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MCQs TextBOOK
Ahmed Jihad Mahmoud
Alla Yasir Badawi
Medical Students
Batch 14
Al Neelain University
2012-2013
AlNeelain University
MCQs TextBook
Batch XIV
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Contents
ANATOMY , 5
Thorax,6
Abdomen,28
Pelvis,49
Upper Limb,59
Lower limb,79
Head and Neck,101
Surgical Anatomy,112
HISTOLOGY , 123
EMBERYOLOGY , 139
NEUROANATOMY, 155
BIOCHEMISTRY, 168
Cell and Water, 169
CHO, 174
Lipid,178
Protein, 182
Enzymes, 189
Vitamins, 194
Nuclic Acid, 198
CHO Metabolism, 204
Lipid M etabolism, 221
Protein Metabolism, 231
Nucleotide Metabolism, 241
Biochemical Techniques, 253
Oral, 256
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PHYSIOLOGY,269
Body Fluids, 270
Excitable Tissue, 276
Immunity, 287
Autonomic Nervous System, 293
Hematology Part One, 298
Hematology Part Two, 319
Cardiovascular System Part One, 331
Cardiovascular System Part Two,347
Respiratory System Part One, 366
Respiratory System Part Two, 377
Gastrointestinal System Part One, 391
Gastrointestinal System Part Two, 400
Renal System Part One, 417
Renal System Part Two, 421
Sport And Excercise,434
Endocrine System,446
Central Nervous System, 452
Body Temperature, 459
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MCQs TextBook
Batch XIV
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‫بسم هللا الرحمن الرحيم‬
‫الحمد هلل والصالة والسالم على رسول هللا ‪ ,‬أما بعد ‪:‬‬
‫فانه ليشرفنا في أسرة الدفعة ‪ 41‬ان نضع بين ايديكم هذا الكتاب‬
‫الذي يحتوي على اسئلة االختيار من متعدد مجموعة من اختبارات‬
‫سابقة مع حل للكثير منها ‪ ,‬ولكن ما يجب التنويه اليه ان هذا الكتاب‬
‫يحتوي على اخطاء مطبعية ‪ ,‬وكذلك اخطاء في بعض الحلول ‪ ,‬لكن‬
‫ذلك ال ينقص من السبب الرئيس إلنشاء الكتاب أال وهو تيسير‬
‫عملية البحث عن اسئلة االختبارات النهائية وجعلها في متناول‬
‫الجميع ‪.‬‬
‫اسرة الدفعة ‪41‬‬
‫‪Batch XIV‬‬
‫‪MCQs TextBook‬‬
‫‪AlNeelain University‬‬
5
ANATOMY
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THORAX
1. The following statements concerning the trachea are true except:
a) It lies anterior to the esophagus in the superior mediastinum
b) In deep inspiration the carina may descend as far as the level
of the sixth thoracic vertebra
c) The left principal bronchus is wider than the right principal bronchus
d) The arch of the aorta lies on its anterior and left sides in the superior
mediastinum
e) The sensory innervation of the mucous membrane lining the trachea is
derived from branches of the vagi, ad the recurrent laryngeal nerves
2. The following statements concerning the root of the right lung are true except:
a) The right phrenic nerve passes anterior to the lung root
b) The azygos vein arches over the superior margin of the lung root
c) The right pulmonary artery lies posterior to the principal bronchus
d) The right vagus nerve passes posterior to the lung root
e) The vessels and nerves forming the lung root are enclosed by a cuff of
pleura
3. The following statements concerning the right lung are true except:
a) It possesses a horizontal and an oblique fissure
b) Its covering of visceral pleura is sensitive to pain and temperature
c) The lymph from the substance of the lung reaches the hilum by the
superficial and deep lymphatic plexuses
d) The pulmonary ligament permits the vessels and nerves of the lung root to
move during movements of respiration
e) The bronchial veins drain into the azygos and hemiazygos veins
4. Which of the following structures does NOT form the anterior surface of the
heart?
a) Right Ventricle
b) Right Atrium
c) Left Ventricle
d) Left Atrium
e) Right Auricle
5. In a postereoanterior radiograph of the thorax, which of the following
structures does NOT form the left margin of the heart shadow:
a) Left Auricle
b) Pulmonary Trunk
c) Arch of Aorta
d) Left Ventricle
e) Superior Vena Cava
6. All of the following statements concerning the esophagus are correct except:
a) It receives an arterial blood supply from both the descending thoracic aorta
and the left gastric artery
b) It is constricted by the presence of the left principal bronchus
c) It crosses from right to left posterior to the descending aorta
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d) It pierces the diaphragm with the left vagus on its anterior surface and the
right vagus on its posterior surface
e) It joins the stomach about 16 inches (41 cm) from the incisor teeth
7. All of the following statements concerning the mediastinum are correct except:
a) The mediastinum forms a partition between the two pleural cavities
b) The mediastinal pleura demarcates the lateral boundaries of the
mediastinum
c) The heart occupies the middle mediastinum
d) Should air enter the left pleural cavity, the structures forming the
mediastinum are deflected to the right
e) The anterior boundary of the mediastinu m extends to a lower level than the
posterior boundary
8. All of the following statements regarding the conducting system of the heart
are true except:
a) The impulse for cardiac contraction spontaneously begins in the sinoatrial
node
b) The atrioventricular bundle is the sole pathway for conduction of the waves
of contraction between the atria and the ventricles
c) The sinoatrial node is frequently supplied by the right and left coronary
arteries
d) The sympathetic nerves to the heart slow the rate of discharge from the
sinoatrial node
e) The atrioventricular bundle descends behind the septal cusp of the tricuspid
valve
9. All of the following statements regarding the mechanics of inspiration are true
except:
a) The diaphragm is the most important muscle of inspiration
b) The suprapleural membrane can be raised
c) The sternum moves anteriorly
d) The ribs are raised superiorly
e) The tone of the muscles of the anterior abdominal wall is diminished
10. Which of the following statements concerning the lungs is correct?
a) There are no lymph nodes within the lungs
b) The right lung is in direct contact with the arch of the aorta and the
descending thoracic aorta
c) Inhaled foreign bodies most frequently enter the r ight lung
d) The structure of the lungs receive its blood supply from the pulmonary
arteries
e) The costodiaphragmatic recesses are lined with visceral pleura
11. Which of the following statements concerning the blood supply of the heart is
INCORRECT?:
a) The coronary arteries are branches of the ascending aorta
b) The right coronary artery supplies both the right atrium and right ventricle
c) The circumflex branch of the left coronary artery descends in the anterior
interventricular groove and passes around the apex of the heart
d) Arrhythmias (abnormal heart beats) can occur after occlusion of a coronary
artery
e) Coronary arteries can be classified as functional end arteries
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12. Which of the following statements concerning the bronchopulmonary
segments is INCORRECT?:
a) The veins are intersegmental
b) The segments are separated by connective tissue septa
c) The arteries are intrasegmental
d) Each segment is supplied by a secondary bronchus
e) Each pyramid-shaped segment has its base pointing toward the lung surface
13. Which of the following statements is (are) correct regarding the
bronchopulmonary segments?:
a) The right lung has three segments
b) The arteries supplying each segment are segmental in position
c) The base of easch pyramid-shaped segment points towards the hilus
d) The veins draining each segment are segmental in position
e) There are no autonomic nerves within a segment
14. Which structure(s) compress(es) the posterior surface of the heart during
cardiopulmonary resuscitation?
a) The body of the sternum
b) The heads of the ribs
c) The tracheal bifurcation
d) The inferior vena cava
e) The bodies of the thoracic vertebrae
15. Pericardiocentesis is best achieved by passing a needle through:
a) The fourth intercostals space
b) The sixth intercostals space at the left paravertebral border
c) The second intercostals space at the midclavicular line
d) The subcostal angle
e) The second intercostals space at the right sternal angle
16. The following statements concerning the main bronchi are true except:
a) The right main bronchus is wider than the left main bronchus
b) The right main bronchus is shorter than the left main bronchus
c) The right main brnchus is more vertical in position than the left main
bronchus
d) The left main bronchus passes to the left and in front of the oesophagus
e) The left main bronchus gives off the superior lobar bronchus before
entering the hilum of the lung
17. The following statements concerning the diaphragm are true except:
a) All the muscle of the diaphragm is supplied by the phrenic nerves
b) On contraction, the diaphragm increases the intrathoracic pressure
c) The right crus provides a sphincterlike mechanism for the esophagus
d) On contraction, the diaphragm assists in the return of venous blood to the
right atrium and of lymph to the thoracic duct
e) When viewed from the front, the central tendon of the diaphragm lies
behind the xiphisternal joint
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18. Which of the following statements concerning the lungs is incorrect?
a) Each lung is very elastic, and should the thoracic cavity be opened by a stab
wound, the lung shrinks to one-third or less in volume
b) The cardiac notch lies in the lower lobe of the left lung
c) The visceral pleura covering each lung lines the fissures that are situated
between the lobes
d) The apex of each lung extend up into the root of the neck and lies anterior
to the lower roots of the brachial plexus
e) The bronchi, connective tissue and visceral pleura of the lungs are supplied
by the bronchial arteries
19. When aging, the following detrimental changes occur in the thorax except:
a) The ribs and costal cartilages become more rigid
b) The elastic tissue in the lungs tends to degenerate
c) The maubriosternal joint becomes more mobile
d) The thoracic and abdominal muscles tend to atrophy
e) The xiphoid process becomes ossified
20. The following anatomic events occur at the level of the sternal angle (angle of
Louis) except:
a) The right and left pulmonary arteries enter the lungs
b) The right recurrent laryngeal nerve arises from the right vagus nerve
c) The trachea bifuricates
d) The ascending aorta becomes continuous with the arch of the aorta
e) The second costal cartilages articulate with the sternum
21. All of the following structures open into the right atrium except:
a) The superior vena cava
b) The coronary sinus
c) The anterior cardiac vein
d) The inferior vena cava
e) The right pulmonary veins
22. Sudden occlusion of the anterior interventricular branch of the left coronary
artery produces infarction (tissue death) in which one of the following areas?
a) The entire diaphragmatic surface of the left ventricle
b) The anterior part of the ventricular septum and the anterior (septal)
papillary muscle of the left ventricle
c) The posterior wall of the right atrium
d) The atrioventricular bundle
e) The right auricle
23. The conducting system of the heart is composed of the following structures
except:
a) The purkinje plexus
b) The deep cardiac p lexus
c) The sinoatrial node
d) The atrioventricular bundle
e) The atrioventricular node
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24. The following anatomic facts regarding the right coronary artery are true
except:
a) It gives rise to a marginal branch
b) It passes forward between the right auricle and the pulmonary trunk
c) It gives rise to an anterior interventricular branch
d) It arises from the anterior aortic sinus
e) It descend in the right atrioventricular groove
25. During fetal life, the following facts regarding the circulatory system are true
except:
a) The blood passing through the foramen ovale is more oxygenated than that
passing through the right atrioventricular orifice
b) The direction of blood flow through the ductus arteriosus is from right to
left
c) The ductus venosus permits blood to bypass the liver
d) The blood in the abdominal aorta is relatively more oxygenated than that in
the internal carotid arteries
e) The valve of the inferior vena cava deflects blood toward the foramen ovale
26. In patients with the tetralogy of Fallot, there are four cardiac anomalies.
Which of the following is characteristic of the condition?
a) Pulmonary stenosis with hypertrophy of the right ventricle
b) Large atrial septal defect
c) Hypertrophy of the left ventricle
d) Stenosis of the aorta
e) High blood pressure in the left ventricle
27. Pain arising in the heart is commonly referred to the following skin areas
except:
a) Up into the neck and jaw
b) Down the medial side of the arm
c) The point of the shoulder
d) The epigastric area
e) Over the sternum
28. The following statements regarding structures in the intercostals spaces are
correct except:
a) The anterior intercostals arteries of the upper six intercostals spaces
are branches of the internal thoracic artery
b) The intercostals nerves travel forward in an intercostal space
between the internal intercostal and innermost intercostals muscles
c) The intercostals blood vessels and nerves are posterior in the order of vein,
nerve and artery from superior to inferior in a subcostal groove
d) The lower five intercostals nerves supply sensory innervation to the skin of
the lateral thoracic and anterior abdominal walls
e) The posterior intercostals veins drain backward into the azygos and
hemiazygous veins
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29. The following statements concerning the diaphragm are correct except:
a) The right crus provides a muscular sling around the esophagus and
possibly prevents regurgitation of stomach contents into the esophagus
b) On contraction, the diaphragm raises the intra-abdominal pressure and
assists in the return of the venous blood to the right atrium of the heart
c) The level of the diaphragm is higher in the recumbent position than in the
standing position
d) On contraction, the central tendon descends, reducing the intrathoracic
pressure
e) The esophagus passes through the diaphragm at the level of the eighth
thoracic vertebra
30. Which of the following statements is incorrect concerning the intercostals
nerves?
a) They provide motor innervation to the peripheral parts o f the diaphragm
b) The provide motor innervation to the intercostals muscles
c) They provide sensory innervation to the costal parietal pleura
d) They contain sympathetic fibres to innervate the vascular smooth muscle
e) The seventh to eleventh intercostals nerves provide sensory innervation to
the parietal peritoneum
31. With a patient in the standing position, fluid in the left pleural cavity tends to
gravitate down to the:
a) Oblique Fissure
b) Cardiac Notch
c) Costomediastinal Recess
d) Horizontal Fissure
e) Costodiaphragmatic Recess
32. To pass a needle into the pleural cavity in the midaxillary line, the following
structures will have to be pierced except the:
a) Internal intercostal muscle
b) Levatores costarum
c) External intercostal muscle
d) Parietal pleura
e) Innermost intercostals muscle
33. The following statements concerning the thoracic outlet (anatomic inlet) are
true except:
a) The manubrium sterni forms the anterior border
b) On each side, the lower trunk of the brachial plexus and the subclavian
artery emerge through the inlet and pass laterally over the upper surface of
the first rib
c) The body of the seventh cervical vertebra forms the posterior boundary
d) The first ribs form the lateral boundaries
e) The esophagus and trachea pass through the outlet
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34. The following statements concerning the thoracic wall are correct except:
a) The trachea bifuricates opposite the manubriosternal joint (angle of Louis)
in the midrespiratory position
b) The arch of the aorta lies behind the body of the sternum
c) The apex beat of the heart can normally be felt in the left intercostals space
about 3.5 inch (9 cm) from the midline
d) The lower margin of the right lung on full inspiration could extend down in
the midclavicular line to the eighth costal cartilage
e) All intercostals nerves are derived from the anterior rami of thoracic spinal
nerves
35. All of the following commonly occur on inhalation except:
a) The diaphragm descends
b) The external intercostal muscles contract
c) The abdominal muscles contract and push the abdominal viscera cranially
d) The ribs are raised
e) The vertical dimension of the thoracic cavity increases
36. When passing a needle through the chest wall and into the pleural cavity in
the midaxillary line, the following structures will be pierced except:
a) The external intercostal muscle
b) The skin
c) The parietal pleura
d) The levator costarum
e) The internal intercostals muscle
37. Hemiazygos vein receives the following veins:
a) Right superior intercostal
b) Left superior intercostal
c) Supreme (Highest) intercostal
d) All of the above
e) None of the above
38. On the neck of the first rib there are:
a) Stellate ganglion
b) First thoracic nerve
c) Superior intercostal vein
d) Both A and B
e) All of the above
39. On the plane between the sternal angle and lower border of T4 the:
a) First posterior intercostals vein opens into azygos vein
b) Oesophagus deviates to the left of the midline
c) Right main bronchus starts
d) Right recurrent laryngeal nerve recurves around ligamentum arteriosum
e) First costal cartilage joins the sternum
40. The oesophagus:
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a) Is entirely supplied by the inferior thyroid artery
b) At cardiac orifice the epithelium is simple columnar
c) Transverses the left crus
d) Has a uniform lumen
e) Has striated muscle in the lower part
41. The left coronary artery has the following branches:
a) Circumflex
b) Marginal
c) Conus
d) S.A. Nodal
e) Interventricular
42. The coronary sinus receives the following veins, except:
a) Anterior cardiac
b) Middle cardiac
c) Small cardiac
d) Posterior vein of the left ventricle
e) Great cardiac
43. The left lung has:
a) Oesophageal groove
b) Cardiac Notch
c) Lingula
d) Both A and B
e) Both B and C
44. Regardig the thoracic wall:
a) The subcostal muscles are best developed in the upper part of the thorax
b) The innermost intercostal muscles are often regarded as pasts of the
external intercostal muscles
c) The anterior intercostals membrane is the membranous portion of the
internal intercostal muscle
d) The anterior intercostals arteries are branches of the internal thoracic
arteries
e) The intercostals nerves at the posterior rami of the 12 thoracis nerves
45. The conducting system of the heart comprises:
a) The sinoatrial node, his bundle, right and left branches
b) The sinoatrial node, atrioventricular node, his and her bundle, superior and
inferior crura
c) The atrioventricular node and atrial nodes, his bundle, right and left crura
d) The sinoatrial node, the atrioventricular node, and bundle, right and left
branches, and purkinje fibers network
e) SA and AV node, his and her bundle, anterior and inferior crura, purkinje's
fibers and network
46. The posterior mediastinum:
a) Extends from the 4th thoracic vertebra to the diaphragm
b) Includes the descending thoracic aorta and azygos veins
c) Includes the vagi and splanchnic nerves
d) Includes the thoracic duct and oesophagus
e) All of the above
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47. Select the one best answer:
a) The superior epigastric artery is a branch of external iliac artery
b) The anterior portion of the rectus sheath is formed by the aponeurosis of the
external abdominal oblique and transverses abdominis muscle
c) The inguinal canal terminates at the superficial inguinal ring (a defect in the
external abdominal oblique muscle)
d) The conjoint tendon consists of lower fibers of the external abdominal
oblique muscle and the inguinal ligament
e) The internal spermatic fascia is derived from the internal oblique muscle
48. Regarding the skeleton of the thorax:
a) The floating ribs are ribs 8-12
b) A typical rib consists of all of the following: head, neck, a shaft with its
costal groove
c) The most typical rib is rib 1
d) The sternal angle marks the articulation of rib 3
e) A line through the sternal angle bisects the disc between vertebra T2 and T3
49. The bronchial arteries arise from:
a) Thoracic aorta
b) Left subclavian
c) Internal thoracic
d) Arch of the aorta
e) 3rd intercostals artery
50. The arch of the aorta is crossed by:
a) Thoracic duct
b) Trachea
c) Right vagus
d) Left phrenic
e) Azygos vein
51. The intercostaobrachial nerve is the:
a) First intercostal
b) Second lateral cutaneous
c) Second intercostal
d) Medial pecotral
e) Medial cutaneous of the arm
52. The splanchnic nerves are:
a) Preganglionic parasympathetic
b) Postganglionic sympathetic
c) Preganglionic sympathetic
d) Relay in the sympathetic chain
e) Pass behind the diaphragm
53. The middle cardiac vein drains into:
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a) Right atrium
b) Heart chambers
c) Coronary sinus
d) Great cardial vein
e) All of the above
54. The atrio-ventricular sulcus lodges:
a) Cardiac veins
b) Coronary sinus
c) Conus artery
d) SA Node
e) Marginal artery
55. The fibrous pericardium is attached directly to:
a) Serous pericardium
b) Manubrium of sternum
c) Central tendon of diaphragm
d) Pleura
e) Vertebral column
56. The base of the heart is formed by:
a) Left atrium
b) Ventricles
c) Right atrium
d) Left ventricle
e) Coronary sinus
57. The length of the left principal bronchus is:
a) 2 cm
b) 3 cm
c) 4 cm
d) 5 cm
e) 8 cm
58. The broncho-pulmonary segments are formed by:
a) Labor bronchi
b) Segmental bronchi
c) Pulmonary ducts
d) Alveolar sacs
e) All of the above
59. Which of the following statements concerning the thoracic wall is TRUE?
a) The intercostal muscles consist of four layers of muscles
b) The first rib articulates with the sternal angle
c) The sternum is made up of three bony parts: manubrium, body and xiphoid
process
d) The internal thoracic vessels lie between the internal intercostals and the
external intercostals muscles
e) The intercostal vein, artery and nerve run deep to the innermost intercostals
muscles
60. Which statement about the mediastinum is TRUE:
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a) The mediastinum is the space above the heart
b) The middle mediastinum contains the heart
c) The superior mediastinum contains the decending aorta
d) The inferior mediastinum contains the superior and inferior vena cave
e) The posterior mediastinum cotains the thymus gland, the sterno-pericardial
ligaments and lymph gland
61. Which statement about the thoracic diaphragm is FALSE:
a) The diaphragm receives blood supply from a branch of the internal thoracic
artery
b) The diaphragm receives blood supply from below via the inferior phrenic
artery
c) The diaphragm receives autonomic innervation from C6-7
d) The diaphragm receives sensory innervation from the phrenic nerves
e) The diaphragm consists of a central tendon and a muscular periphery
62. In a patient with a tumor in superior mediastinum compressing the superior
vena cava, all of the following veins would seve as alternate pathways for the
blood to return to the right atrium, except:
a) Lateral thoracic vein
b) Internal thoracic vein
c) Hemiazygos vein
d) Vertebral venous plexus
63. In angina pectoris, the pain radiating down the left arm is mediated by
increased activity in afferent (sensory) fibres contained in the:
a) Carotid branch of the glossopharyngeal nerve
b) Phrenic nerve
c) Vagus nerve and recurrent laryngeal nerve
d) Thoracic splanchnic nerve
64. A knife wound into the heart, at the level of the fifth left intercostals space,
near the sternum, would penetrate all of the following layers except:
a) Fibrous pericardium
b) Serous visceral pericardium
c) Serous parietal pericardium
d) Visceral and parietal pleura
e) Pericardial cavity
65. A vertical oriented stab from a knife with a three inch blade leaves an entry
wound at the root of the neck just above the right manubrio-clavicular joint.
Which of the following possibilities should be considered:
a) A right pneumothorax
b) Damage to the right apex of the lung
c) Blood accumulating in the right pleural cavity
d) All of the above
e) None of the above
66. In an x-ray photograph, one sees an abnormal shadow in the left posterior
mediastinum. It could arise from pathology of the:
a) Thymus
b) Left bronchus
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c) Aortic arch
d) Azygos vein
e) Oesophagus
67. To remove blood from the pericardial sac without entering the pleural cavity.
A syringe needle must be passed:
a) Immediately to the right of the sternum in the sixth intercostal space
b) Immediately to the left of the sternum in the sixth intercostal space
c) 2.5 cm to either side of the sternum in the sixth intercostal space
d) Between the xiphoid and the eighth costal cartilage
e) Between the fourth and fifth right intercostal space in the midclavicular line
68. Which of the following statements is INCORRECT of the trachea:
a) Lie in front of the oesophagus
b) Is formed of complete rings of hyaline cartilage
c) Is supplied by inferior thyroid artery
d) Recurrent laryngeal nerve never lies between it and the oesophagus
e) Is 10cm long
69. The following statements are true of the right principal bronchus except:
a) Wider and shorter than left
b) Enters the right lung opposite T5
c) Foreign bodies enter it more often than left
d) Gives rise to superior lobar bronchus after it enters right lung
e) Azygos vein arches over it
70. The oesophageal opening transmits the following except:
a) Vagal trunks
b) Oesophagus
c) Lymphatics
d) Oesophageal branches of left gastric artery
e) Oesophageal branches of right gastric artery
71. The diaphragm's blood supply is by following arteries:
a) Lower intercostal
b) Internal thoracic
c) Thoracic aorta
d) Abdominal aorta
e) All of the above
72. Pneumothorax can defined as presence of air in the pleural space, it can be
caused accidently by the surgeon's knife when operating on:
a) The gall-bladder
b) The kidney
c) The duodenum
d) The small bowel
e) The pancreas
73. The intercostal neurovascular bundle is located:
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a) Above the superior border of the ribs
b) Superficial to the ribs anteriorly
c) In the subcostal groove
d) Superficial to the anterior intercostal membrane
e) Between the external and internal intercostals muscles
74. Which of the following is true about the thoracic wall?
a) Each rib articulates with the transverse process of the vertebra above
b) The breast is usually bound firmly to the pectoralis major, allowing no
movement
c) Most lymph from the breast drains axillary lymph nodes
d) The internal thoracic artery lies posterior to the transverses thoracis muscle
e) The intercostal nerve lies between the internal and external intercostals
muscles
75. Which of the following statements is true?
a) The papillary muscle attaches to the cusps of the aortic valve via chorda
b) The right atrioventricular valve consists of two cusps
c) The aortic valve has a right coronary cusp, a left coronary and a posterior
(non-coronary) cusp
d) The cusps of the heart valves are normally vascular but they may loose their
blood supply as a result of disease such as rheumatic fever
e) An incompetent (defective) let left atrioventricular valve would allow blood
to pass into the left lung during diastole
76. Which statement about the pleura is true?
a) Parietal pleura is innervated by the intercostals and phrenic nerves
b) Parietal pleura extends into the fissures of the lungs
c) The costodiaphragmatic recess is filled with lung tissue during heavy
expiration
d) The pleura does not extend into the neck
e) Mediastinal pleura is innervated by the vagus nerve
77. The transverse pericardial sinus:
a) Is a diverticulum of the superior vena cava
b) Lies between the pulmonary veins
c) Lies between the major arteries leaving the heart and the major veins
entering the heart
d) Contains the right coronary artery
e) Contains the ligamentum arteriosum
78. Which of the following statements is true?
a) The parietal pericardium and the visceral pericardium constitute the serous
pericardium of the heart
b) The coronary vessels are found in the parietal pericardium
c) The parietal pericardium is fused with the central tendon of the diaphragm
d) The pericardial cavity is the cavity within the visceral pericardium that
contains the heart
e) The epicardium consists of the myocardium and endocardium
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79. Which of the following statements is true?
a) The coronary sinus receives blood from the anterior cardiac veins and
returns it to the heart
b) Normally, the posterior interventricular artery comes from the right
coronary artery
c) The anterior ventricular artery is usually a branch of the right
coronary artery
d) The coronary arteries branch off the coronary sinus
e) The characteristic sounds heard during auscultation of the heart results from
blood flowing through the cardiac veins and coronary arteries
80. Which of the following statements concerning the pleural cavities is TRUE?
a) The pleural cavity is a space filled with lung tissue
b) The space between the parietal pleura and endothoracic fascia is often
referred to as pleural recess
c) Parietal pleura is the same as the endothoracic fascia
d) The pulmonary ligaments consist of pleura
e) All of the pleural sac is sensitive to pain
81. Referred visceral pain is one of the common problems of the thoracic viscera.
Pain felt at the tip of the shoulder referred from diaphragmic peritoneum is due
to:
a) The tip of the shoulder is innervated by C4
b) Sensation from this peritoneum is conveyed by splanchnic nerves
c) The common vascular sympathetic plexus between the two areas
d) Embryological origin of the peritoneum at the tip of the shoulder
82. A patient presents after a road traffic accident with tenderness over the rib
which is level with the inferior angle of the right scapula:
a) The sixth
b) The seventh
c) The eight
d) The ninth
83. Concerning the intercostals neurovascular bundle, all the following
statements are true except:
a) They run in the plane between the middle and the innermost layers of
muscles
b) The 10th nerve is sensory to the skin at level of the umbilicus
c) The 11th nerve is sensory to the skin at level of suprapubic region
d) There are 11 intercostal vessels and nerves and a subcostal vessel and nerve
84. The intercostobrachial nerve is the:
a) Lateral cutaneous branch of the 2nd intercostal nerve
b) Collateral branch of the 2nd intercostal nerve
c) Anterior cutaneous branch of the 3rd intercostal nerve
d) Posterior cutaneous branch of the 1st intercostal nerve
85. Select the incorrect statement about the esophagus:
a) Traverses the left diaphragmatic crus
b) Has striated muscle in its upper part
c) Is supplied by inferior thyroid artery
d) Is lined by stratified squamous epithelium
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e) Is 25 cm
86. Azygos vein receives the following veins except:
a) Bronchial veins
b) Esophageal veins
c) Left superior intercostals vein
d) Lower posterior intercostals vein
e) Hemiazygos vein
87. The phrenic nerve:
a) Contains axons that originate for the most part from the central ramus of C4
b) Provides sensory innervation to the pericardium
c) Both A and B
d) Neither A nor B
88. Structures of areas common to the right ventricle:
a) Fossa ovalis
b) Musculi pectinati
c) Both A and B
d) Neither A nor B
89. The posterior intercostals arteries are branches of:
a) The internal thoracic artery
b) The subclavian artery
c) The aorta
d) The highest intercostal artery
e) The bronchi connective tissue and visceral pleura of the lungs are supplied
by the bronchial arteries
90. Which of the following fissures of the lungs lies directly beneath the anterior
portion of the 4th rib:
a) The right horizontal fissure
b) The left horizontal fissure
c) The right oblique fissure
d) The left oblique fissure
91. An aneurysm (ballooning) of the arch of the aorta would most affect all
except one of the following :
a) Left primary bronchus
b) Esophagus
c) Left recurrent laryngeal nerve
d) Thoracic duct
e) Phrenic nerve
92. The anterior intercostal arteries are branches of the:
a) Posterior intercostals arteries
b) Internal thoracic arteries
c) Mediastinal arteries
d) Highest intercostal
e) Subcostal arteries
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93. The bare area of the heart or pericardium where the pleura does not cover it
is related to the:
a) Costodiaphragmatic recess
b) Cupola of the pleura
c) The right 4th-6th parasternal region
d) The left 4th-6th parasternal region
e) Pulmonary ligament
94. Which of the following features is NOT part of a typical thoracic vertebra:
a) Foramen transversarium
b) Transverse process
c) Lamina
d) Spinous process
e) Heart-shaped body
95. Imagine a knife passing through the thoracic wall into the lung through an
intercostals space. From superficial to deep, which is the correct order of layers
(not all layers will be listed):
a) External intercostals m., endothoracic fascia, internal intercostals m.,
parietal pleura
b) External intercostals m., innermost intercostals m., parietal pleura, visceral
pleura
c) Internal intercostals m., endothoracic fascia, pleural cavity, parietal pleura
d) Endothoracic fascia, internal intercostals m., visceral pleura, pleural cavity
e) External intercostals m., innermost intercostals m., pleural cavity,
endothoracic fascia
96. Which of the following does not travel in a thoracic ventral ramus?
a) Somatic motor fibers
b) Somatic sensory fibers
c) Preganglionic sympathetic fibers
d) Postganglionic sympathetic fibers
e) Parasympathetic fibers
97. Which of the following pathways is correct for the passage of arterial blood
from the heart to the 4th anterior intercostals artery?
a) Axillary a. to thoracoacromial trunk to anterior intercostals a.
b) Subclavian a. to superior epigastric a. to anterior intercostals a.
c) Brachiocephalic trunk to common carotid a. to internal thoracic a. to
anterior intercostals a.
d) Subclavian a. to internal thoracic a. to anterior intercostals a.
e) Subclavian a. to axillary a. to internal thoracic a. to anterior intercostals a.
98. Which of the following statements regarding the lungs is false?
a) They right lung has three lobes
b) The impression for the aorta is found on the mediastinal surface of the left
lung
c) The cupula of an inflated lung rises above the level of the clavicle
d) The right main bronchus is shorter, wider and more vertical than the left
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main bronchus
e) The right lung is divided into eight bronchopulmonary segments
99. Which of the following statements regarding the pleura is false?
a) The visceral pleura is continuous with the parietal pleura at the root of the
lung
b) In the costodiaphragmatic recess, costal parietal pleura is in contact with
diaphragmatic parietal pleura
c) Visceral pleura is extermly sensitive to pain
d) Parietal pleura is divided into costal, diaphragmatic, mediastinal and
cervical parts
e) The pleural cavity lies between the visceral and parietal layers of pleura and
contains serous fluid
100. Which of the following statements regarding the relationships in the thorax
is false?
a) The phrenic nerve runs posterior to the root (hilum) of the lung
b) The left vagus nerve becomes the ant erior vagal trunk
c) The intercostals neurovascular bundle, from superior to inferior, contains
the intercostals vein, artery and nerve
d) The esophageal hiatus lies anterior to the aortic hiatus in the diaphragm
e) The transverse pericardial sinus lies posterior to the great arteries of the
heart
101. Which of the following statements is true?
a) The pulmonary circulations starts with the right atrium and ends with the
left atrium
b) The pulmonary circulation starts with the right ventricle and ends with the
left atrium
c) The systemic circulation (to the body) starts with the right ventricle and
ends with the left ventricle
d) The systemic circulation starts with the left atrium and ends with the right
ventricle
e) The systemic circulation starts with the right atrium and ends with the right
ventricle
102. Which one of the following statements about the pericardium is false?
a) The pericardium has a fibrous, inelastic outer layer
b) The pericardium has a parietal and visceral layer that secretes fluid
c) The coronary vessels are found in the visceral pericardium (epicardium)
d) The pericardial reflections are where the pericardium is fused to the
diaphragm
e) The roots of the great vessels are surrounded by fibrous pericardium
103. Which statement about the coronary arteries is false?
a) The posterior interventricular artery is often a branch of the right coronary
artery, but it may branch from the left coronary artery in some individuals
b) The heart normally has two coronary arteries that emerge from the
descending aorta
c) Coronary arteries receive sympathetic innervation
d) Coronary arteries receive parasympathetic innervation
e) The heart occupies less than 1/2% of body weight but it uses 4% of the
blood pumped to the body
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104. Which statement about cardiac veins is true?
a) The middle cardiac vein runs with the marginal branch of the right coronary
artery
b) Blood from the anterior cardiac veins return directly to the right atrium
without passing through the coronary sinus
c) The great cardiac vein is found in the anterior atrioventricular sulcus
d) The coronary sinus is on the anterior surface of the heart
e) All Thebesian veins empty into the right atrium
105. Which statement about the chambers of the heart is true?
a) The moderator band (septomarginal trabecula) is found in the left ventricle
b) The fossa ovalis is seen in the right atrium
c) The mitral (bicuspid) valve is seen in the right ventricle
d) The semilunar valves are seen in the left and right atria
e) The pectinate muscles are seen in the left and right ventricles
106. Which statement concerning the pulmonary veins is false:
a) In the hilum of the lung, they tend to lie inferior to the pulmonary arteries
b) They drain blood into the right atrium
c) Their branches in the lungs generally lie between bronchopulmonary
segments
d) They are innervated by autonomic nerves
e) They carry oxygenated blood
107. The lungs receive their blood supply from:
a) Pulmonary arteries
b) Bronchial arteries
c) Circumflex arteries
d) Coronary arteries
e) Pulmonary veins
108. In comparison to the right lung, the left lung:
a) Has no pleura surrounding it
b) Has one fewer lobe and is smaller
c) Has one fewer lobe and is larger
d) Has one more lobe and is smaller
e) Has one more lobe and is larger
109. Which statement is false about the intercostals nerves:
a) They can be found inferior to an intercostals artery in the intercostals space
b) They run between the internal and innermost intercostal muscles
c) They are ventral rami of thoracic spinal nerves
d) They innervate the intercostals muscles as well as the overlying pectoral
muscles
e) The second intercostals nerve (T2) normally gives off the intercostals nerve
110. Which of the following structures does (do) not open into the right atrium?
a) Coronary sinus
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b) Anterior cardiac veins
c) Pulmonary veins
d) Inferior vena cava
e) Thebesian veins
111. The internal thoracic artery gives the following branches except:
a) Pericardiophrenic
b) 2nd anterior intercostal
c) Superior epigastria
d) Muculophrenic
e) Bronchial artery
112. The following veins are tributaries of the coronary sinus except:
a) Great cardiac
b) Small cardiac
c) Anterior cardiac
d) Middle cardiac
e) Oblique vein of left atrium
113. Middle cardiac vein is located at the:
a) Anterior interventricular sulcus
b) Posterior interventricular sulcus
c) Posterior AV groove
d) Anterior AV groove
e) Right margin of the heart
114. Which of the following statements about the spinal nerves is true?
a) Spinal nerve T4 has a white and a gray ramus communicans
b) Spinal nerve T1 exits the vertebral column between the vertebra C7 and T1
c) The greater splanchnic nerve contains preganglionic sympathetic fibers
d) Intercostal nerves lie between the external and internal intercostals muscles
e) The stellate ganglion is the somatic sensory ganglion of T1
115. Which of the following is false about the heart's innervation?
a) Sympathetic nerve impulses dilate the coronary arteries and increase the
force of contraction of cardiac muscle
b) Visceral sensory fibers traveling with the sympathetic nerves carry
sensation from the heart muscle
c) Sympathetic innervation to the heart originates in regions T5-T12 of the
spinal cord
d) The phrenic nerve passes close to the heart but does not innervate cardiac
muscle
e) Parasympathetic innervation in the cardiac plexus comes from the vagus
nerve
116. Regarding the ligaments of the vertebral column, which of the following is
false?
a) Interspinous ligaments connect adjacent spinous processes
b) Ligamenta flava connect the transverse processes of adjacent vertebra
c) The anterior longitudinal ligament interconnects vertebral bodies
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d) The intervertebral disc is filled with fibrogelatinous pulp, the nucleus
pulposus
e) The ligamentum nuchae attaches to spinous processes of cervical vertebrae
117. Which statement about the lungs is false:
a) The right lung has ten segments
b) The left lung has ten segments
c) The cardiac notch is a feature of the left lung
d) The lingual is a feature of the right lung
e) Both lungs have an oblique fissure
118. Which of the following is true of the azygos vein?
a) It lies close to the intercostal veins but does not connect directly with them
b) It lies on the left side of the thorax
c) It is normally part of the portal system of venous drainage
d) It empties into the superior vena cava
e) It is typically smaller than the hemiazygos vein
119. The Coronary Sinus is found in the:
a) Posterior atrioventricular groove
b) Anterior interventricular groove
c) Posterior interventricular groove
d) Anterior atrioventricular groove
e) Sulcus terminalis
120. Which of the following statements about the thoracic diaphragm is true?
a) The esophagus enters the abdominal cavity posterior to the median arcuate
ligament
b) The esophageal hiatus is at vertebral level T10
c) The diaphragm relaxes during inspiration
d) The left crus of the diaphragm is longer than the right crus
e) The left dome of the diaphragm is usually higher than the right dome
121. Pectoralis minor:
a) Inserts on the coracoid process of the scapula
b) Is innervated by the lateral pectoral nerve only
c) Flexes the arm
d) Lies superficial to pectoralis major
e) Forms the inferior border of the deltopectoral triangle
122. The left lung has:
a) Oesophageal groove
b) Cardiac Notch
c) Lingula
d) Posterior vein of the left ventricle
e) Great cardiac
123. The pleural sac:
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a) Is pierced only by fibers of the vagus nerve
b) Has a portion known as diaphragmatic pleura which is a subdivision of the
visceral pleura
c) Has a cervical extension called the pleural cupola
d) Forms a costodiaphragmatic recess on the left side only
e) Is completely insensitive to pain
124. Which of the following is false of the circulation of the thoracic wall:
a) Blood supply to the upper anterior thoracic wall comes from the
thoracoacromial artery
b) Blood from the anteriormost aspect of the thoracic wall drains into the
internal thoracic vein
c) Unlike the intercostals arteries, posterior intercostals veins do not
anastomose with the anterior intercostals veins
d) The posterior intercostal arteries are branches of the descending aorta
e) The internal thoracic artery branches into the musculophrenic and the
superior epigastric as it approaches the diaphragm
125. Which of the following statements is true?
a) Somatic sensory fibers are supplied to the pericardium by the phrenic
nerves
b) The cardiac plexus of nerves contains only preganglionic sympathetic
nerves
c) The vagus nerve supplies postganglionic sympathetic branches to the heart
d) The sympathetic nerves to the heart slow down the heart rate
e) The parasympathetic nerves to the heart speed-up the heart rate
126. Which of the following statements is true?
a) The aortic valve contains two cusps, an anterior and posterior cusp
b) The valve on the pulmonary trunk contains three cusps, a right coronary
cusp, a left coronary cusp and a posterior non-coronary cusp
c) The right atrioventricular valve has three cusps
d) The left atrioventricular valve has three cusps
e) The valve of the inferior vena cava contains two cusps
127. Which statement is true about the coronary arteries?
a) They are the third pair of branches off of the aorta
b) They supply blood to the parietal pericardium
c) The right coronary artery normally has two main branches: the marginal
artery and the posterior interventicular
d) The left coronary artery normally has only one main branch: the left
anterior descending artery
e) The internal thoracic artery anastomoses with the coronary arteries which
supply the heart
128. Which statement about the heart is true?
a) Systemic circulation begins at the left ventricle and ends at the right atrium
b) The pulmonary circulation begins at the right ventricle and ends at the right
atrium
c) The sinuatrial node is located in the interventricular septum
d) The septomarginal trabeculum is in the left ventricle
e) The pectinate muscles (musculi pectinati) are in the left and right ventricles
129. The main blood supply to lung tissue comes from:
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a) Pulmonary arteries
b) Pulmonary veins
c) Thebesian veins
d) Bronchial veins
e) Bronchial arteries
130. The right lung:
a) Has two lobes
b) Has 11 bronchopulmonary segments
c) Usually has a groove for the right brachiocephalic vein
d) Usually exhibits a groove for the descending aorta
e) Has a prominent cardiac notch
131. Which is the correct pathway of blood-flow through the heart:
a) Right atrium, left atrium, right ventricle, left ventricle, aorta
b) Right atrium, right ventricle, left atrium, left ventricle, aorta
c) Vena cava, right atrium, left atrium, right ventricle, left ventricle, aorta
d) Vena cava, left atrium, pulmonary trunk, right atrium, left ventricle, aorta
e) Lungs, pulmonary trunk, left atrium, left ventricle, aorta
132. Which statement is true?
a) The esophagus pierces the diaphragm at the level of T8
b) The diaphragm attaches to the posterior aspect of the sternum at the level of
the sternal angle
c) The central tendon of the diaphragm is fused with the serous pericardium
just beneath the heart
d) When the diaphragm contracts is moves inferiorly, decreasing intrathoracic
pressure, resulting in air being taken into the lungs
e) The diaphragm, by changing pressure in the thorax and abdomen prevents
blood from returning to the heart
133. The arch of the aorta is crossed by the following structures except:
a) Left phrenic nerve
b) Left vagus nerve
c) Left superior intercostal vein
d) Left main bronchus
e) Left brachiocephalic vein
134. Which of the following statements about the conduction system of the heart
is false?
a) The SA (sinuatrial) node is the "pacemaker" of the heart
b) The SA node is supplied by the sympathetic and parasympathetic nerves
c) The AV (atrioventricular) node receives impulses from the SA node
d) Impulses from the AV node travel to the AV bundle
e) The AV node is located at the base of the anterior papillary muscle
135. Which of the following structures pass behind the medial arcute ligament of
the diaphragm?
