infection?
Smooth muscle
Innervated by the perineal nerve
Lying between the perineal membrane and Colles fascia
Enclosed in the pelvic fascia
Part of the pelvic diaphragm
Male pseudohermaphroditism
Hypospadias
Epispadias
Cryptorchid testis
Chordee
49. An elderly man with prostatitis is seen at an internal medicine clinic. The
seminal colliculus of his prostate gland is infected, and its fine openings are
closed. Which of the following structures is/are most likely to be disturbed?
52. A 78-year-old man has carcinoma of the rectum. The cancer is likely to
metastasize via the veins into which of the following structures?
Spleen
Kidney
Liver
Duodenum
Suprarenal gland
53. During a partial hysterectomy leaving the ovaries intact, the surgeon
detaches the ovary from the uterus by transecting the ovarian ligament. This
ligament developed from which embryonic structure?
Mesonephric duct
Urogenital folds
Gubernaculum
Processus vaginalis
Paramesonephric ducts
شيت الجامعة
PELVIS
1. The following statements concerning the uterus are correct except:
a) The fundus is part of the uterus above the openings of uterine tubes
c) The nerve supply of the uterus is from the inferior hypogastric plexuses
2. Concerning the vas deferens, all of the following statements are true except:
a) It emerges from the deep inguinal ring and passes around the lateral
margin of the inferior epigastric artery
peritoneum
e) It joins the duct of the seminal vesicle to form the ejaculatory duct
3. Concerning the pelvic part of the ureter, the following statements are true
except:
a) It enters the pelvis in front of the bifurication of the common iliac arteries
b) The ureter enters the bladder by passing directly through its wall, there
c) It has a close relationship to the ischial spine before it turns medially toward
the bladder
d) The blood supply of the distal part of the ureter is from the superior vesical
artery
4. Concerning the seminal vesicle, the following statements are true except:
a) The seminal vesicles are related posteriorly to the rectum and can be
b) The seminal vesicles are two lobulated organs that store spermatozoa
a) The lymph drainage is into the para-aortic (lumbar) lymph nodes at the
b) The round ligament of the ovary extends from the ovary to the upper end of
the lateral wall of the body of the uterus
c) The ovarian fossa is bounded above by the external iliac vessels and behind
by the internal iliac vessels
d) The left ovarian artery is a branch of the left internal iliac artery
6. Concerning the nerve supply to the urinary bladder, the following statements
are true except:
lumbar ganglia
hypogastric plexuses
c) The afferent sensory fibers arising in the bladder wall reach the spinal cord
via the pelvic splanchnic nerves and also travel with the sympathetic nerves
d) The parasympathetic preganglionic fibers arise from the second, third and
a) The area of the vaginal lumen around the cervix is divided into four fornices
b) The upper part of the vagina is supported by the levator ani muscles and
c) The perineal body lies posterior to and supports the lower part of the vagina
8. Concerning the visceral layer of pelvic fascia in the female, the following
statements are true except:
e) On the lateral wall of the pelvis, it fuses with the parietal layer of the pelvic
fascia
a) Lymph from the cervix of the uterus drains into the internal and external
b) Lymph from the prostate drains into the external iliac lymph
nodes
c) Lymph from the posterior fornix of the vagina drains into the internal and
d) Lymph from the trigone of the bladder drains into the internal and external
e) Lymph from the fundus of the uterus drains into the para-aortic lymph
10. The following statements concerning the main venous drainage of pelvic
structures are true except:
a) The venous blood from the left ovary drains into the inferior vena
cava
b) The venous blood from the prostate drains into the interal iliac veins
c) The venous blood from the urinary bladder drains into the internal iliac
veins
d) The venous blood from the mucous membrane of the rectum drains into the
superior rectal vein
e) The venous drainage of the seminal vesicles drains into the internal iliac
veins
11. The following statements concerning the female urethra are true except:
a) It lies immediately anterior to the vagina
b) Its external orifice lies about 2 in. (5 cm) from the clitoris
a) Sigmoid colon
b) Ureters
c) Perineal body
d) Ischial spines
e) Iliopectineal line
13. The following statements concerning the ischiorectal fossa are true except:
c) The lateral wall is formed by the obturator internus muscle and its fascia
14. The following statements concerning the penis are true except:
a) Its root is formed in the midline by the bulb of the penis which continues
b) Its roots laterally are formed by the crura, which continue anteriorly as the
corpora cavernosa
e) The penis is suspended from the lower part of the anterior abdominal wall
15. The following statements concerning the perineal structures are correct
except:
e) The lymph drainage of the skin around the anus is into the medial group of
b) Perineal membrane
c) Sphincter urethrae
e) Parietal pelvic fascia covering the upper surface of the sphincter urethrae
muscle
17. In the male, the following structures can be palpated on rectal examination
except:
b) Urogenital diaphragm
c) Anorectal ring
e) Ureter
18. The following statements concerning the anal canal are true except:
e) The mucous membrane of the lower half receives its arterial supply from
19. The following statements concerning the subcutaneous part of the external
anal sphincter are correct except:
d) It is not responsible for causing the anal canal and the rectum to join at an
acute angle
20. The following statements concerning the defecation are true except:
a) The act is often preceded by the entrance of the feces into the rectum, which
gives rise to the desire to defecate
d) The internal sphincter contracts and causes the evacuation of the feces
e) The mucous membrane of the lower part of the anal canal is extruded
b) The sympathetic preganglionic nerve fibers arising from the first and
22. The following structures receive innervation from the branches of the
pudendal nerve except:
a) Labia minora
b) Urethral sphincter
d) Ischiocavernosus muscles
23. The following structures are closely related to the rectouterine pouch (pouch
of Douglas) except:
a) Anteriorly is situated in the posterior surface of the upper part of the vagina
cervix
24. Support for the uterus either directly or indirectly, is provided by the
following structures except:
b) The mesosalpinx
25. The following statements regarding the ovary are correct except:
c) It is attached to the lateral pelvic wall by the round ligament of the ovary
e) The right ovarian vein drains into the inferior vena cava
26. The following statements regarding the urinary bladder are true except:
a) It lies in the visceral layer of the pelvic fascia beneath the peritoneum
