Islamic Republic of Iran

Ministry of Health and Medical Education

Deputy of Education
Secretariat of the General Medical Education Council

Comprehensive Examination
of basic medical sciences

February 2024

Number of questions: 190

Number of pages: 33
Exam time: 200 minutes

Candidate details
Name: ....................................................
Family name: ........................................
Candidate ID number: ............................

Important notes:

- Choose the best option for each question.

- This exam does not have negative mark.
- Before answering the questions, check the exam booklet carefully to
make sure of the correct number of the pages and questions. In case
of any problems, inform the exam proctors; otherwise, no objection
will be accepted after the exam.
Comprehensive Examination of basic medical sciences February 2024

Physiology

1- What is the effect of curare toxin and curare-like drugs on the cell?
a) Inhibition of acetylcholine receptors
b) Opening of acetylcholine-dependent sodium channels
c) Inactivation of acetylcholinesterase enzyme
d) Inhibition of acetylcholine release from the nerve ending

2- In myasthenia gravis, which one is destroyed and which muscles are affected?
a) Myelin sheet - Skeletal
b) Muscarinic receptors - Intestine
c) Nicotinic receptors - Skeletal
d) Nicotinic receptors - Intestine

3- In a patient with multiple sclerosis (MS) in which the neurons lose their surrounding
myelin sheath, which of the following change in the nerve cell leads to a decrease in
signal transmission speed and subsequent muscle paralysis?
a) Increase in intracellular resistance
b) Increase in membrane capacitance
c) Increase in destruction of ion channels
d) Increase in membrane resistance

4- Which option best describes cell structures?

a) Lysosomes are rich in catalase enzymes
b) Peroxisomes contain numerous hydrolytic enzymes
c) Lysosomes have self-replicating properties
d) Glycocalyx can act as a receptor

5- Which of the following items produces fibrin stabilizing factor?

a) Neutrophils
b) Red blood cells
c) Injured endothelium
d) Platelets

6- Which of the following factors is involved in the removal of calcium from the
myocardial cell and the cessation of contraction at the end of the plateau of cardiac
action potential?
a) Voltage-gated calcium channels
b) Calcium - adenosine triphosphatase pump
c) Calcium-sodium channels
d) Calcium-sodium exchanger

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7- How does sympathetic nerve stimulation increase the strength of cardiac contraction?
a) Increases conduction time to the ventricles
b) Decreases ventricular muscle relaxation rate
c) Reduces membrane permeability to potassium
d) Increases membrane permeability to calcium

8- By increasing the velocity of blood flow in the small arteries, the larger blood vessels
dilate. The secretion of which compound is the cause of this phenomenon?
a) Prostaglandin I
b) Bradykinin
c) Nitric oxide
d) Adenosine

9- What happens when the intra-capillary hydrostatic pressure increases?

a) Lymph flow and capillary filtration increase
b) Lymph flow and capillary reabsorption decrease
c) Lymph flow decreases and capillary reabsorption increases
d) Lymph flow and capillary filtration decrease

10- In which of the following cases, the turbulent flow in the vessels increases?
a) Living in high altitude
b) Pregnancy
c) Smokers
d) Pulmonary diseases

11- Marked vasodilation, high cardiac output and sludging of the blood are characteristics
of which type of circulatory shock?
a) Neurogenic shock
b) Anaphylactic shock
c) Septic shock
d) Hypovolemic shock

12- Which of the following choices increased mean circulatory filling pressure:
a) Increased vascular compliance
b) Increased cardiac output
c) Increased blood pressure
d) Blood infusion

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13- In emphysema and pulmonary fibrosis, respectively, what change occurs in the
Respiratory membrane’s diffusing capacity in the lungs compared to a healthy
individual?
a) Increase - Increase
b) Decrease - Decrease
c) Decrease - Increase
d) Increase - Decrease

14- In the lungs, when air intake exceeds 1.5 liters, the Herring-Breuer reflex affects which
center and in what manner?
a) Apneustic - Inhibitory
b) Pneumotaxic - Stimulatory
c) Ventral respiratory group - Stimulatory
d) Dorsal respiratory group - Inhibitory

15- Which one of the following is higher at the apex of the lung than at the base when a
person is standing?
a) Ventilation perfusion ratio (V/Q)
b) Blood flow
c) Ventilation
d) Lung compliance

16- In a patient, most of the ileum has been removed following an accident. The absorption
of which of the following items will be impaired?
a) Vitamin C and folic acid
b) Calcium and iron
c) Vitamin B12 and bile salts
d) Fat-soluble vitamins

17- If the primary peristalsis contractions of the pharynx and esophagus are not performed
in a person (despite the presence of secondary peristalsis contractions in the lower
part of the esophagus in response to the expansion of the esophagus), which of the
following areas is likely destroyed?
a) Cerebral cortex
b) Pharyngeal constrictor muscle
c) Enteric nerves (intrinsic) of the esophageal wall
d) Autonomic nerves related to the esophagus

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18- Which pancreatic protease's function in protein digestion results in the production of
amino acids?
a) Carboxypeptidase
b) Trypsin
c) Chymotrypsin
d) Elastase

19- Which of the following conditions cause hypernatremia with overhydration?

a) Diuretic overdose
b) Diabetes insipidus
c) Excess secretion of ADH
d) Excess secretion of aldosterone

20- An increase in colloid osmotic pressure in renal peritubular capillaries leads to which
of the following response?
a) Increased GFR
b) Decreased GFR
c) Increased urine volume
d) Decreased urine volume