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a) Subcostal nerve
b) Right phrenic nerve
c) Sympathetic chain
d) Epigastric artery
e) Vagal trunks
136. Which statement about the vertebrae is true?
a) 4 sacral vertebrae fuse to form the sacrum
b) Spinous processes of vertebrae project laterally from the vertebral arches
c) All vertebrae have foramina in their transverse processes
d) The first cervical vertebra has no body
e) The size of the vertebral bodies decreases from superior to inferior
137. Which of the following is not at the same level as the sternal angle?
a) The disc between vertebra T4 and T5
b) The attachment of the costal cartilage of rib 2
c) The horizontal fissure of the right lung
d) The bifurication of the trachea into primary bronchi
e) The arch of the aorta
138. The thoracic duct is primarily responsible for:
a) Passing lymph through the thorax to the subclavian or brachiocephalic vein
b) Shunting blood between the aorta and pulmonary trunk in fetal circulation
c) Transferring blood between the right atrium and left atrium
d) Draining blood from the intercostal spaces
e) Connecting the right and left lungs
139. Azygos vein receives the following veins except:
a) Bronchial veins
b) Esophageal veins
c) Left superior intercostals vein
d) Lower posterior intercostal vein
e) Hemiazygos vein
140. On the plane between the sternal angle and lower border of T4:
a) Azygos vein enters the superior vena cava
b) Thoracic duct reaches the left side of the esophagus
c) Aortic arch starts and ends
d) All of the above
ABDOMEN
1. The following statements concerning the liver are true except:
a) The quadrate lobe drains into the right hepatic duct
b) The lesser omentum suspends the stomach from the visceral
surface of the liver
c) The left triangular ligament of the liver lies anterior to the abdominal part of
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the esophagus
d) The attachment of the hepatic veins to the inferior vena cava is one of the
most important supports of the liver
e) The ligamentum venosum is attached to the left branch of the portal vein in
the porta hepatis
2. The following statements concerning the pancreas are true except:
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
e) The transverse mesocolon is attached to the anterior border of the pancreas
3. The following statements concerning the ileum are true except:
a) The circular smooth muscle of the lower end of the ileum serves as a
sphincter at the junction of the ileum and cecum
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
along the antimesenteric border
d) The plicae circulares are more prominent at the distal end of the ileum than
in the jejunum
e) The parasympathetic innervation of the ileum is from the vagus nerve
4. The hilum of the right kidney contains the following important structures,
except the:
a) Renal Pelvis
b) Tributaries of the renal vein
c) Sympathetic nerve fibres
d) Part of the right suprarenal gland
e) Branches of the renal artery
5. The following statements concerning the left suprarenal gland are incorrect
except:
a) It extends behind the inferior vena cava
b) It is separated from the left kidney by the pararenal fat
c) Its vein drains into the left renal vein
d) It is usually located on the upper pole and lateral border of the left kidney
e) The medulla is innervated by postganglionic sympathetic nerve fibres
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
b) It lies on the right side of the inferior vena cava
c) From its anterior surface arise the celiac, superior mesenteric and inferior
mesenteric arteries
d) It enters the abdomen in front of the twelfth thoracic vertebra
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e) The thoracic duct leaves the abdomen through the aortic opening of the
diaphragm on the right side of the aorta
7. The following statements concerning the abdominal part of the sympathetic
trunk are NOT TRUE except:
a) It enters the abdomen behind the lateral arcuate ligament
b) The trunk possesses six segmentally arranged ganglia
c) All the ganglia receive white rami communicantes
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:
a) The plexus lies within the psoas muscle
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
9. The following veins form important portal-systemic anastamoses, except the:
a) Esophageal branches of the left gastric vein and tributaries of the azygos
vein
b) Superior rectal vein and the inferior vena cava
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:
a) Both have three anatomic sites that are constricted
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
the psoas muscle
d) Both pass anterior to the testicular or ovarian vessels
e) Both lie anterior to the sacroiliac joints
11. Concerning the inferior mesenteric artery, all of the following statements are
true except:
a) Its colic branch supplies the descending colon
b) It gives off the inferior pancreaticoduodenal artery
c) It supplies the sigmoid colon
d) Its branches contribute to the marginal artery
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
c) Inferior Vena Cava
d) Hepatic artery
e) Lymph Nodes
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13. The following statements concerning the liver are true except:
a) Its lymph drainage is to the celiac nodes
b) The quadrate and the caudate lobes are functionally part of
the left lobe
c) Its parasympathetic innervation is from the vagus nerve
d) It receives highly oxygenated blood from the portal vein
e) The triangular ligaments connect the liver to the diaphragm
14. The following differences exist between the ileum and the ascending colon
except:
a) The ascending colon has appendices epiploicae, whereas the ileum
does not
b) The arterial supply to the wall of the ileum is arranged so that it produces
areas of weakness through which mucosal herniations may occur
c) The ascending colon may have a well-developed marginal artery, whereas
the ileum does not
d) The ileum has a longitudinal muscle that forms a continuous layer around
the wall, whereas the ascending colon has tenia coli
e) The ascending colon is retroperitoneal, whereas the ileum is intraperitoneal
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
b) The first part of the duodenum is completely retroperitoneal
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:
a) The appendix is situated in the right iliac region
b) At the base of the appendix, the teniae coli of the cecum fuse to form a
complete, longitudinal muscle layer in the wall of the appendix
c) Afferent pain nerve fibers accompany the sympathetic nerves and enter the
spinal cord at the level of the tenth thoracic segment
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:
a) It receives its motor innervation from the sympathetic autonomic nerves
b) It lies on the level of the third lumbar vertebrae
c) It is inhibited by the impulses passing down the vagus nerve
d) It is formed by a thickening of the circular layer of smooth muscle in the
stomach wall
e) The cavity of the pylorus is called the pyloric canal
18. The following structures form the boundaries of the entrance into the lesser
sac (epiploic foramen) except:
a) The inferior vena cava
b) The bile duct
c) The portal vein
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d) The quadrate lobe of liver
e) The first part of the duodenum
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:
a) The marginal artery (of Drummond)
b) The middle colic artery
c) The left lumbar arteries
d) Anastomoses between the superior, the middle and the inferior
hemorrhoidal arteries
e) The sigmoid 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
ninth costal cartilage
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
and supraclavicular nerves to the skin over the shoulder
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
b) The superior and the inferior epigastric veins
c) The lateral thoracic, the paraumbilical and the portal veins
d) The posterior intercostal and the lumbar veins
e) The lateral thoracic and the superior epigastric veins
22. Which of the following structures may be eroded by a perforating gastric
ulcer on the posterior wall of the stomach?
a) The inferior mesenteric artery
b) The splenic artery
c) The right kidney
d) The second part of the duodenum
e) The quadrate lobe of the liver
23. Which of the following statements regarding the left ureter is correct?
a) It has the inferior mesenteric vein lying on its lateral side
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
e) It lies within the peritoneal cavity
24. The following structures are connected to the liver. Which structures provide
the greatest support for the liver?
a) The falciform ligament
b) The coronary ligament
c) The ligamentum teres
d) The hepatic veins joining the inferior vena cava
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e) The ligamentum venosum
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?
a) The sigmoid colon
b) The descending colon
c) The transverse colon
d) The ascending colon
e) The jejunum
26. Which of the following statements regarding the superficial inguinal ring is
incorrect?
a) It is a perforation in the aponeurosis of the external oblique muscle
b) Its greatest width lies above and medial to the pubic tubercle
c) It is strengthened posteriorly by the conjoint tendon
d) The internal spermatic fascia is attached to its margins
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?
a) A loss of secretomotor nerve supply to the mucosal glands of the stomach
b) Hoarse voice because of paralysis of the intrinsic muscles of the larynx on
the left side
c) Increased heart rate because of decreased parasympathetic input to the
cardiac plexus
d) Incontinence because of an absence of parasympathetic input to the bladder
e) Compromised input into the greater splanchnic nerves
28. The skin of the umbilicus receives its sensory innervation from:
a) T7
b) T12
c) L1
d) T10
e) L2
29. In both sexes, the inguinal canal is formed by:
a) The descent of the gonad
b) The contraction of the gubernaculum
c) The processus vaginalis
d) The ilioinguinal nerve
e) The contraction of the cremaster muscle
30. The lacunar ligament:
a) Formed from the conjoint tendon
b) Part of the posterior wall of the rectus sheath
c) Not continuous with the inguinal ligament
d) An important medial relation to the femoral ring of the femoral sheath
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e) Attached to the inferior ramus of the pubis
31. The following statements concerning the superficial fascia of the anterior
abdominal wall are true except:
a) It has a superficial fatty layer and a deep membranous layer
b) Scarpa's fascia fuses with the fascia lata just below the inguinal ligament
c) Camper's fascia is continuous with the Colles' fascia in the perineum
d) It is continuous with the dartos muscle in the wall of the scrotum
e) It does not contribute to the femoral sheath
32. The rectus sheath contains the following structure except:
a) The pyramidalis muscle (when present)
b) The ligamentum teres
c) The inferior epigastric artery
d) The T7-12 anterior rami
e) The rectus abdominis muscle
33. The following statements concerning the epididymis are correct except:
a) It lies within the scrotum and posterior to the testis
b) It has an expanded upper end called the head
c) The tail gives rise to the vas deferens
d) It is supplied by the testicular artery
e) Its lymph drains into the superficial inguinal nodes
34. The jejunum and ileum can be differentiated on the basis of the following
anatomic features except:
a) Numerous (4-5) arterial arcades are associated with the jejunum
b) The plicae circulares are much more prominent in the jejunum than in the
ileum
c) Fat depositions are generally present throughout the mesentery associated
with 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
35. The spermatic cord contains the following structures except:
a) The scrotal arteries and veins
b) The vas deferens
c) The pampiniform plexus
d) The testicular artery
e) Autonomic nerves
36. The following structures pass through the esophageal hiatus in the
diaphragm except:
a) The left vagus nerve
b) Branches of the left gastric artery
c) The left phrenic nerve
d) The right vagus nerve
e) A tributary of the portal vein
37. The following statements regarding the peritoneum are incorrect except:
a) The parietal peritoneum is only sensitive to stretch
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b) The parietal peritoneum lining the anterior abdominal wall is innervated by
the lower six thoracic and the first lumbar spinal nerves
c) The visceral peritoneum is innervated by the posterior primary rami of the
twelfth thoracic and the lumbar spinal nerves
d) The visceral peritoneum is sensitive to pain, temperature and touch
e) The peritoneum lining the lesser sac has no nerve supply
38. If the portal vein becomes blocked, the following venous anastomoses are
important in uniting the portal with the systemic venous systems except:
a) Esophageal branches of the left gastric and the azygos veins
b) Veins of the ligamentum teres and the paraumbilical veins
c) The superior and the inferior rectal veins
d) The right colic veins and the lumbar veins
e) The middle and the inferior rectal veins
39. In a patient with cancer of the stomach who requires a total gastrectomy, the
following arteries must be ligated except:
a) The common hepatic artery
b) The short gastric arteries
c) The left and right gastroepiploic arteries
d) The right gastric artery
e) The left gastric artery
40. When performing a midline abdominal paracentesis (tapping the abdominal
cavity) below the umbilicus, the cannula will pass through the following
anatomic structures except:
a) The skin and the fascia
b) The linea alba
c) The transversalis fascia and extraperitoneal fat
d) The rectus abdominis muscle
e) The parietal peritoneum
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
b) An inguinal hernia is more common than a femoral hernia in females
c) A direct inguinal hernia is more common in elderly men than in boys
d) The opening of the sac of a direct inguinal hernia is wide
e) The contents of an indirect inguinal hernia may be strangulated against the
lacunar ligament
42. The following statements regarding the portal vein are true except:
a) It courses through a portion of the lesser omentum
b) It enters the liver at the porta hepatis
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
e) It passes in front of the neck of the pancreas
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:
a) The superior pancreaticoduodenal artery anastomosing with the inferior
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pancreaticduodenal artery
b) The right gastric artery anastomosing with the left gastric artery
c) The gastroduodenal artery anastomosing with the splenic artery
d) The esophageal arteries anastomosing with the inferior phrenic arteries
e) The right gastroepiploic artery anastomosing with left gastroepiploic artery
44. The following general statements are incorrect except:
a) The superior and inferior epigastric vessels anastomose on the anterior
surface of the rectus abdominis muscle
b) The inguinal ligament is attached laterally to the anterior inferior iliac spine
c) The abdominal aorta bifurcates below, in front of the fourth lumbar
vertebrae
d) The foregut ends in the third (inferior) segment of the duodenum
e) The umbilicus is located approximately at the vertebral level L5
45. The following veins drain directly into the inferior vena cava except:
a) The hepatic veins
b) The renal veins
c) The lumbar veins
d) The inferior mesenteric vein
e) The right testicular (ovarian) vein
46. To tap a hydrocele (collection of fluid in the tunica vaginalis) a cannula must
pierce the following structures except:
a) The skin
b) The fatty subcutaneous tissue (fascia of Camper)
c) Dartos muscle
d) The cremasteric fascia
e) The external and the internal spermatic fasciae
47. Which of the following arteries supplies the suprarenal (adrenal) gland:
a) The aorta
b) The lumbar arteries
c) The superior phrenic artery
d) The testicular (ovarian) artery
e) The subcostal artery
48. The following structures are present in the porta hepatic except:
a) Lymph nodes
b) The right and left branches of the portal vein
c) The right and left hepatic ducts
d) The right and left hepatic veins
e) The right and left branches of the hepatic artery
49. The following statements regarding the celiac plexus are true except :
a) The celiac plexus is not a purely sympathetic plexus
b) The celiac plexus does not surround the celiac artery
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c) The celiac ganglia are made of nerve cell bodies and nerve fibers
d) Parasympathetic preganglionic fibers pass through the plexus, generally
synapsing with postganglionic neurons within the walls of the organs they
innervate
e) Sympathetic preganglionic fibers to the celiac plexus originate from the
thoracic spinal segments and travel in thoracic splanchnic nerves
50. The right kidney has the following important relationships except:
a) It is related to the neck of the pancreas
b) It is anterior to the right costodiaphragmatic recess
c) It is related to the second part of the duodenum
d) It is related to the right colic flexure
e) It is anterior to the right twelfth rib
51. The following structures form the walls of the inguinal canal except the:
a) Conjoint tendon
b) Aponeurosis of external oblique muscles
c) Internal oblique muscle
d) Lacunar ligament
e) Fascia transversalis
52. The following structures and events serve to strengthen the walls of the
inguinal canal except:
a) The inguinal ligament is made tense by extending the hip joint
b) The contracting internal oblique muscle reinforces the anterior wall of the
the canal in front of the weak deep inguinal ring
c) The strong conjoint tendon reinforces the posterior wall of the canal behind
the weak superficial inguinal ring
d) Contraction of the arching fibres of the internal oblique and transverse
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
two rings no longer lie opposite one another
53. In the female, the inguinal canal contains the following structures except the:
a) Ilioinguinal nerve
b) Remnant of the processus vaginalis
c) Round ligament of the uterus
d) Inferior epigastric artery
e) Lymph vessels from the fundus of the uterus
54. All of the following structures concerning the spermatic cord are true except:
a) It extends from the deep inguinal ring to the scrotum
b) It contains the testicular artery
c) It is covered by five layers of spermatic fascia
d) It contains the pampiniform plexus
e) It contains lymph vessels that drain the testis
55. All the following structures are present in the inguinal canal in the male
except:
a) Internal spermatic fascia
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b) Genital branch of the genitofemoral nerve
c) Testicular vessels
d) Deep circumflex iliac artery
e) Ilioinguinal nerve
56. All of the following statements concerning the conjoint tendon are true
except:
a) It is attached to the pubic crest and the pectineal line
b) It is formed by the fusion of the aponeuroses of the transverses abdominis
and internal oblique muscles
c) It is attached medially to the linea alba
d) It is continuous with the inguinal ligament
e) It may bulge forward in a direct inguinal hernia
57. All of the following statements concerning the an indirect inguinal hernia are
true except:
a) It is the most common form of abdominal hernia
b) The neck of the hernial sac lies medial to the inferior epigastric artery
c) The sac is the remains of the processus vaginalis
d) The hernial sac can extend into the scrotum
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
b) Dartos muscle and Colles' fascia
c) Tunica albuginea
d) Internal spermatic fascia
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
thigh as far as the lesser trochanter of the femur
b) The quadratus lumborum is covered anteriorly by fascia that forms the
lateral arcuate ligament
c) The iliacus muscles is innervated by the femoral nerve
d) The transverses abdominis muscles does form part of the posterior
abdominal wall
e) The diaphragm does not contribute to the musculature on the posterior
abdominal wall
60. Regarding hernias in the inguinal region
a) The sac of an indirect hernia lies posterior to the spermatic cord
b) The sac of a direct hernia lies lateral to the internal ring
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
e) The sac of the femoral hernia has a wide neck
61. The borders of Hesselbech's trangle include the epigastric vessels, the edge of
the rectus sheath and:
a) Poupart''s ligament (the reflected inguinal ligament)
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b) The internal oblique aponeurosis
c) The external oblique aponeurosis
d) Transversalis fascia
e) The conjoint tendon
62. The only statement regarding the small bowel which is true is:
a) The entire small bowel is intra-peritoneal
b) The jejunum is longer in length, large in diameter, and thinner-walled than
the ileum
c) The muscularis, the muscle layer, provides the strength for the
placement of sutures or staples for surgical anastomoses
d) Peyer's patches are most prominent in the distal ileum
e) The marginal artery of Drummond provides the blood supply to 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
muscle and peritoneum
c) The skin, subcutaneous fat, anterior rectus sheath, rectus muscle, posterior
rectus sheath and peritoneum
d) The skin, subcutaneous fat, extraperitoneal fat, anterior rectus sheath and
muscle
e) The skin, subcuataneous fat, anterior rectus sheath, peritoneum and
posterior rectus sheath
64. The appendix:
a) Arises from the posteromedial aspect of the caecum below the ileoceccal
valve
b) Has an extremely variable position
c) Is supplied by a branch from the right colic artery
d) Is devoid of lymph nodes
e) Is removed surgically through akocher incision
65. The following are correct regarding the gall-bladder except:
a) The Hartmann's pouch lies close to the fundus
b) The cystic artery will be found in Calot's triangle in the majority of cases
c) The cystic artery has no accompanying vein
d) Bleeding during surgery can be controlled by compressing the hepatic
artery
e) Cholecystectomy can be done through a right paramedian incision
66. Below the arcuate line, which of the following structures lies posterior to the
rectus muscle?
a) Linea alba
b) Aponeurosis of transverses abdominis
c) Aponeurosis of internal oblique
d) Transversalis fascia
e) Aponeurosis of external oblique
67. Which of the following structures of the spermatic cord is derived from the
internal oblique muscle?
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a) Internal spermatic fascia
b) External spermatic fascia
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:
a) First part of the duodenum
b) Second part of the duodenum
c) Third part of the duodenum
d) Gall bladder
e) Vermiform appendix
70. Which of the following organs is retroperitoneal?
a) Spleen
b) Stomach
c) Jejunum
d) Pancreas
e) Transverse colon
71. Which of the following is not a symptom of portal vein hypertension?
a) Esophageal bleeding
b) Hemorrhoids
c) Caput medusae
d) Indirect inguinal hernia
e) Engorged veins of the posterior abdominal wall
72. What structure passes behind the medial arcuate ligament of the abdominal
diaphragm:
a) The aorta
b) The esophagus
c) The psoas major muscle
d) The quadratus lumborum muscle
e) The inferior vena cava
73. Which of the following is not a branch of the superior mesenteric artery?
a) Right colic artery
b) Left colic artery
c) Middle colic artery
d) Iliocolic artery
e) Inferior pancreaticoduodenul artery
74. Which of the following is not characteristic of the large intestine?
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a) Taenia coli
b) Haustra
c) Appendices epiploicae
d) Vermiform appendix
e) Epiploic foramen
75. Which of the following statements about the liver is false?
a) Its blood supply normally comes from the celiac trunk
b) It is the largest gland in the body
c) It has four lobes right, left, quadrate and caudate
d) It is connected to the stomach by the lesser omentum
e) Its venous drainage is via the portal vein
76. Which of the following is false about the normal pattern of arterial blood
supply to the stomach:
a) Lesser curvature/ Right gastric artery
b) Pylorus/ Left gastric artery
c) Greater curvature/ left gastroepiploic artery
d) Greater curvature/ right gastroepiploic artery
e) Fundus/ Short gastric arteries
77. The area around the umbilicus receives sensory innervation from the:
a) Superficial epigastric arteries
b) Anterior branch of the ventral ramus of the spinal nerve T 10
c) Subcostal nerve
d) Splanchnic nerve
e) Vagus
78. Inferior the arcuate line, which of the following structures lies posterior to
the rectus muscle?
a) Aponeurosis of external oblique
b) Aponeurosis of internal oblique
c) Aponeurosis of internal oblique and tranversus abdominis
d) Internal oblique fascia
e) Transversalis fascia, peritoneum
79. Which layer of the spermatic cord is derived from the internal oblique
muscle of the abdominal wall?
a) External spermatic fascia
b) Cremaster muscle
c) Internal spermatic fascia
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) They are more common in the males than in females
c) They follow the path of the inguinal canal
d) They often result from a patent processus vaginalis
e) They involve and outpouching of gut below the inguinal ligament
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81. Which of the following is not a site of portal systemic anastomosis?
a) Lower part of esophagus
b) Umbilicus
c) Rectum
d) Greater curvature of the stomach
e) Posterior abdominal wall
82. The conjoint tendon (falx ingunalis) is formed by the:
a) Transverse abdominis muscle or its aponeurosis
b) Internal abdominal oblique muscle or its aponeurosis
c) Both A and B
d) Neither A nor B
83. Which of the following supply the lesser curvature of the stomach?
a) Left gastric artery
b) Right gastric artery
c) Short gastric arteries
d) All of the above
e) Both A and B
84. Which of the following is not involved in arterial blood supply to the anterior
abdominal wall?
a) Superior epigastric artery
b) Intercostal arteries
c) Deep circumflex iliac artery
d) Musculophrenic artery
e) Inferior epigastric artery
85. The external oblique muscle:
a) Inserts on the internal surfaces of the seventh through twelfth costal
cartilages
b) Makes up the entire rectus sheath inferior to the umbilicus
c) Originates on the pubic symphysis and pubic crest
d) Extends the trunk
e) Is innervated by the inferio r six thoracic spinal nerves (intercostals nerves
and subcostal nerves)
86. Which of the following is the obliterated umbilical vein?
a) Ligamentum venosum
b) Ligamentum teres
c) Median umbilical ligament
d) Lateral umbilical ligament
e) Falciform ligament
87. The hepatic hilum consists of:
a) Hepatic duct
b) Branches of the portal vein
c) The hepatic artery
d) The hepatic vein, cystic duct and main pancreatic duct
e) The portal vein, hepatic artery and common hepatic duct
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88. The abdominal aorta:
a) Is surrounded by the central portion of the diaphragm
b) Is surrounded by plexus of autonomic nerve fibers
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
90. Regarding the pancreas:
a) Exocrine secretions are released into the interstitial spaces
b) The pancreas is invested by a prominent and distinct connective tissue
capsule
c) The pancreas is retroperitoneal except for the tail which is intraperitoneal
d) Centroaciner cells appear acidophilic when stained by routine hematoylin
and eosin methods due to the high number of secretory vesicles
e) All of the above
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
e) All of the above
92. The renal arteries:
a) Originate directly from the abdominal aorta
b) Provide arterial blood to the adrenal glands
c) Provide arterial blood to the kidneys
d) Usually form four anterior segmental arteries within the hilum of the kidney
e) All of the above
93. The median, medial and lateral umbilical folds of the anterior abdominal
wall are formed respectively by the:
a) Urachus, obliterated umbilical arteries and inferior epigastric arteries
b) Urachus, obliterated umbilical arteries and veins
c) Obliterated umbilical arteries and veins
d) Urachus and inferior epigastric artery
e) Urachus, obliterated umbilical arteries and superficial epigastric arteries
94. The following statements are true about the cisterna cyli except:
a) Receives lymph from nodes draining the posterior abdominal wall
b) Is in direct continuity with the inferior vena cava
c) Is a terminal dilation of the thoracic duct
d) Is generally located inferior to the aortic hiatus
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95. The following statements about the kidney are true except:
a) Is in contact with the spleen on the left side
b) Is in contact with duodenum on the right side
c) Is located retroperitoneally
d) Receives its blood supply from a branch of the celiac trunk
96. Select the one best answer:
a) The superior epigasrtic artery is a branch of the external iliac artery
b) The anterior portion of the rectus sheath is formed by the aponeurosis of the
external abdominal oblique and transverses abdominis muscle
c) The inguinal canal terminates at the superficial inguinal ring ( a defect in
the external abdominal oblique muscle)
d) The conjoint tendon consists of lower fibers of the external abdominal
muscle and the inguinal ligament
e) The internal spermatic fascia is derived from the internal oblique muscle
97. Which of the following is not true in relation to the stomach?
a) It is located at the supramesocolic compartment
b) The right gastroepiploic artery running along the greater curvature, is a
branch of the gastrodudodenal artery
c) The cardiac notch is an incisure found at the most dependent point of the
lesser curvature
d) The greater curvature gives attachment to the greater omentum
e) Cardiac orifice is at T11 vertebral level
98. Select the correct statement:
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 caudate lobe is the bed for the gallbladder
e) The cystic bile duct leads into the proximal duodenum
99. The posterior limit of the omental (epiploic) foramen is:
a) The free border of the lesser omentum
b) The hepatic artery
c) The caudate lobe
d) The duodenum
e) The inferior vena cava
100. Indicate the correct statement:
a) The pancreas is located in the epigastric and right hypochondriac regions
b) The pancreas is divided into head, neck and tail
c) The uncinate process projects medially behind the superior mesenteric
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
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101. The common bile duct and the pancreatic ducts empty into the:
a) First part of the duodenum
b) Second part of the duodenum
c) Third part of the duodenum
d) Second part of the duodenum (8cm) from the pylorus
e) Middle of the 2nd part of the duodenum
102. Which of the following is retroperitoneal?
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
c) The psoas major
d) The quadratus lumborum
e) The inferior vena cava
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?
a) Inferior vena cava
b) External iliac vein
c) Splenic vein
d) Ascending lumbar veins
e) Left renal vein
106. Bleeding from the cystic artery during cholecystectomy can be controlled by
digital pressure on:
a) The fundus of the gall bladder
b) The region of Hartmann's pouch
c) The anterior wall of the foramen of Winslo w
d) The lesser curvature of the stomach
e) The celiac artery
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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
e) Aponeurosis of internal abdominal oblique
108. Which of the following groups of structures receives its arterial blood
supply from the superior mesenteric artery?
a) Ascending colon, transverse colon, descending colon, sigmoid colon
b) Left colic flexure, descending colon, ascending colon, rectum
c) Left colic flexure, descending colon, spleen, sigmoid colon
d) Jejunum, ileum, cecum, ascending colon
e) Descending colon, left colic flexure, rectum, sigmoid colon
109. Which of the following statements regarding circulation to abdominal
organs is false?
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
c) The superior mesenteric vein drains the ileum and jejunum
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
superior mesenteric artery
110. Which of the following statements regarding the abdomen is false?
a) The falciform ligament is a dorsal mesentery
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
e) The hepatic veins drain into the inferior vena cava
111. Which of the following combinations is not a postal-systemic (portocaval)
anastomosis?
a) Left gastric veins and esophageal veins
b) Superior, middle and inferior rectal veins
c) Superior and inferior epigastric veins
d) Para-umbilical veins and epigastric veins
e) Colic veins and retroperitoneal veins
112. Which of the following statements regarding the posterior abdominal wall is
false?
a) The iliopsoas muscle flexes the hip
b) The quadratus lumborum muscle receives somatic motor innervation via the
lateral femoral cutaneous nerve
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
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posterior abdominal wall
e) The cisterna chyli is an enlargement at the inferior end of the thoracic duct
113. Which of the following statements regarding the kidney is false?
a) The superior (proximal), expanded end of the ureter is called the renal
pelvis
b) Renal arteries arise directly from the abdominal aorta
c) The right gonadal vein drains into the right renal vein
d) The suprarenal glands receive their blood supply from the inferior, middle,
and superior suprarenal arteries
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?
a) Aponeurosis of external oblique
b) Deep inguinal ring
c) Aponeurosis of internal oblique
d) Internal oblique fascia
e) Transversalis fascia
115. Which of the following statements regarding the autonomic innervation of
abdominal organs is false?
a) Autonomic axons carried in the vagus nerve synapse in ganglia in the celiac
plexus
b) The superior hypogastric plexus is composed of autonomic nerves and
ganglia
c) Preganglionic cell bodies for axons comprising the least splanchnic nerves
lie in the spinal cord segment T12
d) The lumbar splanchnic nerves carry preganglionic sympathetic axons
e) The pelvic splanchnic nerves provide preganglionic parasympathetic axons
to the digestive tract beyond (distal to) the left colic flexure
116. Caput medusae signify:
a) Cirrhosis
b) Portal hypertension
c) Essential hypertension
d) Umbilical hernia
e) Epigastric hernia
117. The ureter crosses all except:
a) Vas deferens
b) Uterine artery
c) Inferior mesenteric artery
d) Pelvic brim
e) Sacro-iliac joint
118. Which is true regarding the kidneys:
a) The anterior surface of the right kidney includes a colic area
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
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d) The perirenal fascia is a synonym for renal fascia
e) The inferior poles may extend to the level of the first sacral vertebra
119. Which is false regarding the appendix:
a) In the majority of cases hangs down below the caecum
b) Receives arterial blood from the anterior caecal artery
c) May be over 20 cm long
d) Has a wider lumen in infants
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
b) The appendices epiploicae of the large intestine, which have no blood
supply
c) The haustrations of the large intestine, which are caused by contractions of
both layers of intramural smooth muscle
d) Peyer's patches will occur in both small & large intestines
e) Brunner's glands which are present in the duodenum
121. Which is incorrect regarding the pancreas:
a) Its venous drainage is via the splenic vein
b) The congenital malformation known as annular pancreas arises because of
malrotation of the ventral bud of the pancrease
c) It is supplied by the arterial blood via the celiac, superior mesenteric and
splenic arteries
d) The tip of the tail lies in the gastrosplenic ligament
e) The bile duct is sometimes embedded within its substance
122. Which is false about the superior mesenteric artery:
a) It arises about the level of L1
b) It has no branches which supply the large intestine
c) It does not supply the jejunum by its first branch
d) It emerges from the substance of the pancreas
e) It supplies the transverse colon by its last branch
123. The duodenum:
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,
abdominal aorta and the common bile duct
c) Receives artrial blood from the superior pancreaticoduodenal, inferior
pancreaticoduodenal and inferior mesenteric artery
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:
a) At the saphenous opening
b) Above and medial to the pubic tubercle
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c) Below and lateral to the pubic tubercle
d) In the obturator canal
e) Lateral to the iliacus muscle
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
b) The long axis of the uterus is usually bent anteriorly on the
long axis of the vagina (anteversion)
c) The nerve supply of the uterus is from the inferior hypogastric plexuses
d) The anterior surface of the cervix is completely covered with peritoneum
e) The uterine veins drain into the internal iliac veins
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
b) It crosses the ureter in the region of the ischial spine
c) The terminal part is dilated to form the ampulla
d) It lies on the posterior surface of the prostate but is separated from it by
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
being no valvular mechanism at its entrance
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
e) It enters the bladder at the upper lateral angle of the trigone
4. Concerning the seminal vesicle, the following statements are true except:
a) The seminal vesicles are related posteriorly to the rectum and can be
palpated through the rectal wall
b) The seminal vesicles are two lobulated organs that store spermatozoa
c) The upper ends of the seminal vesicles are covered by peritoneum
d) The function of the seminal vesicles is to produce a secretion that is added
to the seminal fluid
e) The seminal vesicles are related anteriorly to the bladder, and no
peritoneum separates these structures
5. Concerning the ovary, the following statements are true except:
a) The lymph drainage is into the para-aortic (lumbar) lymph nodes at the
level of the first lumbar vertebra
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
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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
e) The obturator nerve lies lateral to the ovary
6. Concerning the nerve supply to the urinary bladder, the following statements
are true except:
a) The sympathetic postganglionic fibers originate in the first and second
lumbar ganglia
b) The parasympathetic postganglionic fibers originate in the inferior
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
fourth sacral segments of the spinal cord
e) The parasympathetic postganglionic fibers are responsible for closing the
vesical sphincter during ejaculation
7. Concerning the vagina, the following statements are true except:
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
transverse cervical ligaments
c) The perineal body lies posterior to and supports the lower part of the vagina
d) The upper part of the vagina is not covered with peritoneum
e) The vaginal wall receives a branch of the uterine artery
8. Concerning the visceral layer of pelvic fascia in the female, the following
statements are true except:
a) In the region of the cervix of the uterus, it is called the parametrium
b) It is condensed to form the pubocervical, transverse cervical, and
sacrocervical ligaments of the uterus
c) It covers the obturator internus muscle
d) It does not become continuous above with the fascia transversalis
e) On the lateral wall of the pelvis, it fuses with the parietal layer of the pelvic
fascia
9. The following statements concerning the lymphatic drainage of pelvic
structures are correct except:
a) Lymph from the cervix of the uterus drains into the internal and external
iliac lymph nodes
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
external iliac lymph nodes
d) Lymph from the trigone of the bladder drains into the internal and external
iliac lymph nodes
e) Lymph from the fundus of the uterus drains into the para-aortic lymph
nodes at the level of the first lumbar vertebrae
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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
c) It is about 1.5in (3.75 cm) long
d) It pierces the urogenital diaphragm
e) It is straight, and only minor resistance is felt as a catheter is passed through
the urethtral sphincter
12. The following structures can be palpated by a vaginal examination except:
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:
a) The pudendal nerve lies in its lateral wall
b) The floor is formed by the superficial fascia and skin
c) The lateral wall is formed by the obturator internus muscle and its fascia
d) The medial wall is formed in part by the levator ani muscle
e) The roof is formed by the urogenital diaphragm
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
anteriorly as the corpus spongiosum
b) Its roots laterally are formed by the crura, which continue anteriorly as the
corpora cavernosa
c) The penile urethra lies within the corpus spongiosum
d) The glans penis is a distal expansion of the fused corpora cavernosa
e) The penis is suspended from the lower part of the anterior abdominal wall
by two condensations of deep fascia
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15. The following statements concerning the perineal structures are correct
except:
a) The anorectal ring is formed by the subcutaneous, superficial and deep
fibers of the external sphincter
b) The urogenital diaphragm is attached laterally to the inferior ramus of the
pubis and the ischial ramus
c) The bulbourethral glands are situated in the deep perineal pouch
d) The anococcygeal body is rarely damaged in child birth
e) The lymph drainage of the skin around the anus is into the medial group of
superficial inguinal nodes
16. The urogenital diaphragm is formed by the following structures except:
a) Deep transverse perineal muscle
b) Perineal membrane
c) Sphincter urethrae
d) Colles' fascia (membranous layer of superficial fascia)
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:
a) Bulb of the penis
b) Urogenital diaphragm
c) Anorectal ring
d) The anterior surface of the rectum
e) Ureter
18. The following statements concerning the anal canal are true except:
a) It is about 1.5 in (3.8 cm) long
b) It pierces the urogenital diaphragm
c) It is related laterally to the external anal sphincter
d) It is the site of an important portal-systemic anastomosis
e) The mucous membrane of the lower half receives its arterial supply from
the inferior rectal artery
19. The following statements concerning the subcutaneous part of the external
anal sphincter are correct except:
a) It encircles the anal canal
b) It is not attached to the anococcygeal
c) It is composed f striated muscle fibers
d) It is not responsible for causing the anal canal and the rectum to join at an
acute angle
e) It is innervated by the middle rectal nerve
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
b) The muscles of the anterior abdominal wall contract
c) The external anal sphincters and the puborectalis relax
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
through the anus ahead of the fecal mass
21. The process of ejaculation depends on the following processes except:
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a) The sphincter of the bladder contracts
b) The sympathetic preganglionic nerve fibers arising from the first and
second lumbar segments of the spinal cord must be intact
c) The smooth muscle of the epididymis, ductus (vas) deferens, seminal
vesicles and prostate contracts
d) The bulbourethral glands and the urethral glands are active
e) The bulbospngiosus muscles relax
22. The following structures receive innervation from the branches of the
pudendal nerve except:
a) Labia minora
b) Urethral sphincter
c) The posterior fornix of the vagina
d) Ischiocavernosus muscles
e) Skin of the penis or clitoris
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
b) Posteriorly is situated the upper part of the rectum
c) The trigone of the bladder is directly related to its anterior wall
d) Anteriorly is situated in the posterior surface of the body of the uterus
e) Laterally is situated in the sacrocervical ligaments passing forward to the
cervix
24. Support for the uterus either directly or indirectly, is provided by the
following structures except:
a) The perineal body
b) The mesosalpinx
c) The transverse cervical (cardinal) ligaments
d) The levator ani muscles
e) The pubocervical ligaments
25. The following statements regarding the ovary are correct except:
a) It is attached to the posterior layer of the broad ligament
b) It ovulates an ovum into the peritoneal cavity
c) It is attached to the lateral pelvic wall by the round ligament of the ovary
d) It normally is not related to the posterior fornix of the vagina
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
trigone, which is smooth
c) Parasympathetic nerve fibers innervate the detrusor muscle
d) The trigone is the area between the openings of the urethra and the two
ureters
e) In children, the bladder is located entirely within the pelvis
27. The broad ligament contains all of the following except:
a) The round ligament of the ovary
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b) The uterine artery
c) The round ligament of the uterus
d) The uterine tubes
e) Ureters
28. Malignant tumors of the trigone of the bladder spread (metastasize) to the
following lymph nodes:
a) Lumbar
b) Sacral
c) External iliac only
d) External and internal iliac
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:
a) The anterior abdominal wall
b) The ischiorectal fossa
c) The scrotum
d) The penis
e) The superficial perineal puch
30. The deep perineal space (pouch) contains the:
a) Internal pudendal artery
b) Pudendal artery
c) Sphincter urethtrae
d) Both A and B
e) Both A and C
31. The following is true about the pudendal canal except:
a) Can be palpated throughout its entire length during rectal examination
b) Is a fascial tunnel
c) Contains the terminal branches of the pudendal nerve
d) Lies in the lateral wall of the ischiorectal fossa
32. All of the following statements about the ductus deferens are true except:
a) It opens via the ejaculatory duct into the prostatic urethtra
b) It begins at the head of the epididymis
c) It is one of the contents of the spermatic cord
d) It enters the abdominal cavity at the deep inguinal ring
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
b) The levator ani muscle is composed of the pubococcygeus, puborectalis and
iliococcygeus
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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
34. Which one of the following is true:
a) The urinary bladder in the male sits at a lower level than that of the female
because of the presence of the prostate
b) The scrotum is actually an external genital organ, but is in direct continuity
with male pelvic organs via the vas deferens
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
division of the internal iliac artery
35. The urethra is located in the:
a) Ischiorectal fossa
b) Deep perineal pouch
c) Superficial perineal pouch
d) Both B and C
e) All of the above
36. The bulb of the penis is located in the:
a) Deep perineal pouch
b) Superficial perineal pouch
c) Ischiorectal fossa
d) None of the above
37. Primary support for the uterus is derived from the:
a) Lateral (transverse) cervical ligaments
b) Pubocervical ligaments
c) Sacrocervical ligaments
d) Round ligament of the uterus
e) Broad ligament
38. Which is not considered a usual branch of the anterior division of the
internal iliac artery:
a) Internal pudendal artery
b) Iliolumbar artery
c) Obturator artery
d) Umbilical artery
e) Middle rectal artery
39. Which of the following statements about the rectum is false?
a) The sciatic nerve is derived from the segments L4 and 5; S1, 2 and 3
b) In the pudendal nerve is derived from the segments L3, 4 and 5
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c) The pelvic splanchnic nerve is derived from the segments S2, 3 and 4
d) The obturator nerve is derived from the segments L2, 3 and 4
e) The lumbosacral trunk is derived from the segments L4 and 5
40. Which of the following ligaments is attached to the uterus and composed of
peritoneum:
a) Transverse cervical (cardinal) ligaments
b) Broad ligament
c) Round ligament
d) Suspensory ligament of ovary
e) Medial umbilical fold
41. Which statement is false about the pudendal nerve?
a) It carries fibers from the spinal cord segments S2-S4
b) It innervates the levator ani muscle
c) It innervates the internal sphincters of bladder and rectum
d) It runs in the ischiorectal fossa
e) It exits the pelvis through the greater sciatic foramen
42. The male urethtra:
a) In rupture urethra urine may be found in the scrotum
b) Its entire epithelial lining is stratified squamous type
c) Is 5 inches long
d) The membranous part receives the ejactulatory ducts
e) Has 3 constrictions
43. The transverse (lateral) cervical ligament is pierced by the:
a) Superior hypogastric plexus
b) Uterine artery
c) Ureter
d) Both B and C
e) All of the above
44. The deep perineal space is deep to the perineal membrane. It contains:
a) Membranous urethra
b) Vagina
c) Deep transverse perinea muscles
d) All of the above
e) Both A and C
45. Regarding the spermatic cord, select the false statement:
a) The vas deferens starts in the tail of epididymis
b) The internal spermatic fascia arises from the internal oblique muscle
c) The testicular artery arises from the aorta
d) The cremasteric artery arises from the inferior epigastric artery
e) Lymphatics from the ductus deferens drain to internal iliac nodes
46. Which of the following is not a branch of the internal iliac artery?
a) Inferior vesical
b) Umbilical
c) Superior gluteal
d) Iliolumbar
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e) Inferior epigastric
47. Which of the following is true?
a) The urinary bladder in male sits at a lower level than that of the female
because of the presence of the prostate
b) The scrotum is actually an external genital organ, but is in direct continuity
with male pelvic organs via the ductus deferens
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
division of the internal iliac artery
e) The lymphatics of the ovary drain to the internal iliac nodes
48. The following statements concerning the ischio-anal fossa are true except:
a) The pudendal nerve lies in its lateral wall
b) The floor is formed by the superficial fascia and skin
c) The lateral wall is formed by the obturator internus muscle and its fascia
d) The medial wall in part is formed by the levator ani muscle
e) The roof is formed by the urogenital diaphragm
49. Which is statement is not true concerning the anal canal?
a) It is about 1.5 inches (3.75cm) long
b) It is lined by ciliated columnar epithelium
c) It is related laterally to the external anal sphincter
d) It is the site of an important portal-systemic anastomosis
e) The mucous membrane f the lower half receives its arterial supply from the
inferior rectal artery
50. All of the following structures exit the pelvis via the greater sciatic foramen
except:
a) Piriformis muscle
b) Superior gluteal vessels
c) Internal pudendal vessels
d) Obturator internus muscle
e) Inferior gluteal vessels
51. The pelvic diaphragm:
a) Forms the inferior boundary of the pelvic cavity
b) Can be divided into levator ani and coccygeus muscles
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
e) All of the above
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
53. Which of the following statements is true?
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a) The internal pudendal artery is embedded in a fascial canal within the
urogenital triangle
b) The pudendal nerve is a branch of the lumbar plexus
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
passing through the greater sciatic foramen
e) The pudendal nerve supplies the external anal sphincter
54. Which of the following has an intra- and extrapelvic component:
a) Broad ligament
b) Ovarian ligament
c) Round ligament of the uterus
d) Transverse cervical (cardinal) ligament
e) More than one of the above
55. Which structures do not pass through the deep perineal pouch of the
urogenital triangle:
a) Urethra
b) Root of the clitoris
c) Deep transverse perineal muscle
d) Internal pudendal artery
e) Vagina
56. The urinary bladder:
a) Is lined by stratified squamous epithelium
b) Has lymphatics which drain to nodes alongside the internal iliac artery
c) Has a trigone whose endothelium is endoderm-derived
d) Has a medial umbilical ligament arising from its apex
e) Lies anterior to the anal canal in the male
57. Concerning the pudendal nerve, select the incorrect statement:
a) Is the main motor and sensory supply of the pelvic floor and perineum
b) Has a root value of S1-3
c) Passes between piriformis and coccygeus to reach the ischioanal fossa
d) Has the inferior rectal nerve as one of its branches which supplies the
levator ani
e) Has the perineal nerve as one of its terminal branches
58. Which is not true about the rectum?
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
the internal iliac artery which may sometimes be absent
c) Receives some of its blood supply from the internal pudendal artery via the
inferior rectal artery
d) Has a venous drainage which includes the middle rectal vein, which drains
to the portal circulation
e) Has a lymph drainage which reaches both the inferior mesenteric and
internal iliac lymph nodes
59. The Prostate Gland:
a) Has peritoneum on its posterior surface
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b) Releases its secretions into the ejaculatory duct
c) Is supported by both the urogenital and pelvic diaphragms
d) If healthy, cannot be palpated by rectal digital examination
e) All of the above
UPPER LIMB
1. The following structures pass posterior to the flexor retinaculum of the wrist
except the:
a) Flexor digitorum superficialis tendons
b) Median nerve
c) Flexor pollicis longus tendon
d) Ulnar nerve
e) Anterior interosseous nerve
2. The following tendons are inserted into the base of the proximal phalanx of the
thumb except the:
a) Extensor pollicis brevis
b) Abductor pollicis longus
c) Oblique head of adductor pollicis
d) Flexor pollicis brevis
e) Firs palmer interosseous
3. The following muscles abduct the hand at the wrist joint except the:
a) Flexor carpi radialis
b) Abductor pollicis longus
c) Extensor carpi radialis longus
d) Extensor digiti minimi
e) Extensor pollicis longus
4. The following bones form the proximal row of carpal bones except the:
a) Lunate
b) Pisiform
c) Scaphoid
d) Triquetral
e) Trapezium
5. The tendons of the following muscles form the rotator cuff except the:
a) Teres minor
b) Supraspinatus
c) Subscapularis
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d) Teres major
e) Infraspinatus
6. The quadrangular space is bounded by the following structures except the:
a) Surgical neck of the humerus
b) Long head of triceps
c) Deltoid
d) Teres major
e) Teres minor
7. The lymph from the upper lateral quadrant of the breast drains mainly into:
a) Lateral axillary nodes
b) Internal thoracic nodes
c) Posterior axillary nodes
d) Anterior axillary nodes
e) Deltapectoral group of nodes
8. The radial nerve gives off the following branches in the posterior
compartment of the arm except the:
a) Lateral head of the triceps
b) Lower lateral cutaneous nerve of the arm
c) Medial head of the triceps
d) Brachioradialis
e) Anconeus
9. The medial collateral ligament of the elbow joint is closely related to the
following structure:
a) Brachial artery
b) Radial nerve
c) Ulnar artery
d) Basilic vein
e) Ulnar nerve
10. All of the following statements concerning the brachial plexus are true
except:
a) The roots of C8 and T1 join to form the lower trunk
b) The roots, trunks, and divisions are not located in the axilla
c) The nerve that innervates the levator scapulae is a branch of the upper trunk
d) The cords are named according to their position relative to the first part of
the axillary artery
e) No nerves originate as branches from the individual divisions of the
brachial plexus
11. The anterior fascial compartment of the forearm contains the following
arteries except the:
a) Brachial
b) Anterior interosseous
c) Radial
d) Ulnar
e) Profunda
12. The boundaries of the anatomic snuffbox include the following except the:
a) Abductor pollicis brevis
b) Extensor pollicis longus
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c) Extensor pollicis brevis
d) Abductor pollicis longus
13. The following structures are attached to the greater tuberosity of the
humerus except the:
a) Supraspinatus muscle
b) Coracohumeral ligament
c) Teres minor muscle
d) Infraspinatus muscle
e) Subscapularis muscle
14. The following structures form the boundaries to the superior entrance into
the axilla except the:
a) Clavicle
b) Coracoid process
c) Upper border of scapula
d) Outer border of first rib
15. The carpal tunnel contains the following important structures except the:
a) Flexor pollicis longus tendon
b) Flexor digitorum profundus tendon
c) Median nerve
d) Flexor carpi radialis tendon
e) Flexor digitorum superficialis tendons
16. Collateral circulation around the shoulder joint would involve all the
following except:
a) The subscapular artery
b) The superficial cervical artery
c) The suprascapular artery
d) The anterior circumflex humeral artery
e) The lateral thoracic artery
17. The proximal row of carpal bones includes all the following carpal bones
except:
a) The pisiform
b) The capitate
c) The lunate
d) The triquetral
e) The scaphoid
18. A shoulder separation, which involves the lateral end of the clavicle sliding
onto the superior aspect of the acromion, would most likely result from damage
to:
a) The costoclavicular ligament
b) The sternoclavicular ligament
c) The coracoclavicular ligament
d) The glenohumeral ligament
e) The coracoacromial ligament
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19. Select the muscle that will compensate in part for paralysis of the supinator
muscle:
a) The extensor carpi ulnaris muscle
b) The brachialis muscle
c) The triceps brachii muscle
d) The biceps brachii muscle
e) The anconeus
20. The synovial sheath of the flexor pollicis longus muscle forms:
a) The thenar space
b) The ulnar bursa of the wrist
c) The midpalmer space
d) The radial bursa of the wrist
e) The digital synovial sheath for the index finger
21. To test for trapezius muscle paralysis, you would ask the patient to:
a) Flex the arm fully
b) Adduct the arm against resistance
c) Push against a wall with both hands
d) Shrug the shoulder
e) Abduct the arm fully
22. The lymph from the medial quadrants of the breast drain mainly into:
a) The posterior axillary (subscapular) nodes
b) The internal thoracic nodes
c) The anterior axillary (pectoral) nodes
d) The lateral axillay (brachial) nodes
e) The infraclavicular (deltopectoral) nodes
23. Cutting the dorsal scapular nerve would most likely result in paralysis of:
a) The supraspinatus muscle
b) The deltoid muscle
c) The rhomboid majo r muscle
d) The trapezius muscle
e) The infraspinatus muscle
24. Regarding the "winged scapula," the following facts are correct except:
a) The spinal part of the accessory is damaged
b) The inferior angle of the scapula projects backwards
c) The serratus anterior muscle may be wasted
d) The long thoracic nerve is damaged
e) The scapula can no longer me pulled anteriorly around the chest wall
25. After injury to a nerve at the wrist, the thumb is laterally rotated and
adducted. The hand looks flattened and "apelike." Which nerve has been
damaged?
