1.

Regarding pentose phosphate pathway:

a. NAD is used as a coenzyme

b. Is an alternative pathway for glucose oxidation that releases energy

c. Its metabolic error causes essential pentosuria

d. Glucose-6-phosphate catalyzes the commited step

e. Produces pentoses required for synthesis of nucleic acids

2. In the fed state:
f. Blood level of insulin level drop.
g. Glycogen synthesis is inhibited.
h. Both hormone sensitive lipase
i. Gluconeogenesis is inhibited.
j. Liprotein lipase is activated
3. Ketone bodies:
k. Can be used as an energy substrate for the liver F
l. Are formed in various tissues F
m. Can be transformed to glucose F
n. Can be oxidized to CO2 and water T
o. Are preferred to be used by the heart T
4. Concerning cholesterol biosynthesis:
p. Eight isoprene units are required.
q. The rate of synthesis is controlled by the rate of production of HMG-CoA.
r. Oxygen is incorporated into the molecule at the C-17 position.
s. NADPH is required for the formation of HMG-CoA.
t. HMG-CoA reductase is down-regulated by cholesterol.
5. Purine and pyrimidine nucleotides can be used
u. As nucleoside triphosphates for nucleic acid synthesis T
v. In energetic metabolism of cells T
w. For activation of metabolic intermediates of saccharides and lipids T
x. In enzymatic reactions: some coenzymes are nucleotides T
y. All of the above are incorrect F
6. Which of the following statements about RNA is incorrect?
z. The kind of RNA which in the free form has the greatest percentage of specific, tertiary
structure is mRNA. F
aa. rRNA binds with phospholipids to form ribosomal subunits. F
bb. tRNA molecules are relatively small, generally containing less than 100 nucleotides. T
cc. Like DNA, RNA is animal cells is often found in double-stranded, duplex structures. F
dd. RNA, in contrast to DNA, is found only in the cytoplasm of cells. F
7. Frameshift mutations demonstrate that:
ee. The DNA code is a triplet T

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 ff. The DNA code has no commas T
gg. Most codons do not specify an amino acid F
hh. There is an intermediate molecule, mRNA F
ii. None of the above F

8. The following is /are true regarding diabetes mellitus in children:

a. Type 1 is autoimmune. T
a. Type 2 never occur in children F
a. Hyperglycemia impairs immunity. T
a. Can present with failure to thrive. T
a. Insulin is not required in the management. T
9. Aldosterone:
a. Is secreted by zona glomerulosa of adrenal medulla F
a. Secretion is stimulated by hyperkalemia T
a. Increases sodium reabsorbtion in the kidney by increasing EnaCs T
a. Secretion is inhibited by high level of ACTH F
a. Acts via cAMP as a second messenger F
10. T4:
jj. synthesis steps take place inside the thyroid cells F
kk. has more affinity to albumin than TBG T
ll. has membrane receptors F
mm. increases β1 receptors in the heart T
nn. is a precursor for T3 T
11. Glucagon:
oo. Is a glycoprotein hormone F
a. Is diabetogenic hormone T
a. Causes glycogenolysis in both liver and muscles F
a. Increases cardiac muslce contractibility T
a. Causes lipogenesis by inhibiting the hormone-sensitive hormone F
12. The following are endocrine cuteneous manifestions of preganancy:
a. Herbes simplex
a. Chloasma
a. Aalopecia areata
a. Striae distensae
a. Necrobiosis lipoidica
13. The pancreas:
a. Is a pure endocrine gland.F
a. Lies in contact with anterior abdominal wall.F
a. Has two pancreatic ducts.T
a. Secretes enzymes only F
a. Its head is surrounded by duodenum.
14. The parathyroid glands:
pp. Are two in number F
qq. Lie posterior to the thyroid lobesT
rr. their functional units are called parathyroid follicles F

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 ss. are supplied by the superior parathyroid arteries T
tt. each one measures 15 mm in length .T

15. Micro-adenoma of pituitary gland

a) MRI T
b) CT T
c) U.S F
d) X ray F
e) None of the above F
16. Regarding type 1 diabetes:
uu. It is caused by autoimmune destruction of B cells.
vv. It constitutes 90% of diabetic patients.
ww. It is caused by drugs as corticosteroids.
xx. It is more common among children.
yy. It is due to severe insulin deficiency.
17. The following is /are common malignant tumors of the thyroid:

zz. Nodular goiter

aaa. Papillary carcinoma.