21- At which segment of the nephron is the tubular fluid osmolality always hypotonic?
a) End of proximal tubule
b) Descending loop of Henle
c) Beginning of distal tubule
d) End of collecting ducts

22- Which one reduces the ability of the kidney to concentrate urine?
a) Increased blood flow in the medulla of the kidneys
b) Having a high protein diet
c) Keeping urea in the medulla of the kidney
d) Use of furosemide diuretic

23- By which process, estrogen hormone plays a role in determining the bone mass in
adults?
a) Increase OPG – increase RANKL
b) Increase OPG –decrease RANKL
c) Decrease OPG – increase RANKL
d) Decrease OPG – decrease RANKL

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24- Which of the following items indicates "aldosterone escape" phenomenon?

a) Increased urinary potassium excretion due to decreased plasma pH
b) Decreased urinary hydrogen excretion due to alkalosis
c) Decreased urinary water excretion due to increased arterial osmolality
d) Increased urinary sodium excretion due to increased arterial pressure

25- Increased secretion of which hormone leads to insulin resistance?

a) Somatotropin
b) Thyroxine
c) Aldosterone
d) Somatostatin

26- Which one could reduce subsequent to increased secretion of thyroid hormones?
a) Heart rate
b) Peripheral vascular resistance
c) Arterial pressure
d) Cardiac output

27- Which phase of endometrial cycle is in the time line of follicular ovarian cycle and
which hormone has severe increase during this period?
a) Proliferative- Estrogen
b) Proliferative- Progesterone
c) Secretary- Estrogen
d) Secretary - Progesterone

28- Which of the following factors does not trigger an epileptic seizure in a genetically
predisposed person?
a) Intense emotional stimuli
b) Fever
c) Metabolic acidosis
d) Drugs that stimulate the central nervous system

29- Which of the following occurs in a person with anterograde amnesia?

a) Memory of past events are not remembered.
b) Only the most recent memory is remembered.
c) Consolidation of new information is impaired.
d) Skill memory is impaired.

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30- Complete cut of the spinal cord at the level of the first lumbar vertebra (L1) leads to
which of the following?
a) Temporary loss of conscious proprioception below the lesion
b) Temporary loss of stretch reflexes under the lesion
c) Permanent loss of voluntary control of movement above the lesion
d) Permanent loss of consciousness above the lesion

31- If the cerebellum is damaged, which of the following symptoms is seen?

a) Resting tremor
b) Sudden flailing movements of a limb
c) Muscle hypertonia
d) Speech disorder

32- In case of damage to the optic chiasm, which part of the visual field cannot be seen?
a) Temporal (peripheral) vision of both sides
b) Nasal vision (central) of both sides
c) Right temporal vision and left nasal vision
d) Nasal vision on the right and temporal vision on the left

33- Bilateral destruction of the primary auditory cortex leads to which disorder?
a) Inability to interpret heard words
b) Disturbance in recognizing the direction of sound
c) Inability to recognize the pattern and tone of the voice
d) Complete deafness of both ears

34- In the gating of pain by the brain and spinal cord's analgesic system, where does the
block of pain transmission occur?
a) Hypothalamus
b) Reticular formation
c) Dorsal horn of spinal cord
d) Intralaminar nuclei of thalamus

Biochemistry

35- Which condition occurs as a result of anaerobic glycolysis?

a) Metabolic acicdosis
b) Respiratory alkalosis
c) Respiratory acidosis
d) Metabolic alkalosis

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36- The most stable and most regular second structure in proteins are …………..,
respectively.
a) Beta-sheet, Turns
b) Alpha-helix, Alph-helix
c) Loops, Beta-sheet
d) Turns, Alpha-helix

37- Which of the following compound is a sialic acid?

a) N-acetylneuraminic acid
b) 6-deoxy-L-galactose
c) L-Fucose
d) 6-deoxy-L-Mannose

38- In which types of inhibition, the structure of the inhibitor is similar to the substrate?
a) Competitive
b) Non-competitive
c) Un-competitive
d) Irreversible

39- Aspirin as a non-steroidal anti-inflammatory drug inhibits activity of wich enzyme.

a) Amylase
b) Lipase
c) Kinase
d) Cyclooxygenase

40- Which compound blocks oxidative phosphorylation by blocking the flow of protons
through ATP synthase?
a) Antimycin A
b) Oligomycin
c) Atractyloside
d) Dimercaprol

41- Which one of the following statements is NOT CORRECT at high altitude condition?
a) Increase in the number of erythrocytes
b) Increase in the concentration of hemoglobin
c) Increase in the synthesis of 2,3-bisphosphogylcerate
d) Increase in the affinity of hemoglobin for O2

42- Which one is the allostric modulator of Phosphofrucokinase-I (PFK-1) enzyme?

a) NADH
b) Glucose-6-P
c) Idoacetamide
d) Citrate

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43- In gluconeogenesis pathway lactate makes which subestence as a first intermediate to

make glucose.
a) Pyruvate
b) Oxaloacetate
c) Malat
d) Glucose-6-P

44- How much is the energy yield of glycolysis in the mature red blood cells in term of ATP
molecules?
a) 2
b) 4
c) 36
d) 38

45- Which glycogen storage disease is manifested by muscle weakness, myalgia, and heart
failure related death in children?
a) Pompe
b) Andersen
c) Von Gerke
d) McArdle