a) The anterior interosseous nerve
b) The ulnar nerve
c) The deep branch of the radial nerve
d) The median nerve
e) The superficial branch of the radial nerve
26. The dermatome present over the lateral side of the wrist is:
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a) C8
b) C6
c) T1
d) T2
e) C5
27. A 14-year-old boy fell of a wall and fractured his right humerus at midshaft.
The wrist joint immediately assumed a flexed position that the patient was
unable to correct. Extension and supination of the forearm was weakened but
not abolished, and skin sensation over the lateral side of the dorsum of the hand
was diminished. Select the one peripheral nerve, that if damged, could account
for these symptoms and signs.
a) The ulnar nerve
b) The median nerve
c) The radial nerve
d) The axillary nerve
e) The musculocutaneous nerve
28. A patient can raise (abduct) her arm no further than to a 15 o position. This
suggests paralysis of which muscle? :
a) The rhomboid minor
b) The deltoid
c) The supraspinatus
d) The teres minor
e) The subscapularis
29. The following statements regarding the rotator cuff are incorrect except:
a) It adds to the stability of the shoulder joint
b) It is formed by the tendons of the long muscles in the region of the shoulder
joint
c) It consists of muscle fibers located close to the shoulder joint
d) All the muscle tendons are innervated by the suprascapular nerve
e) The muscle tendons are not fused to the capsule of the shoulder joint
30. The quadrangular space in the region of the shoulder transmits the following
structures except:
a) The axillary nerve
b) The posterior circumflex humeral artery
c) The lymphatic vessels
d) The radial nerve
e) The posterior circumflex humeral vein
31. A patient with a knife wound to the front of the left wrist is seen in the
emergency department. Examination reveals that two superficial tendons on
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either side of the median nerve have been severed. Which of the following
tendons are these?
a) The flexor pollicis longus and pronator quadratus tendons
b) The flexor carpi ulnaris and the flexor digitorum profundus tendons
c) The flexor digitorum superficialis and flexor carpi radialis tendons
d) The brachioradialis and pronator teres tendons
e) The abductor pollicis longus and the extensor pollicis brevis tendons
32. The following statements regarding the lateral cord of the brachial plexus are
true except:
a) It contains sympathetic nerve fibers
b) It has a branch that supplies the pectoralis major muscle
c) It has a branch that supplies the skin on the lateral side of the forearm
d) It has a branch that supplies the skin on the lateral side of the upper arm
e) It lies lateral to the second part of the axillary artery
33. An examination of a patient with carpal tunnel syndrome may reveal all the
following symptoms and signs except:
a) Atrophy of the muscles of the thenar eminence
b) Weakness in opposition of the thumb
c) Loss of skin sensation on the medial part of the palm
d) Loss of skin sensation on the ventral surface of the index finger
e) Normal skin sensation on the ventral surface of the little finger
34. The following movements are expected to be normal after a complete section
of the medial cord of the brachial plexus except:
a) Extension of the wrist
b) Flexion of the elbow
c) Abduction of the shoulder joint
d) Metacarpophalangeal flexion and interphalangeal extension of the medial
four fingers
e) Metacarpophalangeal flexion and interphalangeal extension of the thumb
35. The following statements regarding the sympathetic innervation of the
arteries of the upper limb are correct except:
a) Have preganglionic nerve fibers originating in spinal cord segments T2-8
b) Cause vasoconstriction of the arteries and veins of the skin
c) Have preganglionic nerve fibers synapsing in the middle cervical, the
inferior cervical, and the first thoracic ganglia
d) Many of the postganglionic fibers are distributed within the branches of the
brachial plexus
e) The sympathetic nerves do not innervate the sweat glands
36. Which statement about the shoulder and arm is true?
a) A quadrangular space is bounded by teres minor, teres major, and the long
and medial heads of triceps brachii
b) The radial nerve and profunda brachii artery run between medial and lateral
heads of triceps brachii
c) The quadrangular space gives passage to the radial nerve
d) The circumflex scapular artery is a branch of a subclavian artery
e) The suprascapular nerve passes through the triangular space
37. Which of the following muscles does not contribute to wrist abduction?
a) Flexor carpi radialis
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b) Extensor carpi radialis longus
c) Brachioradialis
d) Abductor pollicis longus
e) Extensor pollicis longus
38. Suprascapular nerve from:
a) Posterior cord
b) Lateral cord
c) Both medial & lateral cords
d) Upper trunk
e) None of the above
39. Medial side of palmer aspect of ring finger is supplied by:
a) Median nerve
b) Radial nerve
c) Dorsal cutaeous branch of ulnar nerve
d) Superficial branch of ulnar nerve
e) Palmer cutaneous branch of ulnar nerve
40. An inability to oppose the thumb to the little finger can result from damage
to the nerve:
a) Ulnar
b) Axillary
c) Radial
d) Median
41. Which of the following statements is incorrect?
a) Musculocutaneous nerve innervates muscles of the anterior compartment of
the arm
b) Median nerve lies between brachialis and brachioradialis in the cubital
fossa
c) The anterior interosseous nerve is a branch of the median nerve
d) The flexor carpi ulnaris is innervated by the ulnar nerve
e) The extensor indices is innervated by the posterior interosseous nerve
42. The following statements about the radial nerve are true except:
a) Arises from the posterior cord of the brachial plexus
b) Runs in the spiral groove of the humerus
c) Runs with the posterior humeral circumflex artery
d) Supplies sensation to part of dorsum of the hand
e) Supplies posterior compartment of the arm
43. Which of the following flex the metacarpophalangeal joints and extend the
interphalangeal joints in the hand:
a) Lumbricals
b) Interossei
c) Both A and B
d) Neither A nor B
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44. Paralysis of the pectoralis major muscle will cause weakness in the following
shoulder movements:
a) Medial rotation
b) Adduction
c) Flexion
d) Circumduction
e) All of the above
45. Select the incorrect statement:
a) Profunda brachii runs with the ulnar nerve in the arm
b) The median nerve and brachial artery run with the medial intermuscular
septum in the arm
c) The superior ulnar collateral artery anastomoses with the posterior ulnar
recurrent to provide a route of collateral circulation around the elbow
d) The anterior humeral circumflex artery has anastomoses with the posterior
humeral circumflex artery
46. The anterior interosseous nerve supplies:
a) Pronator teres muscle
b) Lateral two lumbricals
c) Medial two lumbricals
d) Flexor pollicis longus
e) Skin overlying the anterior surface of the wrist joint
47. Arterial supply of the breast comes from:
a) Internal thoracic artery
b) Lateral thoracic artery
c) Posterior intercostals arteries
d) Thoraco-acromial artery
e) All of the above
48. The following nerves are involved in abduction of the shoulder joint except:
a) Suprascapular nerve
b) Axillary nerve
c) Musculocutaneous nerve
d) Long thoracic nerve
e) Spinal accessory nerve
49. The supraspinatus muscle:
a) Initiates adduction of the arms
b) Is a rotator cuff muscle
c) Is attached on the lesser tubercle of the humerus
d) Is innervated by the dorsal scapular nerve
e) Is a medial rotator of the shoulder joint
50. The following statements regarding the lateral cord of the brachial plexus are
true except:
a) It contains sympathetic nerve fibers
b) Has a branch that supplies the pectoralis major
c) Has a branch that supplies the lateral side of the forearm skin
d) Has a branch that supplies the lateral side of the arm skin
e) Lies lateral to the second part of the axillary artery
51. Brachioradialis muscle:
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a) Flexes the forearm
b) Is supplied by the radial nerve
c) Both A and B
d) Neither A nor B
52. Damage to which nerve would result in an inability toe extend the wrist:
a) Radial nerve
b) Ulnar nerve
c) Median nerve
d) Musculocutaneous nerve
e) Axillary nerve
53. The importance of the anatomical snuff box is:
a) The radial artery runs through it
b) The most frequently fractured carpal bone forms the floor
c) Both A and B
d) Neither A nor B
54. The following statements about the median nerve are true except:
a) Does not supply any muscle in the arm
b) Supplies all muscles in the thenar eminence
c) Supplies two lumbrical muscles
d) Supplies sensation to the lateral palmer hand
e) Supplies all muscles in the extensor part of the forearm
55. Attaching the coracoid process of the scapula is/are:
a) Pectoralis major
b) Short head of biceps brachii
c) Both A and B
d) Neither A nor B
56. Which of the following statements is incorrect?
a) Musculocutaneous nerve innervates muscles of the anterior compartment of
arm
b) Median nerve lies between brachial and brachioradialis in cubital fossa
c) Anterior interosseous nerve is a branch of median nerve
d) Flexor carpi ulnaris is innervated by the ulnar nerve
e) Extensor indices is innervated by the posterior interosseous nerve
57. Pick the best association, the teres major muscle:
a) Rotator cuff
b) Axillary nerve
c) Both A and B
d) Neither A nor B
58. The axillary artery:
a) Ends at the lower border of the teres minor
b) Divided into three segments by the clavicular head of the pectoralis major
c) Continuation of the subclavian artery on the right side and brachiocephalic
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artery on the left side
d) Has the cords of the brachial plexus along its entire length
e) Pulse can be palpated in the axilla
59. Which of the following structures is not included in the posterior axillary
wall?
a) Latissimus dorsi
b) Teres major
c) Pectoralis major
d) Subscapularis
60. All of the following insert on to the greater tubercle of the humerus except:
a) Subscapularis
b) Teres minor
c) Supraspinatus
d) Infraspinatus
e) All of the above
61. The ulnar nerve supplies:
a) Lateral half of flexor digitorum superficialis
b) Flexor carpi ulnaris
c) Flexor carpi radialis
d) Lateral half of flexor digitorum profundus
e) All of the above
62. Which of the following is not found in the axilla:
a) Apical group of lymph nodes
b) Dorsal scapular nerve
c) Breast tissue
d) Third part of axillary artery
63. Select the incorrect statement about the structures of the cubital fossa:
a) The brachioradialis forms the lateral border of the fossa
b) Bicepital aponeurosis is not pierced during normal blood drawing from the
medial cubital vein
c) Brachialis and supinator form the floor of the fossa
d) The ulnar nerve enters fossa deep to the pronator teres
64. Which of the following muscles does not insert into the scapula?
a) Trapezius
b) Levator scapulae
c) Pectoralis major
d) Rhomboids
e) All of the above
65. The musculocutaneous nerve:
a) Becomes the medial antebrachial cutaneous nerve
b) One of the two terminal branches of medial cord of the brachial plexus
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c) Both A and B
d) Neither A nor B
66. Muscles important in the abduction of the arm include:
a) Deltoid
b) Supraspinatus
c) Both A and B
d) Neither A nor B
67. Nerves which come off the roots of the brachial plexus include:
a) Lower subscapular
b) Long thoracic
c) Both À and B
d) Neither A nor B
68. Lateral rotators of the arm include:
a) Subscapularis
b) Infraspinatus
c) Both A and B
d) Neither A nor B
69. Injury of the radial nerve just proximal to the elbow joint would cause:
a) Wrist drop
b) Failure to produce extension of forearm
c) Both A and B
d) Neither A nor B
70. Select the incorrect statement:
a) Carpal tunnel contains tendons of flexor carpi radialis and flexor digitorum
superficialis and profundus
b) Two proper palmer digital nerves and proper dorsal digital nerves innervate
each digit (finger)
c) Thenar muscles are flexor pollicis brevis, abductor pollicis brevis &
opponens pollicis
d) Median nerve is located in midpalmer compartment of hand
71. The terminal branches of the posterior cord of the brachial plexus:
a) Musculocutaneous
b) Radial
c) Both A and B
d) Neither A nor B
72. Which of the following is not supplied by the recurrent branch of the median
nerve:
a) Abductor pollicis brevis
b) Flexor pollicis brevis
c) Adductor pollicis
d) Opponens pollicis
73. The following muscles originate from the common extensor tendon except:
a) Brachioradialis
b) Flexor digitorum superficialis
c) Both A and B
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d) Neither A nor B
74. All of the following muscles are attached to the humerus except:
a) Pectoralis minor
b) Pecotralis major
c) Subscapularis
d) Supraspinatus
e) Teres minor
75. Rotator cuff muscles include:
a) Teres major
b) Teres minor
c) Both A and B
d) Neither A nor B
76. Which statement concerning the serratus anterior muscle is/are not true:
a) It originates from the subscapular fossa
b) Its innervated by long thoracic nerve
c) Both A and B
d) Neither A nor B
77. The tendon of which muscle is found within the shoulder joint cavity?
a) Infraspinatus
b) Supraspinatus
c) Coracobrachialis
d) Long head of biceps brachii
e) Short head of biceps brachii
78. Coursing through the radial groove of the humerus with the radial nerve is
the:
a) Profunda brachii artery
b) Brachial artery
c) Both A and B
d) Neither A nor B
79. What are the two tendons on either side of the median nerve at the wrist:
a) Flexor pollicis longus & pronator quadratus
b) Flexor carpi ularis & flexor digitorum profundus
c) Flexor digitorum superficialis & flexor carpi radialis
d) Brachioradialis and pronator teres
e) Abductor pollicis longus and extensor pollicis brevis
80. The carpal tunnel syndrome does not affect:
a) Skin of thenar eminence
b) Thenar muscles
c) Flexor pollicis brevis
d) First lumbrical
81. The carpal tunnel contains the following except:
a) Flexor digitorum profundus
b) Flexor digitorum superficialis
c) Ulnar nerve
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d) Median nerve
82. The ulnar nerve supplies:
a) Flexor digitorum superficialis
b) Abductor digiti minimi
c) Middle finger
d) Abductor pollicis brevis
e) First lumbrical
83. Select the correct statement regarding the ulnar nerve:
a) Passes through the cubital fossa
b) Supplies teres minor
c) Arises from posterior cord
d) Supplies adductor pollicis
e) Supplies shoulder joint
84. The anterior wall is formed of all of the following except:
a) Pectoralis major
b) Teres minor
c) Pectoralis minor
d) Subclavius
e) Clavipectoral fascia
85. Select the correct tendon(s) contained in the cubital fossa:
a) Brachialis tendon
b) Biceps brachii
c) Both A and B
d) Neither A nor B
86. The floor of the cubital fossa is formed of:
a) Deep fascia of the forearm
b) Bicepital aponeurosis
c) Both A and B
d) Neither A nor B
87. Paralysis of the serratus anterior causes:
a) Flattening of the shoulder
b) Winging of the scapula
c) Both A and B
d) Neither A nor B
88. Serratus anterior is supplied by:
a) Dorsal scapular nerve
b) Thoracodorsal nerve
c) Long thoracic nerve
d) Lower subscapular nerve
89. The tendons of which muscles pass within the joint cavities:
a) Infraspinatus
b) Long head of triceps brachii
c) Long head of biceps brachii
d) Both A and B
e) Both B and C
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90. The following bony points can be felt in the floor of the anatomical snuff box:
a) Radial styloid
b) Scaphoid
c) Trapezium
d) All of the above
e) None of the above
91. Which of the following veins begin at the roof of the cubital fossa:
a) Basilic
b) Cephalic
c) Both A and B
d) Neither A nor B
92. Concerning upper limb arterial supply all of the following are true except:
a) The brachial artery can be compressed over the cubital fossa
b) The radial artery may be palpated at the cubital fossa
c) The ulnar artery can be compressed over the pisiform bone
d) The pulsation of the subclavian artery could be felt over the 1 st rib
e) The ulnar artery is the main blood supply of the hand
93. Concerning peripheral nerve injuries, all of the following are incorrect
except:
a) The radial nerve arises from the medial cord
b) If the radial nerve is injured in the axilla the patient has partial claw hand
c) The median nerve has no branches in the hand
d) The ulnar nerve injury at the elbow will give appearance of wrist drop
e) Ape hand results from median nerve injury in the elbow
94. Which of the following muscles have their origin in the scapula and cross the
elbow?
a) Corachobrachialis & biceps brachii
b) Corachobrachialis & brachialis
c) Brachialis and biceps brachii
d) Biceps & Triceps
e) Brachialis & Triceps
95. Which of the following would not be affected by damage to the ulnar nerve?
a) Wrist adduction
b) Thumb adduction
c) Sensation in the skin on the palm side of digit five
d) Extension of the wrist
e) Wrist flexion
96. The two muscles abducting the humerus above the head:
a) Serratus anterior and trapezius
b) Deltoid and subscapularis
c) Supraspinatus and subscapularis
d) Teres major and subscapularis
e) Deltoid and teres major
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97. In the shoulder joint:
a) Flexion is produced by the costal head of pectoralis major
b) Abduction is initiated by the deltoid
c) Deltoid is the main adductor
d) Extension is produced by the corachobrachialis
e) Lateral rotation is perforemed by teres major
98. The floor of the cubital fossa is formed by:
a) Brachialis muscle
b) Supinator
c) Anconeous
d) Both A and B
e) Both B and C
99. Scapular anastomosis includes:
a) Dorsal scapular artery
b) Suprascapular artery
c) Circumflex scapular artery
d) Both A and B
e) All of the above
100. In the middle of the arm:
a) Deltoid is inserted medially
b) Corachobrachialis is inserted medially
c) Basilic vein penetrates the deep fascia
d) Both B and C
e) Both A and B
101. Arterial supply of the breast comes from the:
a) Internal thoracic artery
b) Superior thoracic artery
c) Posterior intercostals arteries
d) Both A and B
e) Both A and C
102. The following muscles originate from the greater tubercle of the humerus:
a) Teres minor
b) Supraspinatus
c) Infraspinatus
d) All of the above
e) None of the above
103. Damage to which nerve would result in a lack sensation in the skin over the
deltoid muscle:
a) Radial
b) Ulnar
c) Median
d) Musculocutaneous
e) Axillary
104. Medial rotators of the humerus include:
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a) Latissmus dorsi
b) Subscapularis
c) Both A and B
d) Neither A nor B
105. The musculocutaneous nerve:
a) Originates from the medial cord
b) Contains fibers from spinal nerves C5, 6 and 7
c) Supplies sensory innervation to the medial forearm
d) Both A and B
e) All of the above
106. The radial nerve:
a) Supplies cutaneous sensation to the lateral forearm
b) Supplies cutaneous sensation to the medial forearm
c) Both A and B
d) Neither A nor B
107. Which of the following structures does not cross the shoulder
(glenohumeral) joint:
a) Coracoclavicular ligaments
b) Glenohumeral ligaments
c) Long biceps tendon
d) Subscapularis tendon
108. Which of the following muscles are not a medial rotator of the shoulder
joint?
a) Subscapularis
b) Teres major
c) Latissmus dorsi
d) Pectoralis major
e) Teres minor
109. Which statement about blood supply of the upper extremity is false:
a) The humeral circumflex arteries are branches of the axillary artery
b) The cephalic vein runs up the arm lateral to the biceps
c) The median cubital vein connects the basilica and cephalis veins
d) The terminal branches of the brachial artery are the radial and ulnar arteries
e) In the cubital fossa, the brachial artery runs superficial to the bicepital
aponeurosis
110. Which artery does not participate in the arterial anastomose around the
scapula?
a) Subscapular artery
b) Suprascapular artery
c) Posterior circumflex humeral artery
d) Lateral thoracic artery
e) Transverse (superficial) cervical artery
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111. Sensory innervation to the lateral side of the forearm is supplied by the:
a) Musculocutaneous nerve
b) Radial nerve
c) Ulnar nerve
d) Axillary nerve
e) Median nerve
112. Which of the following statement about the triceps brachii is false:
a) The long head of triceps extends the forearm
b) The medial head of triceps extends the forearm
c) The lateral head of triceps extends the arm
d) The triceps is innervated by the radial nerve
e) The triceps receives its blood supply from the profunda brachii artery
113. Which statement about the brachial plexus is true?
a) The brachial plexus is formed by ventral rami of C3-T1
b) The superior trunk contains only nerves innervating the ventral division of
the arm
c) The lateral cord is formed by the posterior divisions of the middle and
superior trunk
d) There are 6 trunks and 3 divisions
e) It begins in the neck and ends in the axilla
114. Pectoralis minor:
a) Inserts in the coracoid process of the scapula
b) Is innervated by the lateral pectoral nerve only
c) Flexes the arm
d) Lies superficial and lateral to the pectoralis major
e) Forms the inferior border to the deltopectoral triangle
115. At the middle of the arm these statements are true except:
a) Median nerve crosses the brachial artery
b) Deltoid is inserted along medial border of the humerus
c) Superior ulnar collateral artery pierces medial intramuscular septum
d) Coracobrachialis is inserted along the medial border of the humerus
e) Basilic vein pierces the deep fascia
116. The tendons of which muscles pass within the joint cavities:
a) Infraspinatus
b) Popliteus
c) Long head of biceps brachii
d) Both A and B
e) Both B and C
117. All of the following pass superficial to the flexor retinaculum except:
a) Palmar branch of ulnar nerve
b) Palmer branch of median nerve
c) Tendon of palmaris longus
d) Tendon of flexor pollicis longus
e) Ulnar nerve
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118. Winging of the scapula will result from injury to:
a) Infraspinatus
b) Trapezius
c) Serratus Anterior
d) Teres Major
e) Teres Minor
119. Which statement about the hand is false?
a) The thenar muscles are innervated by the median nerve
b) The hypothenar muscles are innervated by the ulnar nerve
c) The palmar interossi are innervated by the median nerve
d) The dorsal interossei are innervated by the ulnar nerve
e) The lumbricals are innervated by the ulnar and median nerves
120. Which of the following wrist bones does not articulate with a metacarpal:
a) Trapezium
b) Lunate
c) Hamate
d) Capitate
e) Trapezoid
121. A fracture of the medial epicondyle of the humerus is most likely to damage
which of the following nerves?
a) Ulnar
b) Radial
c) Median
d) Musculocutaneous
e) Deep radial
122. Which of the following arteries accompanies the radial nerve into the
posterior compartment of the arm?
a) Brachial artery
b) Deep brachial artery (profunda brachii)
c) Anterior circumflex humeral artery
d) Posterior circumflex humeral artery
e) Circumflex scapular artery
123. Inability to flex the elbow is most likely an indicator of an injury to which of
the following nerves?
a) Axillary nerve
b) Median nerve
c) Radial nerve
d) Musculocutaneous nerve
e) Ulnar nerve
124. The Scapula:
a) Has a spine on its dorsal surface which bounds the upper limit for the origin
of the fibers of subscapularis
b) Has the digitations of serratus anterior inserting into its lateral border
c) Has the coracoid process projecting forwards as the lateral projection of the
spine of the scapula
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d) Gives attachment to one head of the biceps brachii
e) Has the coracoid process which provides attachment to three muscles and
three ligaments
125. Which is false regarding the ulnar nerve:
a) Has a root value of C5-7
b) Passes just medial to the pisiform bone
c) Carries nerve fibers which supply the elbow joint
d) Supplies skin on both the palmer and dorsal aspects of the hand
e) Supplies palmaris brevis
126. The median nerve:
a) Has a root value of C5-7
b) Provides innervation to the shoulder joint
c) Is sensory to the palmer aspect of the little, ring and middle fingers
d) Supplies pronator quadratus indirectly
e) Lies deep to the tendons of flexor digitorum superficialis at the wrist
127. Which is false regarding the extensor expansions?
a) Divide into three parts distally
b) Are made up of the extensor tendon, the lumbricals and the interossei
c) Contribute to flexion of the metacarpophalangeal joint
d) Insert into the proximal, middle and distal phalanges
e) Are affected in radial nerve injuries
128. The interossei:
a) Are all innervated by the median nerve
b) Are divided into palmer and dorsal, the former being the larger and more
powerful
c) Include the palmer interossei which abduct the fingers
d) Include the dorsal interossei which all arise by two heads
e) Of the middle finger adducts the finger
129. Which of the following muscles flex the forearm:
a) Brachialis
b) Coracobrachialis
c) Both A and B
d) Neither A or B
130. Muscles in the anterior (flexor of forearm) which are supplied by the ulnar
nerve include:
a) Flexor digitorum superficialis
b) Flexor carpi ulnaris
c) Both A and B
d) Neither A or B
131. Structures passing deep to or within the flexor retinaculum include all the
following except:
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a) Tendon of palmaris longus
b) Tendon of flexor digitorum superficialis
c) Median nerve
d) Tendon of flexor digitorum profundus
e) All of the above pass within the flexor retinaculum
132. The tendon of which muscle is a good guide to finding the ulnar artery at
the wrist:
a) Palmaris longus
b) Flexor carpi ulnaris
c) Flexor carpi radialis
d) Flexor carpi radialis longus
133. Medial rotation of the humerus is produced by which muscle?
a) Teres minor
b) Teres major
c) Both A and B
d) Neither A nor B
134. In a fracture of the clavicle, the lateral fragment is displaced onward. This is
due to the pull of the:
a) Upper limb
b) Trapezius
c) Pectoralis major
d) Sternocleidomastoid
e) Subclavius
135. Following injury to a nerve at the wrist, the thumb is laterally rotated and
adducted. The hand has a flattened appearance and is 'ape-like'. Which of the
following nerves is damaged?
a) Ulnar nerve
b) Anterior interosseous nerve
c) Deep radial nerve
d) Musculocutaneous nerve
e) Median nerve
136. The fingernail of the index finger requires removal because of an underlying
abscess. The nerve that requires blocking by a local anesthetic agent is the:
a) Dorsal digital branch of the ulnar nerve
b) Dorsal digital branch of the radial nerve
c) Palmar digital branch of the ulnar nerve
d) Palmar digital branch of the median nerve
e) Terminal branches of the posterior interosseous nerve
137. The ulnar nerve was damaged by a deep laceration at the left wrist when a
17-year old male put his hand through a plate glass window. Select the correct
statement(s) about the patient's symptoms:
a) He cannot adduct his ring finger and hold a piece of paper between his ring
and middle fingers
b) The motor innervation to the flexor digiti minimi brevis and the 3 rd and 4th
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lumbricals is lost so that the ring and little finger are hyperextended at the
metacarpophalangeal joints
c) He is able to hold a toothpick between the pads of his thumb and index
d) The middle and distal phalanges of the ring and little finger are flexed at the
proximal interphalangeal joint and the distal interphalangeal joint
e) All of the above
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
d) Common peroneal nerve
e) Superficial peroneal 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
3. Which of the following muscles is a flexor of the thigh?
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
b) Extensor digitorum brevis
c) Tibialis posterior
d) Extensor hallucis brevis
e) Tibialis anterior
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5. The following muscles invert the foot except the:
a) Tibialis anterior
b) Extensor hallucis longus
c) Extensor digitorum longus
d) Peroneus tertius
e) Tibialis posterior
6. The following facts concerning the dorsalis pedis artery are correct except:
a) It is a continuation of the anterior tibial artery
b) It enters the sole of the foot by passing between the two heads of the first
dorsal interosseous muscle
c) It can be palpated on the dorsum of the foot between the tendons of tibialis
anterior and extensor hallucis longus muscle
d) It joins the lateral planter artery
e) On its lateral side lies the terminal part of the deep peroneal nerve
7. The following structures contribute to the boundaries of the popliteal fossa
except the:
a) Semimembranosus muscle
b) Plantaris
c) Biceps femoris
d) Medial head of the gastrocnemius muscle
e) Soleus
8. The following structures pass through the greater sciatic foramen except the:
a) Superior gluteal artery
b) Sciatic nerve
c) Obturator internus tendon
d) Pudendal nerve
e) Inferior gluteal vein
9. The femoral ring is bounded by the following structures except the:
a) Femoral vein
b) Lacunar ligament
c) Superior ramus of the pubis
d) Femoral artery
e) Inguinal ligament
10. A femoral hernia descends through the femoral canal, and the NECK of the
hernial sac lies:
a) At the saphenous opening
b) Above and medial to the pubic tubercle
c) Below and lateral to the pubic tubercle
d) In the obturator canal
e) Lateral to the iliacus muscle
11. The following structures pass through the subsartorial canal except the:
a) Posterior division of the obturator nerve
b) Saphenous nerve
c) Femoral artery
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d) Nerve to the vastus intermedius
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
13. The peroneal artery is a branch of which artery?
a) Anterior tibial artery
b) Popliteal artery
c) Posterior tibial artery
d) Arcuate artery
e) Lateral planter artery
14. Which statement is NOT true of the ankle joint?
a) It is strengthened by the deltoid (medial collateral ligament)
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
d) It is most stable in the fully plantar-flexed position
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:
a) Superficial circumflex iliac artery
b) Obturator artery
c) Branches from the medial and lateral circumflex femoral arteries
d) Deep external pudendal artery
e) Inferior gluteal artery
17. The lymph drainage of the skin covering the ball of the big toe is into the:
a) Vertical group of superficial inguinal nodes
b) Popliteal nodes
c) Horizontal group superficial inguinal nodes
d) Axillary nodes
e) Internal iliac nodes
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18. The lymph drainage of the skin covering the medial side of the knee joint is
into the:
a) Popliteal nodes
b) Internal iliac nodes
c) Vertical group of superficial inguinal nodes
d) Horizontal group of superficial inguinal nodes
e) Obturator nodes
19. The lymph drainage of the skin of the buttock is into the:
a) Axillary nodes
b) Superior gluteal nodes
c) Vertical group of superficial inguinal nodes
d) Horizontal group of superficial inguinal nodes
e) Internal iliac nodes
20. The lymph drainage of the skin of the calf is into:
a) Vertical group of superficial inguinal nodes
b) Internal iliac nodes
c) Horizontal group of superficial inguina nodes
d) Popliteal nodes
e) Obturator nodes
21. Hyperextension of the hip joint is prevented by:
a) Obturator internus tendon
b) Ischiofemoral ligament
c) Tensor fascia lata muscle
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?
a) The peroneal artery
b) The posterior tibial artery
c) The medial planter artery
d) The lateral planter artery
e) All of the above
23. In children, the chief femoral arterial supply to the head of the femur is
derived from:
a) The obturator artery
b) The internal pudendal artery
c) Branches from the medial and lateral circumflex humeral arteries
d) The deep circumflex iliac artery
e) The superficial circumflex iliac artery
24. The femoral ring is:
a) The opening in the deep fascia of the thigh for the great saphenous vein
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b) The opening in the adductor magnus muscle for the femoral artery
c) The proximal opening in the femoral canal
d) The compartment in the femoral sheath for the femoral artery
e) The compartment in the femoral sheath for the femoral nerve
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?
a) The lateral collateral ligament
b) The posterior cruciate ligament
c) The anterior cruciate ligament
d) The medial collateral ligament
e) The patellar ligament
26. A femoral hernia has the following characteristics except:
a) It is more common in women than in men
b) The swelling occurs below and lateral to the pubic tubercle
c) It descends through the femoral canal
d) The neck is related immediately laterally to the femoral artery
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:
a) They are supplied by the tibial nerve
b) They are found in the posterior compartment of the leg
c) They arise from the femoral condyles and flex the knee joint
d) They insert via the tendo calaneus
e) They planter flex the ankle joint
28. All the following statements about the sartorius are correct except:
a) It flexes the leg at the knee joint
b) It flexes the thigh at the hip joint
c) It laterally rotates the thigh at the hip joint
d) It adducts the thigh at the hip joint
e) It attaches to the anterior superior iliac spine
29. To lift the left foot off the ground while walking, which of the following
muscles play an important role?
a) The left gluteus medius muscle
b) The left gluteus maximus muscle
c) The right adductor longus muscle
d) The right gluteus medius muscle
e) None of the above
30. Rupture of the tendo calcaneus results in the inability to:
a) Dorsiflex the foot
b) Evert the foot
c) Invert the foot
d) Planterflex the foot
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e) None of the above
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?
a) The deep peroneal nerve
b) The superficial peroneal nerve
c) The common peroneal nerve
d) The tibial nerve
e) The obturator nerve
33. The femoral nerve arises from the following segments of the spinal cord:
a) L2-3
b) L4, 5; S1, 2 and 3
c) L2, 3 and 4
d) L1 and 2
e) L5; S1, 2 and 3
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:
a) The tendon of the obtarator internus muscle
b) The internal pudendal vessels
c) The nerve to the obtarator internus muscle
d) The pudendal nerve
e) The inferior gluteal nerve
36. The femoral sheath is formed by which of the following layer(s) of fascia?
a) The pectineus fascia
b) The fascia iliaca and the fascia transversalis
c) The fascia lata and the membranous layer of the superficial fascia
d) The psoas fascia and the fatty layer of superficial fascia
e) The processus vaginalis
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37. The following facts regarding the great saphenous vein are true except:
a) It arises on the dorsum of the foot
b) It enters the leg by passing anterior to the medial malleolus
c) It drains into the femoral vein approximately 1.5 inch (3.8 cm) below
and lateral to the pubic tubercle
d) It is accompanied by the saphenous nerve
e) It has no communication with the deep veins of the leg
38. Which of the following muscles everts the foot?
a) The tibialis posterior muscle
b) The flexor hallucis longus muscle
c) The peroneus longus muscle
d) The tibialis anterior muscle
e) The flexor digitorum longus muscle
39. The lateral meniscus of the knee joint:
a) Has a thick inner border
b) Is strongly attached around its circumference to the tibia
c) Is more frequently torn than the medial meniscus
d) Is strongly attached to the lateral collateral ligament
e) Is attached by its anterior horn to the tibia in front of the intercondylar
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?
a) The semitendinosus muschle
b) The gluteus medius muscle
c) The pectineus muscle
d) The gracilis muscle
e) The semimembranosus muscle
41. The following facts regarding the obturator nerve are true except:
a) It originates from the lumbar plexus
b) It enters the thigh immediately beneath the inguinal ligament
c) It innervates the adductor muscles of the thigh
d) It divides into an anterior and posterior division
e) It supplies the skin on the medial side of the thigh
42. Injury to the common peroneal nerve results in an:
a) Inability to invert the foot
b) Inability to planterflex the ankle
c) Inability to evert the foot
d) Inability to planterflex the big toe
e) Inability to feel skin sensation on the medial side of the leg
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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:
a) The short head of the biceps femoris muscle
b) The gastrocnemius muscle
c) The plantaris muscle
d) The popliteus muscle
e) The long head of the biceps femoris muscle
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
45. The first metatarsal bone forms:
a) Medial longitudinal arch only
b) Medial and lateral longitudinal arches only
c) Transverse arch only
d) Medial longitudinal and transverse arches
e) Lateral longitudinal and transverse arches
46. Calcaneus forms:
a) Medial longitudinal arch only
b) Medial and lateral longitudinal arches only
c) Transverse arch only
d) Medial longitudinal and transverse arches
e) Lateral longitudinal and transverse arches
47. Which of the following does not insert into the planter aspect of the foot?
a) Flexor digitorum longus
b) Peroneus tertias
c) Peroneus longus
d) Tibialis posterior
e) Flexor hallucis longus
48. Which of the following muscles does not arise from the calcaneus?
a) Flexor digitorum brevis
b) Extensor digitorum brevis
c) Flexor accessorius
d) Flexor hallucis brevis
e) Abductor hallucis
49. The movement of eversion of the foot takes place at the following joints
except:
a) Subtalar joints
b) Ankle joints
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c) Talocalcaneonavicular joint
d) Calcaneocuboid joint
e) Transverse tarsal joints
50. The Great Saphenous Vein:
a) Lies anterior to the medial malleolus
b) Lies posterior to the central axis of the knee joint
c) Has communication with the short saphenous vein
d) Pierces the femoral sheath
e) All of the above
51. Which of the following nerve/vessel pairs are INCORRECT:
a) Sural nerve/ short saphenous vein
b) Superficial peroneal nerve/ peroneal artery
c) Tibial nerve/ posterior tibial artery
d) Deep peroneal nerve/ anterior tibial artery
e) Tibial nerve/ popliteal artery
52. Muscles attached to the ischial tuberosity include all except:
a) Inferior gamellus
b) Adductor magnus
c) Long head of biceps femoris muscle
d) Gluteus medius
e) Semitendinousus
53. Select the incorrect statement about the gluteus maximus:
a) Gets its entire motor innervation from the inferior gluteal nerve
b) Is an important hip stabilizer in walking
c) Produces hip extension
d) Inserts primarily into the iliotibial tract
e) Takes a portion of its origin from the sacrotuberous ligament
54. Flexion of the knee can be produced by all of the following except:
a) Adductor magnus
b) Short head of biceps femoris
c) Gastrocnemius
d) Sartorius
e) Gracilis
55. The cruciate anastomosis of the hip includes all the following arteries except:
a) Medial femoral circumflex
b) Lateral femoral circumflex
c) Inferior gluteal
d) First perforating artery
e) Obturator artery
56. The foot receives cutaneous innervation from:
a) Sural nerve
b) Medial planter nerve
c) Saphenous nerve
d) Deep peroneal nerve
e) All of the above
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57. The fascia lata is an insertion for the following muscles:
a) Gluteus minimus
b) Tensor fascia lata
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:
a) Superficial peroneal nerve
b) Deep peroneal nerve
c) Both A and B
d) Neither A nor B
60. Tibialis posterior:
a) Takes its origin from the tibia
b) Takes its origin from the fibula
c) Both A and B
d) Neither A nor B
61. The interossei of the foot
a) Are all involved in abduction of toes
b) Originate from adjacent side of proximal phalanges 2-4
c) Both A and B
d) Neither A nor B
62. Adductor magnus is innervated by which of the following?
a) Femoral nerve
b) Obturator nerve
c) Deep peroneal nerve
d) Lateral plantar nerve
e) None of the above
63. Small saphenous vein travels with which of the following nerves?
a) Sural nerve
b) Deep peroneal nerve
c) Saphenous nerve
d) Tibial nerve
64. Posterior tibial artery travels with which of the following nerves?
a) Sural nerve
b) Deep peroneal nerve
c) Saphenous nerve
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d) Tibial nerve
e) Superior gluteal nerve
65. Which of the following is involved in arterial anastomosis around the hip
joint?
a) Internal pudendal artery
b) Medial femoral circumflex artery
c) Both A and B
d) Neither A nor B
66. Which of the following muscles produce knee flexion?
a) Gracilis
b) Soleus
c) Both A and B
d) Neither A nor B
67. "Foot drop" can be caused by trauma to:
a) Common peroneal nerves
b) Femoral nerve
c) Both A and B
d) Neither A nor B
68. The femoral sheath:
a) Contains 3 compartments: each for the femoral artery, vein and nerve
b) Saphenous opening on anterior surface for the great saphenous vein
c) Both A and B
d) Neither A nor B
69. Which is/are not innervated by lateral plantar nerves?
a) Adductor hallucis
b) Abductor digiti minimi
c) Flexor digitorum brevis
d) Fourth lumbrical
e) All of the above
70. Which of the following is a branch of the posterior tibial artery?
a) Dorsalis pedis artery
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
b) Inferior gluteal nerve
c) Tendon of obturator internus
d) Internal pudendal artery
e) Internal pudendal vein
72. Structures located in the subsartorial (adductor) canal include:
a) Saphenous nerve
b) Popliteal vein
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c) Great saphenous vein
d) Profunda femoris artery
e) All of the above
73. The great sciatic foramen transmits all of the following except:
a) Superior gluteal artery
b) Inferior gluteal artery
c) Internal pudendal artery
d) External pudendal artery
74. The femoral triangle:
a) Has a portion of vastus lateralis in its lateral floor
b) Contains lymph nodes which drain skin of 7th thoracic dermatome
c) Has adductor longus muscle as its base
d) Contains femoral nerve
e) All of the above
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
d) Long head of biceps femoris
e) All of the above
76. Sacrospinous ligament traverses the:
a) Greater sciatic foramen
b) Lesser sciatic foramen
c) Both A and B
d) Neither A nor B
77. Which can be found in the lateral compartment of the leg?
a) Peroneus brevis
b) Peroneus tertias
c) Both A and B
d) Neither A nor B
e) None of the above
78. Which of the following is not normally a branch of the profunda femoris
artery?