b) When the bladder is empty, the internal surface is wrinkled except at the
d) The trigone is the area between the openings of the urethra and the two
ureters
e) Ureters
28. Malignant tumors of the trigone of the bladder spread (metastasize) to the
following lymph nodes:
a) Lumbar
b) Sacral
e) Superficial inguinal
29. In males, traumatic injury to the perineum may rupture the bulb of the penis
or penile urethra. The resulting leakage of blood or urine may be found in all of
the following areas except:
c) The scrotum
d) The penis
b) Pudendal artery
c) Sphincter urethtrae
d) Both A and B
e) Both A and C
b) Is a fascial tunnel
32. All of the following statements about the ductus deferens are true except:
e) It is retroperitoneal
33. Which one of the following is true regarding the muscles of the pelvis:
a) The obturator internus muscle leaves the pelvis through the greater sciatic
foramen
c) The pelvic diaphragm is a sling of muscle that separates the true pelvis from
the false pelvis
d) The piriformis is one of the components forming the lateral pelvic walls
a) The urinary bladder in the male sits at a lower level than that of the female
c) The efferent ductules unite at the superior aspect of the testis to form the
ductus deferens
d) The gonadal artery in the male and female is a branch from the anterior
a) Ischiorectal fossa
d) Both B and C
c) Ischiorectal fossa
b) Pubocervical ligaments
c) Sacrocervical ligaments
e) Broad ligament
38. Which is not considered a usual branch of the anterior division of the
internal iliac artery:
b) Iliolumbar artery
c) Obturator artery
d) Umbilical artery
a) The sciatic nerve is derived from the segments L4 and 5; S1, 2 and 3
c) The pelvic splanchnic nerve is derived from the segments S2, 3 and 4
40. Which of the following ligaments is attached to the uterus and composed of
peritoneum:
b) Broad ligament
c) Round ligament
c) Is 5 inches long
e) Has 3 constrictions
b) Uterine artery
c) Ureter
d) Both B and C
44. The deep perineal space is deep to the perineal membrane. It contains:
a) Membranous urethra
b) Vagina
e) Both A and C
b) The internal spermatic fascia arises from the internal oblique muscle
46. Which of the following is not a branch of the internal iliac artery?
a) Inferior vesical
b) Umbilical
c) Superior gluteal
d) Iliolumbar
e) Inferior epigastric
a) The urinary bladder in male sits at a lower level than that of the female
c) The efferent ductules inite at the superior aspect of the testis to form the
ductus deferens
d) The gonadol artery in the male and female is a branch from the anterior
48. The following statements concerning the ischio-anal fossa are true except:
c) The lateral wall is formed by the obturator internus muscle and its fascia
e) The mucous membrane f the lower half receives its arterial supply from the
50. All of the following structures exit the pelvis via the greater sciatic foramen
except:
a) Piriformis muscle
c) Exhibits midline openings for the rectum and urethra in the male
d) Is attached to the pubis, lateral pelvic wall (arcus tendineus) and ischial
spine
52. The ovaries are anchored to the lateral pelvic wall by the:
a) Ovarian ligament
b) Broad ligament
c) Suspensory ligament
d) Mesovarium
e) Round ligament
urogenital triangle
c) The posterior scrotal (labial) nerves are not branches of the inferior rectal
nerve
d) The pudendal nerve enters the perineum (from the gluteal region) by
a) Broad ligament
b) Ovarian ligament
55. Which structures do not pass through the deep perineal pouch of the
urogenital triangle:
a) Urethra
e) Vagina
b) Has lymphatics which drain to nodes alongside the internal iliac artery
a) Is the main motor and sensory supply of the pelvic floor and perineum
d) Has the inferior rectal nerve as one of its branches which supplies the
levator ani
a) Receives its blood supply from the superior, middle and inferior rectal
arteries, the superior being the main artery supplying the mucous membrane
b) Receives some of its blood supply from the middle rectal artery- a branch of
c) Receives some of its blood supply from the internal pudendal artery via the
d) Has a venous drainage which includes the middle rectal vein, which drains
e) Has a lymph drainage which reaches both the inferior mesenteric and
ABDOMEN
c) The left triangular ligament of the liver lies anterior to the abdominal part of
the esophagus
d) The attachment of the hepatic veins to the inferior vena cava is one of the
e) The ligamentum venosum is attached to the left branch of the portal vein in
a) The pancreas receives part of its arterial supply from the splenic
artery
b) The main pancreatic duct opens into the third part of the duodenum
c) The uncinate process of the pancreas projects from the head of the pancreas
d) The bile duct (common bile duct) lies posterior to the head of the pancreas
b) The branches of the superior mesenteric artery serving the ileum form more
arcades than those serving the jejunum
c) Peyer's patches are present in the mucous membrane of the lower ileum
d) The plicae circulares are more prominent at the distal end of the ileum than
in the jejunum
4. The hilum of the right kidney contains the following important structures,
except the:
a) Renal Pelvis
5. The following statements concerning the left suprarenal gland are incorrect
except:
d) It is usually located on the upper pole and lateral border of the left kidney
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6. The following statements concerning the abdominal aorta are true except:
a) It bifurcates into the two common iliac arteries in front of the fourth lumbar
vertebra
c) From its anterior surface arise the celiac, superior mesenteric and inferior
mesenteric arteries
e) The thoracic duct leaves the abdomen through the aortic opening of the
d) Gray rami communicantes are given off to the lumbar spinal nerves
e) The splanchnic nerves from the thorax join the trunks below the diaphragm
8. The following statements concerning the lumbar plexus are true except:
b) The plexus is formed from the posterior rami of the upper four lumbar
nerves
c) The femoral nerve emerges from the lateral border of the psoas muscle
d) The obturator nerve emerges from the medial border of the psoas muscle
e) The iliohypogastric nerve emerges from the lateral border of the psoas
muscle
a) Esophageal branches of the left gastric vein and tributaries of the azygos
vein
c) Paraumbilical vein and the superficial veins of the anterior abdominal wall
d) Veins of the ascending and descending parts of the colon with the lumbar
veins
e) Veins from the bare areas of the liver with the phrenic veins
10. The following statements concerning the ureters are true except:
b) Both receive their blood supply from the testicular or ovarian arteries
c) Both are separated from the transverse processes of the lumbar vertebrae by
11. Concerning the inferior mesenteric artery, all of the following statements are
true except:
e) It arises from the aorta immediately below the third part of the duodenum
12. Which of the following structures is NOT present within the lesser omentum?
a) Portal vein
b) Bile duct
d) Hepatic artery
e) Lymph Nodes
13. The following statements concerning the liver are true except:
14. The following differences exist between the ileum and the ascending colon
except:
does not
b) The arterial supply to the wall of the ileum is arranged so that it produces
d) The ileum has a longitudinal muscle that forms a continuous layer around
15. Which of the following statements is (are) correct regarding the duodenum?
a) The duodenum receives its entire blood supply from the superior mesenteric
artery
c) The bile duct enters the second (vertical) portion of the duodenum
d) The lymph from the fourth part of the duodenum drains into the celiac
nodes
e) The tip of the appendix cannot reach down into the pelvic cavity
16. The following statements concerning the appendix are correct except:
b) At the base of the appendix, the teniae coli of the cecum fuse to form a
c) Afferent pain nerve fibers accompany the sympathetic nerves and enter the
d) The appendix receives its blood supply from a branch of the posterior cecal
artery
e) The tip of the appendix cannot reach down into the pelvic cavity
17. The following statements concerning the pyloric sphincter are correct except:
stomach wall
18. The following structures form the boundaries of the entrance into the lesser
sac (epiploic foramen) except:
19. After complete occlusion of the origin of the inferior mesenteric artery with a
blood clot, the blood supply of the left portion of the colon is maintained by the
following arteries except:
hemorrhoidal arteries
20. The following statements concerning the gall bladder are correct except :
a) The arterial supply is from the cystic artery, which is a branch of the right
hepatic artery
b) The fundus of the gallbladder is located just beneath the tip of the right
c) The peritoneum completely surrounds the fundus, the body and the neck
d) The nerves of the gallbladder are derived from the celiac plexus
e) Pain sensation from gallbladder disease may be referred along the phrenic
21. In patients with an obstruction of the superior vena cava, blood may return
to the right atrium through the following anastomotic channels except:
a) The lateral thoracic, the lumbar, and the superficial epigastric veins
23. Which of the following statements regarding the left ureter is correct?
b) Its lumen is constricted at the point where it crosses the brim of the pelvis
c) Its entire arterial supply is derived from the left renal artery
d) It lies in direct contact with the tips of the transverse processes of the
lumbar vertebrae
24. The following structures are connected to the liver. Which structures provide
the greatest support for the liver?
25. A gallstone has eroded through the posterior wall of the gallbladder and
entered the intestinal tract. Which part of the intestinal tract is likely to initially
contain the stone?
e) The jejunum
26. Which of the following statements regarding the superficial inguinal ring is
incorrect?
b) Its greatest width lies above and medial to the pubic tubercle
e) In males, it allows passage of the spermatic cord and the ilioinguinal nerve
27. A surgeon decides to divide the anterior vagal trunk (vagotomy) as it lies on
the anterior surface the abdominal part of the esophagus as therapy for a
chronic gastric ulcer not responding to medical treatment. Which of the
following is likely to result from this procedure?
cardiac plexus
28. The skin of the umbilicus receives its sensory innervation from:
a) T7
b) T12
c) L1
d) T10
e) L2
31. The following statements concerning the superficial fascia of the anterior
abdominal wall are true except:
b) Scarpa's fascia fuses with the fascia lata just below the inguinal ligament
33. The following statements concerning the epididymis are correct except:
34. The jejunum and ileum can be differentiated on the basis of the following
anatomic features except:
b) The plicae circulares are much more prominent in the jejunum than in the
ileum
d) The jejunum is located in the upper left region of the abdominal cavity
e) Peyer's patches are characteristic of the lower ileum and may be visible on
the surface
e) Autonomic nerves
36. The following structures pass through the esophageal hiatus in the
diaphragm except:
37. The following statements regarding the peritoneum are incorrect except:
38. If the portal vein becomes blocked, the following venous anastomoses are
important in uniting the portal with the systemic venous systems except:
39. In a patient with cancer of the stomach who requires a total gastrectomy, the
following arteries must be ligated except:
41. The following statements are correct regarding and inguinal hernia except:
a) The inferior epigastric artery lies medial to the neck of an indirect inguinal
hernia
lacunar ligament
42. The following statements regarding the portal vein are true except:
c) It receives venous blood from both the large and small intestines
d) It originates at the junction of the superior mesenteric and the splenic veins
43. If the common hepatic artery is unavoidably ligated during surgery, the
arterial supply to the liver is maintained by the following anastomic connections
except:
pancreaticduodenal artery
b) The right gastric artery anastomosing with the left gastric artery
b) The inguinal ligament is attached laterally to the anterior inferior iliac spine
vertebrae
45. The following veins drain directly into the inferior vena cava except:
46. To tap a hydrocele (collection of fluid in the tunica vaginalis) a cannula must
pierce the following structures except:
a) The skin
c) Dartos muscle
47. Which of the following arteries supplies the suprarenal (adrenal) gland:
a) The aorta
48. The following structures are present in the porta hepatic except:
a) Lymph nodes
49. The following statements regarding the celiac plexus are true except :
c) The celiac ganglia are made of nerve cell bodies and nerve fibers
synapsing with postganglionic neurons within the walls of the organs they
innervate
50. The right kidney has the following important relationships except:
51. The following structures form the walls of the inguinal canal except the:
a) Conjoint tendon
d) Lacunar ligament
e) Fascia transversalis
52. The following structures and events serve to strengthen the walls of the
inguinal canal except:
b) The contracting internal oblique muscle reinforces the anterior wall of the
c) The strong conjoint tendon reinforces the posterior wall of the canal behind
abdominis muscles lowers the roof of the canal so that the canal is
practically obliterated
e) After birth, as the result of growth, the deep inguinal ring moves laterally
away from the superficial ring so that the canal becomes oblique and the
53. In the female, the inguinal canal contains the following structures except the:
a) Ilioinguinal nerve
54. All of the following structures concerning the spermatic cord are true except:
55. All the following structures are present in the inguinal canal in the male
except:
c) Testicular vessels
e) Ilioinguinal nerve
56. All of the following statements concerning the conjoint tendon are true
except:
57. All of the following statements concerning the an indirect inguinal hernia are
true except:
b) The neck of the hernial sac lies medial to the inferior epigastric artery
e) At the superficial inguinal ring, the hernial sac lies above and medial to the
pubic tubercle
58. To pass a needle into the cavity of the tunica vaginalis in the scrotum, the
following structures have to be pierced except:
a) Skin
c) Tunica albuginea
e) Cremasteric fascia
59. The following statements are true about muscles forming the posterior
abdominal wall except:
a) The psoas major muscle has a fascial sheath that extends down into the
abdominal wall
abdominal wall
c) The sac of a direct hernia lies medial to the inferior epigastric vessels
d) The sac of a direct inguinal hernia usually comes down to the scrotum
61. The borders of Hesselbech's trangle include the epigastric vessels, the edge of
the rectus sheath and:
d) Transversalis fascia
62. The only statement regarding the small bowel which is true is:
c) The muscularis, the muscle layer, provides the strength for the
duodenum
63. The following layers are encountered in a paramedian surgical incision (an
incision lateral to midline) from above downwards:
a) The skin, subcutaneous fat, deep fascia, rectus muscle and peritoneum
b) The skin, superficial fascia, subcutaneous fat, anterior rectus sheath, rectus
c) The skin, subcutaneous fat, anterior rectus sheath, rectus muscle, posterior
d) The skin, subcutaneous fat, extraperitoneal fat, anterior rectus sheath and
muscle
a) Arises from the posteromedial aspect of the caecum below the ileoceccal
valve
b) The cystic artery will be found in Calot's triangle in the majority of cases
artery
66. Below the arcuate line, which of the following structures lies posterior to the
rectus muscle?