46- Disruption in production of which subestence is the cause for susceptibility to the
oxidative agents in Favism.
a) NADH
b) FADH2
c) NADPH
d) Coenzyme A

47- Which fatty acids catabolism is impaired in zellweger syndrome?

a) Short chain fatty acids
b) Medium chain fatty acids
c) Very-long chain fatty acids
d) Branched chain fatty acids

48- Which lipoprotein play key role in the reverse cholesterol transport?
a) LDL
b) IDL
c) VLDL
d) HDL

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49- Deficiency of the enzyme xanthine oxidase leads to:

a) Hypouricemia
b) Hyperuricemia
c) Hypoammonemia
d) Hyperammonemia

50- Which enzymes have a role in conversion of phenylalanine to tyrosine amino acid?
a) Tyrosine hydroxylase and dopa hydroxylase
b) Phenylalanine hydroxylase and Dihydrobiopeterin reductase
c) Phenylalanine hydroxylase and tetrahydrobiopeterin reductase
d) Phenylalanine hydroxylase and tyrosine oxidace

51- Which enzyme defect in the urea cycle lead to hyperammonemia type 2?
a) Carbamoyl phosphate synthetase I
b) N-Acetylglutamate synthetase
c) Ornithine permease
d) Ornithine transcarbamoylase

52- POMC is not as a precursor for which option?

a) ACTH
b) a-LPH
c) b-MSH
d) b-ENDROPHIN

53- Activity of the hormone-sensitive lipase (HSL) is decreased by which of the following
hormones?
a) Insulin
b) Glucagon
c) Cortisol
d) Adrenaline

54- Uroporphyrinogen decarboxylase deficiency leads to which of the following diseases?

a) Congenital erythropoeitic porphyria
b) Porphyria cutanea tarda
c) Hereditary coproporphyria
d) Acute intermittent porphyria

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Bacteriology

55- Which of the following choices is true about antimicrobial effect of ultra violet (UV)
radiation?
a) Ionizes water to free radicals that damage DNA molecules.
b) Has high penetrating power on subjects.
c) Causes protein denaturation.
d) Causes thymine-thymine dimers on the DNA strands.

56- Which of the following characteristics is true about the capsule of bacteria?
a) Its composition is often protein.
b) It exists often in Gram positive bacteria.
c) It is used in the serotyping of some bacteria
d) It is used as a target of antibiotics.

57- The most antigenic variation is observed in which of the following bacteria?
a) Treponema pallidum
b) Staphylococcus aureus
c) Borrelia recurrentis
d) Leptospira interrogans

58- Which of the following streptococci is the most common agent of neonatal meningitis?
a) Streptococcus mutans
b) Streptococcus agalactiae
c) Enterococcus faecalis
d) Streptococcus bovis

59- Which of the following antimicrobial agents is a "high-level disinfectant"?

a) Glutaraldehyde
b) Isopropanol
c) Triclosan
d) Benzalkonium chloride

60- To detect infection with which microorganism, IFN-γ release assays (IGRAS) test is
used?
a) Helicobacter pylori
b) Corynebacterium diphtheriae
c) Mycobacterium tuberculosis
d) Nocardia asteroidies

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61- Which of the following microorganisms mimics appendicitis symptoms in children?

a) Yersinia enterocolitica
b) Escherichia coli
c) Salmonella typhi
d) Enterobacter cloacae

62- Which antibiotic is effective in the treatment of infections due to Mycopalsma spp?
a) Clarithromycin
b) Penicillin
c) Vancomycin
d) Bacitracin

63- "Condylomata lata" is observed in which of the following infectious diseases?

a) Lyme
b) Syphilis
c) Weil
d) Granuloma inguinal

64- Which of the following antibiotics is narrow-spectrum?

a) Tetracycline
b) Gentamicin
c) Meropenem
d) Vancomycin

65- "Invasion, intracellular replication, and cell-to-cell spread" are common features in the
pathogenesis of which bacteria?
a) Salmonella - Mycobacterium
b) Shigella - Listeria
c) Francisella - Yersinia
d) Legionella - Brucella

66- Which of the following bacteria does not cause bacteremia and the toxin is the main
factor of its pathogenesis?
a) Corynebacterium diphtheria
b) Pseudomonas aeruginosa
c) Haemophilus influenzae
d) Chlamydia pesittaci

67- Which of the following bacteria has a conjugate vaccine?

a) Mycobacterium tuberculosis
b) Neisseria meningitides
c) Clostridium tetani
d) Bordetella pertussis

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68- Which of the following bacteria has a short common period?

a) Staphylococcus aureus
b) Salmonella entritidis
c) Clostridium perfringens
d) Campylobacter jejuni

69- Which of the following test is a non-invasive method for detection of Helycobacter
pylori infection?
a) Pathology
b) Faecal antigen
c) Culture
d) Rapid ureases

Parasitology

70- Regarding Trichomonas vaginalis, which one of the following is more accurate?
a) The drug of choice for trichomoniasis is metronidazole.
b) Trichomonas vaginalis is acquired by contact with the cysts of the organism during sexual
intercourse.
c) Trichomoniasis detection method is based on serological tests.
d) There is no need to treatment of asymptomatic sex partner

71- What is the usual method of diagnosing visceral leishmaniasis, also known as Kalazar
disease, in Iran?
a) IHAT (Indirect hemagglutination test)
b) ELISA (Enzyme-linked immunosorbent assay)
c) DAT (Direct agglutination test)
d) IFA (Immunofluorescence assay)