a) Obturator
b) Medial femoral circumflex
c) Lateral femoral circumflex
d) Its perforating artery
e) 4th perforating artery
79. The cruciate anastomosis:
a) Receives one of its major contributions from the obturator artery
b) Receives blood from the 1st perforating artery
c) Both A and B
d) Neither A nor B
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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
82. Obturator externus is innervated by which of the following nerves?
a) Ilioinguinal nerve
b) Femoral nerve
c) Obturator nerve
d) Lateral femoral nerve
e) Genitofemoral nerve
83. Soleus is:
a) Attached to the calcaneus
b) Attached to the proximal phalanx of medial toe
c) Attached to 5th metatarsal
d) Both A and B
e) None of the above
84. The fascia lata is an insertion for the following muscle(s)?
a) Gluteus maximus
b) Gluteus medius
c) Both A and B
d) Neither A nor B
85. Adductor magnus muscle:
a) Derives blood supply from branches of profunda femoral artery
b) Gets nerve supply from femoral and obturator nerves
c) Inserts on the medial condyle of the tibia
d) Has partial origin from the ischial spine
e) All of the above
86. The femoral artery:
a) Has a common sheath with the femoral nerve
b) Begins midway between anterior superior iliac spine & pubic symphisis
c) Lies medial to the femoral vein
d) Has no superficial branches
e) Its profunda branch supplies the calf muscles
87. Select the incorrect statement about the femoral artery:
a) Lies on psoas major
b) Is continuation of the external iliac artery
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c) Passes beneath the inguinal ligament
d) Is used in cannulation
e) Lies medial to the femoral canal
88. Which of the following statements is incorrect regarding the adductor
magnus muscle?
a) Supplied by tibial part of sciatic nerve
b) Inserted into adductor tubercle
c) Supplied by anterior division of obturator nerve
d) Femoral nerves pass through a gap in the muscle
89. Select the correct statement about the adductor magnus:
a) Arises from the posterior inferior iliac spine
b) Inserts entirely into the liner aspera
c) Flexor of the knee joint
d) Has a double nerve supply
90. Which of the following muscles is attached to both tibia and fibula:
a) Tibialis posterior
b) Popliteus
c) Flexor pollicis longus
d) Both B and C
e) None of the above
91. Select the false statement regarding deep muscles of the calf:
a) Supplied by deep peroneal nerve
b) They flex the toes
c) Are the main planterflexors of the ankle joint
d) Maintain the medial longitudinal arch of the foot
92. The short muscles of the first layer of the sole are:
a) Flexor digitorum brevis
b) Abductor hallucis
c) Abductor digit minimi
d) All of the above
e) None of the above
93. The muscles of the first layer of the sole are innervated by:
a) Medial planter nerve
b) Lateral planter nerve
c) Both A and B
d) Neither A nor B
94. Which of the following muscles is innervated by the tibial nerve?
a) Popliteus
b) Semimembranosus
c) Both A and B
d) Neither A nor B
95. The medial longitudinal arch of the foot involves the:
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a) Spring ligament
b) Navicular bone
c) Cuboid bone
d) Both A and B
e) All of the above
96. Which of the following muscles inserts on the fibula?
a) Flexor hallucis longus
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
b) Profunda femoris artery
c) Obturator nerve
d) Long saphenous vein
e) Pectineus muscle
98. The small saphenous vein drains predominantly to:
a) The femoral vein
b) The tibial vein
c) The popliteal vein
d) The greater saphenous vein
e) The dorsal venous arch of the foot
99. The only artery to enter the lesser sciatic foramen is the:
a) Sciatic artery
b) Inferior gluteal artery
c) Obturator artery
d) Internal pudendal artery
e) Deep femoral 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) The femoral artery
b) Perforating branches from the profunda artery
c) The obturator artery
d) The popliteal artery
e) The tibial artery
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102. The sural nerve is a branch of the:
a) Femoral nerve
b) Tibial nerve
c) Common peroneal nerve
d) Deep peroneal nerve
e) Obturator nerve
103. The femoral sheath is formed by which of the following layer(s) of fascia?
a) The pectineus fascia
b) The fascia lata and fascia transversalis
c) The fascia lata and the membranous layer of the superficial fascia
d) The psoas fascia and the fascia transversalis
e) The process vaginalis
104. Which of the following statements about the femoral nerve is false?
a) It is formed by dorsal division fibers of the lumbar plexus
b) It innervates the knee extensors
c) It lies medial to the femoral artery in the femoral triangle
d) It supplies sensory innervation to the medial side of the leg and foot via the
saphenous nerve
e) It innervates the sartorius muscle
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:
a) Between the long and short head of biceps femoris
b) Between abductor longus and adductor brevis
c) Between two parts of adductor magnus
d) Between semitendinosus and semimembranosus
e) Between vastus medialis and lateralis
106. Blood supply to gluteal muscles comes primarily from:
a) The femoral artery
b) The obturator artery
c) The profundal femoris (deep femoral) artery
d) The popliteal artery
e) Branches of the internal iliac artery
107. Which of the following muscles does not cross the knee joint?
a) Semimembranosus
b) Semitendinosus
c) Gracilis
d) Sartorius
e) Adductor magnus
108. Which of the following is a symptom of a torn medial collateral ligament of
the knee?
a) The leg can be abducted
b) The leg can be adducted
c) Anterior drawer
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d) Posterior drawer
e) Inability to flex the knee joint
109. The saphenous nerve is a branch of the:
a) Femoral nerve
b) Tibial nerve
c) Common peroneal nerve
d) Deep peroneal 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
111. Nail bed of the middle toe is innervated by:
a) Branches of femoral nerve
b) Branches of tibial nerve
c) Branches of deep peroneal nerve
d) Branches of superficial peroneal nerve
112. Posterior femoral cutaneous nerve tranverses the:
a) Greater sciatic foramen
b) Lesser sciatic foramen
c) Both A and B
d) Neither A nor B
113. Sartorius produces which of the following actions:
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
e) Long head of biceps femoris
115. Anterior tibial artery:
a) Becomes dorsalis pedis artery in the foot
b) Lies between tibialis anterior and extensor hallucis longus tendons at the
ankle joint
c) Both A and B
d) Neither A nor B
116. Hip extension could be produced by:
a) Semimembranosus
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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:
a) Tendon of flexor hallucis longus
b) Tendon of flexor digitorum longus
c) Tendon of flexor digitorum brevis
d) Tibial nerve
e) Posterior tibial artery
118. Obturator externus is paralyzed by injury of which of the following nerves:
a) Nerve to obturator
b) Femoral nerve
c) Obturator nerve
d) Lateral femoral cutaneous nerve
e) Genitofemoral nerve
119. The close association of the insertion of sartorius, gracilis, and
semitendinousus muscles resembles the pes anserina (goose's foot). These
features would be found on the:
a) Lateral tibial condyle
b) Medial proximal shaft of the tibia
c) Lateral femoral condyle
d) Medial femoral condyle
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?
a) The tibial nerve
b) The sural nerve
c) The deep peroneal nerve
d) The saphenous nerve
e) The superficial peroneal nerve
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:
a) It will be abducted and extended
b) It will be abducted and flexed
c) It will be adducted and extended
d) It will be adducted and internally rotated
122. Superior gluteal nerve:
a) Innervates gluteus medius
b) Lies in the interval between gluteus minimus and gluteus medius
c) Leaves the pelvis via the greater sciatic foramen
d) Lacks a cutaneous component
e) All of the above
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123. The anterior compartment of the leg:
a) Contains muscles capable to produce inversion and eversion
b) Contains muscles all of which insert in the foot
c) Receives its blood as a branch of the popliteal artery
d) Is tightly compressed between the tibia and fibula by deep fascia
e) All of the above
124. All of the following nerves innervate the flexors acting on the knee joint
except :
a) Deep peroneal nerve
b) Femoral nerve
c) Obturator nerve
d) Tibial nerve
e) Common peroneal 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
b) Great saphenous vein
c) Saphenous nerve
d) Nerve to vastus medialis
127. Regarding the lateral planter 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) Supplies lateral 31/2 toes on the planter aspect
d) Is corresponding to the median nerve in the hand
e) Supplies first and second lumbricals
128. In the popliteal fossa:
a) Popliteal artery is the deepest of its contents
b) Upper medial boundary is formed by sartorius and semitendinosus
c) Small saphenous vein pierces its roof to enter the popliteal vein
d) Upper lateral boundary is formed by lateral head of gastrocnemias
e) Plantaris lies in its floor
129. Midinguinal point:
a) Midway between anterior superior iliac spine and pubic tubercle
b) Midway between anterior superior iliac spine and pubic symphysis
c) Midway between anterior superior iliac spine and pubic crest
d) Femoral artery lies two centimeters medial to this point
e) Deep inguinal ring is five centimeters above this point
130. Which of the following ligaments attaches to the navicular and calcaneus?
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a) Anterior tibiofibular ligament
b) Short plantar ligament
c) Anterior talofibular ligament
d) Long plantar ligament
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?
a) Between the long and short head of biceps femoris
b) Between adductor longus and adductor brevis
c) Between two parts of adductor magnus
d) Between semitendinosus and semimembranosus
e) Between vastus medialis and vastus lateralis
134. Which of the following vessel/nerve pairings (course together) is
INCORRECT:
a) Great saphenous vein/ Saphenous nerve
b) Small saphenous vein/ Sural nerve
c) Anterior tibial artery/ Deep peroneal nerve
d) Profunda femoris artery/ Femoral nerve
e) Posterior tibial artery/ Tibial nerve
135. Contents of the femoral triangle include all of the following except:
a) Profunda femoris artery
b) Great saphenous vein
c) Femoral canal
d) Femoral sheath
e) Obturator nerve
136. Muscle(s) which could produce inversion include:
a) Tibialis anterior
b) Tibialis posterior
c) Extensor hallucis longus
d) Flexor hallucis longus
e) All of the above
137. Which of the following is/are not attached to the ischial tuberosity:
a) Short head of biceps femoris
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b) Abductor magnus
c) Semitendinosus
d) Inferior gemellus
e) Long head of biceps femoris
138. The inguinal lymph nodes do not receive lymph from:
a) The big toe
b) The buttock
c) The anterior abdominal wall
d) The scrotum
e) The testes
139. In the sole of the foot:
a) The lumbricals, which arise from the tendons of flexor digitorum brevis, lie
in the second layer of muscles
b) Both flexor digiti minimi brevis and longus are innervated by the lateral
plantar nerve
c) Adductor hallucis has a transverse and oblique head
d) The deepest layer contains only the interossei
e) The tendon of tibialis posterior is inserted into the base of the talus
140. Which is false concerning the extensor compartment of the leg:
a) Include tibialis anterior which arises from the lateral aspect of the upper
fibula
b) Includes extensor hallucis longus, which is innervated by the deep peroneal
nerve
c) Includes deep peroneal nerve
d) Includes tibialis anterior whose tendon is a prominent landmark on the
medial aspect of the dorsum of the foot
e) Include peroneus tertius which is absent in a number of normal individuals
141. Which is false concerning the hip joint:
a) Receives a large portion of its blood supply from the artery in the ligament
of the head of the femur
b) Is innervated only by the sciatic nerve
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
142. A ligament that is important in maintaining the medial portion of the
longitudinal arch is the:
a) Deltoid ligament
b) Calcaneofibula ligament
c) Long plantar ligament
d) Short plantar ligament
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e) Plantar calcaneonavicula ligament
143. Tibial nerve:
a) Lies in the deep posterior compartment of the leg
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:
a) Medial femoral circumflex
b) Lateral femoral circumflex
c) Inferior epigastric
d) Inferior gluteal
e) First perforating artery
145. Adductor hallucis is innervated by which of the following nerves?
a) Femoral nerve
b) Obturator nerve
c) Deep peroneal nerve
d) Lateral planter nerve
e) None of the above
146. Peroneus brevis is:
a) Attached to the calcaneus
b) Attached to the proximal phalanx of the medial toe
c) Attached to the fifth metatarsal
d) Both A and B
e) None of the above
147. Buttock lymph drainage to:
a) Vertical group of superficial inguinal nodes
b) Popliteal nodes
c) Horizontal group of superficial inguinal nodes
d) Axillary nodes
e) Node of the above
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:
a) Superficial peroneal nerve
b) Deep peroneal nerve
c) Sural nerve
d) Tibial nerve
e) Saphenous nerve
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HEAD & NECK
1. The levator palpebrae superious muscle is innervated by the:
a) Facial nerve
b) Trochlear nerve
c) Trigeminal nerve
d) Oculomotor nerve
e) Abducent nerve
2. The inferior oblique muscle of the eye is innervated by the:
a) Abducent nerve
b) Trigeminal nerve
c) Oculomotor nerve
d) Facial nerve
e) Trochlear nerve
3. The lateral rectus muscle of the eye is innervated by the:
a) Optic nerve
b) Trochlear nerve
c) Oculomotor nerve
d) Facial nerve
e) Abducent nerve
4. The superior oblique muscle of the eye is innervated by the:
a) Trigeminal nerve
b) Trochlear nerve
c) Abducent nerve
d) Chorda tympani nerve
e) Oculomotor nerve
5. The orbicularis oculi muscle is innervated by the:
a) Facial nerve
b) Lacrimal nerve
c) Maxillary nerve
d) Nasociliary nerve
e) Frontal nerve
6. The mandibular division of the trigeminal nerve leaves the skull through the:
a) Superior orbital fissure
b) Foramen rotundum
c) Foramen ovale
d) Jugular foramen
e) Foramen magnum
7. The vagus nerve leaves the skull through the:
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a) Jugular foramen
b) Occipital foramen
c) Inferior orbital fissure
d) Foramen rotundum
e) Foramen spinosum
8. The abducent nerve leaves the skull through the:
a) Foramen rotundam
b) Jugular foramen
c) Inferior orbital fissure
d) Superior orbital fissure
e) Foramen ovale
9. The ophthalmic division of the trigeminal nerve leaves the skull through the:
a) Inferior orbital fissure
b) Foramen ovale
c) Foramen rotundum
d) Superior orbital fissure
e) Pterygopalatine foramen
10. The maxillary division of the trigeminal nerve leaves the skull through the:
a) Foramen spinosum
b) Foramen rotundum
c) Superior orbital fissure
d) Foramen ovale
e) Jugular foramen
11. The oculomotor nerve leaves the skull through the:
a) Inferior orbital fissure
b) Foramen rotundum
c) Superior orbital fissure
d) Foramen magnum
e) Foramen ovale
12. The optic canal is an opening in the:
a) Lesser wing of the sphenoid bone
b) Occipital bone
c) Petrous part of the temporal bone
d) Frontal bone
e) Squamous part of the temporal bone
13. The carotid canal is located in the:
a) Sphenoid bone
b) Occipital bone
c) Petrous part of the temporal bone
d) Greater wing of the sphenoid bone
e) Parietal bone
14. The foramen spinosum is located in the:
a) Sphenoid bone
b) Occipital bone
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c) Frontal bone
d) Petrous part of the temporal bone
e) Squamous part of the temporal bone
15. The hypoglossal canal is located in the:
a) Squamous part of the temporal bone
b) Occipital bone
c) Frontal bone
d) Sphenoid bone
e) Parietal bone
16. The foramen rotundum is located in the:
a) Lesser wing of the sphenoid bone
b) Frontal bone
c) Petrous part of the temporal bone
d) Occipital bone
e) Greater wing of the sphenoid bone
17. The facial nerve canal is located in the:
a) Temporal bone
b) Greater wing of the sphenoid bone
c) Occipital bone
d) Mastoid process
e) Lacrimal bone
18. The foramen magnum is located in the:
a) Sphenoid bone
b) Temporal bone
c) Parietal bone
d) Frontal bone
e) Occipital bone
19. The genioglossus muscle _____ the tongue:
a) Retracts
b) Depresses
c) Elevates
d) Protrudes
e) Changes the shape of
20. The hyoglossus muscle:
a) Changes the shape of the tongue
b) Elevates the tongue
c) Depresses the tongue
d) Protrudes the tongue
e) Retracts the tongue upwards and backwards
21. In styloglossus muscle:
a) Protrudes the tongue
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b) Depresses the tongue
c) Retracts the tongue upwards and backwards
d) Changes the shape of the tongue
e) Elevates the tongue
22. The palatoglossus muscle:
a) Depresses the tongue
b) Elevates the tongue
c) Changes the shape of the tongue
d) Retracts the tongue upwards and backwards
e) Protrudes the tongue
23. The following muscles of the pharynx receive their motor innervation from
the pharyngeal plexus via the cranial part of the accessory nerve except:
a) Superior constrictor
b) Palatopharyngeus
c) Stylopharyngeus
d) Middle constrictor
e) Salpingopharyngeus
24. The following statements concerning the stellate ganglion are correct except:
a) It is formed from a fusion of the inferior cervical ganglion with the first
thoracic ganglion
b) It has white and gray rami communicantes, which pass to spinal nerves
c) It is located behind the vertebral artery
d) It lies in the interval between the transverse process of the seventh cervical
vertebra and the neck of the first rib
e) The large anterior tubercle of the transverse process of the fifth cervical
vertebra is an important surface landmark when performing a stellate
ganglion block
25. A following statements concerning the chorda tympani are correct except:
a) It contains parasympathetic postganglionic fibers
b) It contains special sensory (taste) fibers
c) It joins the lingual nerve in the infratemporal fossa
d) It is a branch of the facial nerve in the temporal bone
e) It carries secretomotor fibers to the submandibular and sublingual salivary
glands
26. The following statements concerning the pituitary gland (hypophysis cerebri)
are correct except:
a) It is separated from the optic chiasma by the diaphragma sellae
b) The sphenoid sinus is inferior to it
c) It receives its arterial supply from the internal carotid artery
d) It is suspended from the floor of the third ventricle by the pars anterior
e) It is deeply placed with the sella turcica of the skull
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27. The following statements concerning the submandibular lymph nodes are
correct except:
a) They drain into the deep cervical lymph nodes
b) They drain the tip of the tongue
c) They drain the skin of the forehead
d) They are situated on the superficial surface of the submandibular salivary
gland
e) They drain the mucous membrane lining the cheek
28. The following statements concerning the cervical part of the oesophagus are
correct except:
a) The sensory nerve supply is the recurrent laryngeal nerve
b) The lymph drains into the deep cervical lymph nodes
c) It is the site of an important portal-systeminc anastomosis
d) The lumen is narrowed at the junction with the pharynx
e) It begins at the level of the cricoid cartilage, opposite the body of the sixth
cervical vertebra
29. The following statements concerning the parotid salivary glands are correct
except:
a) The facial nerve passes through it, dividing the gland into superficial and
deep parts
b) The secretomotor nerve suppy is derived from the facial nerve
c) The parotid duct pierces the buccinator muscle and opens into the mouth
d) The external carotid artery divides within its substance to form the
superficial temporal and maxillary arteries
e) The retromandibular vein is formed within it by the union of the superficial
temporal vein and maxillary vein
30. The following statements concerning the head and neck are correct except:
a) The mastoid process of the temporal bone cannot be palpated in the new
born
b) The deep cervical lymph nodes are situated in the neck along a line that
extends from the midpoint between the tip of the mastoid process and the
angle of the mandible down to the sternoclavicular joint
c) The external jugular vein runs down the neck from the angle of the jaw of
the middle of the clavicle
d) The anterior fontanelle can be palpated in a baby between the squamous
part of the temporal bone, the parietal bone, and the greater wing of the
sphenoid
e) The roots of the brachial plexus emerge into the posterior triangle on the
neck between the scalenus anterior and scalenus medius muscles
31. The following facts concerning the tongue are correct except:
a) The intrinsic muscles of the tongue are innervated by the hypoglossal nerve
b) The taste buds of the vallate papillae are innervated by the
glossopharyngeal nerve
c) The posterior third of the tongue forms part of the anterior wall of the
oropharynx
d) Lymphoid tissue is found on the anterior third of the dorsum of the tongue
e) On either side of the frenulum of the tongue are situated the openings of the
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submandibular ducts
32. Which of the following muscles elevates the soft palate during swallowing?
a) Tensor veli palatini
b) Palatoglossus
c) Palatopharyngeus
d) Levator veli palatini
e) Salpingopharyngeus
33. Which of the following muscles partially inserts on the articular disc of the
temoromandibular joint?
a) Medial pterygoid
b) Anterior fibers of the temporalis
c) Masseter
d) Posterior fibers of the temporalis
e) Lateral pterygoid
34. Assuming the patient's eyesight is normal, in which cranial nerve is there
likely to be a lesion when the direct and consensual light reflexes are absent?
a) Trochlear notch
b) Optic nerve
c) Abducent nerve
d) Oculomotor nerve
e) Trigeminal nerve
35. A patient is unable to taste a piece of sugar placed on the anterior part of the
tongue. Which cranial nerve is likely to have a lesion?
a) Hypoglossal
b) Vagus
c) Glossopharyngeal
d) Facial
e) Maxillary division of the trigeminal
36. On asking a patient to say "ah," the uvula is seen to be drawn upward to the
right. Which cranial nerve is likely to be damaged?
a) Left glossopharyngeal
b) Right hypoglossal
c) Left accessory (cranial part)
d) Right vagus
e) Right trigeminal
37. When testing the sensory innervation of the face, it is important to remember
that the skin of the tip of the nose is supplied by one of the following nerves:
a) Zygomatic branch of the facial nerve
b) Maxillary division of the trigeminal nerve
c) Ophthalmic division of the trigeminal nerve
d) External nasal branch of the facial nerve
e) Buccal branch of the mandibular division of the trigeminal nerve
38. Impaired function of which of the following muscles produce difficulty in
protruding the jaw?
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a) The anterior belly of the digastric
b) The lateral pterygoid
c) The medial pterygoid
d) The masseter
e) The temporalis
39. The nasal cavity is closed off from the oropharynx during swallowing by:
a) Elevation of the tongue to the roof of the mouth
b) Contraction of the aryepiglottic muscles
c) Contraction of the tensor and the levator veli palatine muscles
d) Relaxation of the pharyngeal constrictor muscles
e) Bending of the epiglottis
40. A muscle that protrudes the tongue is:
a) The styloglossus
b) The hyoglossus
c) The genioglossus
d) The palatoglossus
e) The mylohyoid
41. All the following statements regarding the palatine tonsil are correct except:
a) It is related laterally to the superior constrictor muscle and the external
palatine vein
b) The main blood supply is from the facial artery
c) The lymphatic drainage is into the submandibular lymph nodes
d) It is covered on its medial surface by mucous membrane and on its lateral
surface by a fibrous capsule
e) The tonsil reaches its maximum size during early childhood
42. Sustained tension of the vocal cords (folds) is best achieved through the
action of which one of the following muscles?
a) The cricopharyngeus
b) The cricothyroid
c) The aryepiglottic
d) The salpingopharyngeus
e) The posterior cicoarytenoid
43. Muscles or nerves that are responsible for adducting the eyeball (rotating the
cornea medially) include the following except:
a) The superior rectus muscle
b) The medial rectus muscle
c) The oculomotor nerve
d) The inferior oblique muscle
e) The inferior rectus muscle
44. During operations on the thyroid gland, the following nerve may be injured
when tying the inferior thyroid artery:
a) The sympathetic trunk
b) The internal laryngeal nerve
c) The descendens cervicalis
d) The recurrent laryngeal nerve
e) The superior laryngeal nerve
45. The following facts regarding Horner's syndrome are true except:
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a) Ptosis may be present because of loss of innervation to the smooth muscle
portion of the levator palpebrae superioris
b) Pupillary constriction may occur because of loss of innervation to the
dilator pupillae muscle
c) Horner's syndrome can be caused by injury to the superior cervical
sympathetic ganglion
d) Excessive sweating may occur on one side of the face
e) Horner's syndrome can be caused by injury to the sympathetic chain (trunk)
in the neck
46. A patient has lost cutaneous sensation over the tip of the nose. Which nerve is
most likely damaged?
a) The facial nerve
b) The ophthalmic division of the trigeminal nerve
c) The greater auricular nerve
d) The mandibular division of the trigeminal nerve
e) The maxillary division of the trigeminal nerve
47. Infection of the middle ear can spread along all the following pathways
except:
a) Through the tegmen tympani to the middle cranial fossa
b) Through the medial wall into the labyrinth
c) Through the canal for the tensor tympani muscle into the internal carotid
artery
d) Through the floor into the internal jugular vein
e) Through the aditus to the mastoid antrum into the mastoid air cells
48. Compression of the facial nerve in the facial canal in the posterior wall of the
middle ear could result in all the following except:
a) A cessation of lacrimal secretion
b) Paralysis of the posterior belly of the digastric muscle
c) Inability to whistle
d) Decreased saliva in the mouth
e) Loss of taste sensation to the anterior two-thirds of the tongue
49. The Parotid Gland:
a) Is related to the masseter muscle
b) Is penetrated through its lower part by the external carotid artery
c) Has a duct which pierces the buccinator muscle
d) Both B & C
e) A, B & C are correct
50. Concerning the infra-temporal fossa:
a) Its medial boundary is the medial surface of lateral pterygoid plate
b) Its lateral wall is the ramus of the mandible
c) It contains the maxillary artery
d) Both A & B
e) Both B & C
51. All of the following provide innervation to the tongue except:
a) Hypoglossal XII
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b) Glossopharyngeal IX
c) Maxillary V2
d) Mandibular V3
e) Facial VII
52. Select the correct pairing:
a) Stylopharyngeus- pharyngeal plexus
b) Stylohyoid- vagus nerve
c) Levator palati- glossopharyngeal nerve
d) Palatopharyngeal- pharyngeal plexus
e) Palatoglossus- hypoglossal nerve
53. The foramen rotundum transmits the maxillary division of the 5 th cranial
nerve to the:
a) Pterygopalatine fossa
b) Infratemporal fossa
c) Orbit
d) Foramen lacerum
e) Temporal fossa
54. Concerning the larynx:
a) The mucosa below the vocal cords is innervated by the recurrent laryngeal
nerve
b) The crico-thyroid muscle is innervated by a branch of the superior laryngeal
nerve
c) The posterior crico-arytenoid muscle adducts the vocal cords
d) Both A and B
e) Both B and C
55. Select the correct pairing:
a) Inferior constrictor- hyoid bone
b) Oropharynx- piriform recess
c) Anterior ethmoidal sinus- middle meatus
d) Nasolacrimal duct- bulla ethmoidalis
e) Choanae- external nares
56. Which of the following does not enter the orbit via the superior orbital
fissure?
a) Mandibular division of trigeminal nerve
b) Oculomotor nerve
c) Trochlear nerve
d) Abducent nerve
e) Opthalmic division of trigeminal nerve
57. Select the correct statement:
a) The laryngopharynx extends from the tip of the soft palate to the level of
the cricoid cartilage (C6)
b) The salpingopharyngeus muscle is innervated by the glossopharyngeal
nerve
c) The pharyngeal constrictor muscles have a common origin from the median
raphe
d) The pharyngeal tonsils lie in the nasopharynx
e) The levator palate muscle depresses the soft palate
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58. The following is not found in the pharynx:
a) Piriform recess
b) Palatine tonsil
c) Vagus nerve
d) Lateral glossoepiglottic fold
e) None of the above
59. Each of the following structures is found (in part) within the posterior
triangle of the neck except:
a) Accessory nerve
b) Transverse cervical artery
c) Subclavian vein
d) Occipital artery
e) Internal carotid artery
60. Which one of the following statements is true:
a) Thyrocervical trunk comes off the second part of the subclavian artery
b) Costocervical trunk comes off the second part of the subclavian artery
c) Superior thyroid artery is a branch of the thyrocervical
d) Suprascapular artery is often a branch of the costocervical trunk
e) Internal thoracic artery is a branch of the third part of the subclavian artery
61. The accessory meningeal artery enters the skull via:
a) Foramen ovale
b) Foramen lacerum
c) Foramen spinosum
d) Foramen rotundum
62. The sternocleidomastoid muscle:
a) Is located beneath the platysma muscle
b) Acts alone to tilt the head to its own side and rotate face to the opposite side
c) Both A & B
d) Neither A or B
63. The only laryngeal cartilage to completely encircle the airway is the:
a) Thyroid cartilage
b) Cricoid cartilage
c) Epiglottic cartilage
d) Arytenoid cartilage
e) Corniculate cartilage
64. The only intrinsic laryngeal muscle not innervated by the recurrent laryngeal
nerve is the:
a) Posterior cricoarytenoid muscle
b) Lateral cricoarytenoid muscle
c) Thyroarytenoid muscle
d) Transverse arytenoid muscle
e) Cricothyroid muscle
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65. The internal laryngeal nerve passes between the following two structures to
enter the larynx:
a) Cricoid and thyroid cartilages
b) Cricoid and arytenoids cartilages
c) Thyroid and epiglottic cartilages
d) Thyroid cartilage and hyoid
e) Hyoid bone and epiglottic cartilage
66. The action(s) of the lateral pterygoid muscle includes:
a) Lateral displacement of the mandible
b) Elevation of the mandible
c) Both A and B
d) Neither A nor B
67. The internal jugular vein:
a) Lies within the carotid sheath
b) Receives the inferior petrosal sinus
c) Vagus lies between it and internal carotid artery
d) All of the above
e) None of the above
68. Select the correct pairing:
a) Pharyngeal tonsil- Oropharynx
b) Maxillary sinus- Superior meatus
c) Posterior ethmoid air cells- Middle meatus
d) Middle ear- Nasopharynx
e) Sphenoid sinus- Hiatus semilunaris
69. The auriculotemporal nerve is split as it travels through the infratemporal
fossa by which of the following vessels?
a) Deep auricular artery
b) Middle meningeal artery
c) Anterior tympanic artery
d) Posterior deep temporal artery
70. The internal carotid artery:
a) Is contained within the carotid sheath
b) Serves as a major source of blood for the brain, pituitary gland and eye
c) Both A and B
d) Neither A nor B
71. Motor nerves of the cervical plexus include:
a) Phrenic
b) Ansa cervicalis
c) Both A and B
d) Neither A nor B
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72. Select the correct structures passing between the middle and inferior
constrictors:
a) Superior laryngeal vessels
b) External laryngeal nerve
c) Internal laryngeal nerve
d) Both A & B
e) Both A & C
73. Select the correct statement regarding the medial lemniscus:
a) It begins in the spinal cord
b) It is formed of the lateral and anterior spinothalamic tracts
c) It is concerned with proprioception (muscle – joint sense)
d) It ends in the sensory area of the cortex
e) It lies lateral to the spinal lemniscus
SURGICAL ANATOMY
1. Air in the pleural cavity:
a) Is a normal finding
b) Is called pneumothorax
c) Is called hydrothorax
d) Is called haemothorax
e) Is called pyothorax
2. Cervical rib:
a) Is a common rib finding
b) It can be a fibrous band
c) No complication is recorded from its presence
d) Commonly arise from the 5th cervical vertebra
e) More common in female
3. Bronchoiectasis:
a) It is narrowing of bronchi
b) Irreversible damage of the medium sized bronchi
c) It is easy to treat
d) It causes no problem for breathing
e) More common among females
4. One of the following is a common finding in congenital
diaphragmatic hernia?
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a) Normal breathing
b) Distended abdomen
c) Scaphoid abdomen
d) Normal x-ray abdomen
e) Abnormal heart sounds
5. Hernia through foramen of Morgagnio
a) Is a hernia through the diaphragm
b) Is incisoanal hernia
c) Hernia through anterior abdominal wall
d) Muscle hernia
e) Hernia through posterior abdominal wall
6. Linea semilunaris:
a) Located at the middle of the rectus abdominis muscle
b) Located at the medial border of the rectus abdominis
c) Located transversely above the umbilicus
d) Located at the lateral border of the rectus abdominis
e) Located transversely below the umbilicus
7. Transversalis Fascia:
a) Is an anterior boundary of the femoral ring
b) Is a posterior boundary of the femoral ring
c) Is an anterior boundary of the inguinal canal
d) Is a posterior boundary of the inguinal canal
e) It forms the roof of the inguinal canal
8. The cystic artery most frequently arises from:
a) Coeliac axis
b) Gastroduodenal artery
c) Left hepatic artery
d) Right hepatic artery
e) Superior mesenteric artery
9. The appendix:
a) Located at the distal of the ileum
b) Blood supply from the inferior mesenteric artery
c) It has no submucosa
d) Blood supply from the superior mesenteric artery
e) Not found in young adults
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10. The Meckel's diverticulum:
a) Is found in the large bowel
b) Can be hernial content
c) Found on mesenteric border of the small bowel
d) Found in 80% of people
e) The length is usually 30cm
11. The common cause of an early death in thoracic trauma is:
a) Hypoxaemia
b) Hyponatraemia
c) Hyperkalaemia
d) Hypervolaemia
e) Acid-base balance disturbance
12. In flail chest:
a) The chest wall moves inwards during expiration
b) The chest wall movement is not affected
c) The chest wall moves inwards during inspiration
d) The chest wall moves outwards during inspiration
e) The chest wall moves outwards during inspiration
13. Patient with simple rib fracture:
a) Needs immediate fixation of the fractured rib
b) Needs strapping of the chest wall
c) Needs analgesia and chest physiotherapy
d) Needs emergency surgery
e) Needs immobilization of the chest wall
14. Fracture of the first rib:
a) Is a common rib fracture
b) Is a rare rib fracture
c) It can occur with a minor trauma
d) Does not need assessment to the other organs
e) It does not alert the surgeon to other injuries
15. Pneumothorax;
a) It is presence of blood in the pleural cavity
b) Presence of blood in the pericardial cavity
c) Presence of air in the pleural cavity
d) Presence of fluid in the pleural cavity
e) Presence of air in the pericardial cavity
16. The chest tube drain:
a) Commonly inserted at the 5th intercostal space midclavicular
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line
b) Commonly inserted at the 5th intercostal space midaxillary line
c) Commonly inserted at the 7th intercostal space
d) Commonly inserted at the 9th intercostal space
e) Commonly inserted at the 2nd intercostal space
17. Cervical rib:
a) Is a normal rib
b) It is always bony
c) It originates from the 1st thoracic vertebra
d) It is commonly symptomatic
e) It can be present with vascular and neurological symptoms
18. Diaphragmatic hernia:
a) If it is congenital appear late in life
b) It is common on the right side
c) If it is congenital appear early in life
d) Usually asymptomatic
e) It usually causes abdominal distension
19. Foramen Ovale:
a) It is an opening between the two ventricles
b) An opening between the two atria
c) Communication between the aorta and the pulmonary vein
d) Communication between the aorta and the pulmonary artery
e) Communication between the pulmonary artery and the
pulmonary vein
20. The following is one of Fallot's Tetralogy:
a) Pulmonary vein stenosis
b) Left ventricular hypertrophy
c) Right ventricular hypertrophy
d) Aortic stenosis
e) Atrial septal defect
21. Concerning bones of the upper limb, all of the following
statements are true except:
a) Avulsion fracture of the coracoid process occurs to vigorous
contraction of
the brachialis muscle
b) The clavicle is usually fractured at its middle third
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c) Avulsion fracture of the greater tuberosity of the humerus is
due to vigorous
contraction of the supraspinatus
d) Fracture of the shaft of the humerus may be complicated with
radial nerve
injury
e) Supracondylar fracture of the humerus may be complicated
with
Volkmann's ischaemia of the forearm
22. The fingernail of the index finger requires removal because of an
underlying abscess. The nerve that require blocking by a local
anesthetic agent is the:
a) Dorsal digital branch of the ulnar nerve
b) Dorsal digital branch of the radial nerve
c) Palmer digital branch of the ulnar nerve
d) Palmer digital branch of the median nerve
e) Terminal branches of the posterior interosseous nerve
23. The ulnar nerve was damaged by a deep laceration to the wrist
when a 17-year-old male put his hand through a plate glass window.
Select the correct statement(s) about the patient's symptoms:
a) He cannot adduct his ring finger and holds a
piece of paper between his ring and middle
fingers
b) The motor innervation to the flexor digiti minimi brevis and
rd
the 3 and 4th
lumbrical is lost so that the ring and little finger are
hyperextended at the
metacarpophalangeal joints
c) He is able to hold a toothpick between the pads of his thumb
and index
finger
d) The middle and distal phalanges of the ring and little finger are
flexed at the
proximal and distal interphalangeal joints
e) All of the above
24. Following surgical removal of a firm nodular cancer swelling in
the right breast and exploration if the right axilla, on examination
the patient was found to have a winged right scapula. Most likely this
could have occurred due to injury to the:
a) Subscapular muscle
b) Coracoid process of scapula
c) Long thoracic nerve
d) Circumflex scapular artery
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25. The most important stabilizer against valgus deformity in flexed
elbow is:
a) Radial head
b) Medial joint capsule
c) Anterior bundle of the medial collateral ligament
d) Posterior bundle of the medial collateral ligament
e) Transverse bundle of the medial collateral ligament
26. Regarding the anterior cruciate ligament:
a) It is tense when the knee is flexed
b) It is tense when the knee is extended
c) Inserted into the lateral aspect of the lateral condyle of the
femur
d) Is less commonly torn than the posterior cruciate
e) It is avascular
27. Which of the following causes foot drop only:
a) Injury to the common peroneal nerve
b) Injury to the sural nerve
c) Injury to the deep peroneal nerve
d) Injury to the saphenous nerve
e) Injury to the femoral cutaenous nerve
28. During a direct lateral approach to the hip joint, which
neurovascular structures may be injured by excessive retraction of
the gluteus medius muscle:
a) The femoral nerve
b) The superior gluteal nerve
c) The sciatic nerve
d) The inferior gluteal nerve
e) The medial femoral circumflex artery
29. A vascular necrosis of the femoral head occurs in the following
state:
a) Subcapital fracture of the femoral head
b) Subtrochanteric fracture
c) Intertrochanteric fracture
d) Immediately reduced posteriorly dislocated hip
e) Fracture shaft of femur
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30. During an automobile accident, a patient fractured the neck of
her right radius and damaged a closely related nerve. At physical
examination, the patient exhibited the following except:
a) Weakness in extending the terminal phalanx of the thumb
b) A loss of skin sensation on the lateral part of the dorsum of the
hand
c) An inability to extend the metacarpophalangeal joint of the
index finger
d) A normal ability to adduct the thumb at the carpometacarpal
joint
e) Normal skin sensation down the medial border of the hand
31. Diminsihed sweating and increased warmth and vasodilation of
the skin vessels over the hypothenar eminence as well as the ring and
little fingers could result from the following except:
a) A lesion of the posterior cord of the brachial plexus
b) Ulnar nerve damage behind the medial epicondyle of the
humerus
c) A lesion of the medial cord of the brachial plexus
d) A lesion of the eighth cervical nerve
e) Ulnar nerve damage over the front of the wrist
32. After a football injury, an orthopedic surgeon noted that the right
tibia could be moved anteriroly with excessive freedom when the
knee was flexed. In this patient, which ligament is most likely torn?
a) The lateral collateral ligament
b) The posterior cruciate ligament
c) The anterior cruciate ligament
d) The medial collateral ligament
e) The patellar ligament
33. Normal venous flow in the lower limbs:
a) Assisted by gravity
b) One way, because valve system is in 3 types of veins
c) Multi-directional
d) From deep to superficial veins
e) Not enhanced by calf and thigh muscle activity
34. Vascular Necrosis occurs most commonly after:
a) Fractured metatarsal bone
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b) Fractured shaft of femur
c) Fractured shaft of tibia
d) Fractured neck of femur
e) Fractured peroneal malleolus
35. Which of the following is not a clinical feature of acute arterial
ischemia of the lower limb?