bbb. Follicular carcinoma.

ccc. Medullary carcinoma.

ddd. Toxic nodule

18. Which of the following is associated with vitiligo?

a. Thyrotoxic Graves's disease T
a. Cushing's syndrome F
a. Type 2 diabetes mellitusF
a. Diabetes insipitus F
a. Acromegaly F
19. All of the following occur in humans except:

eee. Serine cysteine

fff. Homocysteinemethioneine

ggg. Phenylalanine tyrosine

hhh. Argininearginine phosphate

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 iii. Proline glutamate

20. For the following amino acids:

A. aspartate D. leucine

B. methionine E. valine

C. glutamate

jjj. Amino acids A and B are glucogenic

kkk. Amino acids B, C and D are essential

lll. Amino acid D is exclusively ketogenic

mmm. Amino acid C is degraded to pyruvate after transamination

nnn. Amino acid E is catabolized to succinyl CoA

Student's Name: Index No.

Section B: Choose one best answer

1. Prostaglandins:
ooo. Are endocrine hormones
ppp. Are synthesized from palmitic acid
qqq. Enhance smooth muscles contraction
rrr. Are involved in control of inflammation and blood pressure
sss.Both C and D are correct
2. All of the following apply to hormones except:
ttt. Paracrine effect
uuu. Endocrine effect
vvv. Autocrine effect
www. All require second messengers
xxx. Mediate their effect by binding to specific receptors
3. Restriction endonucleases:
a. Digest DNA duplex molecules from the 5'-OH ends
a. Attack only single stranded DNA.
a. Have base sequence specificity for palindromes. T
a. Digest double stranded DNA molecules randomly.
a. Can only act on DNA-RNA double helices.
4. A class of molecules that recognizes codons is:

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 yyy. Ribosome
zzz.mRNA
aaaa. Restriction endonuclease
bbbb. tRNA
cccc. Amino acid
5. Regarding Cushing syndrome, the following are true except:
dddd. Truncal adiposity
eeee. Thin extremities
ffff. Moon face
gggg. Purplish striae
hhhh. hypotension
6. Insulin:
a) Is secreted only by D cells of the pancreas
b) Is a hyperglycemic hormone
c) Is essential for life
d) Secretion is stimulated by gastric inhibitory hormone
e) Secretion is controlled by anterior pituitary gland
7. Oxytocin:
a) Mainly secreted by supra-optic nucleus in the hypothalamus
b) Is needed for milk production in early pregnancy
c) Is the efferent pathway of suckling reflex
d) Stimulated by alcohol ingestion
e) Its secretion decreases during late pregnancy

8. In thyrotoxicosis:
iiii. Arrhythmias are uncommon in elderly patients
jjjj. Radioactive iodine is the most effective treatment
kkkk. Graves disease is usually associated with a big goiter
llll. Secondary thyrotoxicosis is caused by thyroid-stimulating antibodies
mmmm. Surgery is the first line of treatment
9. In Graves' disease, the most prominent feature is:
a. Exophalmus
a. Tachycardia
a. Cardiomegaly
a. Congestive heart failure
10. The thyroid gland:
a) Is a mixed gland
nnnn. Lies at the base of the mouth
oooo. Has two lobes T
pppp. Is related anteriorly to the parathyroid glands
qqqq. Secretes thyroxin hormone only
11. A 30 year old lady was found to have high serum calcium of 12mg/dl during investigation of
fracture right radius from a minor fall. X-ray of the bones showed osteoporosis. Serum
phosphate was low and alkaline phosphatase was high. Renal function test was normal. TSH
levels and liver function tests were also normal. The most important next investigation for this

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patient is:
a) 25-hydroxyvitamin D
b) Serial measurements of serum calcium
c) Parathyroid hormone level
d) CT chest, abdomen and pelvis to screen for malignancy
e) Serum cortisol
12. A 40 year old lady is referred to the endocrinology clinic for evaluation of a single 4X4cm
nodule in the right lobe of the thyroid. She has her cervical lymphadenopathy. She is clinically
euthyroid and her thyroid functions are normal. The most important investigation to rule out
malignancy of this nodule is:
rrrr. Thyroid ultrasound
ssss. Observe and review after six months to see if the nodule grows in size
tttt. Fine needle aspiration cytology
uuuu. Suppression with thyroxin
vvvv. Thyroid antibodies measurement
13. A 40 year old woman presented with a 3 month history of increased sweating, feeling warm all the
time and loss of 6 kg over this period. On examination she had a pulse rate of 110/ minute, regular,
warm moist hands and five finger tremors. The thyroid gland was not palpatable. Blood pressure
=130/70.
The most likely diagnosis for this patient is:
wwww. Pheochromocytoma
xxxx. Severe anxiety
yyyy. Thyrotoxicosis
zzzz. HIV disease