72- What is the most common organism causing keratitis in soft contact lens users?
a) Naegleria fowleri
b) Acanthamoeba castellanii
c) Entamoeba moshkovskii
d) Dientamoeba fragilis

73- Which drug is effective on hypnozoites of malaria parasites?

a) Chloroquine
b) Amodiaquine
c) Primaquine
d) pyrimethamine

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74- What is the most prevalent cause of death in AIDS patients co-infected with
Toxoplasma gondii?
a) Endocarditis
b) Lymphadenitis
c) Meningitis
d) Encephalitis

75- Which of the following helminthic parasite is recommended to be screen before organ
transplantion?
a) Ancylostoma duodenale
b) Strongyloides stercoralis
c) Trichuris trichiura
d) Ascaris lumbricoides

76- Which of the human intestinal worms causes obstruction?

a) Hymenolepis nana - Trichuris trichiura
b) Dipylidium caninum - Heterophyes heterophyes
c) Strongyloides stercoralis - Trichostrongylus orientalis
d) Taenia saginata - Ascaris lumbricoides

77- Which of the following human diseases is caused by Toxocara canis?

a) Ground itch
b) Visceral larva migrans
c) Cutaneous larva migrans
d) Swimmer’s itch

78- Starry dogs play main role in spread of which following parasitic infections?
a) Taeniasis
b) Fascioliasis
c) Hydatidosis
d) Ascariasis

Entomology

79- 1-Which insect has genal and pronotal comb?

a) Ctenocephalides
b) Xenopsylla
c) Pulex
d) Pediculus

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80- Which insect causes genital pediculosis?

a) Pediculus humanus
b) Phthirus pubis
c) Cimex lectularius
d) Anopheles stephens

Mycology

81- Which of the following Items are correct about the most common clinical symptoms of
endothrix and favusa ringworm respectively?
a) Black dot - gray patch
b) Scutula- black dot
c) Gray patch - scutula
d) Black dot- scutula

82- Which Candida species are more virulent?

a) Candida Albicans
b) Candida Stellatoidea
c) Candida Guillermondii
d) Candida Tropicalis

83- Malnutrition is effective in the occurrence of which mycosis?

a) Candidal enteritis
b) Abdominal-pelvic mucormycosis
c) Disseminated cryptococcosis
d) Esophageal candidiasis

84- What are the main ethiologic agents of Tinea versicolor?

a) Malasessezia obtuza- Malasessezia sympodialis
b) Malasessezia globosa- Malasessezia obtuza
c) Malasessezia furfur- Malasessezia globosa
d) Malasessezia furfur- Malasessezia slooffia

85- Which are "drug of choice" for gastrointestinal mycosis and systemic mycosis?
a) Itraconazole- Clotrimazole
b) Grizeofulvin- Terbinafine
c) Nystatin; 5- Fluorocytosine
d) Nystatin- Amphotericin-B

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Virology

86- Which of the following HBV serologic markers is observed in individuals by recovered
from HBV infection?
a) HBcAb- HBsAg
b) HBsAg- HBsAb
c) HBsAb- HBcAb
d) HBcAg-HBeAb

87- Which of the following types of papillomaviruses are the most common associated
with cervical cancer?
a) HPV-16, 18
b) HPV- 6, 11
c) HPV- 1, 27
d) HPV - 2, 4

88- Which of the following viral vaccines is a live attenuated vaccine?

a) Papilloma virus
b) Rabies
c) Oral polio vaccine
d) Hepatitis A

89- A 3-months-old infant developed a respiratory illness that the pediatrician diagnosed
as bronchiolitis and treated by ribavirin. The most likely cause of infection is?
a) Rhinovirus
b) Adenovirus
c) Human Metapneumovirus
d) Respiratory syncytial virus

90- Which of the following viruses cause retinitis in HIV infected patients with CD4 T cells
count below 200 cells/ micro liter?
a) HHV-8
b) CMV
c) EBV
d) HHV-6

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Anatomy

91- Which of the following tracts is decussate in the medulla oblongata?

a) Rubro - spinal tract
b) Spino - tectal tract
c) Globose – Emboliform-Rubral pathway
d) Cuneate fasciculus

92- The fine touch by which of the following lemnisci?

a) Spinal lemniscus
b) Lat lemniscus
c) Med lemniscus
d) Trigeminal lemniscus

93- Which of the following venous sinus is located on the free border of the Flax cerebri?
a) Sup. petrosal
b) Inf. sagital
c) Transverse
d) Sup. sagittal

94- Which nucleus in thalamus receives the gustatory (taste information)?

a) Medial geniculate body (MGB)
b) Ventral Anterior (VA)
c) Medial dorsal (MD)
d) Ventral posterior medial (VPM)

95- Which of the following nuclei is located in the pons?

a) The motor nucleus of the trigeminal nerve
b) The parasympatethic nucleus of the occulomotor nerve
c) The parasympatethic nucleus of the glossopharyngeal nerve
d) The motor nucleus of ambiguous

96- All of the following structures are located on the medial surface of the cerebral
hemisphere except?
a) calcarine sulcus
b) Lamina terminalis
c) Broca area
d) Supplementary motor area

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97- All of the following items are located on the sphenoid bone, except:
a) Oval foramen
b) Round (rotundum) foramen
c) Jugular foramen
d) Pterygoid or vidian canal