a) Linea alba
d) Transversalis fascia
67. Which of the following structures of the spermatic cord is derived from the
internal oblique muscle?
c) Cremaster muscle
d) Dartos muscle
e) Vas deferens
68. Which of the following organs does not receive its blood supply from the
celiac trunk?
a) Liver
b) Stomach
c) Spleen
d) Jejunum
e) Gall bladder
69. The common bile duct and the main pancreatic duct empty into the:
d) Gall bladder
e) Vermiform appendix
a) Spleen
b) Stomach
c) Jejunum
d) Pancreas
e) Transverse colon
a) Esophageal bleeding
b) Hemorrhoids
c) Caput medusae
72. What structure passes behind the medial arcuate ligament of the abdominal
diaphragm:
a) The aorta
b) The esophagus
73. Which of the following is not a branch of the superior mesenteric artery?
d) Iliocolic artery
a) Taenia coli
b) Haustra
c) Appendices epiploicae
d) Vermiform appendix
e) Epiploic foramen
76. Which of the following is false about the normal pattern of arterial blood
supply to the stomach:
77. The area around the umbilicus receives sensory innervation from the:
c) Subcostal nerve
d) Splanchnic nerve
e) Vagus
78. Inferior the arcuate line, which of the following structures lies posterior to
the rectus muscle?
79. Which layer of the spermatic cord is derived from the internal oblique
muscle of the abdominal wall?
b) Cremaster muscle
d) Tunica vaginalis
e) Tunica albuginea
80. Which of the following statements about indirect inguinal hernia is false?
a) They enter the abdominal wall lateral to the inferior epigastric artery
b) Umbilicus
c) Rectum
c) Both A and B
d) Neither A nor B
83. Which of the following supply the lesser curvature of the stomach?
e) Both A and B
84. Which of the following is not involved in arterial blood supply to the anterior
abdominal wall?
b) Intercostal arteries
d) Musculophrenic artery
cartilages
a) Ligamentum venosum
b) Ligamentum teres
e) Falciform ligament
a) Hepatic duct
c) Both A and B
d) Neither A nor B
89. Position of the deep inguinal ring relative to the inferior epigastric vessels is:
a) Medial
b) Lateral
c) Posterior
d) Anterior
e) Superior
capsule
91. Primary arterial supply of which region travels via the superior mesenteric
artery?
a) Infradiaphragmatic foregut
b) Midgut
c) Hindgut
d) Both A and C
d) Usually form four anterior segmental arteries within the hilum of the kidney
93. The median, medial and lateral umbilical folds of the anterior abdominal
wall are formed respectively by the:
94. The following statements are true about the cisterna cyli except:
95. The following statements about the kidney are true except:
c) Is located retroperitoneally
b) The anterior portion of the rectus sheath is formed by the aponeurosis of the
external abdominal oblique and transverses abdominis muscle
e) The internal spermatic fascia is derived from the internal oblique muscle
c) The cardiac notch is an incisure found at the most dependent point of the
lesser curvature
a) Falciform ligament
b) The liver occupies the right hypochondriac and epigastric region of the
abdomen
c) The quadrate lobe of the liver is adjacent to the inferior vena cava
d) The duodenum
vessels
d) The posterior surface of the head of the pancreas is related to the left crus
e) The posterior aspect of the neck of the pancreas is covered with peritoneum
and is adjacent to the pylorus
101. The common bile duct and the pancreatic ducts empty into the:
a) Spleen
b) Stomach
c) Jejunum
d) Head of pancreas
e) Transverse colon
103. What structure passes behind the medial arcuate ligament of the abdominal
diaphragm:
a) The aorta
b) The oesophagus
104. A posterior ulcer of the first part of the duodenum may penetrate the wall
and erode an artery running behind it, causing severe internal haemorrhage.
This artery is likely to be:
a) Hepatic
b) Right gastric
c) Gastroduodenal
d) Left gastric
e) Splenic
105. A tumor originating from the sigmoid colon may reach the liver via the
blood stream. Which of the following veins would be first involved in the
pathway?
c) Splenic vein
106. Bleeding from the cystic artery during cholecystectomy can be controlled by
digital pressure on:
107. Which of the following structures forms the floor (inferior border) of the
inguinal canal:
a) Conjoint tendon
b) Inguinal ligament
c) Transversalis fascia
d) Peritoneum
108. Which of the following groups of structures receives its arterial blood
supply from the superior mesenteric artery?
a) The common hepatic artery gives rise to the gastroduodenal artery and
propehepatic artery
b) Blood from the kidneys returns to the heart via the hepatic portal system
d) The superior portion of the rectum receives its blood from the inferior
mesenteric artery
e) The duodenum receives its arterial blood via the celiac trunk and the
b) The bile duct enters the duodenum through the major duodenal papilla
c) The gastric arteries run parallel to the lesser curvature of the stomach
d) The epiploic foramen (of Winslow) is the opening into the lesser sac
112. Which of the following statements regarding the posterior abdominal wall is
false?
b) The quadratus lumborum muscle receives somatic motor innervation via the
c) The medial and lateral arcuate ligaments serves as attachment sites to the
thoracic diaphragm
d) Lumbar arteries arising from the abdominal aorta, supply blood to the
e) The cisterna chyli is an enlargement at the inferior end of the thoracic duct
a) The superior (proximal), expanded end of the ureter is called the renal
pelvis
c) The right gonadal vein drains into the right renal vein
d) The suprarenal glands receive their blood supply from the inferior, middle,
e) The renal pyramids collect urine and empty it into the minor calyces via the
renal papillae
114. Inferior to the arcuate line, which of the following structures lies posterior
to the rectus muscle?