14. In a patient with Graves' hyperthyroidism which of the following laboratory data is correct?
aaaaa. Increased TSH, increased FT4, increased FT3
bbbbb. Decreased TSH, increased FT4, increased FT3
ccccc. Normal TSH, increased FT4, increased FT3
ddddd. Normal TSH, decreased FT4, decreased FT3
eeeee. Normal TSH, normal FT4, and normal FT3
15. An obese woman (BMI=38 kg /m2) has high triacylglyceride level with normal cholesterol. The best
treatment for this patient is:
fffff. Bile acid binding resins
ggggg. Nicotinic acid
hhhhh. Weight reduction through diet and exercise
iiiii. Genfibrozil
16. A 25 year old lady presents with polyuria and polydepsia of sudden onset for the last three months.
Her fluid intake has been in the range of more than four litres per day and her urine volume has been
more than three litres. She keeps a bottle of water beside her bed when she goes to sleep. She is not
taking diuretics. Random blood sugar is 155mg/dl. She has normal renal function. Serum calcium is
normal as well as potassium. She is happily married and has no psychological stress. The next most
important investigation for this patient is:
jjjjj.Cranial CT scan
kkkkk. Psychatric evaluation

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 lllll. Thyroid function test
mmmmm.Water deprivation test - measuring urine and plasma osmolality
nnnnn. Serum magnesium
17. Which of the following is a cause of secondary hypertension?
a. Sheehan's syndrome
a. Diabetes insipidus
a. Primary hyperparathyroidism
a. Simple goiter
a. Addison's disease
18. Which of the following is a known precipitating factor of diabetic ketoacidosis?
a. Pneumonia
a. Omission of meal
a. Elevation of blood pressure
a. Use of angiotensin-converting enzyme inhibitor
a. Weight gain
19. Which of the following is compatible with the diagnosis of obesity?
a. Body mass index of 15 kg/m2
a. Body mass index of 20 kg/m2
a. Body mass index of 24 kg/m2
a. Body mass index of 28 kg/m2
a. Body mass index of 32kg/m2
20. Retro-sternal goiter is better assessed by:
a) U.S
b) Plain x-ray
c) MRI
d) CT
e) Isotope scan
Student's Name: Index No.

Section C ( 15 marks )

Q1: Fill in the blanks with the suitable word from the list below.
Each answer may only be used once.
LCAT Apo B-100 Apo B-48 Apo CII Taurocholate Lovastatin

_______________________a bile salt

______________________ activates lipoprotein lipase

______________________VLDL's are initially made with this protein

________________________chylomicrons are initially made with this protein

_______________________extracellular enzyme esterifying cholesterol

___________________________ inhibits cholesterol biosynthesis

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Q2: Ahmed is an obese doctor. He came to the clinic suffering from severe pain in his knee joint
and big toe. On examination there are signs of inflammations in the joint.
Laboratory investigation revealed the following:
Uric acid level 13mg/dl.
A. What is the diagnosis?
………………………………………………………………………………………………
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B. Give two causes of the above condition:
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C. How can we treat this patient?
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Q3: Gluoneogenesis is the synthesis of glucose for non carbohydrate source.
A. Mention four substrates for synthesis of glucose.
1/…………………………… 2/………………………………..
3/ …………………………… 4/………………………………..
A. Explain briefly how can an exercising muscle synthesizes glucose from excess lactate
( Aid your answer with a diagram)
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................ Student's Name: Student's Name: Index No.

Section D (10 marks)

Problem 1
A 30 year old lady is referred to the endocrinology clinic where she presented to the obstetric clinic
for investigation of infertility. She is married for 5 years and has not been able to conceive. Her
periods have been irregular for three years and for the last six months she did not have any period.
She is not on any drug. Physical examination was normal apart from milk discharge from both
breasts.
2. What is the most likely diagnosis of this patient?
…………………………………………………………………………………………………...
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3. What are the most important two investigations you should order to confirm the diagnosis?
a) ………………………………………………………………………………………………...
b)…………………………………………………………………………………………………

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4. What other relevant investigations should he order?
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5. How should this patient be treated?
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