98- Doppler ultrasound shows a 58-year-old man with a common carotid artery aneurysm
and its compressive effect on the Ansa Cervicalis. Which muscle do you think will have
the least dysfunction?
a) Omohyoid. M
b) Sternothyroid. M
c) Sternohyoid. M
d) Geniohyoid. M

99- If the posterior cranial cavity is fractured, which of the structures is likely to be injured?
a) Hypoglossal nerve
b) Vertebral artery
c) Facial nerve
d) Mandibular nerve

100- All of the following elements are adjacent to the anterior surface of the anterior
scalene muscle, except:
a) Deep cervical artery
b) Supraclavicular artery
c) Subclavian vein
d) Phrenic nerve

101- All of the following muscles are innervated by the mandibular nerve trunk, except:
a) Tensor villi palatini
b) Lateral pterygoid
c) Tensor tympani
d) Medial pterygoid

102- After having a palatine tonsillectomy, which of the following nerves has most likely
been injured?
a) Glossopharyngeal nerve
b) Internal laryngeal nerve
c) Lingual nerve
d) Chorda tympani

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103- The scala vestibular and tympanic by which of the following structures separated from
each other?
a) Spiral ligament
b) Vestibular membrane
c) Spiral lamina
d) Basilar membrane

104- The cilliary gangilion receive the parasympathetic fibers from which the following
muscles innervation?
a) Inferior rectus
b) Inferior oblique
c) Medial rectus
d) Superior oblique

105- All of the following anatomical structures traver from the adductor canal except:
a) Profundae femoris artery
b) Femoral artery
c) Nerve of vastus medialis muscle
d) Saphenous nerve

106- Which of the following arterial branches do not participate in cruciform anastomosis?
a) First perforating artery
b) Superior gluteal artery
c) Medial femoral circumflex artery
d) Lateral femoral circumflex artery

107- The lateral meniscus is associated with which of the following muscles tendon?
a) Biceps femoris
b) Semitendinosus
c) Semimembranosus
d) Poptiteus

108- Which of the following muscles the more support the medial longitudinal arch in the
gating?
a) Tibialis posterior
b) Fibularis longus
c) Fibularis brevis
d) Extensor hallucis longus

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109- In the talus neck fracture the avascular necrosis is observed in which part of the bone
mostly?
a) Head of talus
b) Neck of talus
c) Head and the neck of talus
d) The body and posterior surface of the talus

110- Which of the following cutaneous nerves with the penetration into lateral head of the
triceps and deep faciae is subcutaneously nerve?
a) Posterior cutaneous nerve of forearm
b) Posterior cutaneous nerve of arm
c) Lateral cutaneous nerve of forearm
d) Upper lateral cutaneous nerve of arm

111- The which of the following tendon muscle is the main index for finding of the redial
artery palpation?
a) Abductor pollicis longus
b) Palmaris longus
c) Flexor pollicis longus
d) Flexor carpi radialis

112- All of the following muscles are innervated by ulnar nerve except:
a) Palmaris brevis
b) Abductor digiti minimi
c) The second lumbrical
d) The third dorsal interosseous

113- All of the following structures are located on the anterior surface of the right ureter
except:
a) Deodenum
b) Ileocolic vessels
c) Root of mesentery
d) Inferior mesenteric vein

114- Which of the following arteries provide the arterial anastomosis between celiac trunk
and superior mesenteric arteries?
a) Superior and inferior pancraticodeodenal arteries
b) Right and left gastric arteries
c) Right and left gasteroepipeloic arteries
d) Middle and left colic arteries

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115- Which of the following structures are participate in the formation of the superior and
posterior wall of the inguinal canal?
a) Transverse abdomens muscles
b) Internal oblique muscle
c) Faciae transversalis
d) Inguinal ligament
116- Which of the following ligaments are participate in the formation of lateral wall of the lesser sac?
a) Gastro colic
b) Phrenico colic
c) Gastro hepatic
d) Gastro splenic

117- Which of the following statements is correct about the liver?

a) The most posterior structures in the porta hepatis are the hepatic arteries.
b) The right and quadrate lobes of the liver separated by the ligamentum venosum from each
other.
c) The eosophagial groove is located on the posterior surface of the left liver lob.
d) Coronary ligament are located on the posterior surface of the left liver lob.

118- All of the following anatomic structures are located in the posterior of the first part of
deodenum except:
a) Coledok duct
b) Hepatic artery
c) Portal vein
d) Gastrodeodenal artery

119- The posterior layer of the rectus abdominal muscle sheath is performed by which of
the following structures in the 1/4 lower part of the abdomen?
a) Faciae transversalis
b) External oblique muscle
c) Internal oblique muscle
d) Transverse abdomens muscles

120- Which of the following cardiac veins are located in the coronary sulcus?
a) Anterior Cardiac Vein artery
b) Middle Cardiac Vein artery
c) Great Cardiac Vein artery
d) Small Cardiac Vein artery

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121- The sense of the fibrous pericardium is provided by which of the following nerves?
a) Intercostal Nerve
b) Vagus Nerve
c) Phrenic Nerve
d) Sympathetic Trunk

122- The seventh to nine anterior intercostal spaces is supplied by which of following
arteries?
a) Internal thoracic
b) Thoracic aorta
c) Superior epigastric
d) Musculophrenic

123- Which of the following structures traverse in the posterior of the pericardial oblique
sinus?
a) Esophagus
b) Ascending aorta
c) Azygus vein
d) Inferior vena cava