e) Transversalis fascia
a) Autonomic axons carried in the vagus nerve synapse in ganglia in the celiac
plexus
ganglia
c) Preganglionic cell bodies for axons comprising the least splanchnic nerves
to the digestive tract beyond (distal to) the left colic flexure
a) Cirrhosis
b) Portal hypertension
c) Essential hypertension
d) Umbilical hernia
e) Epigastric hernia
a) Vas deferens
b) Uterine artery
d) Pelvic brim
e) Sacro-iliac joint
b) The anterior surface of the left kidney does not include a colic area
c) The suprarenal, pancreatic and colic areas of the left kidney are covered
with peritoneum
e) The inferior poles may extend to the level of the first sacral vertebra
e) Has a base which is said to lie at the point where the three taenia coli meet
120. There are a number of features which allow distinction between the large
and small intestine, including:
a) The taenia coli of the large intestine, which are aggregates of circular
smooth muscle
supply
c) It is supplied by the arterial blood via the celiac, superior mesenteric and
splenic arteries
a) Has the common bile duct passing posterior to its first part
b) Has posterior relationships in its third part with the inferior vena cava,
d) Has an interior that is thrown into folds throughout the length of the
duodenum
e) Is entirely retroperitoneal
124. A femoral hernia descends through the femoral canal, and the neck of the
hernial sac lies:
LOWER LIMB
1. Which of the following nerves innervates at least one muscle that acts on both
the hip and knee joints?
a) Ilioinguinal nerve
b) Femoral nerve
c) Saphenous nerve
2. In walking, the hip bone of the suspended leg is raised by which of the
following muscles acting on the supported side of the body?
a) Gluteus maximus
b) Obturator internus
c) Gluteus medius
d) Obturator externus
e) Quadratus femoris
a) Superior gamellus
b) Adductor longus
c) Gracilis
d) Psoas
e) Obturator internus
4. Which of the following muscles dorsiflexes the foot at the ankle joint?
a) Peroneous longus
c) Tibialis posterior
e) Tibialis anterior
a) Tibialis anterior
d) Peroneus tertius
e) Tibialis posterior
6. The following facts concerning the dorsalis pedis artery are correct except:
b) It enters the sole of the foot by passing between the two heads of the first
c) It can be palpated on the dorsum of the foot between the tendons of tibialis
e) On its lateral side lies the terminal part of the deep peroneal nerve
a) Semimembranosus muscle
b) Plantaris
c) Biceps femoris
e) Soleus
8. The following structures pass through the greater sciatic foramen except the:
b) Sciatic nerve
d) Pudendal nerve
a) Femoral vein
b) Lacunar ligament
d) Femoral artery
e) Inguinal ligament
10. A femoral hernia descends through the femoral canal, and the NECK of the
hernial sac lies:
11. The following structures pass through the subsartorial canal except the:
b) Saphenous nerve
c) Femoral artery
e) Femoral vein
12. The floor of the femoral triangle is formed by the following muscles except
the:
a) Pectineus
b) Adductor longus
c) Iliacus
d) Psoas
e) Adductor brevis
b) Popliteal artery
d) Arcuate artery
b) It is a hinge joint
c) It is formed by the articulation of the talus and the distal ends of the tibia
and fibula
e) It is a synovial joint
15. "Unlocking" of the knee joint to permit flexion is caused by the action of
which muscle?
a) Vastus medialis
b) Articularis genu
c) Gastrocnemius
d) Biceps femoris
e) Popliteus
16. In the adult, the chief arterial supply to the head of the femur is from the:
b) Obturator artery
17. The lymph drainage of the skin covering the ball of the big toe is into the:
b) Popliteal nodes
d) Axillary nodes
18. The lymph drainage of the skin covering the medial side of the knee joint is
into the:
a) Popliteal nodes
e) Obturator nodes
19. The lymph drainage of the skin of the buttock is into the:
a) Axillary nodes
d) Popliteal nodes
e) Obturator nodes
b) Ischiofemoral ligament
d) Iliotibial tract
e) Ligamentum teres
22. If the dorsalis pedis artery is severed just proximal to its medial and lateral
tarsal branches, blood can still reach the dorsum of the foot through which of the
following vessels?
23. In children, the chief femoral arterial supply to the head of the femur is
derived from:
a) The opening in the deep fascia of the thigh for the great saphenous vein
b) The opening in the adductor magnus muscle for the femoral artery
25. After a football injury, an orthopedic surgeon noted that the right tibia could
be moved anteriorly with excessive freedom when the knee was flexed. In this
patient, which ligament is most likely to be torn?
e) The neck is related medially to the sharp edge of the lacunar ligament
27. The gastrocnemias and the soleus muscles have all the following features in
common except:
c) They arise from the femoral condyles and flex the knee joint
28. All the following statements about the sartorius are correct except:
29. To lift the left foot off the ground while walking, which of the following
muscles play an important role?
31. A sprained ankle resulting from excessive eversion most likely demonstrates
a torn:
a) Talofibular ligament
b) Tendo calcaneus
c) Deltoid ligament
d) Interosseous ligament
e) Peroneal retinaculum
32. If the foot is permanently dorsiflexed and everted, which nerve might be
injured?
33. The femoral nerve arises from the following segments of the spinal cord:
a) L2-3
c) L2, 3 and 4
d) L1 and 2
34. The dermantome present over the lateral side of the foot is:
a) S5
b) L3
c) S1
d) L4
e) L5
35. The following structures are transmitted through the lesser sciatic foramen
except:
36. The femoral sheath is formed by which of the following layer(s) of fascia?
c) The fascia lata and the membranous layer of the superficial fascia
37. The following facts regarding the great saphenous vein are true except:
c) It drains into the femoral vein approximately 1.5 inch (3.8 cm) below and
eminence
40. A patient in the supine position with the hip and knee joints extended is
asked to abduct the lower limb against resistance provided by the physician. This
exercise tests which of the following muscles?