a) Swelling
b) Pain
c) Pallor
d) Paralysis
e) Paraesthesia
36. Pott's fracture involves a) fracture of the fibula 4-7cm proximal
to the lateral malleolus and b) rupture of the deltoid ligament or
avulsion of the medial malleolus. This condition is likely produced by
forced:
a) Planter flexion
b) Dorsiflexion
c) Eversion
d) Inversion
e) Lateral rotation
37. With regard to rib fractures following blat chest injuries:
a) Ribs usually fracture near costochondral junctions
b) The first and second ribs are easily fractured
c) In flail chest, ribs dislocate at the dislocate fracture
d) Ribs fracture easily in children compared to adults
38. The Pterion:
a) Is the point where the greater wing of the sphenoid meets with
the zygoma
b) It is 8cm above the mid point of the zygomatic arch
c) It is marked by an eminence
d) Has the posterior branch of the middle meningeal artery
beneath it
e) Is the thinnest part of the lateral wall of the skull
39. In the thyroid gland:
a) The middle thyroid vein in intimately related to the recurrent
laryngeal nerve
b) The superior thyroid artery is intimately related to the external
laryngeal nerve
c) The inferior pole of the gland contains the trunk of the inferior
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thyroid
artery
d) The plane between the false and true capsule is very vascular
e) The thyroida ima artery is found in the majority of subjects
40. With regard to intercostal spaces:
a) The neurovascular bundle lies between the external oblique and
internal
oblique muscles
b) The intercostal vein lies below the intercostal artery in the
subcostal groove
c) The pleura which lines the intercostal muscles in insensitive to
pain
d) The seventh to eleventh intercostals nerve supply the skin of
the abdominal wall
e) Intercostal drains should be inserted just below the upper rib of
the chosen intercostal space
41. Mallet finger is due to:
a) Avulsion of the extension tendon from the distal phalanx of a
finger
b) Avulsion of the extensor tendon from the proximal phalanx of a
finger
c) Avulsion of a flexor digitorum profundus tendon from a finger
d) Avulsion of flexor digitorum superficialis tendon from a finger
e) Avulsion of the abductor pollicis tendon
42. A young man sustained trauma to his right shoulder and found to
have a fracture of the surgical neck of the humerus. On examination,
he has difficulty in abduction of his right arm. The nerve which is
injured is:
a) Radial nerve
b) Ulnar nerve
c) Long thoracic nerve
d) Suprascapular nerve
e) Axillary nerve
43. In venous thrombosis:
a) Superficial thrombosis is more serious
b) The thrombosis can reach the kidney
c) It may cause pulmonary embolism
d) Is common to young men
e) Is common among young women
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44. The following are features of thyrotoxicoisis except:
a) Tiredness
b) Heat intolerance
c) Palpitation
d) Weight gaining
e) Excessive appetite
45. The common source for a pulmonary embolus is:
a) The lower limb veins
b) The left atrium
c) The superior vena cava
d) The renal vein
e) The portal vein
46. The following are early features of congenital diaphragmatic
hernia except:
a) Respiratory distress
b) Presence of bowel in the chest
c) Distended abdomen
d) Bowel air in the chest X-Y
e) Nasogastric tube to be ended the chest
47. The following are features of the right main bronchus except:
a) It is short
b) It is wider
c) It is oblique in course
d) It is a common site for F-B
e) Its blood supply is from the aorta
48. The ligamentum teres:
a) Is the remnant of the ductus venosus
b) Is the remnant of the right umbilical vein
c) Is the remnant of the left umbilical vein
d) Is the remnant of the ductus venosus
e) Is the remnant of the left umbilical artery
49. The ductus venosus:
a) It is a duct between the superior vena cava and inferior vena
cava
b) It is a duct between the left umbilical vein and superior vena
cava
c) It is a duct between the left umbilical vein and inferior vena
cava
d) It is a duct between the left and right umbilical veins
e) It is a duct between the right umbilical vein and inferior vena
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cava
50. Regarding pneumothorax the following statements are true
except:
a) It can be associated with hemothorax in chest injuries
b) Can be defined as abnormal presence of air in the pleural space
c) It can cause shock by decreasing the cardiac output
d) Is caused only by penetrating injuries to the chest
e) Can be treated initially by inserting a wide pore needle in the
second intercostal space
51. Pneumothorax can be defined as presence of air in the pleural
space, it can be caused accidently by the surgeon's knife when
operating on:
a) The gall-bladder
b) The kidney
c) The duodenum
d) The small bowel
e) The pancreas
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HISTOLOGY
HISTOLOGY
1. The function of microvilli is:
a) Movement of substance over all surfaces
b) Increase in surface area for absorption
c) Cellular movement
d) Transport of intracellular organelles through the cytoplasm
e) Specialized uptake of macromolecules
2. All of the following statements are true about epithelia except:
a) There is abundance of intracellular substance
b) They demonstrate strong adhesions between cells
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c) They are derived from any of the embryonic germ layers
d) They have absorbive functions
e) They are capable of secretion
3. The extracellular matrix molecules fibronectin, laminin and
teascin have in common:
a) Distribution only in the basement membrane of developing
tissues & organs
b) The classification of glycoproteins
c) The classification of glycosaminoglycans
d) The classification of fibers
e) They secrete antibodies
4. All of the following statements are true of connective tissue except:
a) It separates tissue from the surrounding enviornment
b) It provides support
c) It functions in defense mechanisms
d) It mediates cell migration
e) It consists of extracellular matrix formed solely by connective
tissue cells
5. Transitional epithelium is:
a) Pseudostratified
b) Ciliated
c) Keratinized
d) Simple squamous epithelium
e) Stratified
6. The Haversian System:
a) The morphological unit of compact bone
b) Found in spongy bone
c) Is composed of woven bone
d) Is found in primary bone
e) Involved in the formation of the outer circumferential lamellae
7. Collagen type II is found in:
a) Hyaline cartilage
b) Teeth
c) Bone
d) Ligaments
e) Tendons
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8. Elastic Cartilage:
a) Is very vascular
b) Is formed of collagen type I fibers
c) Has no perichondrium
d) Is yellow when unstained
e) Can easily calcify
9. Cohesion between epithelial cells include all of the following
except:
a) Zonula Adherence
b) Zonula Occludentes
c) Gap Junctions
d) Desmosomes
e) Microvilli
10. Brown Fat Cells:
a) Unilocular
b) Not found in hibernating animals
c) More numerous than white fat cells
d) Found mainly in adults
e) Found mainly in fetuses
11. All of the following are false concerning loose connective tissue
except:
a) They have abundant ground substance
b) They have few cells
c) They are found in bone
d) They are found in teeth
e) They are found in ligaments
12. Reticular fibers are found in:
a) Kidneys
b) Liver
c) Bone Marrow
d) All of the above
e) None of the above
13. Fibroblasts:
a) Are the main cell types found in connective tissue
b) Synthesize collagen
c) Synthesize glycosaminoglycans
d) Are structural cells
e) Act as phagocytes
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14. Simple Squamous Epithelium:
a) Blood vessels
b) Skin
c) Tongue
d) Oesophegus
e) Epidermis
15. Holocrine secretion is found in:
a) Sebaceous glands
b) Sweat glands
c) Pancreas
d) Mammary glands
e) Prostate
16. The components of connective tissue are:
a) Cells
b) Fibers
c) Ground substance
d) All of the above
e) None of the above
17. Compound Exocrine Glands:
a) Have unbranched excretory ducts
b) Are found in the pancreas
c) Are found in the duodenum
d) Are found in the salivary glands
e) Are found in the partoid
18. All of the following statements are true of connective tissue
except:
a) It separates tissues from the surrounding enviornment
b) It provides support
c) It functions in defense mechanisms
d) It mediates cell migration
e) It consists of extracellular matrix formed solely by connective
tissue cells
19. Compact bone contains all the following except:
a) Outer circumferential lamellae
b) Inner circumferential lamellae
c) Concentric lamellae
d) Interstitial lamellae
e) Spaces
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20. Woven bone is:
a) Common in adults
b) Typical of all spongy bone
c) Also called primary bone
d) Also called secondary bone
e) Found in mature bone
21. Volkmann's Canals
a) Are vertical canals
b) Present in woven bone
c) Present in lamellar bone
d) Surrounded by concentric lamellae
e) Are found in cartilage
22. The primary centers of ossification in long bone develops in:
a) Diaphyses
b) Metaphyses
c) Epiphyses
d) Elastic cartilage model
e) Articular cartilage
23. Elastic fibers are found in:
a) Dermis of the skin
b) Arteries
c) Ligamentum Flavum
d) All of the above
e) None of the above
24. Osteoblasts:
a) Are bone forming cells
b) Synthesize collagen
c) Synthesize glycosaminoglycans
d) Are structural cells
e) Act as phagocytes
25. Pseudostratified Epithelium is found in the:
a) Trachea
b) Blood vessels
c) Pleura
d) Intestine
e) Skin
26. The basement membrane contains all of the following except:
a) Type IV collagen
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b) Heparin sulphate
c) Laminin
d) All of the above
e) None of the above
27. The principal glycosaminoglycans which collagen type IV
interacts with:
a) Fibronectin
b) Laminin
c) Entactin
d) Heparin sulphate
e) Dermatan sulphate
28. The following structures are found in the apical surface of simple
epithelium:
a) Microvilli
b) Desmosomes
c) Cilia
d) All of the above
e) Both A and C
29. All is true of mucous tissue except:
a) Is present in adults
b) Is present in fetuses
c) Is typical of the umbilical cord
d) Contains fibroblasts
e) Is also called wharton's jelly
30. Fibrocartilage has a matrix with large amounts of:
a) Collagen fibers
b) Elastic fibers
c) Lipids
d) Ground substance
e) Reticular fibers
31. Reticular tissue is found in the following except:
a) Liver
b) Bone marrow
c) Endocrine glands
d) Kidneys
e) Compact bone
32. All of the following are true about the perichondrium except:
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a) That it contains blood vessels
b) That is surrounds hyaline cartilage
c) That is surrounds elastic cartilage
d) That is essential for interstitial growth
e) That is essential for oppositional growth
33. The following statements on cell/function are true except:
a) Plasma cells/ Produce antibodies
b) Macrophages/ Phagocytic cells
c) Osteoblasts/ Bone-forming cells
d) Osteoclasts/ Bone-forming cells
e) Endothelium/ Lines blood vessels
34. Presented with a tissue containing non-keratinized stratified
squamous epithelium and skeletal muscle fibers, you would say it
could have been prepared from the:
a) Upper third of the oesophegus
b) Stomach
c) Rectum
d) Duodenum
e) Lower third of the oesophegus
35. Presented with a normal tissue containing transitional epithelium,
you would say that this is from:
a) Urinary bladder
b) Skin
c) Oesophegus
d) Tongue
e) Trachae
36. On looking under the microscope at normal tissue stained by
haematoxylin/eosin one can say that:
a) Cuboidal cells surround the ovary
b) Tendons contain very little ground substance
c) White adipose tissue is formed of unilocular adipocytes
d) None of the above
e) All of the above
37. A biopsy was taken from the respiratory system of a heavy
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smoker, was fixed & stained. You would expect the epithelium to be:
a) Simple columnar
b) Simple cuboidal
c) Simple squamous
d) Simple columnar ciliated
e) Stratified squamous
38. On examining under the microscope a section taken from the
trachea, one would see that:
a) Its epithelium is stratified
b) Its epithelium is pseudostratified
c) Its lamina propria is formed of dense regular connective tissue
d) Its epithelium is transitional
e) None of the above
39. In the comparison of cartilage and bone tissue, one can say::
a) Both are vascular
b) Their cells are present in lacunae
c) Chondoiton sulphate is present in the matrix
d) Cells form collagen
e) Develops from embryonic mesenchyme
40. Presented with a tissue containing transitional epithelium, you
could say it was prepared from the:
a) Oesophegus
b) Stomach
c) Tongue
d) Skin
e) Ureter
41. When looking down the microscope at normal tissue stained with
haemotoxylin and eosin one would see that:
a) The thymus contains Hassall's corpuscles
b) The spleen contains cortex and medulla
c) The neurohypohysis contains chromophil cells
d) The vas deferens is lined by simple cuboidal epithelium
e) The mucosa of the vagina contains glands
42. Brunner's glands are found in:
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a) Ileum
b) Duodenum
c) Oesophagus
d) Colon
e) Jejunum
43. The thymus gland is characterized by all of the following except:
a) Presence of cortex and medulla
b) Presence of Hassal's corpuscles
c) Presence of lymphatic nodules
d) Presence of T lymphocytes
e) Presence of reticular fibers
44. Wharton's jelly is:
a) Mucous tissue
b) Reticular tissue
c) Dense connective tissue
d) Remnant of the notochord
e) Adipose tissue
45. Elastic cartilage:
a) Is very vascular
b) Is formed of collagen type I fibers
c) Has no perichondrium
d) Is yellow when unstained
e) Can easily calcify
46. The gallbladder has:
a) Pseudostratified epithelium
b) Simple columnar epithelium
c) Serous glands
d) A layer of skeletal muscle in its wall
e) Serosa on all its sides
47. All of the following are true about muscular tissue except:
a) Skeletal muscle fibers are branched
b) Cardiac muscle fibers are branched
c) Smooth muscle fibers are spindle shaped
d) Skeletal muscle fibers are striated
e) Smooth muscle fibers are non-striated
48. The following statements about the trachea are true except:
a) It has stratified columnar epithelium
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b) It has pseudostratified columnar epithelium
c) It has goblet cells
d) It has mucous glands in the submucosa
e) It has a cartilage layer formed of hyaline cartilage
49. Regarding the digestive system the following statement are false
except:
a) Peyer's patches are found in the stomach
b) Brunner's glands are found in the colon
c) Sublinguial salivary glands are mainly serous
d) Striated ducts are found in the pancreas
e) Striated ducts are found in the parotid gland
50. Epithelial derivatives of the skin include all of the following
except:
a) Hairs
b) Nails
c) Sweat glands
d) Mammary glands
e) Teeth
51. Normal parathyroid glands of adults possess:
a) Principal cells
b) A capsule
c) Oxyphil cells
d) Fat cells
e) Calcitonin-secreting cells
52. The epithelium lining the oviduct is:
a) Simple columnar epithelium
b) Stratified
c) Ciliated
d) All of the above
e) Only A and C
53. When looking down the microscope at normal tissue stained with
haemotoxylin and eosin one would see that:
a) In the submadibular gland most alveoli are mucus secreting
b) In the sublinguial glands most alveoli are mucus secreting
c) Striated ducts are found in the pancreas
d) The epithelium of the proximal tubules of the kidney is
squamous
e) The interalveolar septum of lung alveoli is supported by smooth
muscles
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54. All of the following are typically found in the sacroplasm of
skeletal muscle except:
a) Glycogen
b) Myoglobin
c) Sacroplasmic reticulum
d) Troponin
e) Nissl bodies
55. All of the following is true about dorsal root ganglia except they
are:
a) Sensory
b) Motor
c) Containing pseudounipolar neuron
d) Located in the intervertebral foramina
e) Paired structures
56. All of the following is true about astrocytes except they:
a) Line the ventricles of the brain
b) Have spherical nuclei
c) Form part of the nervous tissue
d) Have pedicels
e) Participate in the blood-brain barrier
57. The collagen of the matrix of hyaline cartilage (type II) is similar
in molecular and chemical composition to:
a) Elastic cartilage
b) Bone
c) Skin
d) Tendon
e) Basal laminae
58. Lymph is filtered in the:
a) Lymph nodes
b) Tonsils
c) Spleen
d) Thymus
e) Peyer's patches
59. Striated ducts are found in all of the following except:
a) Parotid glands
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b) Submandibular glands
c) Sublingual glands
d) Exocrine pancreas
e) Proximal tubules of the kidneys
60. The dust cells in the lung alveoli:
a) Are phagocytic
b) Secrete surfactant
c) Produce antibodies
d) Participate directly in gaseous exchange
e) Develop from plasma cells
61. All the following are found in the renal corpuscle except:
a) Fenestrated capillaries
b) A very thick basal lamina
c) Macula densa
d) Filtration slits
e) Mesangial cells
62. 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
e) Aponeurosis of internal abdominal oblique
63. Fibroblasts secrete:
a) Collagen fibers only
b) Elastic fibers only
c) Reticular fibers only
d) Amorphous, extracellular material
e) Steroid hormones
64. Collagen fibers are present in all of the following except:
a) The intracellular substance of connective tissue
b) The basal lamina supporting epithelial cells
c) Bone matrix
d) Cartilage matrix
e) Teeth
65. White fat cells (adipocytes) of adults contain:
a) A centrally-placed nucleus
b) A flattened peripheral nucleus
c) A single large lipid droplet in each cell (unilocular)
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d) Both A and C
e) Both B and C
66. Simple squamous epithelium is found in the:
a) Pericardium
b) Pleura
c) Peritoneum
d) All of the above
e) None of the above
67. All of the statements about the perichondrium is false except that
it is:
a) Found covering all cartilage
b) Found in synovial joints
c) Found in fibrocartilage
d) Found in fetuses only
e) In elastic cartilage
68. Peyer's patches:
a) Glands of the esophagus
b) Absorptive areas of the jejunum
c) Lymphatic areas of the large intestine
d) Concentrations of lymphatic tissue in the ileum
e) Lymphatic nodules in the stomach lining
69. The colon has all of the following except:
a) Small villi
b) Crypts of Lieberkuhn
c) Many goblet cells
d) Taenia coli
e) Appendicies epiplociae
70. The appendix has:
a) A similar general histological structure to that of the colon
b) Abundant connective tissue
c) Appendicies epiplociae
d) Villi
e) Folds along most of its length
71. In the human esophagus all of the following can be found except:
a) Simple columnar epithelium
b) Striated skeletal muscles
c) Glands in the submucosa
d) A muscularis mucosae
e) Glands in the lamina propria
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72. The gastric glands of the fundus contains all of the following
except:
a) Goblet cells
b) Zymogen cells
c) Parietal cells
d) Mucous cells
e) Enteroendocrine cells
73. The thymus possesses all of the following except:
a) Cortex
b) Medulla
c) Hassall's corpuscles
d) Lymphatic nodules
e) Epithelial reticular cells
74. The white pulp of the spleen contains:
a) Lymphatic nodules
b) Central arteries
c) Reticular fibers
d) All of the above
e) None of the above
75. Cohesion between epithelial cells include all of the following
except:
a) Zonula adherence
b) Zonula occludentes
c) Gap junctions
d) Desmosomes
e) Microvilli
76. Which of the following structures contain both skeletal and
smooth muscles in its wall?
a) Ureter
b) Vas deferens
c) Oesophagus
d) Duodenum
e) Rectum
77. The layer in the epidermis which contains keratohyalin granules
is:
a) Stratum spinosum
b) Stratum basale
c) Stratum lucidum
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d) Stratum granulosum
e) Stratum corneum
78. All of the following statements about the vas deferens are false
except:
a) It is lined by pseudostratified epithelium with sterocilia
b) Its muscular coat has two layers
c) It has a large regular lumen
d) It has an adventitia covered by a mesothelium
e) It carries mature spermatozoa to the epididymis
79. The following structures have a cortex and a medulla except:
a) Lymph node
b) Thymus
c) Kidney
d) Ovary
e) Spleen
80. The fetal part of the placenta is formed from:
a) Chorionic plate
b) Decidua basalis
c) Decidua capsularis
d) Myometrium
e) Intervillous spaces
81. The vagina has all of the following except:
a) Stratified squamous epithelium
b) An adventitia rich in elastic fibers
c) A lamina propria rich in leucocytes
d) Glands
e) Inner circular and outer longitudinal muscular layer
82. All of the following are found in the epidermis except:
a) Keratinocytes
b) Pacinian corpuscles
c) Langerhan cells
d) Melanocytes
e) Merkel discs
83. Articular cartilage:
a) Is covered by perichondrium
b) Is hyaline cartilage
c) Receives its nutrients by direct diffusion from the blood
d) Has its cells orderly-arranged in columns
e) Can easily regenerate following injury
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84. Dense regular connective tissue contains all of the following
except:
a) Numerous fibers
b) Numerous cells
c) Fibroblasts
d) Amorphous substance
85. All of the following cells are seen in the CNS except:
a) Fibrous astrocytes
b) Protoplasmic astrocytes
c) Schawn cells
d) Oligodendrocytes
86. Parotid glands:
a) Are the largest of the salivary glands
b) Are the branched acinar exocrine glands
c) Have secretory units that contain both serous and mucous cells
d) Secretory units composed only of serous cells
e) Secretory granules with high amylase content
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EMBRYOLOGY
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EMBRYOLOGY
1. Which of the following synthesize progesterone?
a) Cytotrophoblast
b) Syncytiotrophoblast
c) Both A and B
d) Neither A or B
2. All occur during the morula stage except:
a) Attachment to the uterine epithelium takes place
b) The location of the cells dictates their fate
c) The outer cells pump fluid creating a fluid-filled blastocele
d) Tight junctions appear between cells at the periphery, isolating the inner
cells from the uterine fluid
3. During the first week of human development:
a) The zona pellicoda is formed
b) The cells of the embryo increase in number but become smaller
c) The cells of the embryo increase in size
d) Implantation is completed
e) None of the above
4. During the second week of human development:
a) The trophoblast differentiates into cytotrophoblast & syncytiotrophoblast
b) The utero-placental circulation begins
c) The inner cell mass differentiation into hypoblast and epiblast
d) Primary stem villi appear
e) All of the above
5. As a result of transverse and longitudinal folding of the embryo:
a) The prochordal membrane is moved ventrally and caudally
b) Position of yolk sac becomes incorporated into embryonic body
c) The primitive groove is moved cranially & dorsally
d) Both A and B
e) All of the above
6. Which of the following is/are normally always interposed between fetal and maternal
blood:
a) Extraembronic mesoderm
b) Maternal endothelial cells
c) Syncytiotrophoblast
d) Both A and B
e) All of the above
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7. Maternal blood normally comes into contact with:
a) Syncytiotrophoblast
b) Cytotrophoblast
c) Fetal blood cells
d) Both A and B
e) All of the above
8. Which of the following is not a function of the yolk sac in humans?
a) Site of origin of primodial germ cells
b) Site of origin of fetal blood cells
c) Provides nourishment/metabolic reserves for the embryo
d) Site of origin of epithelium of the primitive gut
e) Facilitates transfer of nutrients into the early embryo
9. At the time of ovulation the endometrium is in the:
a) Menstral phase
b) Early proliferative phase
c) Late proliferative phase
d) Early secretory phase
e) Late secretory 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
11. Always normally situated between maternal and fetal blood:
a) Cytotrophoblast
b) Syncytiotrophoblast
c) Both A and B
d) Neither A nor B
12. Bleeding may occur near the 13th day of development:
a) May be confused with normal menstral bleeding
b) Is caused by increased blood flow into lacunar spaces
c) Both A and B
d) Neither A nor B
13. The extraembryonic membrane which contributes the most tissue to the formation
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of the placenta is the:
a) Amnion
b) Chorion
c) Yolk sac
d) Connecting (body) stalk
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
e) All of the above
15. The primitive streak:
a) Is derived from the outer cells of the morula
b) Is formed during the second week in development
c) Persists as the cloacal membrane
d) Is the site of involution of epiblast cells to form mesoderm
16. The bilaminar germ disc:
a) Consists of hypoblast and epiblast
b) Is derived from trophoblast cells
c) Both A and B
d) Neither A nor B
17. Meiosis is completed within the gonads during gametogenesis in which sex?
a) Gametogenesis in human female
b) Gametogenesis in human male
c) Both A and B
d) Neither A nor B
18. Female pronucleus are fully formed:
a) Before fertilization
b) After fertilization
c) Both A and B
d) Neither A nor B
19. The conceptus is the:
a) Embryo/fetus
b) Amnion and Chorion
c) Deciduas
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d) Both A and B
e) All of the above
20. Functions of the placenta include all the following except:
a) Exchange of maternal and fetal blood
b) Exchange of nutrients and electrolytes
c) Hormone production
d) Gas exchange
e) Transmission of maternal antibodies
21. The secondary oocyte undergoes completion of the second maturation division:
a) Before ovulation
b) At fertilization
c) After ovulation
d) Prenatally
e) At puberty
22. The ovarian follicular cells release:
a) Follicle stimulating hormone
b) Chorionic Gonadotrophin
c) Estrogen
d) Both A and B
e) All of the above
23. The most common site for implantation in ectopic pregnancy is the::
a) Internal os of the uterus
b) Mesentary
c) Ovary
d) Oviduct
e) None of the above
24. At the time of initiation of implantation:
a) The endometrium is in the proliferative phase
b) The predominant ovarian hormone is progesterone
c) The conceptus is approximately one day "old" (postfertilization)
d) Both A and B
e) All of the above
25. All is true about primary oocytes except:
a) Are arrested in prophase of the first meiotic divisi€on
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b) Continue to form after birth
c) Together, with surrounding epithelial cells, for a primordial follicle
d) Suffer from atretion until only approximately 40, 000 are left at puberty
26. Trophoblast and inner cell mass portions are evident in the:
a) Conceptus before implantation has started
b) Conceptus after implantation has started
c) Both A and B
d) Neither A nor B
27. At fertilization:
a) The ovum completes the 2nd meiotic division
b) Cleavage is initiated
c) The sex of the individual is determined
d) The diploid number of chromosomes is restored
e) All of the above
28. All the following are derivatives of mesoderm except:
a) Dermatomes
b) Myotomes
c) Sclerotomes
d) Endothelium
e) Yolk sac
29. The prechordal plate:
a) Is a patent inducer region for future head structures
b) Becomes a portion of the oropharyngeal membrane
c) Is formed within the embryonic epiblast
d) Both A and B
e) All of the above
30. At the time of fertilization, the endometrium is in the:
a) Proliferative phase
b) Secretory phase
c) Menstral phase
d) Both B and C
31. Which of the following contains abundant nutrient reserves?
a) Female gametes
b) Male gametes
c) Both A and B
d) Neither A nor B
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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
33. Which of the following is found in the early placenta?
a) Cytotrophoblast
b) Syncytiotrophoblast
c) Both A and B
d) Neither A nor B
34. The space between the somatopleuric and splanchnopleuric extraembryonic
mesoderm is known as:
a) The primitive yolk sac
b) The secondary yolk sac
c) The blastocele
d) The amniotic cavity
e) The extraembryonic coelom
35. As a result of fertilization:
a) Sex of the offspring is determined
b) The diploic number of chromosomes is restored
c) Cleavage divisions are initiated
d) Genetic heterogeneity is maintained
e) All of the above
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:
a) The cessation of progesterone secretion
b) The gradual elevation of FSH titers
c) The low estrogen titers associated with the maturing follicle
d) The slow elevation of progesterone produced by luteal cells
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e) The surge of luteinizing hormone initiated by high estrogen titers
38. By the 4th day of development, fluid accumulation by the morula results is
separation 0of 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:
a) Enclosure of inner cell mass and blastocyst cavity
b) Formation of embryo proper
c) Invasion of endometrial epithelium
d) Production of hormones
e) Production of 2 distinct cell populations by differentiation
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:
a) 14th day following start of her last menstrual period
b) 14th day following end of her last menstrual period
c) 12th day following end of her last menstrual period
d) 10th day following end of her last menstrual period
e) 10th day following beginning of her last menstrual period
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?
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a) The endothelial lining of fetal capillaries
b) The cytotrophoblast
c) The syncytiotrophoblast
d) The basement membrane of fetal capillaries
e) None of the above
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:
a) Congenital hypertrophic pyloric stenosis
b) Duodenal atresia
c) Patient ileal diverticulum
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
b) With a failure to close the first branchial cleft
c) With a failure to obliterate the cervical sinus
d) Both A and B
e) All of the above
46. Which statement about fetal blood vessels is false:
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
venosus to the inferior vena cave
d) Implantation is completed
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e) None of the above
47. Regarding the blastocyst all the following are true except:
a) Has more cells than a morula
b) Has inner cell mass
c) Has syncytotrophoblast
d) Has trophoblast cells
e) May have zona pellucida
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
50. Fallot's tetralogy includes all the following except:
a) Pulmonary stenosis
b) Aortic overrinding
c) Ventricular septal defect
d) Patency of ductus arteriosus
e) Hypertrophy of the right ventricle
51. The trachea develops from the:
a) Septum transversum
b) Fifth branchial arch
c) Thyroglossal canal
d) Pulmonary mesenchyme
e) Foregut
52. In the developing pancreas, the dorsal bud contributes all the following except:
a) Body of the pancreas
b) Distal portion of the main pancreatic duct
c) Secondary pancreatic duct
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d) Uncinate process
e) Upper half of the head of the pancreas
53. All of the following structures contribute in development of diaphragm except:
a) Body wall
b) Primitive mesoesophagus
c) Septum transversum
d) Pleuro-pericardial membrane
e) Pleuro-peritoneal membrane
54. Spina bifida is a failure of fusion between the:
a) Left and right halves of the vertebral column
b) Pedicle and centrum of the vertebra
c) Left and right laminae of the vertebra
d) Both A and B
e) All of the above
55. A urachal fistula represents a remnant of the:
a) Cloaca
b) Allantois
c) Urogenital sinus
d) Hindgut
e) Mesonephric duct
56. What is the origin of the mucosa of the middle ear:
a) Neural ectoderm
b) Surface ectoderm
c) Mesoderm
d) Endoderm
e) None of the above
57. The left sixth aortic arch gives rise to the:
a) Hemiazygos vein
b) Coronary sinus
c) Ligamentum arteriosum
d) Ligamentum venosum
e) No remnants are found in this structure in the adult
58. The posterior pituitary is of which origin:
a) Endoderm
b) Mesoderm
c) Ectoderm
d) Endoderm and mesoderm
e) Endoderm and ectoderm
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59. The parathyroid glands:
a) They are 3 in number
b) They secrete Calcitonia
c) They develop from the 2nd pharyngeal arch
d) They normally lie anterior to the thyroid gland
e) They develop from the 3rd and 4th pharyngeal arches (pouches)
60. Unilateral upper lip cleft is due to failure of fusion of:
a) Medial nasal processes
b) Maxillary and lateral nasal processes
c) Maxillary and medial nasal processes on one side
d) Maxillary and mandibular processes
e) Medial and lateral nasal processes unilateralla
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
62. What is the origin of the mucosa of the oral pharynx:
a) Branchial arch I
b) Branchial arch II
c) Branchial arch III
d) Branchial arch IV
e) Not of branchial arch origin
63. Which of the following is formed from portions of one sclerotome:
a) Vertebral centrum
b) Intervertebral disc (annulus fibrosus)
c) Both A and B
d) Neither A nor B
64. The clavicle is:
a) The first bone to begin ossification
b) The first bone to complete ossification
c) Intramembranous in origin
d) Both A and C
e) All of the above
65. Limb musculature:
a) Relies on spinal nerve to aid the differentiation process
b) Begins as mesenchymal condensation
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c) Is derived from somatic mesoderm
d) Splits into flexor and extensor compartments
e) All of the above
66. Cervical sinus develop from:
a) Pharyngeal pouch 1
b) Pharyngeal pouch 2
c) Pharyngeal pouch 3
d) Pharyngeal pouch 4
e) This structure is not derived from pharyngeal pouch
67. Parafollicular cells of the thyroid gland develop from:
a) Pharyngeal pouch 1
b) Pharyngeal pouch 2
c) Pharyngeal pouch 3
d) Pharyngeal pouch 4
e) This structure is not derived from pharyngeal pouch
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
c) Inferior portion of the anal canal
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
b) Primary chorionic villi contain only syncytiotrophoblast
c) The intervillous space contains fetal blood
d) The deciduas basalis and the chorion leave constitute the placenta
e) The umbilical cord contains a loose connective tissue called Wharton's jelly
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71. The endocardial cushions are involved in the formation of all of the following
except:
a) Right and left atrioventricular canals
b) Pectinate muscles
c) Atrioventricular valves
d) Membranous part of the interventricular septum
72. Which of the following is the most common type of congenital heart malformation?
a) Dextrocardia
b) Atrial septal defect
c) Ectopic cordis
d) Ventricular septal defect
e) Transposition of the great vessels
73. The adult left atrium is derived embryologically primarily from the:
a) Right horn of the sinus venosus
b) Primitive pulmonary vein
c) Sinus venarum
d) Bulbus cordis
e) Ledt horn of the sinus venosus
74. The primitive aortic arch pattern is transformed into an adult arterial arrangement.
Which pair of arteries (embryonic/adult) is incorrect:
a) 6th arch/ pulmonary artery
b) Right 4th arch/ right subclavian
c) Left 4th arch/ left subclavian
d) 2nd arch/ stapedial artery
e) 3rd arch/ common and internal carotid
75. Azygos vein is derived from the:
a) Right vitelline vein
b) Right subcardinal vein
c) Right anterior cardinal
d) Right supracardinal vein
e) All of the above
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
primitive pleural cavities (pericardioperitoneal canals)
c) Third generation bronchi supply bronchopulmonary segments
d) The pulmonary cartilage, smooth muscle, and connective tissue are derived
from the lung bud endoderm
e) By 24 weeks of development, respiratory bronchioles are present
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77. Tracheoesophageal fistula with blind ending esophagus results in:
a) Polyhydraminos (more than usual amount of amniontic fluid)
b) Oligohydraminos (less than usual amount of amniotic fluid)
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
d) Mesentery of duct of Cavier
e) Mesoderm of the body wall
79. Paraxial (somite) mesoderm gives rise to:
a) Muscles of mastication
b) Muscles in the stomach
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
e) All of the above
81. Gonia cells produced during gametogenesis are usually present in 65-year old
individuals of which sex:
a) Gametogenesis in human female
b) Gametogenesis in human male
c) Both A and B
d) Neither A nor B
82. All of the following are true of amniotic fluid except:
a) It is derived from maternal blood
b) It is swallowed by the fetus from the beginning of the 5 th month
c) It restricts fetal movement within the amniotic cavity
d) It absorbs jolts to the fetus
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83. Epithelium of the tongue posterior to the sulcus terminals is derived from the:
a) First branchial arch
b) Second branchial arch
c) Third branchial arch
d) Fourth branchial arch
e) Not of branchial arch origin
84. What is the origin of the superior parathyroid glands?
a) Pharyngeal pouch I
b) Pharyngeal pouch II
c) Pharyngeal pouch III
d) Pharyngeal pouch IV
e) Not of pharyngeal pouch origin
85. What is the origin of the mandible?
a) Branchial arch I
b) Branchial arch II
c) Branchial arch III
d) Branchial arch IV
e) Not of the branchial arch origin
86. The thyroid gland:
a) Originates from an endodermal outgrowth at the base of the primordial
tongue
b) Is usually detached from the Thyroglossal duct in the adult
c) Both A and B
d) Neither A nor B
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NEUROANATOMY
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NEUROANATOMY
1. The following statements concerning the thalamus are correct except:
a) It is the largest part of the diencephalons and serves as a relay station to all
the main sensory tracts (except the olfactory pathway)
b) It is separated from the lentiform nucleus by the internal capsule
c) It forms the anter ior boundary of the interventricular foramen
d) It may be joined to the thalamus on the opposite side
e) The gray matter of the thalamus is divided by a vertical sheet of white
matter called the internal medullary lamina
2. Which of the following statement is (are) correct concerning the third cranial
nerve nuclei?
a) The oculomotor nucleus is situated in the central gray matter
b) The parasympathetic part of the oculomotor nucleus is called the EdingerWestphal nucleus
c) The fibers from the oculomotor nucleus pass through the red nucleus
d) The oculomotor nucleus lies just posterior to the medial longitudinal
fasciculus
e) All of the above
3. Which of the following statement is incorrect concerning the internal structure
of the midbrain?
a) The tectum is the part posterior to the cerebral aqueduct
b) The crus cerebri on each side lies anterior to the substantia nigra
c) The tegmentum lies posterior to the substantia nigra
d) The central gray matter encircles the red nuclei
4. Which of the following does not match between an artery and its branch?
a) Internal carotid/ posterior communicating
b) Basilar/ posterior inferior cerebellar
c) Vertebral/ anterior spinal
d) Anterior cerebral/ anterior communicating
e) Ophthalmic/ anterior ethmoidal
5. The _______ of the spinal nerve contains both motor and sensory fibers:
a) Anterior ramus
b) Posterior ramus
c) Main trunk
d) All of the above
e) None of the above
6. Concerning the middle cerebral artery:
a) It supplies the auditory area
b) One of its branches is called the artery of cerebral haemorrhage
c) Supplies the motor and sensory areas of the whole body
d) All of the above
e) A and B only
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7. Concerning the central sulcus of the cerebral hemisphere, select the incorrect
statement:
a) It is one of the two major sulci found on the lateral surface
b) It is also called the fissure of Sylvius
c) It separated the motor from the sensory area
d) It runs from the centre of the upper border to a point above the lateral
fissure
e) It usually extends for some distance on the medial surface
8. The motor area for speech usually lies in which gyrus?
a) Inferior temporal gyrus of the left hemisphere
b) Superior frontal gyrus of the right hemisphere
c) Inferior frontal gyrus of the right hemisphere
d) Superior frontal gyrus of the left hemisphere
e) Inferior frontal gyrus of the left hemisphere
9. Select the incorrect statement:
a) When the fetus is three months old the length of the spinal cord is equal to
the length of the vertebral canal
b) At birth the spinal cord reaches the level of the third lumbar vertebra
c) The dura mater end in the second lumbar vertebra
d) As development proceeds the vertebral column grows faster than the spinal
cord
e) The spinal pia mater extends as the filum terminale
10. An epidural hermatoma would most likely result from:
a) A tear in the middle meningea l artery due to a fractured parietal bone
b) A tear in a cerebral vein passing from the subarachnoid space into the
superior sagittal sinus
c) An aneurism of the middle cerebral artery
d) An aneurism of the middle cerebral vein
e) A tear in the basilar artery
11. Which of the following is NOT gray matter of the brain:
a) Corpus callosum
b) Cerebellar cortex
c) Basal ganglia
d) Thalamus
e) Mammillary body
12. Which of the following vessels run in the lateral fissure:
a) Middle cerebral artery
b) Anterior cerebral artery
c) Superior cerebellar artery
d) Great cerebral vein of Galen
e) Sterocleidomastoid artery
13. Which of the following is white matter of the brain:
a) Cerebral cortex
b) Cerebellar cortex
c) Corpus callosum
d) Thalamus
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e) Lentiform muscles
14. The following are parts of the hypothalamus except:
a) Supraoptic nucleus
b) Suprachiasmatic nucleus
c) Araventricular nucleus
d) Mamillary body
e) Pineal body
15. Arachnoid villi:
a) Are situated in the spinal cord
b) Are an integral part of the sigmoid sinus
c) Produce cerebrospinal fluid
d) Pass cerebrospinal fluid to the venous system
e) Are part of the true dura
16. Which statement about tracts and fibers in the brain is false:
a) The pyramidal tracts carry fibers from the precentral gyri
b) The somatic sensory tracts synapse in the thalamus
c) Primary and secondary cortical areas are connected by association fibers
d) The optic tracts synapse in the lateral geniculate nuclei
e) The anterior commissure connect the two halves of the mesencephalon
17. The following statements concerning the subarachnoid space are true except:
a) It is filled with cerebrospinal fluid
b) It extends inferiorly as far as the second sacral vertebra
c) It contains the cerebral arteries and veins
d) The cranial nerves lie outside the subarachnoid space in sheaths derived
from the dura
e) The arachnoid villi project into the venous sinuses as minute outpuchings of
the subarachnoid space
18. Which of the following statements is incorrect concerning the lateral
geniculate body:
a) The lateral geniculate body receives most of the fibers of the optic tract
b) Each lateral geniculate body receives visual information from the opposite
field of vision
c) The lateral geniculate body has a nucleus made up of six layers of nerve
cells
d) The lateral geniculate body is part of the midbrain at the level of the red
nucleus
19. Which of the following regions of white matter would NOT contain
corticospinal fibers?
a) Pyramid of medulla ablongata
b) Lateral white column of spinal cord
c) Cerebra peduncle of midbrain
d) Anterior limb of internal capsule
20. Which of the following concerning the basal nuclei (ganglia) is correct?
a) The amygdaloid nucleus is connected to the caudate nucleus
b) The claustrum does not form part of the basal nuclei
c) The corpus striatum lies medial to the thalamus
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d) The lentiform nucleus is completely divided by the external capsule into the
globus pallidus and the putamen
21. Which of the following statements is (are) correct concerning the internal
capsule?
a) It has an anterior limb, a genu, and a posterior limb
b) The genu and the anterior part of the posterior limb contain the
corticobulbar and corticospinal fibers
c) It is related laterally to the lentiform nucleus
d) It is continuous above with the corona radiate
e) All of the above
22. Which of the following statement is true?
a) Thyrocervical trunk comes off the second part of the subclavian artery
b) Costocervical trunk comes off the second part of the subclavian artery
c) Superior thyroid artery is a branch of the thyrocervical
d) Suprascapular artery is often a branch of the costocervical trunk
e) Internal thoracic artery is a branch of the third part of the subclavian artery
23. The Cerebrospinal fluid is present in:
a) Subarachnoid and subdural spaces
b) Subarachnoid space and ventricles of the brain
c) Subdural space but not in the suubarachnoid space
d) Subdural space and ventricles of the brain
e) None of the above
24. The cerebrospinal fluid is produced in:
a) 3rd ventricle
b) 4th ventricle
c) Lateral ventricle
d) Arachnoid villi
e) The cortex
25. Which of the following statements is correct?
a) The otic ganglion receives parasympathetic fibers from the facial nerve
(VII)
b) The auriculotemporal nerve, a branch of the mandibular division of
trigeminal (V3), supplies sensory fiber to the external ear and to the
temporal region
c) Both the inferior alveolar nerve and the nerve to the mylohoid pass through
the mandibular canal
d) The chorda tympani carries postsynaptic sympathetic fibers
e) The pterygopalatine ganglion receives parasympathetic fibers from the
glossopharyngeal nerve (IX)
26. Which part of the brain is found in the middle cranial fossa:
a) Frontal lobe
b) Parietal lobe
c) Temporal lobe
d) Occipital lobe
e) Cerebellum
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27. Regarding the meninges, which of the following is false?
a) The dura mater is sensitive to pain
b) Rupture of an aneurysm of a cerebral artery leads to subarachnoid
hemorrhage
c) A torn middle meningeal artery bleeds into the space between the endosteal
dura and the bones of the cranium
d) The cerebellomedullary cistern is a subarachnoid space between the
medulla and the cerebellum
e) The diaphragma (tentorium) sellae is a double layer of arachnoid mater
28. A 24-year-old man received a gunshot that damaged his postcentral gyrus.
This most probably will lead to:
a) Loss of ability to hear
b) Loss of ability to smell
c) Agraphia
d) All of the above
29. A 55-year-old woman received a severe head injury after which she is unable
to recognize movement of an object (movement agnosia). Most probably this is
due to damage of the:
a) Frontal lobe
b) Temporal lobe
c) Occipital lobe
d) Parietal lobe
30. Select the correct statement regarding the medial lemniscus:
a) It begins in the spinal cord
b) It is formed of the lateral and anterior spinothalamic tracts
c) It is concerned with proprioception (muscle-joint sense)
d) It ends in the sensory area of the cortex
e) It lies lateral to the spinal lemniscus
31. Concerning the medulla oblongata:
a) The abducent nerve emerges between its pyramid and pons
b) Rootlets of hypoglossal nerve emerges between the pyramid and olive
c) Damage to the anterior spinal artery leads to the medial medullary
syndrome
d) Its closed part is at its lower end
e) All of the above
32. The basilar artery ends by dividing into:
a) Two middle cerebral arteries
b) Two anterior cerebral arteries
c) Two posterior cerebral arteries
d) Posterior communicating and anterior choroid
e) None of the above
33. The ______ wind around the lateral surface of the midbrain
a) Trochlear nerve
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b) Optic tract
c) Posterior cerebral artery
d) All of the above
e) None of the above
34. The lateral surface of the cerebral hemisphere consists of the:
a) Tegmentum in front
b) Tectum in the middle
c) Basis pedunculi behind
d) All of the above
e) None of the above
35. The superior brachium connects the superior collilulus with the:
a) Hypothalamus
b) Uncus
c) Mamillary body
d) Lateral geniculate body
36. Select the wrong statement concerning the sulci of the cerebral hemisphere:
a) The parieto-occipital sulcus lies mainly on the medial surface of the
cerebral hemisphere
b) The lateral sulcus divides into 3 branches
c) The central sulcus is called the fissure of Rolando
d) The parieto-occipital sulcus is called the fissure of sylvius
e) There are two major sulci on the lateral surface which help to divide the
hemisphere into lobes
37. The visual area is found around the _____ sulcus:
a) Parieto-occipital
b) Callosal
c) Collateral
d) Calcarine
e) None of the above
38. The main sensory area of the cerebral hemisphere:
a) Lies in the frontal lobe
b) Lies in the postcentral gyrus
c) Receives pain, temperature, touch and proprioception
d) All of the above
e) Both B and C
39. The basal ganglia of all the following, except:
a) Amygdaloid nucleus
b) Claustrum
c) Uncus
d) Caudate nucleus
e) Lentiform nucleus
40. Select the wrong statement:
a) The pia mater is closely adherent to the spinal cord
b) The denticulate ligaments are thickening of the dura mater
c) The arachnoid mater lines the inner surface of the dura mater
d) The pia mater continues below as the film terminale
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e) The dura mater ends at the level of the second sacral vertebra
41. Which match between the structure and part of the brain is false:
a) Thalamus- diencephalons
b) Cerebellum- rhombencephalons
c) Corpus callosum- telencephalon
d) Pons- mesencephalon
e) Tectum- mesencephalon
42. The medial medullary syndrome includes:
a) Contralateral hemiplegia
b) Ipsilateral paralysis of the tongue
c) Contralateral loss of the deep sensations
d) All of the above
e) None of the above
43. Select the correct pairing:
a) Stylopharyngeus- pharyngeal plexus
b) Stylophyoid- vagus nerve
c) Levator palate- glossopharyngeal nerve
d) Palatopharyngeus- pharyngeal plexus
e) Palatoglossus- hypoglossal nerve
44. Superior orbital fissure syndrome shows the following signs except:
a) Loss of corneal reflex
b) Ptosis
c) Loss of blinking
d) Loss of pupil light reflex
e) Failure of accomodation
45. A subdural hermatoma can result from:
a) The rupture of a cerebral vein entering the superior sagittal sinus
b) The rupture of a vessel in the brain
c) The rupture of the middle meningeal artery
d) The rupture of one of the vessels forming the circle of Willis
e) The rupture of an aneurysm below the arachnoid
46. The corpus striatum is referred to as:
a) Caudate nucleus and putamen
b) Caudate nucleus and globus pallidus
c) Caudate nucleus and lentiform nucleus
d) Amygdaloid body and lentiform nucleus
e) Amygdaloid body and putamen
47. One of the following gyri is not-visible on the medial surface of the cerebral
hemisphere:
a) Parahippocampal
b) Cingulate
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c) Uncus
d) Angular
e) Lingular
48. One of the following arteries does not contribute to the sides of the circle of
Willis:
a) Vertebral
b) Anterior communicating
c) Anterior cerebral
d) Posterior communicating
e) Posterior cerebral
49. The ophthalmic artery is a branch of one of the following arteries:
a) Internal carotid
b) Anterior cerebral
c) Middle cerebral
d) Anterior communicating
e) Anterior choroidal
50. Damage of the calcarine branches of the posterior cerebral artery of one side
results in:
a) Alexia
b) Apraxia
c) Agnosia
d) Agraphia
e) Homonymous hemianopia (disturbance of vision)
51. All the following sulci are visible on the lateral surface of the cerebral
hemisphere except:
a) Central
b) Lateral
c) Parieto-occipital
d) Calcarine
52. One of the following sulci is between the parietal lobe and the frontal lobe:
a) Lateral
b) Cingulated
c) Central
d) Collateral
53. Orbital gyri are part of the:
a) Frontal lobe
b) Occipital lobe
c) Parietal lobe
d) Temporal lobe
54. Corpus callosum is:
a) Commissural fibers
b) Association fibers
c) Projection fibers
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d) Gray matter
55. Injury of the frontal lobe can lead to all of the following except:
a) Mood changes
b) Changes in social behaviour
c) Changes in personality
d) Loss of vision
e) Broca's aphasia
56. Prosopagnosia (difficulty in recognizing faces) is due to injury of:
a) Parietal lobe
b) Occipital lobe
c) Temporal lobe
d) Frontal lobe
57. Concerning the mid brain:
a) It lies below the diencephalon
b) It occupies the notch (hiatus) of the tentorium cerebelli
c) It has roots of nerves concerned with innervation of the eye muscles
d) All of the above is correct
e) None of the above is correct
58. Concerning the cerebellum:
a) It is the largest part of the hind brain
b) It occupies the posterior cranial fossa
c) It is related laterally to the superior sagittal sinus
d) All of the above
e) A & B only
59. Concerning the lentiform nucleus:
a) Its lateral part is called putamen
b) Its medial part is called the globus pallidus
c) The putamen is darker than the globus pallidus in dissection
d) All of the above
e) A & B only
60. Select the incorrect statement:
a) The crossed pyramidal tract lies in the lateral white matter of the spinal cord
b) The fibers of the uncrosses pyramidal tract lie in the anterior white matter
of the spinal cord
c) The cortico-spinal tract lies in the anterior limb of the internal capsule
d) The uncrossed pyramidal tract constitutes about 10-20% of the fibers of the
original pyramidal tract when it lies in the pyramid
e) The pyramidal decussation lies in the lower part of the medulla
61. The ………… cranial nerve does not contain parasympathetic nuclei:
a) 3rd
b) 7th
c) 9th
d) 10th
e) 11th
62. The ………… of the spinal nerve contains both motor and sensory fibers:
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a) Anterior ramus
b) Posterior ramus
c) Main trunk
d) All of the above
e) None of the above
63. The lobes of the cerebrum are:
a) Frontal, temporal, parietal, occipital
b) Frontal, temporal, parietal, pineal
c) Frontal, temporal, parietal, occipital, petrosal
d) Frontal, temporal, parietal, parieto-occipital, occipital
e) Frontal, temporal, parietal, olfactory, occipital
64. Which statement about synapses in the brain is false?
a) The motor tracts start at the precentral cortex
b) The conscious sensory function is transmitted by three order neurons
c) The somatic sensory tracts synapse in the thalamus
d) The pyramidal tracts synapse in the basal ganglia
e) The corticospinal tract decussates in the medulla oblongata
65. The following nuclei are contained in the medulla oblongata except:
a) Spinal nucleus of the trigeminal nerve
b) Dorsal vagus
c) Inferior olivary
d) Substantia glatinosa
e) Hypoglossal
66. Regarding the types of fibers found in spinal nerves and their components,
which of the following is false?