124- Which of the following anatomical structures have the relation proximity with the
medial surface of the both lungs?
a) Superior vena cava
b) Inferior vena cava
c) Esophagus
d) Thoracic aorta

125- Which of the following organs in the female has the peritoneal cover?
a) The superior part of the posterior surface of vaginal
b) The anterior surface of the cervical uterus
c) The base of bladder
d) The lower part of the anterior surface rectum

126- Which cellular junction of the epithelial tissue is associated with intermediate
filaments?
a) Zonula adherens
b) Tight junction
c) Desmosome
d) Gap junction

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127- Which cell acts as Mechanoreceptor in the skin?

a) Merkel
b) Langerhans
c) Melanocyte
d) Keratinocyte

128- All of the following cartilages are the hyaline, excepts:

a) Trachea cartilages
b) Articular cartilages
c) Epiglottis cartilages
d) Costal cartilages

129- Which of the following cell develop the amnioblast layer?

a) Hypoblast
b) Epiblast
c) Cytotrophoblast
d) Syncytiotrophoblast

130- All of the following structures is originated from the neural crest, excepts:
a) Autonomic ganglions
b) Odontoblast cells
c) Schwann cells
d) Kupffer cells

131- Which of the cells in the small intestine play a role in innate immunity?
a) Paneth cells
b) Langerhans cells
c) Enteroendocrine cells
d) Kupffer cells

132- Which of the following structures is participated in the jaxtaglommerular apparatus?

a) Intraglomerular mesangial cell
b) Distal convoluted tubule
c) Proximal convoluted tubule
d) Descending part of henle tube loop

133- Which of the following structures is participated in the corpus luteum formation
a) Granulosa and theca interna
b) Granolosa and theca externa
c) Cumulus oophorus and theca interna
d) Cumulus oophorus and theca externa

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134- Which of the following statements is the characteristic's gastric chief cells?
a) It has the property of the steroid secretory cell.
b) It has found abundantly in the neck of the gastric gland.
c) Its cytoplasm is acidophil due to the large number of mitochondria.
d) It has the large number of RER and secretory granules.

135- Which of the following cells is participate in the formation of the blood-CSF barrier?
a) Astrocyt
b) Epithelial chorroidal
c) Radial glial
d) Micro glial

136- All of the following structures are developed from the ventral bud of the pancrease except:
a) Accessory pancreatic duct
b) The lower part of the pancreas's head
c) The proximal part of the main pancreatic duct
d) Uncineate process

137- Which of the following structures are derivative of from the fourth pharyngeal pouch?
a) Tubothympanic reccess
b) Inferior parathyroid
c) Superior parathyroid
d) Palatine tonsil

138- In the formation of middle part of the lib (philtrum) which following structure is participate?
a) The lateral process of the nose
b) The maxillary process
c) The medial process of nose
d) Palatine process

139- In the embryonic period the rhombic lips make the which part of the brain?
a) Medulla oblongata
b) Cerebellum
c) Cerebral hemispheres
d) Diencephalon

140- All of the following statements is correct regarding to superfacial perineal space except:
a) It's roof is made by the perineal membrane.
b) The corpus covernosum and spongious are it's content.
c) The copper gland is located in this space.
d) In the lower part is confined by the membranus layer of the supefacial perineal.

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141- Which of the following respiratory epithelial cells has the chemical sense receptor?
a) Ciliated columnar cells
b) Goblet cells
c) Small granule cells
d) Brush cells

142- The all of the statements is correct about the eyeball except:
a) The bowman's membrane is as a basement membrane of the corneal epithelium.
b) The descemete's membrane is as a basement membrane of the corneal endothelium.
c) The brouch's membrane is as a layer of cilliary body.
d) The lens epithelium is made frome a layer of cuboidal cell.

Principles of Health Services

143- A 48 years old woman asks getting Pop Smear test in the health center. Doing this
action is defined in which level of prevention?
a) First level
b) Second level
c) Third level
d) Fourth level

144- Which one of the following vaccines should be stored on the upper shelf of the
refrigerator and is sensitive to heat?
a) MMR (Measles, Mumps, Rubella)
b) DPT (Diphteria, Pertusis, Tetanus)
c) IPV (Polio vaccine for Injection)
d) Hepatitis B

145- The famous FOCUS-PDCA model is one of the famous models in...........
a) Health education
b) Quality Improving
c) Service Evaluation
d) Health planning

146- Which item is not correct in the primary health care system or PHC?
a) In 1978 in Alma-Ata, Kazakhstan, it was universally agreed upon
b) Requiring governments to create a structure to provide essential and needed health care
for people in the community
c) Continuous access and continuous funding is not possible
d) Being comprehensive based on family and society is one of its main features

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147- In the recent reports of the school health unit of the province health center, the
increase in cases of head lice infestation in schools has been placed in the health
priorities. The health center of the province announces an instruction regarding
mandatory screening and examination of all students by trained personnel at three-
month intervals. Which of the health promotion approaches is this approach?
a) Social Change
b) Empowerment
c) Educational
d) Behavioral Change

148- Which of the following is not a function of the health system?

a) Financing
b) Stewardship and policy
c) Creating recourses
d) Efficiency

149- Which of the following indicators is calculated based on a hypothetical cohort?

a) Life expectancy
b) Maternal Mortality Ratio
c) U5 Mortality Rate
d) Neonatal Care Coverage

150- The most environmental unit of providing health services in urban area is:
a) Emergency post
b) Health Post
c) Urban comprehensive Health Center
d) Health House