41. The following facts regarding the obturator nerve are true except:
43. After a lesion of the tibial part of the sciatic nerve, some active flexion may
still be possible at the knee joint. The muscles responsible for this remaining
flexion include:
44. Which of the following muscles functions as an internal rotator of the hip:
a) Iliopsoas
b) Sartorius
c) Gluteus medius
d) Obturator externus
e) Gluteus maximus
47. Which of the following does not insert into the planter aspect of the foot?
b) Peroneus tertias
c) Peroneus longus
d) Tibialis posterior
48. Which of the following muscles does not arise from the calcaneus?
c) Flexor accessorius
e) Abductor hallucis
49. The movement of eversion of the foot takes place at the following joints
except:
a) Subtalar joints
b) Ankle joints
d) Calcaneocuboid joint
a) Inferior gamellus
b) Adductor magnus
d) Gluteus medius
e) Semitendinousus
a) Gets its entire motor innervation from the inferior gluteal nerve
54. Flexion of the knee can be produced by all of the following except:
a) Adductor magnus
c) Gastrocnemius
d) Sartorius
e) Gracilis
55. The cruciate anastomosis of the hip includes all the following arteries except:
c) Inferior gluteal
e) Obturator artery
a) Sural nerve
c) Saphenous nerve
a) Gluteus minimus
c) Both A and B
d) Neither A nor B
58. Muscles of the deep posterior compartment of the leg produce which of the
following?
a) Planter flexion
b) Inversion
c) Both A and B
d) Neither A nor B
59. Short head of biceps femoris is innervated by which of the following nerves:
c) Both A and B
d) Neither A nor B
c) Both A and B
d) Neither A nor B
c) Both A and B
d) Neither A nor B
a) Femoral nerve
b) Obturator nerve
63. Small saphenous vein travels with which of the following nerves?
a) Sural nerve
c) Saphenous nerve
d) Tibial nerve
64. Posterior tibial artery travels with which of the following nerves?
a) Sural nerve
c) Saphenous nerve
d) Tibial nerve
65. Which of the following is involved in arterial anastomosis around the hip
joint?
c) Both A and B
d) Neither A nor B
a) Gracilis
b) Soleus
c) Both A and B
d) Neither A nor B
b) Femoral nerve
c) Both A and B
d) Neither A nor B
a) Contains 3 compartments: each for the femoral artery, vein and nerve
c) Both A and B
d) Neither A nor B
a) Adductor hallucis
d) Fourth lumbrical
b) Peroneal artery
c) Both A and B
d) Neither A nor B
71. Structures traversing the lesser sciatic foramen include all of the following
except:
a) Pudendal nerve
a) Saphenous nerve
b) Popliteal vein
73. The great sciatic foramen transmits all of the following except:
75. Which muscle(s) is capable of producing flexion at one joint and extension at
a second joint?
a) Semimembranosus
b) Rectus femoris
c) Lumbricals of foot
c) Both A and B
d) Neither A nor B
a) Peroneus brevis
b) Peroneus tertias
c) Both A and B
d) Neither A nor B
78. Which of the following is not normally a branch of the profunda femoris
artery?
a) Obturator
c) Both A and B
d) Neither A nor B
80. Position of the popliteal artery relative to the popliteal veins on the popliteal
surface of the femur is:
a) Medial
b) Lateral
c) Posterior
d) Anterior
e) Supeior
81. Position of the common peroneal nerve relative to the tendon of the
semitendinosus in the popliteal fossa:
a) Medial
b) Lateral
c) Posterior
d) Anterior
e) Superior
a) Ilioinguinal nerve
b) Femoral nerve
c) Obturator nerve
e) Genitofemoral nerve
d) Both A and B
a) Gluteus maximus
b) Gluteus medius
c) Both A and B
d) Neither A nor B
b) Begins midway between anterior superior iliac spine & pubic symphisis
d) Is used in cannulation
90. Which of the following muscles is attached to both tibia and fibula:
a) Tibialis posterior
b) Popliteus
d) Both B and C
91. Select the false statement regarding deep muscles of the calf:
92. The short muscles of the first layer of the sole are:
b) Abductor hallucis
93. The muscles of the first layer of the sole are innervated by:
c) Both A and B
d) Neither A nor B
a) Popliteus
b) Semimembranosus
c) Both A and B
d) Neither A nor B
a) Spring ligament
b) Navicular bone
c) Cuboid bone
d) Both A and B
b) Biceps femoris
c) Both A and B
d) Neither A nor B
97. All of the following lie within the femoral triangle except:
a) Femoral nerve
c) Obturator nerve
e) Pectineus muscle
99. The only artery to enter the lesser sciatic foramen is the:
a) Sciatic artery
c) Obturator artery
100. Which of the following muscles does NOT receive its blood supply from
branches of the internal iliac artery:
a) Gluteus maximus
b) Superior gamellus
c) Vastus lateralis
d) Iliacus
e) Piriformis
101. The principal blood supply to the posterior compartment of the thigh comes
directly from:
a) Femoral nerve
b) Tibial nerve
e) Obturator nerve
103. The femoral sheath is formed by which of the following layer(s) of fascia?
c) The fascia lata and the membranous layer of the superficial fascia
104. Which of the following statements about the femoral nerve is false?
d) It supplies sensory innervation to the medial side of the leg and foot via the
saphenous nerve
105. The femoral artery passes from the anterior side of the thigh to the back of
the knee where it becomes the popliteal artery. It passes through an opening:
107. Which of the following muscles does not cross the knee joint?
a) Semimembranosus
b) Semitendinosus
c) Gracilis
d) Sartorius
e) Adductor magnus
c) Anterior drawer
d) Posterior drawer
a) Femoral nerve
b) Tibial nerve
e) Obturator nerve
110. Which muscle(s) is/are capable of producing flexion at one joint and
extension at a second joint?
a) Semimembranosus
b) Rectus femoris
c) Vastus medialis
d) Both A and B
e) Both B and C
c) Both A and B
d) Neither A nor B
a) Medial rotation
b) Adduction
c) Both A and B
d) Neither A nor B
114. Which of the following would not be a good example for demonstration of
the ligamentous action (passive insufficiency) of muscles?
a) Semimembranosus
b) Semitendinosus
c) Soleus
d) Rectus femoris
b) Lies between tibialis anterior and extensor hallucis longus tendons at the
ankle joint
c) Both A and B
d) Neither A nor B
a) Semimembranosus
b) Gluteus maximus
c) Both A and B
d) Neither A nor B
117. Structures which cross the ankle joint posterior to the medial malleolus
include all of the following except:
d) Tibial nerve
a) Nerve to obturator
b) Femoral nerve
c) Obturator nerve
e) Genitofemoral nerve
e) Tibial tuberosity
120. A 25 year old sports man presented with (shin splints) and pain over the
medial calf. What sensory nerve innervates this dermatome?