a) White rami communicantes contain preganglionic sympathetic axons and
visceral sensory fibers
b) Ventral rami contain somatic sensory, somatic motor, sympathetic and
visceral sensory fibers
c) Dorsal roots contain visceral sensory and somatic sensory fibers
d) Gray rami communicantes contain postganglionic parasympathetic fibers
that are destined for the body wall
e) A spinal nerve contains somatic motor and somatic sensory fibers, visceral
sensory and visceral motor fibers
67. Regarding the spinal cord, which of the following is false?
a) Cell bodies of sympathetic neurons lie in the lateral horn of the spinal gray
matter from T1-L2
b) In the typical adult the terminal end of the spinal cord lies within the
vertebral canal at the level of vertebrae L1/L2
c) Denticulate ligaments are lateral extensions of the arachnoid mater
d) There are 31 segments of the spinal cord
e) Dorsal root ganglia are outside the spinal cord
68. Which of the following statements is true?
a) Cerebrospinal fluid (CSF) is found in the subdural space
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b) From superficial to deep, the order of the meningeal layers is: dura mater,
pia mater and arachnoid mater
c) The cauda equina is composed of ventral roots only
d) Cerebospinal fluid can be drawn from the sacral hiatus because the dural
sac extends all the way down the coccyx
e) Ventral and dorsal roots come together in the intervertebral foramina to
form the spinal nerves which then subsequently branch into ventral and
dorsal rami
69. Which statement about the spinal cord is false?
a) The cervical spinal cord has 8 segments
b) The lumbosacral enlargement of the spinal cord is called the conus
medullaris
c) Cell bodies of somatic motor nerves are located in the ventral horn
d) There are 5 pairs of sacral spinal nerves
e) The filum terminale attaches the inferior end of the spinal cord to the
coccyx
70. The posterior horn of the spinal cord contains the following nuclei except:
a) Nucleus dorsalis
b) Gracicle
c) Proporius
d) Substantia glatinosa
e) Afferent visceral
71. The antereolateral sulcus of the medulla between pyramid & olive transmit:
a) Hypoglossal nerve
b) Spinal accessory nerve
c) 9th, 10th and 11th cranial nerves
d) All of the above
e) None of the above
72. The medial lemniscus:
a) Is a motor tract
b) Formed in the spinal cord
c) Does not cross to the opposite thalamus
d) Formed by gracile cuneate tracts
e) Ends in the medulla oblongata
73. The part of the rhomboid fossa in the medulla shows the following except:
a) Facial colliculus
b) Hypoglossal trigone
c) Vagal trigone
d) Vestibular area
e) Striae medullaris
74. Choose the true statement:
a) The arachnoid mater ends at S2
b) The spinal cord has a cervical enlargement and a lumbosacral enlargement
c) Cerebrospinal fluid (CSF) is found between the dura mater and arachnoid
mater
d) The bundle of spinal nerve roots in the subarachnoid space caudal to the
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termination of the spinal cord is called conus medullaris
e) The spinal cord in the children ends at the level of L3
75. The following cranial nerves have parasympathetic functions except:
a) X
b) IX
c) VII
d) V
e) III
76. The spinal cord is supplied by the following arteries except:
a) Feeding
b) Anterior spinal
c) Posterior intercostal
d) Posterior spinal
e) Internal carotid
77. The dorsal root ganglion:
a) Contains somatic motor cell bodies
b) Contains parasympathetic cell bodies
c) Is also called the lateral horn
d) Contains visceral sensory and somatic sensory cell bodies
e) Is attached to whit and gray rami communicantes
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BIOCHEMISTRY
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CELL & WATER
1. The following is not found in prokaryotic cells:
a) Cytoplasmic membrane
b) DNA
c) Cytoplasm
d) Nucleus
e) RNA
2. Buffers in the human body include:
a) Carbohydrates
b) Phospholipids
c) Sulphuric Acid and Sulphate
d) Phosphoric Acid and Phosphate
e) None of the Above
3. Water is the ideal solvent in biological systems because of its:
a) Low melting point
b) Low dielectric constant
c) Dipolarity
d) High concentration in cells
e) High ionization potential
4. The following are organelles of prokaryotic cells:
a) Plasma membrane
b) Mitochondria
c) Cytoplasm
d) Endoplasmic reticulum
e) Both A and C are correct
5. The endoplasmic reticulum is:
a) Continuation of the plasma membrane
b) Site for protein synthesis
c) The major site for energy production
d) A double membrane organelle
e) Not found in hepatocytes
6. Mechanisms of transport across the plasma membrane:
a) Are identical in prokaryotes and eukaryotes
b) Include pinocytosis
c) Include phagocytosis
d) Require glycolipids
e) Both B and C are correct
7. Water participates in the following reactions:
a) Hydration
b) Dehydration
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c) Hydrolysis
d) Thiolysis
e) All A, B and C are correct
8. The bonds that are mostly involved in interactions of biomolecules include:
a) The peptide bonds
b) The ionic bonds
c) The covalent bonds
d) Thioester bonds
e) Phosphodiester bonds
9. The dipolarity of water:
a) Results in covalent interaction
b) Facilitates the solubility of most biomolecules
c) Disappears in the solid state
d) Is the basis for ionic interactions
e) Is none of the above
10. Buffers in the human body do not include:
a) Proteins
b) Amino acids
c) Sulphuric acid & sulphate
d) Phospheric acid & phosphate
e) Carbonic acid & bicarbonate
11. Metabolic acidosis can result from:
a) Excessive vomiting
b) Uncontrolled diabetes mellitu s
c) Increased pH
d) Increased carbohydrate intake
e) None of the above
12. The plasma pH is maintained by the buffering effect of:
a) Proteins
b) Carbonic acid & Bicarbonate
c) The kidney
d) Gastric HCl
e) A, B and C are correct
13. Buffers in the human body do not include:
a) Carbonic acid bicarbonate
b) Plasma proteins
c) Sulphuric acid & sulphate
d) Phospheric acid & phosphate
e) Hemoglobin
14. The mitochondrion:
a) Has a higher density than the nucleus
b) Sediment before the nucleus in gradient centrifugation
c) Is a site for protein synthesis
d) Has the same size as the nucleus
e) Is absent in eukaryotes
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15. The equation pH=pK + Log (Conjugate acid/ Conjgate base):
a) Is known as the Handerson Hasselbalch equation
b) Assumes that water ionizes
c) Assumes that water does not ionize
d) Applies to strong acids
e) is incorrect
16. At neutral pH, a mixture of amino acids in solution would be predominantly:
a) Dipolar ions
b) Nonpolar molecules
c) Positive and monovalent
d) Hydrophobic
e) Negative and monovalent
17. The cytosol:
a) Is composed of all subcellular organelles except the nucleus
b) Sediments before the nucleus in gradient centrifugation
c) Is the site for glycogen synthes is
d) Contains enzymes of the TCA cycle
e) Is absent in prokaryotes
18. Interactions between biomolecules usually involve:
a) Covalent bonds and hydrogen bonds
b) Ionic bonds and hydrogen bonds
c) Disulphide bridges and hydrophobic interactions
d) Hydrogen bonds and disulphide bridges
e) All of the above
19. Bonds involved in the interactions between biomolecules usually include:
a) Covalent bonds
b) Hydrogen bonds
c) Ionic bonds
d) Hydrophobic interactions
e) B, C and D are all correct
20. Which of the following bonds is covalent?
a) Hydrophobic
b) Hydrogen
c) Disulphide
d) Electrostatic
e) Ionic
21. Metabolic acidosis:
a) Results from high bicarbonate in the blood
b) Is associated with increase in pH
c) Occurs in uncontrolled diabetes mellitus
d) Results from excessive vomiting
e) None of above is correct
22. Reactions which involve water include:
a) Thiolysis
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b) Phosphorylysis
c) Hydrolysis
d) Hydrogenation
e) Dehydrogenation
23. Water:
a) Has high melting point
b) Has low dielectric constant
c) Does not contribute in interaction of biomolecules
d) Has high concentration in cells
e) Ionizes completely at 25 oC
24. The intestinal bicarbonate is produced by:
a) Stomach
b) Duodenum
c) Jejunum
d) Pancreas
e) Colon
25. pH of a buffer solution can be determined by:
a) -log [base]/[acid]
b) -log [acid]/[base]
c) -log [acid-base]
d) pK + log [base]/[acid]
e) pK + log [acid]/[base]
26. Peroxisome site for synthesis of:
a) Ether glycerophospholipids
b) Dolicols
c) Cholesterol
d) Triacylglycerol
e) A, B and C are correct
27. The physiological buffers that maintain intracellular pH include:
a) Proteins
b) Bicarbonate
c) Phosphate
d) A, B and C are correct
e) Albumin
28. The plasma pH that is most suitable with human life is:
a) 6.8 - 8.7
b) 7.0 - 8.5
c) 6.0 - 8.5
d) 7.35 – 7.45
e) 7.45 – 7.95
29. The plasma membrane of the cell:
a) Contains proteins
b) Is a lipid bilayer
c) Is selectively permeable
d) Is different from the mitochondrial membrane
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e) Is all of the above
30. The pH is:
a) The hydrogen ion concentration in solution
b) Measured by colorimeter
c) The same in all body fluid compartments
d) Maintained by buffers
e) Dependent on ionization of strong acids
31. The following are found in prokaryotic and eukaryotic cells:
a) Plasma membrane and cytosol
b) Nucleus and plasma membrane
c) Cytosol and endoplasmic reticulum
d) Mitochondria and cytoskeleton
e) Ribosomes and mitochondria
32. In cell fractionation:
a) Mechanical shearing and detergent solubilization can be used
b) Gradient centrifugation separates organelles in one step
c) Nuclei sediment in the first pellet in differential centrifugation
d) Subcellular organelles can be identified by molecular markers
e) All of the above are correct
33. A patient has aciduria with a urine sample at pH 4.9. What is the
approximate ratio of lactic acid molecules to lactate ions?
a) 1 : 100
b) 100 : 1
c) 10 : 1
d) 1 : 10
e) 1 : 1
34. What is the pH of a buffer solution (HA and A) where HA is 100x the
concentration of A? (pK of HA is 6.8):
a) 4.8
b) 6.8
c) 5.8
d) 7.8
e) 8.8
35. Buffer capacity is:
a) Greatest at a pH equal to the pKa of the acid form of a buffer pair in a
closed system
b) The change in pH that results from adding a given amount of acid or base to
a solution
c) Both A and B
d) Neither A nor B
e) Dependent on the concentration of the buffer
36. Plasma (HCO3-) is regulated by:
a) The rate of respiration
b) Acidification of urine by the kidney
c) The rate of urea synthesis in the liver
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d) Pancreatic production of HCO3e) Loss of bicarbonate in vomiting and diarrhea
37. The cellulose is:
a) An important constituent of the human muscles
b) Important in human diet
c) The main constituent of the plant cell wall
d) Made up of glucose units attached by alpha- 1,4 glycosidic linkage
e) Degraded to free glucose in humans
CARBOHYDRATES
1. The following is the main aldohexose in the blood:
a) Fructose
b) Mannose
c) Glucose
d) Galactose
e) Alcose
2. Glycogen is:
a) A storage form of carbohydrate in plants
b) A polymer of glucose and fructose
c) A structural polysaccharide
d) Abundant in adipose tissue
e) A branched sugar
3. The following properties are common for both glucose and ribose:
a) Both are aldoses
b) Both are found in DNA and RNA
c) Both are found in disaccharides
d) Both are obtained on hydrolysis of amylopectin
e) Both are ketoses
4. The following is a disaccharide and non-reducing sugar:
a) Lactose
b) Fructose
c) Maltose
d) Sucrose
e) Cellubiose
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5. Proteoglycans:
a) Are composed of cellulose and pectin
b) Are the major source of energy for ruminants
c) Act as lubricants in the joints
d) Give a blue color with iodine
e) Are degraded to free glucose in the lumen of the intestine
6. Carbohydrates:
a) Are polyhydroxyaldehydes or ketones
b) Are polyhydroxyphenols
c) Include glucagon
d) Are components of phosphingolipids
e) Circulate in the blood as polymers
7. Glycogen is:
a) A storage form of carbohydrate in plants
b) A branched sugar
c) A polymer of glucose
d) A structural polysaccharide
e) Both B and C are correct
8. Benedict's test:
a) Does not differentiate between reducing substances
b) Is not specific for glucose
c) Is positive for ascorbic acid
d) Involves an oxidation-reduction reaction
e) All of the above are correct
9. The following is a structural polymer of glucose:
a) Amylopectin
b) Inulin
c) Amylose
d) Cellulose
e) Mannitol
10. The following properties are common for both D- glucose and D- ribose:
a) Both are reducing sugars
b) Form intramolecular hemiacetal bonds
c) Both are aldoses
d) A, B and C are correct
e) A is the only correct answer
11. The following are non-reducing sugars:
a) Glucose and sucrose
b) Fructose and Trehalose
c) Maltose and Lactose
d) Sucrose and Trehalose
e) Lactose and Ribose
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12. Cellulose:
a) Is a major constituent of the plant framework
b) Is the major source of energy in humans
c) Is a polymer of N-acetyl glucosamine
d) Is made up of glucose units attached by alpha 1,4 glycosidic link
e) Can be degraded to free glucose in humans
13. Glycosaminoglycans:
a) Are bacterial and structural polysaccharides
b) Include chondriotin sulphate
c) Are membrane glycolipids
d) Are polymers of glucose
e) Are the major dietary carbohydrates
14. Carbohydrates:
a) Are polyhydroxyaldehydes and acetone
b) Are polyhydroxyketones
c) Include glycoproteins
d) Are components of glycerophospholipids
e) Are components of lecithin
15. Isomers of glucose:
a) All have six carbon atoms
b) Include mannose
c) Can be epimers or anomers
d) Differ only in configuration
e) All of the above are correct
16. Which of the following statements is true of glucose?
a) It is ketoaldose
b) It is found in DNA and RNA
c) It is part of the disaccharide sucrose
d) It is obtained on hydrolysis of galacesylceramide
e) It is constituent of globular proteins
17. Which of the following can be considered as a non-carbohydrate?
a) Starch
b) Proteoglycan
c) Glycoprotein
d) Cellulose
e) Peptidoglycan
18. Which of the following can be synthesized from glucose in the human body:
a) Ribose
b) Lactose
c) Sucrose
d) Cellulose
e) Both A and B are correct
19. Inulin:
a) Is a glycoprotein
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b) Is the chief constituent of the framework of plants
c) Is a fructosan
d) Solution gives the blue colour with iodine
e) Is used only for determination of the glomerular filtration rate
20. The following are aldohexoses:
a) Fructose and galactose
b) Mannose and fructose
c) Glucose and galactose
d) Galactose and ribose
e) Maltose and glucose
21. Glycogen is:
a) A storage form of carbohydrates in plants
b) Main branched polymer of glucose
c) A structural homopolysaccharide
d) Abundant in adipose tissue
e) Stored in the liver
22. Benedict's test:
a) Is positive for ascorbic acid
b) Involves an oxidation-reduction reaction
c) Does not differentiate between reducing substances
d) Is specific for glucose
e) All of the above are correct
23. The following are polymers of glucose:
a) Pectin and collagen
b) Inulin and glycogen
c) Amylose and cellulose
d) Cellulose and chitin
e) Mannitol and starch
24. The following properties are common for both D-glucose and D-ribose:
a) Are reducing sugars
b) Form intramolecular hemiacetal bonds
c) Have functional groups that can form glycosidic linkages
d) Are aldoses
e) All of the above are correct
25. The following is a non-reducing sugar from plants
a) Glucose
b) Fructose
c) Maltose
d) Sucrose
e) Trehalose
26. Glycosaminoglycans:
a) Are highly hydrophobic
b) Have a cushioning function
c) Contain abundant negative charges
d) Act as enzymes
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e) Are the same as glycoproteins
27. The following is a structural polymer of glucose:
a) Inulin
b) Chitin
c) Amilopectin
d) Cellulose
e) Peptidoglycan
28. Glycoproteins:
a) Contain more protein than carbohydrates
b) Act as receptors
c) Contain N-linked and/or O-linked oligiosaccharides
d) Act as enzymes
e) Are space occupying
LIPIDS
1. The following are essential amino acids:
a) Linoleic acid and Palmitic acid
b) Palmitic acid and Archidonic acid
c) Linolenic acid and Linoleic acid
d) Stearic acid and Linolenic acid
e) Linoleic acid and Arachidonic acid
2. Arachidonic Acid:
a) Is a branched fatty acid
b) Contains 3 double bonds
c) Is a precursor for eicosanoids
d) Contains 5 double bonds
e) Is a 20-carbon saturated fatty acid
3. A membrane phospholipids that contains glycerol is:
a) Phosphatidyl Choline
b) Sphingomyelin
c) Cerebroside
d) Ganglioside
e) Ceramide
4. Lipids are important in the human body because they act as:
a) Enzymes
b) Immune molecules
c) Lubricants
d) Stored genetic information
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e) Energy source
5. The following compound is a simple lipid
a) Methionine
b) Lecithin
c) Cholesterol
d) Triacylglycerol
e) Amylopectin
6. Fatty acids:
a) Are always dicarboxylic
b) Are only composed of an even number of C atoms
c) Are obtained from the hydrolysis of triacylglycerol
d) Contains glycerol
e) Are the only components of cell membrane lipids
7. The following are saturated fatty acids:
a) Linoleic acid and archidic acid
b) Palmitic acid and stearic acid
c) Linolenic acid and myristic acid
d) Stearic acid and linolenic acid
e) Oleic acid and lauric acid
8. Arachidonic acid is:
a) The same as arachidic acid
b) Essential fatty acid
c) The precursor of prostaglandins
d) Not found in membrane lipids
e) Is a 22-carbon compound
9. Membrane phospholipids which contain glycerol include:
a) Lecithin and cardiolipin
b) Sphingomyelin and lecithin
c) Cerebroside and Phosphatidyl serine
d) Cardiolipin and gangliosides
e) Ceramide and phosphatidyl inosital
10. Lipids are important in the human body because they act as:
a) Enzymes and hormones
b) Hormones and energy source
c) Coenzyme and enzymes
d) Stored genetic information
e) Energy source and lubricants
11. The following are derived lipids:
a) Vitamin D and methionine
b) Lecithin and cholesterol
c) Cholesterol and palmitic acid
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d) Dolicol and coenzyme Q
e) Amylopectin and prostaglandins
12. Structural lipids include:
a) Gangliosides and aminoglycosides
b) Cerebrosides and cholesterol
c) Phenylaline and phosphatidylserine
d) Phosphatidylserine and glucosamine
e) Glycosaminoglycans and proteoglycans
13. Lipids are stored in mammalian tissues:
a) Starch
b) Triacylglycerol
c) Cholesterol
d) Estrogen
e) Fatty acids
14. In mammals, cholesterol is:
a) A normal membrane constituent
b) Converted to cholic acid by intestinal bacteria
c) Important source of energy
d) Parent molecule for sphingolipids
e) Synthesized in the liver mitochondria
15. In digestion and absorption of lipids:
a) Bile pigments are important biological detergents
b) Hormone-sensitive lipase is secreted by the pancreas
c) Non-specific lipid esterase is the main digestive enzyme
d) Bile salts are important enhancers
e) TAG enters enterocytes directly
16. Unlike prostaglandins, thromboxanes:
a) Are derived from arachidonic acid
b) Are synthesized cyclooxygenase pathway
c) Are released by platelets
d) Act as local hormones
e) Have 20 carbons
17. Complex lipids include:
a) Gangliosides and peptidoglucans
b) Cerebrosides and cellulose
c) Phenylalanine and phosphatidylcholine
d) Phosphatidylserine and cholesterol
e) Glycosaminoglycans and chitin
18. Triacylglycerol and Glycogen:
a) Are storage form of energy in plants
b) Are polymers of glucose
c) Are storage form of energy in animals
d) Have the same energy yield on complete oxidation
e) Are mainly stored in the liver
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19. A membrane phospholipids that does not contain glycerol is:
a) Lecithin
b) Sphingomyelin
c) Cerebroside
d) Cardiolipin
e) Ceramide
20. Unsaturated fatty acids:
a) Are obtained in the diet from animals
b) Are always in the cis configuration
c) Include linolenic acid and arachidonic acid
d) Give important derivatives
e) Are water soluble
21. Phosphatidylcholine:
a) Is also known as lecithin
b) Is a major constituent of lung surfactant
c) Occurs in cell membranes
d) Can be obtained from phosphatidyl ethanolamine
e) All of the above is correct
22. Cholesterol is:
a) Found in plants
b) Membrane lipid
c) Non-amphipathic lipid
d) Precursor of bilirubin
e) A source of energy
23. Cerebrosides:
a) Include glucosylceramide
b) Are derived lipids
c) Contain sialic acid
d) Are glycerophospholipids
e) Are membrane glycoproteins
24. The following is an important function of cholesterol:
a) Synthesis of acetylcholine
b) Synthesis of prostaglandins
c) Formation of bile salts
d) Formation of phosphatidylcholine
e) Increasing membrane rigidity
25. Sphingomyelins:
a) Consist of phosphoric acid, choline and ceramide
b) Consist of ceramide, sphingosine and choline
c) Are glycosphingolipids
d) Are part of the skin pigment melanin
e) Are equally distributed in all tissues
26. The following is true about eicosanoids:
a) Prostacyclines inhibit platelet aggregation
b) Thromboxanes cause platelet aggregation
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c) Prostaglandins enhance smooth muscle contraction
d) Leukotrienes are allergic mediators
e) All of the above is correct
27. The following are amphipathic membrane lipids:
a) Triacylglycerol and cholesterylester
b) Cholesteryl esters and cerebrosides
c) Cholesterol and fatty acid
d) Glycerophospholipds and sphingomyelins
e) Galactosyl ceramide and glycerol
28. The following statement about simple lipids is true:
a) TAG's always contain similar fatty acids
b) Waxes are esters of fatty acids with high molecular weight polyhydric
alcohols
c) Glucosyl ceramide is the main simple lipid in extra-neural tissues
d) Some contain fatty acids with odd carbon number
e) Include only esters of fatty acids with glycerol
29. Complex lipids do not include:
a) Phosphatidyl inositol 4,5 biphosphate
b) Octadecanoic acid
c) Lecithin
d) Glycosphingolipids
e) Ganglioside
30. The following is a storage lipid:
a) Triacylglycerol
b) Cholesteryl esters
c) Cholesterol
d) Phospholipid
e) Galactosyl ceramide
31. In digestion and absorption of lipids:
a) Bile pigments are important biological detergents
b) Hormone-sensitive lipase is secreted by the pancreas
c) Non-specific lipid esterase is the main digestive enzyme
d) Bile salts are important enhancers
e) Phospholipase A2 releases a fatty acid from C2 of TAG
PROTEINS & AMINO ACIDS
1. The peptide bond:
a) Links two amino acids
b) Links two nucleotides
c) Is weaker than the hydrogen bond
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d) Is broken by mild heating
e) Is a non-covalent bond
2. The most important function of proteins in our body is:
a) Emulsification
g
c) Storage
d) Catalysis
e) Energy production
3. Aliphatic non polar amino acids are exemplified by:
a) Isoleucine and Serine
b) Histidine and Alanine
c) Cysteine and Valine
d) Aspartate and Glycine
e) Valine and Isoleucine
4. The following amino acids contain two carboxylic groups:
a) D and E
b) Q and Y
c) A and K
d) C and M
e) H and R
5. Positively charged amino acids are:
a) P and R
b) L and T
c) K and R
d) H and M
e) N and F
6. The primary structure of proteins:
a) Refers to the sequence of amino acids in the polypeptide chain
b) Refers to the helical structure of the protein
c) Describes the beta-pleated sheets
d) Is maintained by hydrogen bonds
e) Is maintained by hydrophobic interactions
7. Denaturation of a protein involves loss of its:
a) Primary structure
b) Secondary & Tertiary structure
c) Primary & Tertiary structure
d) Primary & Quaternary structure
e) Amino acids
8. The alpha helix in a protein:
a) Refers to its tertiary structure
b) Is not affected by amino acid sequence
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c) Is stabilized by covalent bonds
d) Refers to its secondary structure
e) Is the quaternary structure
9. Glycoproteins contain sugar residues covalently bonded to:
a) Lysine
b) Methionine
c) Leucine
d) Asparagine
e) Cysteine
10. The following amino acids contain two carboxylic groups:
a) Aspartate and Glutamate
b) Asparagines and Glutamine
c) Glutamine and Aspartate
d) Proline and Glutamate
e) Glycine and Methionine
11. Positively charged amino acids are:
a) Valine and Arginine
b) Leucine and Lysine
c) Lysine and Arginine
d) Histidine and Cystine
e) Arginine and Glutamine
12. Sulphur containing amino acids:
a) Are non-polar
b) Include cysteine and methionine
c) Are involved in disulphide bridges
d) Are involved in methyl group donation
e) Are non essential amino acids
13. The alpha helix in a protein:
a) Describes the secondary structure
b) Is stabilized by peptide bonds
c) Stabalized by hydrogen bonds between NH and CO main chain groups
d) Is the basis for quaternary structure formation
e) Dictates its tertiary structure
14. The following are classified as acidic amino acids:
a) H and R
b) D and E
c) E and Y
d) A and K
e) C and D
15. Albumin is an important carrier of:
a) Fatty acids and glucose
b) Hyroxine and glycerol
c) Bilirubin and calcium
d) Ammonia and urea
e) Lactate and bilirubin
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16. Hemoglobin and myoglobin have the same:
a) Oxygen affinity
b) Primary structure
c) Quaternary structure
d) Prosthetic group
e) Molecular weight
17. The branched chain amino acids:
a) Are isoleucine and serine
b) Include histidine and valine
c) Undergo transamination and oxidative decarboxylation by similar reactions
d) Are valine, aspartate and glycine
e) Are serine, leucine and isoleucine
18. Hemoglobin and myoglobin:
a) Have the same oxygen affinity
b) Are found in red blood cells
c) Are multimeric protein structures
d) Contain heme
e) Have the same molecular weight
19. Albumin is an important carrier of:
a) Fatty acids and bilirubin
b) Thyroxine and insulin
c) Bilirubin and retinol
d) Calcium and zinc
e) Iron and copper
20. Hemoglobin and cytochromes:
a) Contain Fe3+ as part of the active site
b) Contain heme as prosthetic group
c) Transports oxygen
d) Have similar affinity for oxygen
e) Are found in the mitochondria
21. The alpha helix in a protein:
a) Refers to its tertiary structure
b) Is not affected by the amino acid sequence
c) Is stabilized by covalent bonds
d) Refers to its secondary structure
e) Is the quaternary structure
22. Properties of the peptide bond include:
a) It is a covalent double bond
b) It links to alpha amino acids covalently
c) It is weaker than the hydrogen bond
d) It can be broken by mild heating
e) None of the above
23. Among the important functions of proteins in our body are:
a) Emulsification and buffering
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b) Thermal insulation and energy production
c) Storage of energy and transport
d) Catalysis and hormonal function
e) Buffering and hydrophobocity
24. Negatively charged amino acids:
a) Are serine and glutamate
b) Include glutamine and asparagine
c) Are necessary for protein-protein interactions
d) Are not found in membrane bound proteins
e) Form disulphide bridges
25. Sulphur containing amino acids:
a) Are cysteine and methionine
b) Are non-essential amino acids
c) Can be synthesized from serine
d) Are always found at the carboxy terminal of the polypeptide chain
e) All of the above are correct
26. Albumin is:
a) Synthesized in the liver
b) Water-soluble protein
c) A carrier of bilirubin and calcium and fatty acids
d) Decreased in blood and in protein calorie malnutrition
e) All of the above
27. Hemoglobin S:
a) Results from insertion of a nucleotide
b) Results from substitution mutation
c) Is incompatible with life
d) The deficiency manifest in all children of carrier parents
e) Has the same affinity for oxygen as hemoglobin F
28. All of the following are considered "weak interactions" in proteins except:
a) Van der Waals force
b) Hydrogen bonds
c) Ionic bonds
d) Peptide bonds
e) Hydrophobic interactions
29. Hemoglobin:
a) Has a quaternary structure
b) Contains porphyrin ring
c) Contribute to pH maintenance in blood
d) Affinity towards oxygen increases with cooperativity
e) All of the above is correct
30. Globular proteins:
a) Are structural proteins
b) Include peptide hormones
c) Are always found in the plasma membrane
d) Are relatively water insoluble
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e) Are always glycosylated
31. The following are peptides:
a) Glutathione and vasopressin
b) Gramicidin and tyrosine
c) Vasopressin and epinephrine
d) Ceramide and endorfens
e) Guanosine and insulin
32. Glycoproteins contain sugar residues covalently boded to:
a) Threonine and serine
b) Leucine and arginine
c) Asparagine and glycine
d) Cysteine and histidine
e) Lysine and methionine
33. The following is true about amino acids:
a) Cysteine and serine are polar uncharged
b) Methionine can form a cross link between peptides
c) Histidine and glutamic acid are negatively charged
d) Glycine has D and L isomers
e) Tyrosine is a basic amino acid
34. Enzymes involved in protein digestion are mainly produced by:
a) Stomach
b) Duodenum
c) Jejunum
d) Ileum
e) Pancreas
35. Glycoproteins contain sugar residues covalently boded to:
a) Lysine
b) Threonine
c) Leucine
d) Asparagine
e) Cysteine
36. The following amino acids have nonpolar side chains:
a) Valine and serine
b) Methionine and leucine
c) Arginine and alanine
d) Glycine and asparagine
e) Isoleucine and valine
37. The following is true about amino acids:
a) Ornithine is alpha amino acid
b) Glycine has two carbon atoms
c) Proline is an imino acid
d) All of the above are true
e) Valine is an aromatic amino acid
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38. Which of the following amino acids is most likely to be found in the
transmembrane region of a protein?
a) Lysine
b) Arginine
c) Leucine
d) Aspartate
e) Glutamate
39. Which of the following amino acids are found in the cell but not in protein?
a) Citrulline and ornithine
b) Alanine and phosphotyrosine
c) Citrulline and cysteine
d) Gamma carboxyglutamate and hydroxylysine
e) Phosphoserine and phosphothreonine
40. The sequence of amino acids are found in the cell but not in protein?
a) Glycine-cysteine-glutamate
b) Cysteine-glycine-glutamate
c) Glycine-glutamate-cysteine
d) Glutamate-cysteine-glycine
e) Glutamate-glycine-cysteine
41. The following are peptides:
a) Glutathione and methionine
b) Gramicidin S and vaspressin
c) Vassopressin and sphingosine
d) Ceramide and insulin
e) Arginine and adrenaline
42. Properties of the peptide bond include:
a) It is a covalent double bond
b) It links three alpha-amino acids covalently
c) It is stronger than the hydrogen bond
d) It can be broken by mild heating
e) None of the above
43. Alpha helix:
a) Is stabilized by covalent bonds
b) Has 3.6 amino acid residues per turn
c) Proline favors its formation
d) Denotes secondary structure of a protein
e) Can be found in a tripeptide
44. Denaturation of a protein:
a) Disrupts the primary structure of the protein
b) Alters the secondary and tertiary structures of the protein
c) Breaks all covalent bonds in the protein
d) Has no effect on the biological activity
e) Removes disulphide bridges
45. The amino acids with positively charged side chains include:
a) Arginine and serine
b) Glutamine and alanine
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c) Glutamate and proline
d) Glutamine and tyrosine
e) Arginine and lysine
46. In the polypeptide chain, the peptide bond:
a) Is formed by the alpha carboxylic group of one amino acid and the alpha
amino group of the next amino acid
b) Is rigid
c) Components are planner
d) Is stronger than a single covalent bond
e) All of the above is correct
47. The tertiary structure of a protein is:
a) Its three dimensional structure
b) The relationship between different subunits
c) Not lost by denaturation
d) Stabalized by peptide bonds only
e) Not relevant to its function
48. The major functions of proteins in the human body include:
a) Storage of genetic information
b) Immunity and locomotion
c) Buffering and transport
d) Catalysis and signalling
e) B, C and D are correct
49. Non standard amino acids in protein structure include:
a) Ornithine
b) Citrulline
c) Hydroxyproline
d) Serine
e) Glycine
50. The pancreatic enzyme not involved in protein digestion is:
a) Carboxypeptidase
b) Trypsin
c) Lipase
d) Clastase
e) Chymotrypsin
ENZYMES
1. Oxidoreductases include:
a) Catalases and Mutases
b) Oxygenases and Dehydrogenases
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c) Dehydrogenases and Ligases
d) Aminotransferases and Racemases
e) Epimerases and Oxidases
2. Michaelis constant of enzyme (Km) is:
a) The substrate concentration which gives maximal velocity
b) The substrate concentration which gives 1/2 the maximal velocity
c) 1/2 the substrate concentration which gives maximal velocity
d) The enzyme concentration which gives maximal velocity
e) The enzyme concentration which gives 1/2 the maximal velocity
3. A competitive inhibitor:
a) Increases the Km of the enzyme
b) Decreases the Vmax of the enzyme
c) Increases the Vmax of the enzyme
d) Decreases the Km of the enzyme
e) Increases both Km and Vmax of the enzyme
4. The non-protein part of an enzyme is called:
a) Apoenzyme
b) Holoenzyme
c) Allosteric Enzyme
d) Isoenzyme
e) Coenzyme
5. The major 6 classes of enzymes include:
a) Transferases and Oxygenases
b) Isomerases and Lyases
c) Hydrolases and Epimerases
d) Oxidoreductases and Catalases
e) Transaminases and Transferases
6. Enzymes:
a) Increase the energy barrier for a reaction
b) Are recovered chemically altered after a complete reaction
c) Increase the equilibrium constant of the reaction
d) Activity is subject to regulation
e) Are exclusively proteins
7. Coenzymes
a) The non-protein part of enzymes
b) Needed for enzyme activity
c) Usually vitamin derivatives
d) Termed prosthetic group if bonded tight to their enzymes
e) All of the above are correct
8. At Vmax of an enzyme catalyzed reaction:
a) Further increase in substrate concentration increases the rate of the reaction
b) All the enzyme molecules are combined with substrate
c) The substrate concentration that produces maximal velocity is termed Km
d) Half the enzymes are combined with substrate
e) Km is maximum
9. In case of non-competitive inhibition of enzymes
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a) Vmax can not be reached
b) There is no significant alteration of the active site
c) Inhibitor is structurally similar to the substrate
d) Inhibitor can be removed by increasing substrate concentration
e) Vmax is increased
10. Isoenzymes:
a) Are factors required for enzyme activity
b) Are functional plasma enzymes
c) Show similar responses to inhibitor molecules
d) Are important tools in the diagnosis & prognosis of disease
e) Catalyze oxidation-reduction reactions
11. Hydrolases enzymes include:
a) Racemases and oxygenases
b) Isomerases and lyases
c) Peptidases and lipases
d) Oxidoreductases and catalases
e) Transaminases and hydralases
12. Which of the following statements is true of enzyme catalysts?
a) To be effective they must be present at the same concentration as their
substrate
b) They can increase the equilibrium constant for a given
reaction by a thousand-fold or more
c) They lower the activation energy for conversion of substrate to product
d) Their catalytic activity is independent of pH
e) They are generally equally active on D and L isomers of a given substrate
13. Allosteric effector influences the enzyme activity by:
a) Covalently modifying the enzyme
b) Binding to the substrate and altering its conformation
c) Competing for catalytic site with substrate
d) Changing the specificity of the enzyme for its substrate
e) Binding to a site on the enzyme distinct from catalytic site
14. The following enzyme complex requires both thiamine and lipoic acid:
a) Malate dehydrogenase
b) Alpha-ketoglutarate dehydrogenase
c) Fumarase
d) Isocitrate dehydrogenase
e) Succinate dehydrogenase
15. Sterioisomers:
a) Diversify physical and chemical properties of molecules
b) Have the same spatial configuration
c) Exhibit enzyme specifity
d) Include epimers, anomers and enantiomers
e) All A, C and D are correct
16. In an enzyme catalyzed reaction:
a) Enzymes increase the energy barrier for the reaction
b) Enzymes form a perminant complex with the substrate
c) After the reaction, enzymes are recovered unchanged
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d) V-max is reached in the presence of a non-competitive inhibitor
e) The equilibrium constant is decreased
17. Isomerases:
a) Racemases and mutases
b) Phosphatases and hydratases
c) Lyases and oxidases
d) Transaminases and kinases
e) Hydratases and glucosidases
18. Subclasses of oxidoreductases include:
a) Kinases and oxygenases
b) Reductases and dehydrogenases
c) Racemases and oxidases
d) Catalases and aminotransferases
e) Peroxidases and anomerase
19. The active site of an enzyme:
a) Is rich with hydrophobic amino acid side chains
b) Binds allosteric effectors
c) Is similar in shape to the substrate
d) Occupies most of the enzyme molecule
e) None of the above
20. Coenzymes:
a) Are small organic molecules needed for enzyme activity
b) Are associated with apoproteins
c) Are vitamin derivatives
d) Are called prosthetic groups if they are tightly bound to the enzyme
e) All of the above is correct
21. In competitive inhibition of an enzyme:
a) Km and Vmax are decreased
b) Inhibitor is structurally similar to the substrate
c) Inhibition cannot be reversed by increasing substrate concentration
d) Vmax is decreased
e) The inhibitor binds to the regulatory site on the enzyme
22. In non-competitive inhibition of enzyme activity:
a) Both Vmax and Km are increased
b) Inhibitor has no structural resemblance to the substrate
c) There is a significant alteration of the active site
d) Vmax is decreased
e) A is the only wrong answer
23. The following statements describe Allosteric enzymes:
a) Effectors may enhance or inhibit substrate binding
b) Binding of the substrate to the Allosteric site displaces the effectors
c) They are always multimeric proteins
d) The regulatory site is identical to the active site
e) Binding of substrate to the active site releases allosteric effector
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24. The following statements about regulation of enzyme activity are correct:
a) Phosphorylation/ dephosphorylation is the common covalent modification
b) Regulatory enzymes usually catalyze reversible reactions
c) Allosteric inhibitors are usually the end products
d) Increase in the enzyme level has no effect
e) Irreversible inhibition is physiological type of regulation
25. Phosphorylation/ dephosphorylation of enzymes:
a) Occurs on specific serine and threonine residues
b) Is a covalent type of modification
c) Is a reversible type of regulation
d) Is achieved by the activities of protein kinases and phosphatases
e) All of the above is correct
26. The enzyme for starch digestion is:
a) Salivary amylase
b) Pancreatic amylase
c) Lysosomal glucosidase
d) Both A and B
e) All of the above is correct
27. Hydrolases include:
a) Catalases and mutases
b) Oxygenases and dehydrogenases
c) Esterases and glucosidases
d) Aminotransferases and racemases
e) Epimerases and oxidases
28. The following enzymes are absent in muscles but are present in the liver:
a) Pyruvate carboxylase and citrate synthase
b) Glucose-6-phosphatase and glycerol kinase
c) Lactate dehydrogenase and isocitrate dehydrogenase
d) Pyruvate dehydrogenase and beta-ketothiolase
e) Glycogen synthase and 3-HMG CoA synthase
29. Which of the following statements is true of enzyme catalysts?
a) To be effective, they must be present at the same concentration as their
substrate
b) They can increase the equilibrium constant for a given reaction by a
thousand-fold or more
c) They lower the activation energy for conversion of substrate to product
d) Their catalytic activity is independent of pH
e) They are generally equally active on D and L isomers of a given substrate
30. Isoenzymes:
a) Are differentiated by dialysis
b) Show the same electrophoretic mobility
c) Include lactate dehydrogenase
d) Are used as diagnostic tools
e) Both C and D are correct
31. The pancreatic enzyme not involved in protein digestion is:
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a) Carboxypeptidase
b) Trypsin
c) Lipase
d) Elastase
e) Chymotrypsin
32. Restriction enzymes:
a) Recognize specific nucleotide sequences in DNA
b) Cut both strands of DNA
c) Often produce single stranded tails
d) Do all of the above
e) Do none of the above
33. Enzymes involved in hydrolysis:
a) Are called decarboxylases
b) Use folic acid as a coenzyme
c) Include dehydrogenases
d) Include peptidases
e) Always require coenzyme
34. Enzymes and pH:
a) All enzymes have one optimum pH
b) Enzymes in the stomach require alkaline pH
c) All enzymes in eukaryotic cells require the same pH
d) The optimum pH is the one at which the enzyme has maximum activity
e) The pH is the same in the lysosome and plasma
35. Isomerases:
a) Catalyze oxidation-reduction reactions
b) Do not change the structural formula of the substrate
c) Include transaminases
d) Use water to break covalent bonds
e) Require ATP to form covalent bonds
36. The following vitamin work as coenzymes with the corresponding enzyme:
a) Biotin and carboxylases
b) Cobalamin with isomerases
c) Retinol with lyases
d) Riboflavin with hydrolases
e) Thiamin and isomerases
VITAMINS
1. Vitamin A:
a) Deficiency can give rise to xerophthalmia
b) Is normally excreted in urine
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c) Carnitine, Retinine and Retinone are known forms
d) Is required for collagen synthesis
e) Can be synthesized by intestinal flora
2. Vitamin D:
a) Requires parathyroid hormones for activation
b) Is water-soluble
c) Lowers calcium level in the blood
d) Deficiency from overexposure to the sun
e) Is not required in the diet
3. Vitamin K:
a) Is derived from cholesterol
b) Is synthesized by intestinal flora
c) Deficiency causes night blindness
d) Cannot be stored in the body
e) Is involved in transamination reactions
4. Beriberi:
a) Is due to deficiency of pyruvate dehydrogenase complex
b) Affects the nervous system and the heart
c) Is due to deficiency in Vitamin C
d) Is associated with bone deformity
e) Can be treated by iron supplements
5. Vitamin B12:
a) Is a potent anti-oxidant
b) Deficiency causes pellagra
c) Vegetable seeds are a major source
d) Is not stored in the body
e) Requires the intrinsic factor for absorption
6. Pyridoxal Phosphate:
a) Is vitamin B5
b) Deficiency causes rickets
c) Is coenzyme with pyruvate carboxylase
d) Can be synthesized in the human body
e) Is needed by the enzyme alanine transaminase
7. The following is formed in the liver:
a) Cholicalciferol
b) 7- dehydrocholesterol
c) 1, 25- dihydroxycholecalciferol
d) 25- hydroxycholecalciferol
e) 24, 25- dihydroxycalciferol
8. Pernicous anemia is caused by:
a) A deficiency of dietery vitamin B12
b) A deficiency of dietery folic acid
c) Excessive production of HCl by parietal cells of the stomach
d) A deficiency of the intrinsic factor
e) A deficiency of vitamin C
9. Vitamin A:
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a) Is important for growth and reproduction
b) Is obtained from beta-carotene
c) Retinol and retinoic acid are known forms
d) Is required for keratin synthesis
e) All of the above is correct
10. Pellagra:
a) Due to deficiency of pyruvate dehydrogenase complex
b) Due to deficiency of riboflavin
c) Associated diarrhea, dermatitis and dementia
d) Treated by supplementation of tyrosine
e) Inherited as autosomal recessive character
11. Thiamin pyrophosphate is essential coenzyme for:
a) Pyruvate dehydrogenase and transketolase
b) Transketolase and lactate dehydrogenase
c) Glycogen phosphorylase and glucose-6-phosphatase
d) Lactate dehydrogenase and alpha-ketoglutarate dehydrogenase
e) None of the above
12. Ascorbic acid:
a) Deficiency causes hypochromic microcytic anemia
b) Is required for synthesis of epinephrine and collagen
c) Is required for synthesis of bile acids
d) Promotes iron absorption in GIT
e) All of the above are correct
13. The following is not true about cobalamin:
a) Active form is methylcobalamin
b) Absorption requires a glycoprotein factor
c) Is required for metabolism of propionate
d) Deficiency results in hemolytic anemia
e) Is involved in folate metabolism
14. The effects of vitamin A include all of the following except:
a) Prevention of infection
b) Serving as an antioxidant
c) Cell differentiation
d) The visual cycle
e) Induction of certain cancers
15. The vitamin component of coenzyme A is:
a) Riboflavin
b) Biotin
c) Panthothenic acid
d) Nicotinic acid
e) Pyridoxine
16. Vitamin A:
a) Deficiency can give rise to rickets
b) Is normally excreted in urine
c) Carnitine, Retinine and Retinone are known forms
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d) Is required for collagen synthesis
e) Is important for epithelial growth
17. Vitamin D:
a) Requires thyroid hormones for activation
b) Active form is called calcitrol
c) Lowers calcium level in the blood
d) Deficiency from overexposure to the sun
e) Is not required in the diet
18. Vitamin K:
a) Is derived from cholesterol
b) Is needed for activation of prothrombin
c) Deficiency causes night blindness
d) Cannot be stored in the body
e) Is involved in transamination reactions
19. Beriberi:
a) Is due to deficiency of pyruvate dehydrogenase complex
b) Is due to deficiency in Vitamin C
c) Is associated with bone deformity
d) Can be treated by iron supplements
e) Is associated with high lactate in the blood
20. Vitamin B12:
a) Is a potent anti-oxidant
b) Deficiency causes pellagra
c) Vegetable seeds are a major source
d) Binds transcobalamin I in the liver
e) Is absorbed in the stomach
21. Pyridoxal phosphate:
a) Is vitamin B2
b) Deficiency is very common
c) Is coenzyme with pyruvate carboxylase
d) Can be synthesized in the human body
e) Is coenzyme with aminotransferases
22. Synthesis of vitamin B12 occurs in the:
a) Stomach
b) Duodenum
c) Jejunum
d) Ileum
e) Colon
23. The vitamins involved in energy producing reactions include:
a) Folic acid, thiamin and niacin
b) Biotin, niacin and cobalamin
c) Thiamin, niacin and pantothenic acid
d) Cobalamin, ascorbic acid and riboflavin
e) Pyridoxine, folic acid and cobalamin
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24. The following vitamins act as coenzymes with dehydrogenases:
a) Thiamin and panthothenic acid
b) Biotin and pyridoxine
c) Cobalamin and folic acid
d) Ascorbic acid and biotin
e) Niacin and riboflavin
25. The following vitamins are involved in hemopoiesis:
a) Ascorbic acid and thiamin
b) Folic acid and cobalamin
c) Riboflavin and biotin
d) Pyridoxine and thiamin
e) Niacin and panthothenic acid
26. The vitamins synthesized by intestinal bacteria include:
a) Thiamin and riboflavin
b) Biotin and vitamin K
c) Folic acid and cobalamin
d) Niacin and vitamin C
e) Vitamin D and panthothenic acid
NUCLEIC ACIDS
1. The following are purine nucleotides:
a) ATP and CMP
b) CTP and GDP
c) NAD and TDP
d) GMP and ADP
e) UDP and GTP
2. Watson and Crick model of DNA structure implies that:
a) Thymine base pairs with adenine
b) Thymine base pairs with cytosine
c) DNA is a single strand
d) The purine content is not equal to the pyrimidine content
e) The nitrogenous bases from the backbone of the molecule
3. RNA:
a) Contains deoxyribose
b) Contains adenine, guanine, thymine & cytosine
c) Is usually single stranded
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d) Guanine content is equal to cytosine content
e) Is not found in the nucleus
4. The bonds that stabilize the structure of DNA are:
a) Hydrogen bonds and peptide bonds
b) Phosphodiester bonds and hydrogen bonds
c) Glycosidic bonds and thioester bonds
d) Disulphide bonds and hydrogen bonds
e) Van der Waals forces
5. All the following compose a nucleoside except:
a) Phosphate group
b) Deoxyribose
c) Ribose sugar
d) Pentose sugar
e) Purine base
6. The following are purine nucleotides:
a) AMP and ADP
b) ATP and CMP
c) CTP and GDP
d) NAD and TDP
e) UDP and GTP
7. Select the incorrect statement. Messanger RNA:
a) Is translated in the direction 5'to 3'
b) Is oftend derived from a large precursor by processing in eukaryotes
c) Has a poly A tail in eukaryotes
d) Is a heterogeneous molecule
e) Is extensively processed posttranscriptionally in prokaryotes
8. Nucleotides in nucleic acids are linked together by:
a) Peptide bonds
b) 3' to 5' phosphodiester bond
c) 5' to 3' phosphodiester bond
d) Disulphide bonds and hydrogen bonds
e) Van der Waals forces
9. The following is a purine nucleotide:
a) Cytidylate
b) Guanosine
c) Cytidine monophosphate
d) Uridine
e) Adenylate
10. Regarding Watson-Crick model of DNA structure:
a) The bases are found to the outside
b) The two strands are parallel
c) (G+C / A+T) = 1
d) The opposing strands of DNA are said to be complementary
e) Adenine pairs with thymine by 3 hydrogen bonds
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11. The following statement is correct:
a) DNA is a polymer of nucleosides
b) The two DNA strands are covalently linked
c) The genetic information is stored in the linear sequence of bases along the
molecule
d) DNA is found only in the nucleus
e) Successive nucleotides are linked by 3'-5- thioester bond
12. rRNA:
a) Is the least RNA in the cell
b) Is the smallest among RNA's
c) Is the same in pro- and eukaryotic cells
d) Codes for protein synthesis
e) Has catalytic function in protein synthesis
13. tRNA:
a) Is the most abundant RNA in the cell
b) Acts as adaptor during protein synthesis
c) Is the most heterogeneous of all RNA's
d) Usually binds more than one amino acid
e) Has a catalytic role during protein synthesis
14. The following is correct about the genetic code:
a) 62 codons can code for amino acids
b) It is universal
c) Four codons can terminate protein sythesis
d) Many amino acids have multiple codons
e) All of the above is correct
15. The genetic code is said to be umambiguous, that means:
a) Several triplets code for one amino acid
b) Each triplet codes for one amino acid
c) One gene one protein
d) Each triplet specifies more than one amino acid
e) Each amino acid has one codon
16. If GUA specifies valine, UUA specifies leucine, AUU specifies isoleucine and
ACA specifies threonine, it is most likely that AUA specifies:
a) Valine
b) Leucine
c) Isoleucine
d) Threonine
e) Proline
17. With regard to mitochondrial DNA:
a) It has a circular duplex of ribonucleic acid
b) It accounts for 25% of total human DNA
c) It codes for all mitochondrial enzymes
d) It is inherited exclusively from the mother
e) All of the above is true
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18. The following is a purine nucleotide:
a) Cytidylate
b) Guanosine
c) Cytidine monophosphate
d) Adenine monophosphate
e) Guanosine monophosphate
19. Concerning the different types of RNA:
a) mRNA is the most abundant
b) rRNA is involved in formation of ribosomes
c) tRNA carries codons for amino acids
d) tRNA acceptor arm is found in the 5' end
e) mRNA is the most homogeneous type
18. Which of the following statement is correct:
a) DNA is a polymer of nucleosides
b) The two DNA strands are covalently linked
c) The genetic information is stored in the linear sequence of bases in DNA
d) DNA is found only in the nucleus
e) Successive nucleotides are linked by 3'-5- thioester bond
19. cAMP is:
a) Purine base
b) Involved in signal transduction
c) A synthetic nucleotide analogue
d) Is a nucleoside derivative of cytosine
e) Is the same as AMP
20. Synthetic nucleotide analogs:
a) Include cGMP
b) Include theophylline
c) Can be used as anti-tumor agents
d) 5-fluoro uracil is used for treatment of gout
e) Have only antiviral effect
21. Nucleotides:
a) Include NAD and FAD
b) Are involved in formation of coenzymes
c) Are involved in base plus sugar plus phosphate
d) Important in CHO biosynthesis
e) All of the above is correct
22. The following are the properties of the genetic code:
a) It is degenerate
b) It is commaless
c) It is non overlapping
d) It is a triplet
e) All of the above is correct
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23. Concerning the 20 standard amino acids:
a) Each amino acid has two codons
b) Some amino acids have no codons
c) One codon can code for more than one amino acid
d) An amino acid can have more than one codon
e) None of the above
24. The codon is:
a) Three nucleotides (bases) in mRNA representing an amino acid
b) The sequence of bases in tRNA
c) The same as the gene
d) The base sequence in rRNA
e) None of the above
25. The gene is:
a) Polymer of amino acid linked by peptide bond
b) DNA segment carrying information about a protein
c) Only made of introns
d) The same as chromosomes
e) Only made of exons in eukaryotes
26. The flow of genetic information is the following order:
a) Translation replication  transcription
b) Replication  transcription  translation
c) Transcription  replication  translation
d) Replication  translation  transcription
e) Transcription  translation  replication
27. All of the following are involved in purine nucleotide synthesis:
a) Glycine, Serine, Glutamine
b) Aspartate, Formyl Tetrahydrofolate, Glutamine
c) Asparagine, Glycine, Glutamine
d) Carbon Dioxide, Pyridoxine, PRPP
e) Ribose 5 Phosphate, Glutamate, Formimino Tetrahydrofolate
28. The commited step in purine nucleotide biosynthesis is catalysed by:
a) PRPP Synthase
b) PRPP Glutamylamidotransferase
c) Glucose 6 Phosphate dehydrogenase
d) IMP Dehydrogenase
e) All of the above is correct
29. Denovo purine biosynthesis is inhibited by:
a) Antifolate drugs
b) Glutamine analogs
c) Azaserine and diazanorleucine
d) 6-mercaptopurine and mycophenolic acid
e) All of the above
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30. The salvage pathway of purin nucleotide synthesis involves:
a) Conversion of adenine to AMP by adenosine kinase
b) Conversion of adenosine to AMP by phosphoribosyl transferase
c) Formation of GMP from guanine by HGPRTase
d) Formation of dATP by ribonucleotide reductase
e) C is the only correct answer
31. The following is correct about inherited disorders of purine metabolism:
a) Adenosine deaminase deficiency results in severe immunodeficiency
b) Gout results from decreased Km of PRPP synthase for Ribose-5-Phosphate
c) Complete deficiency of HGPRTase results in Lesch Nyhan Syndrome
d) Xanthinuria results from complete deficiency of xanthine oxidase
e) All of the above is correct
32. Allopurinol:
a) Lowers uric acid in the blood by increasing renal excretion
b) Is xanthine oxidase inhibitor
c) Increases formation of urate by increasing plasma pH
d) Is the natural substrate for orotate phosphoribosyl transferase
e) Inhibits purine and pyrimidine degradation
33. Methotrexate:
a) Inhibits reduction of dihydrofolate to tetrahydrofolate
b) Inhibits TMP synthesis
c) Is an anticancer drug
d) A,B and C are correct
e) C is the only correct answer
34. The end products of pyrimidine catabolism:
a) Include ammonia, beta alanine and CO2
b) Increase in leukemic patients
c) Increases as a result of mitochondrial damage to the liver
d) Are highly water soluble
e) All of the above is correct
35. Orotic Aciduria:
a) Type I reflects a deficiency in both Orotate Phosphoribosyl Transferase and
Oritidylate Decarboxylase
b) Type II reflects deficiency of oritidylate decarboxylase only
c) Is transiently detected in allopurinol treated patients
d) Is detected in ornithine transcarbamoylase deficiency
e) All of the above is correct
36. Possible roles of covalent modification of histones include:
a) Acetylation of histones H3 and H4 is associated with the activation or
inactivation of gene transcription
b) Methylation enhances transcription
c) Phosphorylation of H1 participate in octamer formation
d) ADP-ribosylation is associated with nucleosomal assembly
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e) None of the above is correct
CARBOHYDRATE METABOLISM
1. Gluconeogenesis:
a) Is favoured when isulin concentration is high
b) Occurs in the liver during prolonged fasting
c) Allows skeletal muscle to produce glucose for export to blood for use by the
CNS
d) Is stimulated by high levels of glucose-6-phosphate
e) Uses Acetyl CoA as substrate
2. Glucose-6-phosphate dehydrogenase:
a) Is the key enzyme in glycogenesis
b) Is activated by high levels of NADP+
c) Catalyzes conversion G6P to fructose-6-phosphate
d) Is important in muscle during exercise
e) Not found in RBC's
3. In the TCA cycle:
a) 3 ATP's are produced by substrate-level phosphorylation
b) Oxygen is directly involved
c) All reactions are reversible
d) Succinyl CoA is the precursor for Heme synthesis
e) Oxaloacetate is converted to pyruvate
4. The following can be synthesized from glucose in the human body:
a) Ribose and lactose
b) Lactose and cellulose
c) Sucrose and ribulose
d) Cellulose and fructose
e) Fatty acid sucrose
5. Glucose-6-phosphate deficiency:
a) Is known as Von Gierke's disease
b) Is associated with hypoglycemia in the fed state
c) Inhibits the last step of glycogenolysis and gluconeogenesis in the liver
d) Is associated with hyperuricemia
e) B is the only wrong statement
6. In glycogenesis:
a) ATP is required
b) Phosphoglucomutase catalyses irreversible step
c) Glucose residues are added to the reducing end of glycogen
d) Glycogen synthase is the key enzyme
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e) 2 ATP molecules are consumed
7. In galactosemia:
a) Treatment involves restriction of glucose in diet
b) The liver function can be seriously affected
c) Galactose is deposited in tissues
d) Galactose is readily converted to glucose
e) Galactosuria is the most serious manifestation
8. Uncoupling of oxidative phosphorylation:
a) Decreases the oxygen consumption
b) Releases heat only
c) Occurs during hypoxia
d) Causes a buildup of NADH
e) Produces more ATP
9. The enzyme not involved in glycolyisis is:
a) Aldolase
b) Endolase
c) Pyruvate kinase
d) Phosphoglycerate mutase
e) Alpha phosphoglycerate dehydrogenase
10. Which of the following is not a glycolytic intermediate?
a) Glucose-6-phosphate
b) Fructose-6-phosphate
c) Dihydroxyacetone phosphate
d) Pyruvate
e) Glycerol-3-phosphate
11. Which site utilizes glucose as an energy source exclusively in all conditions:
a) Brain
b) Muscle
c) Liver
d) Fat cell
e) Erythrocyte
12. The following agent interferes with oxidative phosphorylation:
a) Cyanide inhibits NADH-dehydrogenase
b) Carbon monoxide inhibits Coenzyme Q
c) Rotenone enhances electron transfer
d) Oligomyein inhibits electron transfer
e) Dintrophenold uncouples phosphorylation from electron transfer
13. The following compounds are part of the pyruvate dehydrogenase complex:
a) Thiamin diphosphate
b) Lipoamide
c) CoA
d) NAD+
e) All of the above
14. UDP-G:
a) Is derived from vitamin B1
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b) Is a substrate for the enzyme glycogen phosphorylase
c) Is intermediate in glycerophospholipid synthesis
d) Is not required for normal galactose metabolism
e) Can be formed from UDP-Galactose
15. Glycogen phosphorylase:
a) Is a mitochondrial enzyme
b) Is activated by dephosphorylation
c) Acts by the same mechanism as intestinal amylase
d) Produces uridine diphosphate from glycogen
e) Produces glucose-1-phosphate
16. Fructose 2,6 bisphosphate:
a) Is a glycolytic intermediate
b) Activates phosphofructokinase 1
c) Is synthesized by phopshofuctokinase 1
d) Enhances fructose 1,6 bisphosphate
e) Level in the liver is increased by glucagon
17. Pyruvate carboxylase:
a) Converts acetyl CoA to pyruvate
b) Requires carnitine
c) Converts pyruvate to oxaloacetate
d) Is activated by high fructose 1,6 bisphosphate
e) Requires pyridoxal phosphate
18. In glycogen storage diseases:
a) Von Gierke's disease is type III
b) Hypoglycemia is the main feature of type V
c) Type II is associated with glucose 6 phosphatase deficiency
d) Type IV is called Andersen's disease
e) Hepatomegally is the main feature of all types
19. Which of the following statements about galactosemia is correct:
a) Treatment involves restriction of glucose in the diet
b) A deficiency of glucokinase is the major case
c) Is treated by elimination of galactose from the diet
d) Can be treated by restricting sucrose in the diet
e) Is inherited as autosomal dominant character
20. Glucose-6-phosphate dehydrogenase:
a) Is the key enzyme in glycogenesis
b) Deficiency can cause hemolytic anemia
c) Catalyses conversion of G6P to fructose-6-phosphate
d) Is important in muscles during exercise
e) Is not found in RBC's
21. Synthesis of glucose from pyruvate by gluconeogenesis in the liver:
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a) Occurs exclusively in the cytosol
b) Is inhibited during prolonged fasting
c) Requires participation of biotin
d) Requires lactate as intermediate
e) Occurs exclusively in the mitochondrion
22. In the TCA cycle:
a) Four NADH molecules are produced
b) Substrate-level phosphorylation occur by the action of succinyl CoA
thiokinase
c) The reactions can proceed in the absence of molecular oxygen
d) Fumarase reactions occur immediately after isocitrate dehydrogenases
reactions
e) Glutamate dehydrogenase is a key enzyme
23. In fructose metabolism:
a) Deficiency of hexokinase results in fructosuria
b) Glucokinase is the major enzyme
c) Fructokinase phosphorylates fructose
d) Fructose 6 phosphate is produced by fructokinase
e) Aldolase A is the key enzyme
24. Oxidation of glucose by red blood cells gives:
a) Lactate + NADH+H
b) 36 ATP molecules per molecule of glucose
c) Lactate and NAD+
d) Carbon dioxide and water
e) 2 NADPH
25. The pentose phosphate pathway:
a) Produces ATP
b) Is a mitochondrial pathway
c) Is important for reductive biosynthesis
d) Is least active in the liver
e) Is inhibited by high glucose levels
26. The following agent interferes with oxidative phosphorylation:
a) Carbon monoxide inhibits cytochrome reductase
b) Cyanide inhibits NADH-dehydrogenase
c) Rotenone enhances electron transfer
d) Oligomyein inhibits electron transfer and phosphorylation
e) Dintrophenol enhances ATP synthesis
27. UDP-Glucose:
a) Is indirectly involved in bilirubin conjugation
b) Is a substrate for the enzyme 4-epimerase in lactating mammary gland
c) Is intermediate in sphingolipid synthase
d) Is required for galactose metabolism
e) All of the above
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28. Glycogen synthesis:
a) Is a mitochondrial pathway
b) Is activated during the fasting state
c) Occurs in the liver and muscle
d) Produces uridine diphosphate from glycogen
e) All of the above
29. Pyruvate is
:
a) Converted to acetyl CoA by pyruvate carboxylase
b) Four-carbon compound
c) Converted to oxaloacetate by pyruvate dehydrogenase complex
d) Converted to alanine by transamination
e) Intermediate in the TCA cycle
30. In glycogen storage diseases:
a) Fatigability and muscle cramps are main features of Von Geirke's disease
b) Hypoglycemia is the main feature of type V
c) Type II is associated with glucose 6 phosphatase deficiency
d) Type IV is called Andersen's disease
e) Hepatomegally is the main feature of all types
31. The following enzyme would be impaired in biotin deficiency:
a) Fructose 1,6-bisphosphate
b) Pyruvate kinase
c) PEP carboxykinase
d) Pyruvate carboxylase
e) Malate dehydrogenase
32. The following statement about the pentose phosphate pathway is correct:
a) Pentoses can be formed both oxidatively and non-oxidant
b) This pathway is important to fatty acid synthesis because it produces
equivalents
c) Fructose 6 phosphate can be used to make ribose-5-phosphate
d) Glyceraldehyde-3-phosphate can be used to make dinitrophenol
e) All of the above are correct
33. The following is caused by deficiency in aldolase B:
a) Hereditory fructose intolerence
b) Jaundice
c) Hypoglycemia
d) Catarct
e) Ataxia
34. The rate of glycolysis in the liver is increased by:
a) Insulin
b) ATP
c) Citrate
d) NADH
e) Glucose 6-phosphate
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35. The preparative step of glycolysis involves the following:
a) ATP synthesis at the substrate level
b) The incorporation of Pi into a triose phosphate
c) The reduction of NAD+ to NADH
d) The formation of 1,3-bisphosphoglycerate
e) Formation of triose phosphates from a hexose diphosphorase
36. The following is present in the liver, but is absent in muscles:
a) Pyruvate carboxylase
b) Glycogen synthase
c) Lactate dehydrogenase
d) Pyruvate dehydrogenase
e) Glucose-6-phosphatase
37. The following enzyme utilizes FAD as a coenzyme:
a) Malate dehydrogenase
b) Aconitase
c) Succinate dehydrogenase
d) Isocitrate dehydrogenase
e) Lactate dehydrogenase
38. A patient complaining of painful cramps in the legs during exercise and has
easy fatigability, the most likely cause is:
a) Diabetes mellitus
b) Deficiency of glucose-5-phosphatase
c) Deficiency of the debranching enzyme or muscle phosphorylase
d) Defective glycogen synthesis
e) Over-storage of glycogen
39. Malonate inhibits succinate dehydrogenase because:
a) Binds irreversibly to the active site
b) Covalently modifies the enzyme
c) Resembles succinate but cannot react
d) Displaces he FAD coenzyme
e) Chelates a metal ion required by the enzyme
40. In oxidative phosphorylation:
a) An electrochemical potential is created across the inner mitochondrial
membrane
b) ATP is synthesized from ADP and Pi
c) Protons are pumped into the interspace between the inner and outer
mitochondrial membranes
d) The energy released from the electron flow is directly used for synthesis of
ATP
e) D is incorrect
41. Phosphofructokinase-1:
a) Is activated by high level of ATP
b) Catalyzes the only irreversible reaction in glycolysis
c) Is activated by the high level of AMP
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d) Converts fructose 1-phosphate to fructose 1,6-bisphosphate
e) Is costimulated with fructose 1,6 bisphosphatase
42. In gluconeogenesis:
a) Pyruvate is converted to acetyl CoA
b) Valine and Leucine are substrates
c) Energy consumption is high
d) Insulin is needed to enhance the synthesis of glucose
e) Acetyl CoA is a substrate
43. Glycogen synthesis:
a) Is typically the reverse of glycogenolysis
b) Is mitochondrial pathway
c) Is very active in adipose tissue
d) Requires uridine diphosphate-glucose as intermediate
e) Is activated by adrenaline
44. Galactosemia:
a) Causes mental retardation
b) Can cause liver failure
c) Is caused by deficiency of galactose-1-phosphate uridyl transferase
d) Can be treated by restricting galactose from the diet
e) All of the above is correct
45. The following can be obtained from the TCA cycle intermediates:
a) Fatty acids and glucose
b) Cholesterol and ketone bodies
c) Heme and glutamine
d) A, B and C are correct
e) Only B is correct
46. The tissue which can metabolize normally glucose, fatty acids and ketone
bodies for ATP production is:
a) Liver
b) Skeletal muscle
c) Brain
d) Red blood cell
e) All of the above
47. All of the following compounds are part of the pyruvate dehydrogenase
complex except:
a) Thiamine diphosphate
b) Lipoamide
c) Biotin
d) FAD
e) NAD+
48. Which of the following glycolytic intermediates is a close precursor to TAG:
a) Glucose 6 phosphate
b) Fructose 6 phosphate
c) Dihydroxyacetone phosphate
d) Pyruvate
e) 3-phosphoglycerate
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49. The carbon skeleton of glucose can participate in the synthesis of:
a) Purine ring
b) Fatty acid
c) Glutamine
d) Pyrimidine ring
e) All of the above is correct
50. The following agent interferes with oxidative phosphorylation:
a) Cyanide inhibits NADH-dehydrogenase
b) Carbon monoxide inhibits coenzyme Q
c) Rotenone enhances electron transfer
d) Oligomyein inhibits electron transfer
e) Dintrophenol uncouples phosphorylation from electron transfer
51. In oxidative phosphorylation:
a) Ubiquinone transfers electrons from complex I to complex II
b) Dinitrophenol inhibits the flow of electrons
c) The electrons transported from one FADH2 to oxygen will produce 3 ATP's
d) Complex IV contains copper
e) Complex III is called cytochrome oxidase
52. In galactosemia:
a) Cataract results from accumulation of galactose in the lens
b) The liver function can be seriously affected as a result of phosphate
depletion
c) Galactose is deposited in tissues
d) Galactose is readily converted to glucose
e) Galactosuria is the most serious manifestation
53. The pyruvate dehydrogenase complex defect is mainly manifestd in the
following condition:
a) Beriberi
b) Pellagra
c) Pernicious Anemia
d) Scurvy
e) Rickets
54. The committed step in glycolysis is catalyzed by:
a) Hexokinase
b) Phosphofructokinase-1
c) Pyruvate kinase
d) Phosphoglycerate mutase
e) Glyceraldehyde 3 phosphate dehydrogenase
55. The following agent interferes with oxidative phosphorylation:
a) Cyanide inhibits NADH-dehydrogenase
b) Carbon monoxide inhibits Coenzyme Q
c) Rotenone enhances electron transfer
d) Cyanide inhibits cytochrome oxidase
e) Oligomycin inhibits electron transfer
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56. The pyruvate dehydrogenase complex:
a) Requires pyridoxal phosphate
b) Is inactive when thiamin is deficient
c) Deficiency results in pernicious anemia
d) Catalyses a carboxylation reaction
e) Is a key enzyme in the red blood cell
57. Activation of phophofructokinase-1 in the liver:
a) Inhibits hexokinase
b) Enhances gluconeogenesis
c) Enhances the activity of pyruvate kinase
d) Occurs as a result of high glucagons/insulin ratio
e) Results in accumulation of fructose-6-phosphate
58. Which of the following cells utilize glucose, fatty acid and ketone bodies as
fuels:
a) Neuron
b) Myocyte
c) Hepatocyte
d) Adipocyte
e) Erythrocyte
59. Glycogen phosphorylase:
a) Is activated by insulin
b) Is activated by dephosphorylation
c) Requires inorganic phosphate
d) Produces uridine diphosphate glucose from glycogen
e) Is a key enzyme in gluconeogenesis
60. In oxidative phosphorylation:
a) Ubiquinone transfers electrons from complex I to complex II
b) Dinitrophenol inhibits the flow of electrons
c) The electrons transported from one FADH2 to oxygen will produce 3 ATP
d) A decrease in oxygen supply increases the flow of the electrons through the
complexes
e) An increase in the rate of ATP synthesis will decrease electron transport
61. Glycogen:
a) Is found in liver and muscle
b) Is a branched polysaccharide formed from glucose
c) Is responsible for maintenance of blood glucose level between meals
d) Excessively deposits in liver of von Geirk's disease patient
e) All of the above is correct
62. Fructose:
a) Enters directly into glycolysis as Fructose-6-phosphate in the liver
b) Is isomerized to glucose before catabolism
c) Is a potent lipogenic factor
d) Is produced from lactose
e) Is a non-reducing sugar
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63. Hypoglycemia can result from:
a) Deficiency of debranching enzyme (Cori's disease)
b) Deficiency in glucose-6-phosphatase
c) Defects in beta oxidation in the liver
d) Insulin overdose
e) All of the above is correct
64. The common features of glycolysis and the PPP include:
a) Both pathways produce carbon dioxide
b) Both pathways use NAD as coenzyme
c) Both pathways are mitochondrial
d) Both pathways produce ATP
e) Both pathways occur in RBC's
65. Gluconeogenesis:
a) Is the reversal of glycolysis
b) Is active during prolonged fasting
c) Requires participation of carnitine
d) Uses acetate as substrate
e) Is very active in the fed state
66. Galactosemia:
a) Is caused by increased galactose intake
b) Can be avoided by using sucrose-free diet
c) Is associated with hypoglycemia
d) Results from galactose-1-phosphate uridyl transferase deficiency
e) Is a genetic disorder caused by lactase deficiency
67. Hereditary fructose intolerance:
a) Is always associated with hypoglycemia
b) Results from fructokinase deficiency
c) Results from aldose b deficiency
d) Results in accumulation of fructose-6-phosphate
e) Can be treated by restriction of lactose in the diet
68. Muscle glycogen:
a) Accumulates in lysosomes in Pomp's disease
b) Is largely depleted by marathon running
c) Provides phosphohexoses for muscular glycolysis
d) Provides most of glucose in the blood
e) A, B and C are correct
69. An enzyme that produces non-mitochondrial NADH is:
a) Alpha-ketoglutarate dehydrogenase
b) Glyceraldehyde 3 phosphate dehydrogenase
c) Succinate dehydrogenase
d) 6-phophogluconate dehydrogenase
e) 3-HMG CoA synthase
70. Glycerol-3-Phosphate:
a) Is produced by reduction of dihydroxyacetone phosphate
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b) Is precursor of phosphatidic acid
c) Can be produced by glycerol kinase
d) Is intermediate in TAG synthesis
e) All of the above is correct
71. The following agent interferes with oxidative phosphorylation:
a) Cyanide inhibits NADH dehydrogenase
b) Carbon monoxide inhibits coenzyme Q
c) Rotenone enhances electron transfer
d) Oligomycin inhibits complex I
e) Dinitrophenol uncouples phosphorylation from electron transfer
72. In the fed state:
a) Glucose is converted to glycogen and stored in skeletal muscle
b) Adipose tissue converts triglycerides to glucose
c) Amino acids are transaminated to form ketone bodies
d) Glycogen stores in liver are depleted
e) Glycogen phosphorylase is in the active form
73. Twenty four hours after a meal, the primary source of glucose carbons for
the brain is:
a) Skeletal muscle protein
b) Glycerol from adipose tissue
c) Dietary glucose
d) Muscle glycogen
e) Both A and B are correct
74. Activity of the following enzyme is expected to increase in the fed-state:
a) Lactate dehydrogenase
b) Glucose 6-Phosphate dehydrogenase
c) Glucose 6-Phosphatase
d) Glycogen phosphorylase
e) PEP carboxykinase
75. The following enzymes are absent in muscles but are present in the liver:
a) Pyruvate carboxylase and citrate synthase
b) Glucose-6-phosphatase and glycerol kinase
c) Lactate dehydrogenase and isocitrate dehydrogenase
d) Pyruvate dehydrogenase and beta-ketothiolase
e) Glycogen synthase and 3HMG CoA synthase
76. Concerning inhibition of the electron transport chain:
a) Cyanide inhibits NADH dehydrogenase
b) Carbon monoxide inhibits coenzyme Q
c) Rotenone enhances electron transfer
d) Oligomycin inhibits complex I
e) Dinitrophenol uncouples phosphorylation from electron transfer
77. Liver glycogen synthase and PFK-1:
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a) Are activated simultaneously in the fed state
b) PFK-1 is activated before glycogen synthase
c) Both are allosteric enzymes
d) Both are activated by insulin
e) All of the above is correct
78. Insulin activates PFK-1 in the liver by:
a) Increasing the level of AMP
b) Phosphorylation
c) Increasing the level of fructose 2,6 bisphosphate
d) Inhibiting fructose 1,6 bisphosphatase
e) None of the above
79. Metabolism of the major fuels mostly culminate in:
a) Glucose 6 phosphate
b) Pyruvate
c) Oxaloacetate
d) Acetyl CoA
e) Fumerate
80. In the liver during the fed state:
a) Glucokinase indirectly enhances uptake of glucose
b) Hexokinase is inhibited
c) Glucose 6 phosphate dehydrogenase is very active
d) Glycogen phosphorylase is dephosphorylated
e) All of the above is correct
81. Glycerol 3 phosphate dehydrogenase:
a) Converts glycerol 3 phosphate to DHAP in the fed state
b) Converts DHAP to glycerol 3 phosphate in the fasting state
c) Catalyses a reversible reaction
d) Is an allosteric enzyme
e) Is a glycolytic enzyme
82. Liver enzymes which are active in the fed state include:
a) Glycerol kinase
b) PEP carboxykinase
c) Pyruvate kinase
d) Glucose 6 phosphatase
e) Glycogen phosphorylase
83. Insulin:
a) Activates acetyl CoA carboxylase
b) Causes the phosphorylation of acetyl CoA carboxylase
c) Stimulates lipolysis
d) Inhibits the formation of malonyl CoA
e) Inhibits fatty acid synthesis in adipose cells
84. Insulin exerts its effect on target tissue through:
a) Enhancing tyrosine synthesis
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b) Binding tyrosine kinase receptor
c) Increasing phosphorylation of all cellular proteins
d) Increasing intracellular cAMP
e) Inhibition of protein kinase C
85. Glucagon:
a) Is a steroid hormone
b) Binds intracellular receptors
c) Mimic all actions of epinephrine
d) Enhances glycogenolysis in the liver
e) Is transcriptional enhancer
86. Hypoglycemia:
a) Is caused by hyperinsulinemia
b) Is prominent feature of DKA
c) Enhances release of glucagon
d) Affects the brain seriously
e) B is the only wrong statement
88. In Diabetes Mellitus:
a) Type II is more common than type one
b) Type I is more serious than type II
c) Type I is called insulin dependent
d) DKA is usually associated with type I
e) All of the above is correct
89. Glucose alanine cycle:
a) Serves to carry amino groups from the skeletal muscle to the liver
b) Requires participation of gluconeogenesis in the liver
c) Provides the working muscle with glucose made by the liver
d) Requires participation of transamination reactions in both the skeletal
muscle and the liver
e) All of the above is correct
90. Lactate is increased in the blood:
a) During sleep
b) During exercise
c) In Von Gierke's disease
d) Thiamin deficiency
e) B, C and D are correct
91. Glucose, fatty acids and ketone bodies are normally oxidized for ATP
production by:
a) Liver
b) Skeletal muscle
c) Brain
d) Red blood cell
e) All of the above is correct
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92. During prolonged starvation, all of the following tissues can use fuels other
than glucose except:
a) Red blood cells
b) Muscle
c) Brain
d) Kidney
e) Adipose tissues
93. The enzyme which is not involved in glycolysis is:
a) Aldolase
b) Enolase
c) Pyruvate kinase
d) Phosphoglycerate mutase
e) Alpha phosphoglycerate dehydrogenase
94. Activation of phosphofructokinase-1 in the liver:
a) Inhibits hexokinase
b) Enhances gluconeogenesis
c) Enhances the activity of pyruvate kinase
d) Occurs as a result of high glucagons/insulin ratio
e) Results in accumulation of fructose 6 phosphate
95. Which of the following glycolytic intermediates is converted to a precursor of
TAG synthesis:
a) Glucose 6 phosphate
b) Fructose 6 phosphate
c) Dihydroxyacetone phosphate
d) Pyruvate
e) PEP
96. Human liver usually produces glucose during prolonged fasting from:
a) Palmitic acid and alanine
b) Glycerol and lactate
c) Leucine and Serine
d) Galactose and fructose
e) Lactate and acetyl CoA
97. The Electron Transport Chain:
a) Produces ATP at substrate level
b) Produces 3 ATP's per FADH2
c) Gets NADH and FADH2 from beta oxidation and TCA cycle
d) Occurs in the mitochondrial matrix
e) Is inhibited by carnitine
98. The Hexose Monophosphate Shunt:
a) Is the same as PPP
b) Releases CO2
c) Produces NADPH
d) Is active in the adrenal cortex
e) All of the above is correct
99. Phosphofructokinase-1:
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a) Allosteric enzyme
b) Activated by ATP
c) Catalyses a reversible step
d) Produces fructose 2,6 bisphosphate
e) All of the above is correct
100. Type 1 glycogen storage disease:
a) Is known as Cori's disease
b) Is associated with cardiomegally
c) Causes hyperglycemia
d) Is known as McArdle's disease
e) None of the above
101. In the TCA cycle:
a) Malate dehydrogenase catalyzes a reversible reaction
b) Malonate is an intermediate
c) Two ATP molecules are produced
d) All reactions are reversible
e) All intermediates are phosphorylated
102. In gluconeogenesis:
a) Lactate comes from the RBC's and the brain
b) Glycerol is produced from TAG in the adipose tissue
c) Linolenic acid is a substrate
d) The rate of glucose production increases during the fed state
e) B is the only correct answer
103. Glycogenolysis:
a) Is synthesis of glucose from non carbohydrates
b) Produces fructose 1 phosphate
c) Is a cytosolic pathway
d) Is active in the fed state
e) Require glycogen synthase
104. In galactosemia:
a) Galactosuria is the most serious maifestation
b) Cataract results from accumulation of galactose in the lens
c) Galactose is converted to galactitol
d) The liver function can be seriously affected as a result of phosphate
depletion
e) Both C and D are correct
105. Oxidative PPP:
a) Needs F6P as Substrate
b) Is activated by high levels of NAP+
c) Catalyzes conversion of G6P to F6P
d) Is important in muscle during exercise
e) Is active in the fasting state
106. The TCA Cycle:
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a) Provides Acetyl CoA for Ketone Body Synthesis
b) Is inactive in the absence of Oxygen
c) Converts all amino acids to Glucose by Gluconeogenesis
d) Is blocked by excessive Beta-Oxidation
e) Can convert Oxaloacetate to Pyruvate
107. Glucose-6-Phosphatase Deficiency:
a) Is known as Von Gierke's Disease
b) Is associated with Hypoglycemia
c) Inhibits Glycogenolysis & Gluconeogenesis in the liver
d) Is associated with Hyperuricemia
e) All of the above is correct
108. The following is required in both Glycogenesis and Glycogenolysis:
a) CTP
b) Phosphoglucomutase
c) Glucose residues are added to the reducing end of Glycogen
d) Glycogen Synthase
e) Insulin
109. The Liver:
a) Has a high capacity for Fatty Acid Oxidation
b) Can produce Glucose from Glycerol
c) Is the only site for Ketogenesis
d) Activates acetoacetate to acetoacetyl CoA
e) D is the only wrong answer
110. In the fed state, glucose reaching the liver has the following fates:
a) Is converted into Glycogen
b) May be converted into Triacylglycerols
c) Is oxidized to produce ATP
d) Is oxidized via PPP to generate ribose and NADPH
e) All of the above is correct
111. In the well-fed state:
a) There is high glucose level in the portal blood
b) There is high chylomicrons in the portal blood
c) Hexokinase is very active in the liver
d) Lipogenesis is active only in adipose tissue
e) The liver converts Lactate to Fatty Acids
112. The following liver enzymes have decreased concentration in the fasting
state:
a) G-6-Phosphatase
b) Phosphoenolpyruvate Carboxykinase
c) F1,6-Bisphosphate
d) G-6-P Dehydrogenase
e) Pyruvate Carboxylase
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113. Metabolism of major fuels (glucose, fatty acids, amino acids) mostly
culminate in:
a) Glucose-6-Phosphate
b) Pyruvate
c) Oxaloacetate
d) Acetyl CoA
e) Fumerate
114. In the fed state, glucose reaching the liver has the following fates:
a) Is converted into Glycogen
b) May be converted into Triacylglycerols
c) Is oxidized to produce ATP
d) Is oxidized via PPP to generate ribose and NADPH
e) All of the above is correct
115. Glycogen synthesis:
a) Is a reversible pathway
b) Is a mitochondrial pathway
c) Is activated during the fasting state
d) Occurs in the liver and muscle
e) Produces Uridine Diphosphate from Glycogen
116. Fructose 2,6 bisphosphate:
a) Is not a glycolytic intermediate
b) Activates phosphofructokinase 1
c) Is synthesized by phopshofuctokinase 2
d) Inhibits fructose 1,6 bisphosphate
e) All of the above is correct
117. In glycogen storage diseases:
a) Fatigability and muscle cramps are main features of Von Geirke's disease
b) Hypoglycemia is the main feature of type V
c) Type II is associated with glucose 6 phosphatase deficiency
d) Type IV is due to deficiency of the branching enzyme
e) Hepatomegally is the main feature of all types