151- Suppose that a person has had a mole on his face for years and does not pay attention
to it, and is not socially and mentally concerned about it, but when he goes to the
doctor to treat a cold, he is offered a laser to remove the mole. In your opinion, for
example which of the above is one of the types of needs?
a) Necessary need
b) Perceived need
c) Induce need
d) Expressed need

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152- The integration of primary health care and health insurance through which of the
following can be implemented in the Iran?
a) Family physician program and referral system
b) The fourth national development plan
c) Health reform plan
d) Health sector reforms

153- What is the most common cause of death in the world?

a) Cancer
b) Affairs and accidents
c) Cardiovascular diseases
d) Malnutrition

154- Which one of the following items is the most important factor of injustic and inefficient
of health systems?
a) Population transitions
b) Epidemiological transitions
c) Rapid development in medical sciences
d) Hospital oriented

Principles of epidemiology

155- A patient with a positive test of fecal occult blood visits his/ her family physician. The
doctor says: "the probability of colon cancer based on your test is 48%". Which
measure is addressed by the physician?
a) Sensitivity
b) Specificity
c) Positive predictive value
d) Negative predictive value

156- Many COVID-19 cases did not show clinical signs and symptoms and did not progress
towards further stages. What is the natural history of this cases?
a) Clinical
b) Pre-Clinical
c) Sub-Clinical
d) Disability

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157- In which type of study, it is least possible to detect the time order of cause and effect
association (Temporality)?
a) Prospective cohort
b) Historical cohort
c) Clinical trial
d) Cross-sectional

158- A study that provides a comprehensive and detailed description of the 10 cases of
Behcet's syndrome is in which group of studies?
a) Case-Series
b) Case-cohort
c) Case-control
d) Case-crossover

159- In a study, it was observed that the occurrence of deaths due to asthma and bronchitis
increased with the increase in the amount of dust (in PPM) in the western and
southwestern regions. What is the type of study?
a) Experimental study
b) Ecological study
c) Field trial study
d) Case-control study

160- In a large city with 3000.000 population, there were a total of 30.000 deaths in year
2020 from which 6000 were particularly due to an epidemic of influenza. What is the
CASE FATALITY RATE of influenza?
a) 10%
b) 1%
c) 1/1000
d) 2%

161- In the Malekan city with 100000 population, 50 new cases of brucellosis occurred in
2011 from which one case died. What is the incidence rate?
a) 1/1000
b) 5/10000
c) 1/100000
d) 10/100

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162- In a study, newborns who were born with cleft palate were compared with healthy
ones. This comparison was done in terms of exposure to viruses during the mother's
pregnancy. Each mother was asked about viral diseases during pregnancy. In the
results of the study, exposure to viral diseases during pregnancy was significantly
higher in mothers of babies with cleft palate. Which of the following biases is more
likely to occur?
a) Survival bias
b) Selection bias
c) Confounding bias
d) Recall bias

Immunology

163- Which part of lymph node is T-cell rich zone?

a) Paracortex
b) Medulla
c) Cortex
d) Germinal center

164- Which class of antibodies can passes through placenta and leads to passive immunity
in fetus?
a) IgG
b) IgA
c) IgM
d) IgE

165- Which cell has main function in specific killing of viral infected cells?
a) Neutrophil
b) NK cell
c) TCD8+ cell
d) TCD4+ cell

166- Which one is the ligand for TLR-9?

a) LPS
b) Un-methylated CpG DNA
c) ssRNA
d) Flagellae

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167- Which one is the main anti-inflammatory cytokine?

a) IL-6
b) IL-1
c) TNF-α
d) IL-10

168- Complement system is involved in following biological functions, except of…?

a) Anaphylaxis
b) Opsonization
c) Neutralization
d) Cell lysis

169- What`s the mechanism for anergy in T cell peripheral tolerance?

a) Deletion of T cells recognizing self-antigens
b) Recognition of antigen in the absence of co-stimulatory signals
c) Antigen-specific receptor editing
d) Suppression of T cells by regulatory cytokines

170- Which one is correct for MHC-restriction in cellular immune responses?

a) Peptides derived extracellular antigens are presented by MHC I to CD4+ T cells.
b) Peptides derived extracellular antigens are presented by MHC I to CD8+ T cells
c) Peptides derived cytosolic antigens are presented by MHC I to CD4+ T cells
d) Peptides derived cytosolic antigens are presented by MHC I to CD8+ T cells

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)02 ‫زبان انگلیسی (تعداد سوال‬

Reading Comprehension: Answer the questions 1 – 4 based on the following Passage 1

Passage 1: Diabetes mellitus
Diabetes mellitus consists an enormous public health problem globally, associated with high
morbidity and mortality. The disease expected to take dimensions of an epidemic is often called
"the scourge of modern times." Furthermore, the disease involves a variety of implications, such
as personal, family, social as well as high cost for the National Health System for each country.
Untreated diabetes can lead to several health complications like diabetic ketoacidosis, nerve
damage, kidney problems, heart disease, stroke, and negative impacts on mental health—all due to
unregulated high blood sugar. This is a disorder characterized by impaired macronutrient
metabolism including carbohydrates, proteins and fats due to inadequate or inefficient activity of
insulin. The World Health Organization estimates that the total number of diabetics worldwide will
reach 333 million in 2025 from 135 million in 1995. This significant increase is expected to take
place both in developing and developed countries and is mainly attributed to the modern way of
living including sedentary lifestyle, stress and unhealthy nutritional dietary habits. During recent
years, the important role of education regarding Diabetes mellitus self-management has been
demonstrated by numerous studies, globally. Interestingly, many patients seek education about
their therapeutic regimen thus confirming the significance of this issue. Furthermore, it has been
acknowledged that treatment of the disease is more related to lifestyle and less related to the quality
of the provided health care and services. Therefore, education promoting health-related behavior
modification through knowledge as well as enhancing the belief that patients themselves are the
main manager of their own health has come to the forefront of clinical practice.