121. A 55 year old lady had a fall at home. She presented to the casualty with a
shortened, externally rotated leg. She was told after taking x-rays that she had
subtrochanteric fracture of the proximal femur. Which of the following is correct
regarding the position of the proximal fragment:
124. All of the following nerves innervate the flexors acting on the knee joint
except :
b) Femoral nerve
c) Obturator nerve
d) Tibial nerve
125. All of the following are innervated by branches of the femoral nerve except:
a) Sartorius
b) Gracilis
c) Rectus femoris
d) Vastus medialis
e) Pectineus
126. Structures within the adductor (subartorial ; Hunter's) canal include all of
the following except:
a) Femoral artery
c) Saphenous nerve
a) Proximal part runs between first and second muscular layers of the foot
b) Distal part runs between second and third muscular layers of the foot
c) Small saphenous vein pierces its roof to enter the popliteal vein
130. Which of the following ligaments attaches to the navicular and calcaneus?
e) Spring ligament
131. A blow to the head of the fibula is likely to result in damage to which nerve?
a) Tibial
b) Femoral
c) Saphenous
d) Common peroneal
e) Sural
132. Which of the following is not a major weight bearing bone in the lower
limb?
a) The femur
b) The talus
c) The calcaneus
d) The tibia
e) The fibula
133. The femoral artery passes from the anterior compartment of the thigh to the
posterior aspect of the knee through which of the following gaps?
135. Contents of the femoral triangle include all of the following except:
c) Femoral canal
d) Femoral sheath
e) Obturator nerve
a) Tibialis anterior
b) Tibialis posterior
137. Which of the following is/are not attached to the ischial tuberosity:
b) Adductor magnus
c) Semitendinosus
d) Inferior gemellus
b) The buttock
d) The scrotum
e) The testes
a) The lumbricals, which arise from the tendons of flexor digitorum brevis, lie
b) Both flexor digiti minimi brevis and longus are innervated by the lateral
plantar nerve
e) The tendon of tibialis posterior is inserted into the base of the talus
a) Include tibialis anterior which arises from the lateral aspect of the
upper
fibula
nerve
a) Receives a large portion of its blood supply from the artery in the ligament
c) Receives a branch of the femoral nerve via the nerve to the quadratus
femoris
d) Receives blood via the trochanteric anastomosis which is derived from both
gluteal and both circumflex femoral arteries
e) Is a site of direct contact between the femoral vessels and the capsule of the
joint anteriorly
a) Deltoid ligament
b) Calcaneofibula ligament
b) Contains the motor fibers for all the intrinsic plantar muscles of the foot
c) Both A and B
d) Neither A nor B
144. The cruciate anastomosis of the hip joint receives a primary contribution
from all of the following arteries except:
c) Inferior epigastric
d) Inferior gluteal
a) Femoral nerve
b) Obturator nerve
d) Both A and B
b) Popliteal nodes
d) Axillary nodes
148. Foot drop is a condition in which the patient is unable to dorsiflex the foot at
the ankle; the plantar flexor muscles are unopposed. This condition could be
caused by trauma to:
c) Sural nerve
d) Tibial nerve
e) Saphenous nerve
EMBRYOLOGY
a) Cytotrophoblast
b) Syncytiotrophoblast
c) Both A and B
d) Neither A or B
d) Tight junctions appear between cells at the periphery, isolating the inner
d) Implantation is completed
d) Both A and B
6. Which of the following is/are normally always interposed between fetal and
maternal blood:
a) Extraembronic mesoderm
c) Syncytiotrophoblast
d) Both A and B
a) Syncytiotrophoblast
b) Cytotrophoblast
d) Both A and B
a) Menstral phase
10. Lines in the chorionic after the third developmental week is:
a) Cytotrophoblast
b) Syncytiotrophopblast
c) Both A and B
d) Neither A nor B
a) Cytotrophoblast
b) Syncytiotrophoblast
c) Both A and B
d) Neither A nor B
c) Both A and B
d) Neither A nor B
13. The extraembryonic membrane which contributes the most tissue to the
formation of the placenta is the:
a) Amnion
b) Chorion
c) Yolk sac
e) Decidua
14. The extraembryonic epiblast gives rise to or contributes cells to which of the
following germ layers?
a) Ectoderm
b) Mesoderm
c) Endoderm
d) Both A and B
c) Both A and B
d) Neither A nor B
17. Meiosis is completed within the gonads during gametogenesis in which sex?
c) Both A and B
d) Neither A nor B
a) Before fertilization
b) After fertilization
c) Both A and B
d) Neither A nor B
a) Embryo/fetus
c) Deciduas
d) Both A and B
c) Hormone production
d) Gas exchange
a) Before ovulation
b) At fertilization
c) After ovulation
d) Prenatally
e) At puberty
b) Chorionic Gonadotrophin
c) Estrogen
d) Both A and B
23. The most common site for implantation in ectopic pregnancy is the::
b) Mesentary
c) Ovary
d) Oviduct
d) Both A and B
d) Suffer from atretion until only approximately 40, 000 are left at puberty
26. Trophoblast and inner cell mass portions are evident in the:
c) Both A and B
d) Neither A nor B
27. At fertilization:
b) Cleavage is initiated
a) Dermatomes
b) Myotomes
c) Sclerotomes
d) Endothelium
e) Yolk sac
d) Both A and B
a) Proliferative phase
b) Secretory phase
c) Menstral phase
d) Both B and C
a) Female gametes
b) Male gametes
c) Both A and B
d) Neither A nor B
32. Which of the following determines the genetic sex of the zygote?
a) Female gametes
b) Male gametes
c) Both A and B
d) Neither A nor B
a) Cytotrophoblast
b) Syncytiotrophoblast
c) Both A and B
d) Neither A nor B
c) The blastocele
36. At the time of the first missing menstral period, the conceptus is:
a) 3 days old
b) 5 days old
c) 3 weeks old
d) 5 weeks old
37. Primary oocytes have developed by the time of birt. From puberty to
menopause, these germ cells remain suspended in the meiotic prophase. The
oocyte of a mature follicle is induced to undergo the first meiotic division just
prior to ovulation as a result of which of the following hormonal stimuli:
38. By the 4th day of development, fluid accumulation by the morula results is
separation of the cells into trophoblasts and embryoblasts, or inner cell mass.