171- Untreated diabetes may result in all of the following except:

a) nerve damage
b) kidney difficulties
c) stroke
d) inadequate insulin
172- Which statement is false about diabetes?
a) Sedentary lifestyle has resulted diabetes to decline
b) Education about the therapeutic regimen is a significant issue in the diabetic patient
c) Inadequate activity of insulin disturbs the macronutrient metabolism
d) Diabetic patients should be educated to belief that they can manage their own health
themselves
173- According to the passage, why author has called diabetes a “scourge of modern times"?
Because.................
a) diabetes involves both developing and developed countries
b) diabetes is associated with high morbidity and mortality
c) diabetes has negative impacts on mental health
d) it is anticipated that the disease magnitude may extent to an outbreak
174- It can be inferred from the passage that patient education................................ .
a) is a noncompulsory aspect in clinical practice

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b) may assist in promotion of self-management of diabetes

c) can alone control the diabetes
d) has been demonstrated by numerous studies globally

Reading Comprehension: Answer the questions 5 – 7 based on the following Passage 2

Passage 2
Modern scientific and technological developments in the practice of medicine and public health have drawn
nursing into new and wider fields of activity, and its functions have been expanded accordingly. Therefore, nursing
is no longer limited mainly to activities within the hospital, or to what is called curative nursing. It has become
also a community service in which preventive and rehabilitative functions are a vital part of its program. The
modern concept of nursing considers the hospital, however central, as only one of many health agencies in the
community.

175 As we understand from the above text, today ................................. .

a) the only reason people go to hospitals is for nursing care
b) most of the nursing practice now takes place in people's homes
c) hospitals are not the only setting where people receive care or support
d) scientific and technological developments can't by themselves improve the quality of
treatment
176- One can infer from the passage that ...................................................... .
a) nurses were treating more people in the patient's own home in the past
b) hospitals are the only places where nursing care is crucial
c) nurses don't see the hospital and clinic as important units in the community health program
d) hospitals are still the most important component of the healthcare sector
177- According to the passage, the nurse's function has been expanded because of
............................ .
a) the nurse's activities in the hospital
b) hospitals which are the most common work environments for nurses
c) the reluctance of nurses to work in the hospital
d) the progress in science and technology in related fields
Vocabulary
Direction: Complete the following sentences by choosing the best option.
178- It is probable that the carbon monoxide seriously affects the general health and vitality
of the individual, and ...................... them more likely to succumb to pulmonary
tuberculosis or other wasting disease.
a) renders
b) replete
c) resist
d) release
179- Chickenpox is most serious for pregnant women, and immunocompromised individuals
and exposed neonates, who are at risk of severe ......................... disease.
a) dilated
b) donated

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c) disseminated
d) designated
180- A hernia is a ................ of a viscus or part of a viscus through its coverings into an
abnormal situation.
a) occlusion
b) protrusion
c) transfusion
d) diffusion

181- When rifle bullet hits bone there is a gross ............... with fragments of bone acting as
secondary missiles and commonly causing large exit wounds.
a) substitution
b) contribution
c) resolution
d) comminution
182- Nowadays, clinicians in the hospital are .............. with a highly selected sample of
patients and disease states.
a) funded
b) confronted
c) exacerbated
d) interrupted
Medical Terminology
Direction: Complete the following sentences by choosing the best option.
183- Inability to retain urine is known as......................... .
a) urinary frequency
b) urinary incontinence
c) urinary urgency
d) retention of urine
184- Retinoschisis is:
a) splitting of the retina of the eye
b) examination of the retina
c) surgical fixation of the retina
d) inflammation of the retina
185- Not prescribing a specific drug can be referred to as ......................... .
a) concussion
b) cicatrization
c) contraindication
d) contraception
186- The stem cells a patient receives are expected to develop into new ...................... .
a) oncogenic cells
b) bone marrow cells

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c) hemoglobin
d) cartilage
186- Woman who has never given birth is called as .....................
a) primigravida
b) multigravida
c) nullipara
d) primipara
188- The term that can replace “Prostatodynia” is:
a) Prostatopathy
b) Prostatalgia
c) Prostatectomy
d) Prostatoplasty
189- When one intestinal segment slips into another part, it is called as ............ .
a) intussusception
b) ileus
c) volvulus
d) hemorrhoids
190- Any drug that relieves nausea and prevents vomiting is (a)n............................. .
a) antihistamine
b) antiemetic
c) anti-inflammatory
d) antitussive

Good luck

33
Dear volunteer

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with the aim of improving the quality of the questions and process of the exams, accepts the objections
that are sent in the format specified below through the Internet, so that the follow-up stage can be done
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Exam Center, from 12 noon on Sunday 03/03/2024, till 12 noon on Tuesday 05/03/2024.
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Major: Course Name: Question number: Booklet Number:

Source (s): Publication Date: Page (s): Paragraph (s): Line (s):

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