From the 8th-12th day of development, the role of trophoblasts includes all of the
following except:
d) Production of hormones
39. A 26 year old man had viral influenza with fever 39.5o for 3 days. Since
spermatogenesis cannot occur above a scrotal temperature of 35.5 o, he was left
with no viable sperm on his recovery. The time required for spermatogenesis,
spermiogenesis, passage of a viable sperm to the epididymis is approximately:
a) 3 days
b) 1 week
c) 5 weeks
d) 2 months
e) 4 months
40. A 25 year old female states that she has a very regular menstrual cycle that is
24 days in length. The projected time of ovulation for this woman would be
about the:
41. The chorionic villi of the placenta are most numerous in the region of the:
a) Decidua capsularis
b) Chorionic plate
c) Basal plate
d) Maternal septae
e) Decidua basalis
42. The following list contains components of the "placental barrier" during the
first trimester of pregnancy. Which one component is disappearing during late
pregnancy?
b) The cytotrophoblast
c) The syncytiotrophoblast
43. All of the following placental transport mechanism require the expenditure of
cellular energy except:
a) Active transport
b) Pinocytosis
c) Simple diffusion
d) Facilitated diffusion
44. A full-term male infant has vomited 1 hour after suckling. There has been
failure to gait during the first 2 weeks postnatal. The vomitus is not bile-stained
and no respiratory dilation is evident. Wxamination reveals an abdomen neither
tense nor bloated. The most probable explaination is:
b) Duodenal atresia
d) Imperforate anus
e) Tracheo-esophageal fistula
45. A fistula is found that runs between the palatine tonsil fossa and the skin of
the neck immediately anterior to the sternocleidomastoid muscle. Developmetal
failure occured:
a) With a rupture of the tissue between the third branchial cleft and third
pharyngeal pouch
d) Both A and B
a) The ductus arteriosus carries blood from the aorta to the pulmonary trunk
b) The foramen ovale carries blood from the right atrium to the left atrium
c) The umbilical vein carries blood from the umbilical cord via the ductus
d) Implantation is completed
47. Regarding the blastocyst all the following are true except:
c) Has syncytotrophoblast
48. Derivatives of the mesodermal cell layer of the embryo include all the
following except:
a) Adrenal cortex
b) Gonads
c) Peritoneal serosa
d) Spleen
e) Liver parenchyma
49. In the developing embryo, the first bone to begin ossification is the:
a) First rib
b) Humerus
c) Tibia
d) Scapula
e) Clavicle
a) Pulmonary stenosis
b) Aortic overrinding
a) Septum transversum
c) Thyroglossal canal
d) Pulmonary mesenchyme
e) Foregut
52. In the developing pancreas, the dorsal bud contributes all the following
except:
d) Uncinate process
a) Body wall
b) Primitive mesoesophagus
c) Septum transversum
d) Pleuro-pericardial membrane
e) Pleuro-peritoneal membrane
d) Both A and B
a) Cloaca
b) Allantois
c) Urogenital sinus
d) Hindgut
e) Mesonephric duct
a) Neural ectoderm
b) Surface ectoderm
c) Mesoderm
d) Endoderm
a) Hemiazygos vein
b) Coronary sinus
c) Ligamentum arteriosum
d) Ligamentum venosum
a) Endoderm
b) Mesoderm
c) Ectoderm
e) They develop from the 3rd and 4th pharyngeal arches (pouches)
61. In which of the following is precursor cell mitosis evident after puberty:
a) Female gametes
b) Male gametes
c) Both A and B
d) Neither A nor B
a) Branchial arch I
b) Branchial arch II
d) Branchial arch IV
a) Vertebral centrum
c) Both A and B
d) Neither A nor B
c) Intramembranous in origin
d) Both A and C
a) Pharyngeal pouch 1
b) Pharyngeal pouch 2
c) Pharyngeal pouch 3
d) Pharyngeal pouch 4
a) Pharyngeal pouch 1
b) Pharyngeal pouch 2
c) Pharyngeal pouch 3
d) Pharyngeal pouch 4
68. During the third to sixth months of pregnancy, the structure primarily
responsible for erythropoiesis is the:
a) Bone marrow
b) Liver
c) Spleen
d) Thymus
e) Yolk sac
69. Structures derived from the hind gut in the male include all the following
except the:
a) Allantois
b) Descending colon
d) Prostatic urethtra
e) Urinary bladder
70. With regard to the formation of the placenta all of the following are false
except:
a) Tertiary chorionic villi differ from primary chorionic villi by the presence
of blood vessels
d) The deciduas basalis and the chorion leave constitute the placenta
e) The umbilical cord contains a loose connective tissue called Wharton's jelly
71. The endocardial cushions are involved in the formation of all of the following
except:
b) Pectinate muscles
c) Atrioventricular valves
72. Which of the following is the most common type of congenital heart
malformation?
a) Dextrocardia
c) Ectopic cordis
73. The adult left atrium is derived embryologically primarily from the:
c) Sinus venarum
d) Bulbus cordis
74. The primitive aortic arch pattern is transformed into an adult arterial
arrangement. Which pair of arteries (embryonic/adult) is incorrect:
76. All of the following are true concerning development of the bronchi except:
a) Lung buds first form at the caudal end of the laryngotracheal tube
b) During the 5th week of development, the lung bud grows laterally into the
d) The pulmonary cartilage, smooth muscle, and connective tissue are derived
from the lung bud endoderm
c) Both A and B
d) Neither A nor B
78. The definitive diaphragm is formed by fusions of all except one of the
following:
a) Mesoesophagus
b) Septum transversum
c) Pleuroperitoneal membranes
a) Muscles of mastication
c) Both A and B
d) Neither A nor B
80. The embryonic epiblast gives rise to or contributes cells to which of the
following germ layers?
a) Ectoderm
b) Mesoderm
c) Endoderm
d) Both A and B
81. Gonia cells produced during gametogenesis are usually present in 65-year old
individuals of which sex:
c) Both A and B
d) Neither A nor B
83. Epithelium of the tongue posterior to the sulcus terminals is derived from
the:
a) Pharyngeal pouch I
b) Pharyngeal pouch II
d) Pharyngeal pouch IV
a) Branchial arch I
b) Branchial arch II
d) Branchial arch IV
tongue
c) Both A and B
d) Neither A nor B