118. The following enzyme requires biotin as a coenzyme:
a) Fructose 1,6-bisphoshate
b) Pyruvate kinase
c) PEP carboxykinase
d) Pyruvate carboxylase
e) Malate dehydrogenase
119. All the following enzymes are present in the liver and muscle except:
a) Pyruvate Carboxylase
b) Glycogen Synthase
c) Lactate Dehydrogenase
d) Pyruvate Dehydrogenase
e) Glucose-6-Phosphatase
120. The Pyruvate Dehydrogenase Complex:
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a) Requires pyridoxal phosphate
b) Deficiency results in pernicious anemia
c) Is inactive when Vitamin B1 is deficient
d) Catalyzes a carboxylation reaction
e) Is a key enzyme in the Red Blood Cell
LIPIDS METABOLISM
1. The main enzyme for lipid digestion is:
a) Lipoprotein lipase
b) Pancreatic lipase
c) Phospholipase C
d) Enteropeptidase
e) LCAT
2. The site of bicarbonate excretion:
a) Stomach
b) Duodenum
c) Jejunum
d) Ileum
e) Colon
3. Fatty acid oxidation is a significant source of energy in all of the following
except:
a) Liver
b) Kidney
c) Red blood cell
d) Heart
e) Skeletal muscle
4. Malonyl CoA:
a) Is the commited step in fatty acid synthesis
b) Level is decreased in the fasting state
c) Is a precursor of melanin
d) Is synthesized by pyruvate carboxylase
e) Is a precursor of cholesterol
5. During prolonged fasting:
a) B-oxidation of fatty acids is initiated
b) Glycogenesis is very active
c) Blood glucose level is maximum
d) Ketogenesis is maximal
e) Bicarbonate is high in the blood
6. The following are intermediates in cholesterol biosynthesis:
a) Prostacyclin and squaline
b) Lanosterol and squaline
c) Squalene and Malonyl CoA
d) Farnesyl pyrophosphate and thiamine pyrophosphate
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e) Carbamoyl phosphate and mevalonate
7. Lipoprotein lipase:
a) Hydrolyses cholesteryl ester
b) Is present in the cytosol of adipocytes
c) Is active during starvation
d) Hydrolyses TAG in chylomicrons and VLDL
e) Is activated by glucagon
8. 3-HMG CoA is:
a) Intermediate in cholesterol synthesis
b) Intermediate in ketone body degradation
c) Precursor of fatty acids
d) Final product in ketogenesis
e) Three carbon compound
9. The contents of chylomicron include:
a) Apoprotein A
b) Apoprotein B-100
c) Apoprotein B-48
d) No cholesterol
e) Hormone sensitive lipase
10. In mammals, cholesterol serves as precursor of all of the following except:
a) Aldosterone
b) Corticosterone
c) Cholic acid
d) Lanosterol
e) Testosterone
11. Formation of ketone bodies:
a) Occurs in the cytosol of the liver
b) Increases during fasting
c) Starts from pyruvate
d) Requires lactate dehydrogenase
e) Is inhibited during fasting
12. Prostaglandins:
a) Are neurotransmitters
b) Are derivatives of cholesterol
c) Are synthesized by cyclooxygenase from unsaturated fatty acids
d) Include propanol
e) Are found in adipose tissue
13. Concerning cholesterol biosynthesis:
a) Two squalene units are required
b) The rate of synthesis is controlled by the rate of production HMG-CoA
c) The liver is the only site for synthesis
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d) NADH is required
e) Mevalonate is an intermediate
14. For transport across the inner mitochondrial membrane, long chain fatty
acids are attached to:
a) Coenzyme A
b) Acyl tansacylase
c) Phosphatidylethanolamine
d) Acyl transferase
e) Carnitine
15. The activity of lipoprotein lipase is stimulated by:
a) Apo A
b) Apo B-48
c) Apo CII
d) Apo E
e) Apo B-100
16. The rate-limiting step in the conversion of cholesterol to bile acids:
a) Is side-chain oxidation
b) 12-alpha-hydroxylation
c) 7-alpha-hydroxylation
d) 7-beta-hydroxylation
e) Conversion to coprostanol
17. Cholesterol is:
a) A source of energy
b) A precursor of vitamin K
c) Not found in lipoproteins
d) Precursor of steroid hormones
e) The same as the steroid nucleus
18. Fatty acid oxidation is a significant source of energy in all of the following
except:
a) Liver
b) Skeletal muscle
c) Kidney
d) Red blood cell
e) Heart
19. The rate-limiting enzyme in cholesterol biosynthesis is:
a) Isopentyl pyrophosphate isomerase
b) Mevalonate kinase
c) 3-hydroxy 3-methyl glutamyl-CoA reductase
d) Dimethylallyl transferase
e) Squalene synthase
20. Triacylglycerol in chylomicron is mainly hydrolysed by:
a) Hormone-sensitive lipase
b) Lipoprotein lipase
c) Fatty acyl CoA transferase
d) Pancreatic lipase
e) LCAT
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21. The oxidation of the following is coupled to the production of NAD+H in the
cytosol:
a) Acetoacetic acid
b) Succinyl CoA
c) Malic acid
d) Phosphatidic acid
e) Malonyl CoA
end
22. The following compound is a COMMON intermediate in ketogenesis and
cholesterol synthesis:
a) Mevalonic acid
b) Acetoacetic acid
c) Succinyl CoA
d) 3HMG-CoA
e) Malonyl CoA
23. Concerning lipoproteins:
a) VLDL is synthesized in the intestine
b) LDL contains endogenous cholesterol
c) Chylomicrons are synthesized in the liver
d) Lipoprotein lipase is a component of VLDL and chylomicron
e) The protein component decreases hydrophilicity
24. The following is correct on apolipoproteins:
a) Apo CII is coenzyme with HSL
b) Apo AI is coenzyme with choline acetyltransferase
c) Apo B100 interacts with LDL receptor
d) Apo CI is integral component of chylomicrons
e) Apo B48 is integral protein of HDL
25. Malonyl CoA:
a) Activates carnitine acyl transferase 1
b) Is increased due to glucagon stimulation
c) Is a precursor of melanin
d) Is synthesized by acetylCoA carboxylase
e) Is the immediate precursor of palmitate
26. Prostaglandins:
a) Are endocrine hormones
b) Are synthesized from arachidic acid
c) Enhances smooth muscle contraction
d) Are involved in control of inflammation and blood pressure
e) Both C and D are correct
27. Ketone bodies:
a) Are synthesized in the mitochondria of the liver
b) Increase in the blood during starvation
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c) Are good fuels for cardiac muscle
d) Increase in the blood in uncontrolled diabetes mellitus
e) All of the above are correct
28. During diabetic ketoacidosis there is a rise in:
a) Plasma free fatty acids
b) Plasma insulin level
c) Blood pH
d) Plasma alkali reserve
e) Bicarbonate
29. Denovo synthesis of cholesterol occurs mainly in:
a) Adipose tissue and muscles
b) Liver and intestine
c) Endothelial cells and hepatocytes
d) Pancreas and bone marrow
e) All of the above
30. Lipoprotein lipase is:
a) Activated by insulin
b) Active during the fed state
c) Hydrolyses TAG
d) Activated in presence of Apo CII
e) All of the above are correct
31. Examples of sphinglipodoses include:
a) Gaucher's disease and Tay-Sacch's disease
b) Niemann-pick disease and von Gierke's disease
c) Andersen's disease and Krabbe's disease
d) Fabry's disease and rickets
e) Farber's disease and Refsum's disease
32. Acetyl CoA carboxylase:
a) Is activated by citrate
b) Converts acetyl CoA to pyruvate
c) Converts acetyl CoA to malonyl CoA
d) Is a cytosolic enzyme
e) B is the only wrong statement
33. The following is correct:
a) The liver uses ketone bodies and fatty acids as major fuels
b) Skeletal muscles use glucose, fatty acids and ketone bodies as fuels
c) Red blood cells oxidize acetylCoA to carbon dioxide
d) Heart muscles are totally dependent on glucose as fuel
e) The brain uses glucose and ketone bodies as normal fuels
34. Fatty acid synthesis:
a) The committed step is catalyzed by fatty acid synthase
b) Steps shared between cytosol and mitochondria
c) Carnitine is needed for fatty acid transport to the mitochondria
d) Pyruvate carboxylase is a key enzyme
e) The liver and muscles are major sites
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35. Ketone bodies:
a) Include acetoacetate and acetoacetyl CoA
b) Are produced in excess in the fed state
c) Are synthesized from pyruvate
d) Are produced by liver and kidney
e) Are preferred fuels by cardiac muscles
36. The contents of HDL do not include:
a) Apo A
b) Cholesterol
c) Apoprotein B-48
d) Apo E
e) Apo C
37. Prostaglandins:
a) Are local hormones
b) Are derivatives of cholesterol
c) Are synthesized by lipooxygenase from unsaturated fatty acids
d) Include propanol
e) Are found in adipose tissue only
38. In cholesterol biosynthesis:
a) Prostacyclin and squalene are intermediates
b) 3-HMG CoA is a precursor
c) Rate is enhanced by epinephrine
d) Thiamin pyrophosphate is coenzyme with 3-HMG CoA reductase
e) All steps are reversible
39. Lipoprotein lipase:
a) Is cystolic enzyme
b) Is the same as HSL
c) Is active during starvation
d) Requires biotin as coenzyme
e) Is activated by insulin
40. 3-HMG CoA is:
a) Intermediate in cholesterol degradation
b) Intermediate in ketone body synthesis
c) Precursor of fatty acids
d) Final product in ketogenesis
e) Three carbon compound
41. Triacylglycerol and glycogen:
a) Are storage form of energy in animals and plants
b) Are synthesized from glucose
c) Are transported between tissues as lipoprotein particles
d) Have the same energy yield on complete oxidation
e) Are mainly stored in the liver
42. The chylomicron:
a) Carries cholesterol from the intestine
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b) Contains mainly TAG
c) Has apoprotein B-48
d) Has lower density than HDL
e) All of the above are correct
43. Citric acid:
a) Is produced in the mitochondria as a member of the TCA cycle
b) Is an allosteric activator of acetyl CoA carboxylase
c) Is a source of cytoplasmic acetyl CoA
d) Is cleaved in the cytosol by an ATP-dependent lyase
e) All of the above
44. Inherited disorders of B-oxidation:
a) Include Refsum's disease which is due to absence of peroxisomes
b) Acyl CoA dehydrogenase deficiency causes hyperglycemia
c) Include dicarboxylic aciduria
d) Causes hemolytic anemia
e) Includes McArdle disease
45. Acetyl CoA Carboxylase:
a) Catalyzes committed step in glycogen synthesis
b) Converts acetyl CoA to pyruvate
c) Converts acetyl CoA to malonyl CoA
d) Is a mitochondrial enzyme
e) Needs folate as co-enzyme
46. Malonyl CoA:
a) Is activated form of acetyl CoA
b) Is increased during glucagons stimulation
c) Inhibits carnitine palmitoyl transferase-1
d) Synthesis does not require biotin as cofactor
e) Can be converted to glucose in the liver
47. Lipolysis in adipose tissue:
a) Is catalyzed by lipoprotein lipase
b) Is enhanced in the fed state
c) Produces fatty acid and glycerol
d) Is enhanced by insulin secretion
e) Produces ketone bodies
48. Ketone bodies:
a) Formation occurs in the mitochondria of hepatocytes
b) Levels in blood increase with prolonged starvation
c) Are increased in blood patients with uncontrolled diabetes mellitus type-1
d) Are prefentially used by heart muscle
e) All of the above is correct
49. Prostaglandins:
a) Primarily synthesized from eicosanoic acids
b) Closely related to thromboxanes
c) Potent smooth muscle contractor
d) Local hormone
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e) All of the above is correct
50. In lipoproteins:
a) VLDL is the major carrier of dietary triglycerides
b) LDL contains endogeneous cholesterol
c) Chylomicrons are synthesized in the liver
d) Hormone-sensitive lipase is a component of HDL
e) The protein component increases the hydrophobicity
51. Gallstone blocking the common bile duct will result in the impaired intestinal
absorption of all the following except:
a) Retinol
b) Cholecalciferol
c) Cholesterol
d) Diacylglycerol
e) Folic Acid
52. Beta-oxidation of a fatty acid:
a) Produces ATP at substrate level
b) Involves two steps of reduction of fatty acid
c) Has a preference for fatty acids shorter than 12 carbons
d) Requires NAD+
e) Is a cystosolic pathway
53. Glycerol-3-phosphate in adipose tissue arises primarily from:
a) Reduction of dihydroxyacetone phosphate
b) Hydrolysis of phosphatidic acid
c) Phosphorylation of glycerol by glycerol kinase
d) Selective uptake from blood
e) Reduction of glyceraldehydes-3-phosphate
54. Cholesterol is:
a) A normal membrane constituent of plant cells
b) Converted to cholic acid by intestinal bacteria
c) Important source of energy
d) Parent molecule for cholecalciferol
e) Synthesized in the liver mitochondria
55. Derivatives of cholesterol include all of the following except:
a) Cholecalciferol
b) Cortisol
c) Retinol
d) Chenodeoxycholate
e) Aldosterone
56. The activity of acetylCoA carboxylase is enhanced:
a) Dephosphorylation
b) Insulin
c) Citrate
d) Esterification of fatty acylCoA
e) All of the above is correct
57. In lipogenesis and beta oxidation:
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a) Carnitine palmitoyl transferase I is enhanced by malonyl CoA
b) The two pathways are mitochondrial
c) High level of cytosolic fatty AcylCoA enhances lipogenesis
d) Insulin enhances malonyl CoA synthesis which indirectly inhibits beta
oxidation
e) NADPH is needed
58. Conversion of glucose to TAG in the liver requires all of the following except:
a) Acetyl CoA carboxylase
b) Fatty acid synthase
c) Pyruvate dehydrogenase
d) Glucose 6 phosphatase
e) Glycerol 3 phosphate dehydrogenase
59. All of the following are synthesized in the liver in the fed state except:
a) VLDL
b) Glucose
c) LDL
d) PRPP
e) Cholesterol
60. During fasting the following pathways are active in the liver except:
a) Glycogenolysis
b) Glycolysis
c) Ketogenesis
d) Beta oxidation
e) Gluconeogenesis
61. Concerning cooperation between the liver and adipose tissue:
a) TAG is synthesized in the adipose tissue and transported to the liver
b) Ketone bodies are synthesized by the liver and consumed in adipose tissue
c) LDL is released from adipose tissue and oxidized in the liver
d) VLDL is synthesized in the liver and converted to HDL in adipose tissue
e) HDL is synthesized in the liver and degraded in adipose tissue
62. The main sources of energy in skeletal muscle during vigorous exercise are:
a) Fatty acids and creatine phosphate
b) Anaerobic oxidation of glucose and creatine phosphate
c) Blood glucose and ketone bodies
d) Fatty acids and glycerol
e) All of the above are correct
63. In the cardiac muscle:
a) Glycogen is the main energy reserve
b) Ketone bodies are preferred over glucose for energy production
c) Anaerobic glycolysis is vital
d) Fatty acids are not used in the fed state
e) None of the above is correct
64. In the brain:
a) Most of the energy is used for generation of nerve impulses
b) Glucose is a sole fuel under normal conditions
c) There is a high turnover of biomolecules
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d) Ketone bodies can be utilized
e) All of the above is correct
65. Insulin promotes fat storage in adipose tissue cells by:
a) Inhibition of HSL
b) Stimulation of lipoprotein lipase
c) Stimulation of glycolysis
d) Enhancing glucose uptake
e) All of the above is correct
66. Ketone bodies are present in high levels in the blood when:
a) Hepatic glycogen levels are high
b) Fat is being actively synthesized
c) Protein synthesis in muscle is elevated
d) Blood glucose is high
e) Fatty acid oxidation is high in the liver
67. Malonyl-CoA:
a) Is produced from citrate
b) Is increased during glucagons stimulation
c) Inhibits carnitine palmitoyl transferase-1
d) Synthesis require folate as a coenzyme
e) Is converted to glucose in the liver
68. The following is correct about chylomicron:
a) It is formed in the intestinal mucosal cells
b) It contains the apoprotein B48
c) It is carried from the intestinal mucosa to the circulation through lymphatic
vessels
d) The major load is dietary triacylglycerol
e) All of the above is correct
69. The major carrier of cholesterol from the liver to the tissues is:
a) HDL
b) IDL
c) LDL
d) VLDL
e) HDL2
70. The HDL play a major role in:
a) Transport of phospholipids to the tissues
b) Synthesis of triacylglycerol
c) Delivary of apoprotein B100 to VLDL
d) Transport of cholesterol from the tissues to the liver
e) Storage of apoproteins
71. Triacylglycerol is mainly transported between tissues in:
a) VLDL and chylomicron
b) LDL and HDL
c) Chylomicron and IDL
d) The free form
e) HDL and VLDL
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72. The following is correct about lipoproteins:
a) VLDL is the precursor of IDL
b) IDL is the precursor of LDL
c) LDL receptor binds apoB100
d) LDL receptors are defective in familial hypercholesterolemia
e) All of the above is correct
73. Cholesterol is:
a) Supplied to tissues through LDL receptors
b) Taken from tissues by LCAT of HDL
c) Increased in the blood of patient with a defective LDL Receptor
d) Stored in tissues by the action of ACAT
e) All of the above is correct
74. Eicosanoids:
a) Are neurotransmitters
b) Are derivatives of cholesterol
c) Are synthesized by cyclooxygenase from unsaturated fatty acids
d) Include Prostaglandins
e) Are found in adipose tissue only
PROTEIN METABOLISM
1. Amino acids which can be synthesized from glutamate in human body include:
a) Histidine
b) Glutamine
c) Phenylalanine
d) Both A and B
e) Both B and C
2. Gyrate atrophy of the retina:
a) Is inherited as autosomal recessive trait
b) Involves chorioretinal degeneration
c) Results in loss of peripheral vision and tunnel vision
d) Can cause blindness
e) All of the above
3. An amino acid which is strictly ketogenic will be able to produce all of the
following except:
a) Fatty acids
b) Glucose
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c) Ketone bodies
d) Energy
e) Both A and B
4. Which of the following compounds can not participate in transamination
reactions:
a) Oxaloacetate
b) Pyruvate
c) Succinate
d) Aspartate
e) Alanine
5. Ammonia is mainly transported from extrahepatic tissues to the liver in the
form of:
a) Alanine and serine
b) Glycine and threonine
c) Glutamine and alanine
d) Free ammonia
e) Urea
6. The immediate precursor of heme in its biosynthesis is:
a) Protoporphyrin
b) Coproporphyrinogen III
c) Protoporphyrinogen IX
d) Porphobilinogen
e) Urobilin
7. In-born errors of aromatic amino acid metabolism include:
a) Albinism and cystinuria
b) Pheuketonuria and alkaptonuria
c) Citrullinuria and tyrosinemia
d) Cystinnuria and fructosuria
e) Tyrosinosis and ornithinemia
8. Carbamoyl phosphate synthatase I:
a) Is cystolic enzyme
b) Requires one ATP
c) Deficiency causes hyperammonemia type I
d) Is activated by glutamine
e) Catalyses a reversible reaction
9. The carbon skeleton of the following amino acids is catabolized to fumerate:
a) Methionine and leucine
b) Phenylalanine and tyrosine
c) Tyrosine and leucine
d) Tryptophan and valine
e) Threonine and histidine
10. The committed step in heme biosynthesis:
a) Heme synthase
b) Porphobilinogen deaminase
c) Protoporphyrinogen oxidase
d) ALA synthase
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e) Succinyl CoA thiokinase
11. Glycine participates in the synthesis of:
a) Heme and purine
b) Histamine and creatine
c) Carnosine and anserine
d) Pyrimidine and spermine
e) GABA and bile salts
12. An immediate precursor of serine is:
a) Phosphoserine
b) Phosphatidyl ethanolamine
c) Pyruvate
d) Homocysteine
e) Malate
13. Urobilinogen is formed in:
a) The gall bladder
b) The reticuloendothelial system
c) Erythrocytes
d) The liver parenchymal cells
e) The gut
14. Arginine participates in the synthesis of:
a) Glycholic acid and hippurate
b) Creatine and urea
c) Heme and spermine
d) Purines and ceramide
e) Sphingosine and ornithine
15. Arginine is converted directly to:
a) Arginosuccinate by argininosuccinate synthase
b) Citrulline by NO synthase
c) Lysine by arginase
d) Ornithine by lysine oxidase
e) Urea by urease
16. The following are converted to direct transamination to the corresponding
product:
a) Oxaloacetate to aspartate
b) Pyruvate to glycine
c) Succinate to serine
d) Aspartate to alpha-ketoglutarate
e) Alanine to oxaloacetate
17. Most urinary ammonium ions are derived by the enzymatic reaction of:
a) Glutamine
b) Glutamic acid
c) Histamine
d) 6-amino purine derivatives
e) Urea
18. In-born errors of tyrosine catabolism include:
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a) Albinism and cystinosis
b) Phenylketonuria and tyrosinosis
c) Citrullinuria and tyrosinemia
d) Tyrosinemia and alkaptonuria
e) Tyrosinosis and ornithinemia
19. Carbamoyl phosphate:
a) Is formed from ATP and carbon dioxide
b) Is hydrolysed to ammonia and carbon dioxide
c) Is increased due to deficiency of ornithine transcarbamylase
d) Is produced from degradation of arginine
e) Diffuses out of the mitochondria during urea synthesis
20. The conversion of alanine to glucose would be decreased during starvation to
a person with a dietary deficiency of:
a) Ascorbic acid
b) Folate
c) Pyridoxine
d) Vitamin D
e) Vitamin K
21. Maple syrup urine disease is due to defective branched-chain:
a) Acyl-CoA dehydrogenase
b) Amino acid transamination
c) Amino acid transport by the kidney
d) Keto acid decarboxylase
e) Keto acid transamination
22. The one-carbon unit in methylene-tetrahydrofolate is mainly obtained from:
a) S-adenosylmethionine
b) Serine and glycine
c) Arginine
d) Homocysteine
e) Choline
23. Amino acids which are both ketogenic and glucogenic are:
a) Tyrosine and phenylalanine
b) Alanine and valine
c) Leucine and serine
d) Glutamate and aspartate
e) Histidine and serine
24. Lead poisoning characteristically leads to inhibition of the following:
a) Uroporphyrinogen decarboxylase
b) ALA dehydratase
c) ALA synthase and ferrohectase
d) Porphobilinogen deaminase
e) Bilirubin reductase and eoproporphyrin
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25. In acute intermittent porphyria the appearance of high levels of deltaaminolevulinic acid and porphobilinogen in the urine is due to deficiency of the
following enzyme:
a) Delta aminolevulinate synthase
b) Delta aminolevulinate dehydratase
c) Uroporphyrinogen I synthase
d) Ferrochelastase
e) Microsomoal heme oxygenase
26. Increased excretion of urobilinogen is most likely caused by:
a) Erythropoetic porphyria
b) Liver disease such as viral hepatitis
c) Hemolysis
d) Iron deficiency
e) Common bile duct obstruction
27. An increase in plasma conjugated bilirubin concentration is most often
associated with:
a) Increased heme synthesis
b) Erythropoetic porphyria
c) Viral hepatitis
d) High level of bilverdin
e) Common bile duct obstruction
28. The formation of bilirubin from heme:
a) Requires oxygenase
b) Requires bilverdin reductase
c) Occurs in the reticuloendothelial system
d) Releases carbon monoxide and iron
e) All of the above
29. The commited step in heme biosynthesis produces:
a) ALA
b) Porphobilinogen
c) Protoporphyrinogen
d) Uroporphyrinogen
e) Hydroxymethylbilane
30. The immediate precursor of heme in its biosynthesis is:
a) Protoporphyrin III
b) Coproporphyrinogen III
c) Protoporphyrinogen
d) Prophobilinogen
e) Urobilin
31. Urobilinogen in the intestine is:
a) Synthesized from conjugated bilirubin
b) Converted to urobilin in stools
c) Reabsorbed in the terminal ileum and large intestine
d) Colourless
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e) All of the above
32. Positive nitrogen balance is a characteristic of:
a) Normal adults and surgical patients
b) Growing children and pregnant women
c) Advanced cancer patients
d) Prolonged starvation
e) None of the above
33. In-born errors of aromatic amino acid metabolism include:
a) Tyrosinosis and albinism
b) Phenyketonuria and albuminuria
c) Citrullinuria and ochronosis
d) Cystinnuria and alkaptonuria
e) Tyrosinosis and histidinuria
34. Glycine participates in the synthesis of the following specialized products:
a) Glycocholic acid and serine
b) Creatine and spermine
c) Heme and anserine
d) Purines and heme
e) Sphingosine and ornithine
35. In the urea cycle:
a) The whole process is cystosolic
b) One ATP molecule is required
c) Carbamoyl phosphate synthetase I catalyses a reversible reaction
d) Fumerate and urea are released
e) Glutamine is an intermediate
36. Amino acids which can be synthesized from glutamate in the human body
include:
a) Histidine
b) Glutamine
c) Phenylalanine
d) Ornithine
e) Tyrosine
37. Which of the following compounds cannot participate in transamination
reactions:
a) Oxaloacetate
b) Pyruvate
c) Succinate
d) Aspartate
e) Alanine
38. Myocardial infarction increases the serum level of:
a) Lactate dehydrogenase
b) Creatine phosphokinase
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c) Aspartate transaminase (AST)
d) Alanine transaminase (ALT)
e) All of the above is correct
39. The function of many enzymes can be quickly modified by phosphorylation
of specific amino acid residues catalyzed by:
a) Cyclases
b) Kinases
c) Phoshatases
d) Phosphorylases
e) Zymogens
40. In hemoglobin S the mutation in the beta chain results from:
a) Insertion of a nucleotide
b) Replacement of alanine by serine in position 6
c) Deletion of a nucleotide
d) Replacement of glutamate by valine in position 6
e) A and C are correct
41. Glucose-alanine cycle:
a) Serves to carry amino groups from the skeletal muscle to the liver
b) Requires participation of gluconeogenesis in the liver
c) Provides the working muscle with glucose made by the liver
d) Requires participation of transamination reaction in both the skeletal
muscle and the liver
e) All of the above is correct
42. The following is correct:
a) Glycine is involved in the synthesis of heme and purine
b) Histidine is involved in the synthesis if histamine and creatine
c) Serine is involved in the synthesis of carnosine and serine
d) Asparagene is involved in the synthesis of pyrimidine and spermine
e) Glutamine is involved in the synthesis of GABA and bile salts
43. Urobilinogen is detected in the urine of a patient with:
a) Obstructive jaundice
b) Hemolytic jaundice
c) Hepatocellular jaundice
d) Acute pancreatitis
e) None of the above is correct
44. The pancreatic enzyme not involved in protein digestion is:
a) Carboxypeptidase
b) Trypsin
c) Lipase
d) Elastase
e) Chymotrypsin
45. The immediate precursor of heme in its biosynthesis is:
a) Protoporphyrin IX
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b) Coproporphhyrinogen III
c) Protoporphyrinogen IX
d) Porphobilinogen
e) Urobilin
46. The cells which are very active in heme biosynthesis include:
a) Erythroid precursors
b) The liver cells
c) Adipose tissue cells
d) Cardiac muscles
e) Intestinal mucosal cells
47. Glucose-alanine cycle:
a) Serves to carry amino groups from the skeletal muscle to the liver
b) Requires participation of gluconeogenesis in the liver
c) Provides the working muscle with glucose made by the liver
d) Requires participation of transamination reaction in both the skeletal muscle
and the liver
e) All of the above is correct
48. The following diseases are associated with tyrosine metabolism:
a) Phenylketonuria and glycinuria
b) Gyrate atrophy and ochronosis
c) Albinism and alkaptonuria
d) Tyrosinemia and maple syrup urine disease
e) Tyrosinosis and Citrulinemia
49. The following are inborn errors of amino acid metabolism except:
a) Albinism
b) Phenylketonuria
c) Cystinosis
d) Gaucher disease
e) Alkaptonuria
50. Specialized non protein products of the amino acid arginine include all of the
following except:
a) Nitric Oxide
b) Creatine
c) Spermidine
d) Carnosine
e) Spermine
51. In the hepatocytes, the main acceptors of amino nitrogen are:
a) Asparagene and glycine
b) Serine and methionine
c) Pyruvate and aspartate
d) Alpha-ketoglutarate and oxaloacetate
e) Glutamine and ornithine
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52. The amino nitrogen is transported from the extrahepatic tissues to the liver
in the form of:
a) Arginine and serine
b) Glutamate and proline
c) Glutamine and tyrosine
d) Glutamine and alanine
e) Free ammonia
53. Oxidative deamination in the hepatocytes:
a) Is catalysed by glutamate amino transferase
b) Is non-reversible
c) Is catalysed by glutamate dehydrogenase
d) Uses glutamine as substrate
e) Requires ornithine transaminase
54. The following is correct about urea synthesis (cycle) except:
a) Aspartate is a donor of an amino group
b) Occurs in the cytosol and mitochondria
c) Arginine is the precursor of urea
d) Carbamoyl phosphate condenses with ornithine
e) Citrulline is formed in the cytosol
55. The carbon skeletons of the following amino acids are converted to the
corresponding amphibolic intermediates except:
a) Valine to succinyl CoA
b) Histidine to alpha-ketoglutarate
c) Phenylalanine to fumerate
d) Tyrosine to acetyl CoA
e) Leucine to malate
56. In the hepatocytes, the main acceptors of amino nitrogen are:
a) Asparagene and Glycine
b) Serine and Methionine
c) Pyruvate and Aspartate
d) Alpha-Ketoglutarate and Oxaloacetate
e) Glutamine and Ornithine
57. The Amino Nitrogen is transported from the extrahepatic tissue in the form
of:
a) Arginine and Serine
b) Glutamate and Proline
c) Glutamine and Tyrosine
d) Glutamine and Alanine
e) Free Ammonia
58. Oxidative Deamination in the Hepatocytes:
a) Is catalyzed by Glutamate Amino Transferase
b) Is Non Reversible
c) Is Catalyzed by Glutamate Deydrogenase
d) Uses Glutamine as Substrate
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e) Requires Ornithine Transaminase
59. The Urea Synthesis (cycle) in the liver involves all of the following except:
a) Aspartate is a donor of an amino group
b) The Cytosol and Mitochondria
c) Arginine is the precursor of Urea
d) Carbamoyl Phosphate condenses with Ornithine
e) Citrulline and Methionine are Intermediates
60. The Carbon Skeletons of the amino acids mentioned below are converted to
the corresponding amphibolic intermediates except:
a) Alanine to Pyruvate
b) Arginine to Alpha-Ketoglutarate
c) Phenylalanine to Fumerate
d) Tyrosine to Acetyl CoA
e) Leucine to Oxaloacetate
61. The Branched Chain Amino Acids:
a) Degradation is impaired in Maple Syrup Urine Disease
b) Are glucogenic except for leucine
c) Undergo transamination and oxidative decarboxylation by similar reactions
d) May require Vitamin B12 for degradation
e) All of the above is correct
62. Ornithine Delta Transaminase Deficiency:
a) Is inherited as autosomal recessive trait
b) Causes chorioretinal degeneration
c) Results in loss of peripheral vision and tunnel vision
d) Is called Gyrate Atrophy of the Retina
e) All of the above is correct
63. The amino acids which are both Glucogenic and Ketogenic include:
a) Alanine and Isoleucine
b) Phenylalanine and Tryptophan
c) Tyrosine and Serine
d) Cysteine and Hydroxyproline
e) All of the above is correct
64. The following are converted by direct transamination to the corresponding
product:
a) Oxaloacetate to aspartate
b) Pyruvate to alanine
c) Succinate to serine
d) Alpha Ketoglutarate to Glutamate
e) C is the only wrong statement
65. Arginine participates in the synthesis of:
a) Glycholic acid and hippurate
b) Heme and spermine
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c) Creatine and nitric oxide
d) Purines and ceramide
e) Sphingosine and ornithine
66. Amino acids which are only glucogenic include:
a) Tyrosine and Phenylalanine
b) Alanine and Valine
c) Leucine and Serine
d) Glutamate and Valine
e) Histidine and Serine
NUCLEOTIDE METABOLISM
1. The DNA library differs from a genomic DNA library in:
a) Excluding DNA that encodes mitochondrial proteins
b) Excluding DNA that encodes ribosomal proteins
c) Only by having introns excluded from genes
d) Having longer polynucleotide fragments
e) Reflecting the whole activities of all tissues in multicellular organisms
2. The genetic code is:
a) Ambigeous
b) Overlapping
c) Degenerate
d) None specific
e) None of the above
3. In contrast to DNA polymerase, RNA polymerase:
a) Fills the gap between Okazaki fragments
b) Works only in the 5'to 3'direction
c) Edits as it synthesizes
d) Synthesize RNA primer to initiate DNA synthesis
e) Adds nucleoside monophosphates to the growing polynucleotides
4. A promoter site on DNA:
a) Transcribes repressor
b) Initiates transcription
c) Codes for RNA polymerase
d) Regulates termination
e) Translates specific proteins
5. The portion of DNA which is transcribed but not translated is called:
a) Insert
b) Intron
c) Vector
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d) Exon
e) Ribozyme
6. Which of the following sequences is complementary to TGGCAGCCT:
a) TCCGACGGT
b) ACCGTCGGA
c) ACCGUCGGA
d) AGGCTGCCA
e) TGGCTCGGA
7. tRNA reacts specifically with:
a) Specific aminoacyl-adenylates
b) ATP
c) Free amino acids
d) The golgi apparatus
e) Nuclear DNA
8. The polymerase chain reaction (PCR) requires:
a) A double stranded DNA at least partially of known sequence
b) A synthetic non-complementary RNA
c) Dideoxynucleotide triphosphates
d) Reverse transcriptase
e) A pair of specific mismatched DNA primer
9. A cDNA library differs from a genomic DNA library:
a) In excluding DNA that encodes mitochondrial proteins
b) In excluding DNA that encodes ribosomal proteins
c) Only by having introns excised from gene
d) In having longer polynucleotide fragments
e) In reflecting only the activities of the tissue from which it is derived
10. PRPP is:
a) An intermediate in de novo purine biosynthesis
b) Involved in biosynthesis of NAD+ and NADP+
c) An intermediate in pyrimidine biosynthesis
d) Intermediate in the salvage pathway
e) All of the above is correct
11. Restriction endonucleases:
a) Digest DNA duplex molecules from the 5'ends
b) Attack only single stranded DNA
c) Have base sequence specifity
d) Randomly digest double stranded DNA molecules
e) Are not produced in prokaryotes
12. All of the following statements concerning replication of DNA in prokaryotes
are true except:
a) Synthesis of new strands occurs in a 5'to 3' direction
b) Temple strand is read in a 3' to 5' direction
c) Lagging strand synthesis is discontinuous
d) Synthesis occurs in both strands
e) It is a conservative process
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13. 5-phosphoribosyl-1-pyrophosphate (PRPP) is an intermediate in:
a) The de novo synthesis of purine nucleotides
b) The de novo synthesis of pyrimidine nucleotides
c) The salvage pathway for the synthesis of purine nucleotides
d) Both A and C
e) All of the above are correct
14. The end product of purine catabolism in man is:
a) Urea
b) Xanthine
c) Uric acid
d) Produced by the enzyme guanase
e) Inosine monophosphate
15. Restriction endonucleases type II:
a) Are DNA dependent polymerases
b) Are obtained from viruses
c) Cut double-stranded DNA from any source
d) Catalyze labeling of the source
e) All of the above is correct
16. To constract cDNA library:
a) Reverse transcriptase is needed
b) mRNA is the starting material
c) Synthetic linkers with restriction sites are needed
d) Restriction enzymes are used to cut the vector based on the linker choice
e) All of the above is correct
17. Hyperuricemia:
a) Gouty artheritis is a common feature
b) There is a high level of urate in the blood
c) Allopurinol is used for treatment
d) The defect in purine nucleotide metabolism
e) All of the above is correct
18. Inhibition of purine biosynthesis de novo may potentially be due to all of the
following except:
a) Decreased phosphorylation of IMP
b) Inhibition of PRPP aminotransferase
c) Inhibition of PRPP synthetase
d) Depletion of PRPP
e) C and D are correct
19. The sigma subunit of prokaryotic RNA polymerase:
a) Is required to hold the subunits of the core enzyme together
b) Remains with the RNA polymerase until the termination of transcription
c) Is required for proper recognition of prometer
d) Contains the active site for RNA synthesis
e) Is required for termination of transcription
20. An anticodon is:
a) The part of DNA molecule that codes termination
b) A 3-nucleotide sequence of messenger RNA molecule
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c) A specific nucleotide sequence of a tRNA molecule
d) A nucleotide triplet of a ribosomal RNA molecule
e) Covalently bound to colon
21. The polymerase chain reaction (PCR) requires:
a) A double stranded DNA of totally unknown sequence
b) A pair of synthetic RNA primers
c) Dideoxynucleotide triphosphates
d) Reverse transcriptase
e) Both B and D are correct
22. Gout is:
a) Characterized by high level of xanthine in the blood
b) Characterized by high level of urate in the blood
c) Treatable with chloramphenicol
d) A defect in pyrimidine nucleotide metabolism
e) Defect of praline catabolism
23. In biosynthesis of purines:
a) The amino acids Gly, Glu and Asp are involved
b) ATP is not required
c) Glutamine provides the first nitrogen atom in the purine ring
d) Puromycin inhibits purine synthesis
e) All of the above is correct
24. In the Salvage pathway:
a) The nucleotides are converted to bases
b) More energy is required than in the De Novo pathway
c) Purine bases are involved but not the pyrimidine bases
d) Phosphoribosylation of nucleosides occur
e) HGPRTase enzyme is involved
25. All of the following statements are correct except:
a) Pyrimidines are not essential in the human diet
b) CPS1 is involved in pyrimidine biosynthesis
c) Type 1 Orotic aciduria leads to Megaloblastic anemia
d) Allopurinol may precipitate Orotic aciduria
e) Aspartate is important for pyrimidine nucleotides biosynthesis
26. The formation of dATP for DNA synthesis occurs primarily by:
a) De Novo synthesis beginning with dPRPP
b) Salvaging adenine using Adenine phosphoribosyl transferase
c) Conversion of ATP to dATP using thioredoxin
d) Conversion of ADP to dADP using ribonucleotide reductase
e) Conversion of dIMP to dAMP
27. Which of the following would not be expected to contribute to
hyperuricemia:
a) Unusually high level of PRPP
b) Inhibition of xanthine oxidase
c) Usually high turnover of nucleic acids
d) Deficiency of HGPRTase
e) Leukemia
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28. In lagging DNA strand:
a) There are several RNA primers
b) DNA synthesis is discontinuous
c) Polymerization proceeds in 5'3' direction
d) DNA polymerase III is needed
e) All of the above is correct
29. Which of the following statements about DNA ligase is correct?
a) DNA ligase seals the gaps between RNA primers and Okazaki fragments
b) DNA ligase makes single stranded nicks which relieve the supercoiling
c) The energy source for DNA ligase can be either NADPH or GTP depending
on the species
d) DNA ligase joins the free 3' hydroxyl on the Okazaki fragment to the 5'
carbon on the growing strand
e) It is classified as endonuclease enzyme
30. DNA synthesis and RNA synthesis differ in:
a) Production of a complementary polynucleotide from a template
b) Release of pyrophosphate as a reaction product
c) Synthesis proceeds in the 5' to 3' direction
d) Proofreading to eliminate errors
e) First nucleotides incorporated are RNA
31. Restriction sites of restriction endonucleases:
a) Are on double stranded DNA
b) Can be 4-7 bp long
c) Provide blunt and sticky ends
d) Are less when the enzyme recognizes longer DNA sequences
e) All of the above is correct
32. The Polymerase Chain Reaction
a) Requires specific primers to amplify a DNA sequence
b) Involves cyclic thermal denaturation and reannealing of DNA
c) Helps diagnosing sub-clinical infections
d) Exploits Taq polymerase for DNA replication
e) All of the above is correct
33. Which of the following is TRUE for cDNA?
a) DNA, a primer, ATP, dideoxynucleotides, DNA polymerase
b) DNA, end labeled primer, dNTP's, dideoxynucleotides, DNA polymersae
c) RNA, two primers, NTP's, dideoxynucleotides, RNA polymerase II
d) RNA, two primers, NTP's, AZT, Taq polymerase
e) DNA, a primer, dNDP's, dideoxyribonucleotides, RNA polymerase II
34. The following is employed in DNA sequencing:
a) Plasmids
b) Bacteriophage lambda
c) Dideoxynucleotide triphosphate
d) Reverse transcriptase
e) Ligases
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35. Initiation of protein biosynthesis:
a) Involves elongation factor 2
b) Starts by association of the two ribosomal units
c) Requires binding of the ternary complex to 40S subunit
d) Does not involve association of the two ribosomal subunits
e) Requires CTP
36. Amino-acyl-tRNA synthetase:
a) Recognizes codons on mRNA
b) Recognizes the anti-codon on the tRNA
c) Catalyses the binding of amino acid to its respective tRNA
d) Recognizes the Darm of the specific tRNA
e) Both C and D are correct
37. All of the following statements concerning replication of DNA in prokaryotes
are true except:
a) Synthesis of new strands occurs in a 5' to 3' direction
b) Template strand is read in a 3' to 5' direction
c) Lagging strand synthesis is discontinuous
d) Synthesis occurs in both strands
e) It is a conservative process
38. Which of the following is needed for a polymerase chain reaction?
a) A thermostable DNA polymerase
b) Helicase
c) Primase
d) One of the target DNA strands
e) Reverse transcriptase
39. The main metabolic source of one-carbon units that are transferred by
tetrahydrofolate is:
a) Alpha carbon of glycine
b) Beta carbon of serine
c) CO2
d) Methionine
e) Beta carbon of alanine
40. The following is true about DNA-dependent RNA polymerase:
a) Pol I is responsible for synthesis of rRNA and it is less sensitive to alphaamanitin
b) Pol II is responsible for synthesis of mRNA
c) Pol III is responsible for synthesis of tRNA
d) RNA Polymerases have unwindase activity
e) All of the above is correct
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41. In eukaryotes, hnRNA's undergo elaborate post-transcriptional processing as
follows:
a) tRNA is charges with its respective amino acids
b) mRNA is capped at the 5' end
c) rRNA is polyadenylated at the 3' end
d) Intron sequences are spliced by snRNA's
e) Exons are removed and intros are ligated
42. Reverse transcriptase exhibits the following functions:
A ) RNA directed DNA synthesis
b) DNA dependent RNA synthesis
c) DNA dependent DNA synthesis
d) Proofreading of cDNA
e) None of the above is correct
43. With regard to the lac operon, an inducer substance binds to:
a) The operator, causing an allosteric shift which initiates transcription
b) A repressor protein, which then dissociates from the operator
c) Lactose which binds the DNA and completes transcription of the structural
genes
d) A repressor protein, causing it to bind tightly to the operator
e) The promoter, which initiates transcription
44. Transcriptional Activator Proteins:
a) Transcribe a messenger off a DNA template
b) Bind to ribosomes to activate the production of specific proteins
c) Are produced during an infection of bacteria by a phage
d) Are essential to function of transfer RNA's during translation
e) Bind regions near a eukaryotic gene and allows an RNA polymerase to
transcribe a gene
45. The Wobble Hypothesis says:
a) There is loose pairing between the 5' end of a single codon and the 3' end of
more than one anticodon
b) There is loose pairing between the 5' end of a single anticodon and the 3'
end of more than one codon
c) There is a loose pairing between the 3' end of a single anticodin and the 5'
end of more than one codon
d) There is loose pairing between the 3' end of a single codon and the 5' end of
more than one anticodon
e) Codons of a single amino acid differ mainly in the 3rd position, rarely in the
2nd position but never in the 1st position
46. Which of the following sets of components are required for enzymatic DNA
sequencing?
a) DNA, a primer, ATP dideoxynucleotides, DNA polymerase
b) DNA, end-labelled primer, dNTP's, dideoxynucleotides, DNA polymerase
c) RNA, two primers, NTP's, dideoxynucleotides, RNA polymerase II
d) RNA, two primers, NTP's, AZT, Taq Polymerase
e) DNA, a primer, dNDP's, dideoxyribonucleotides, RNA polymerase II
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47. A mutation in structural gene that changes the UGA termination codon to
UGG codon (trp). What effect would this mutation most likely cause?
a) The RNA will not be translated
b) The RNA transcribed from the gene will be much longer than normal
c) The polypeptide produced will be shorter than expected
d) The polypeptide produced will have extra amino acids
e) No effect at all
48. What is the maximum number of amino acids in a peptide coded by the
polyribonucleotide 5' CCAUGUUUGGGUGAGGGCC3' in an in-vivo system
starting from the first base?
a) Six
b) Two
c) Three
d) Four
e) Five
49. All of the following statements about ribosomes are correct except:
a) All ribosomes have two subunits
b) Eukaryotic cells have 80S ribosomes and protein synthesis on these
ribosomes can be inhibited by cycloheximide
c) Prokaryotic cells have 70S ribosomes and protein synthesis on these
ribosomes can be inhibited by chloramphenicol
d) Mitochondria have 80S ribosomes and protein synthesis on these ribosomes
can be inhibited by cycloheximide
e) The larger subunits of all ribosomes have the enzyme peptidyl transferase
which forms peptide bonds
50. Which of the following is mimicked by the antibiotic puromycin?
a) Peptidyl-tRNA
b) Aminoacyl-tRNA
c) Peptidyl transferase
d) Translation release factors
e) Formylmethionyl-tRNA
51. Deamination of cytosine in mRNA produces:
a) An insertion mutation
b) A deletion mutation
c) A point mutation
d) A purine
e) Thymine
52. In a gene (without introns) of a protein containing 300 amino acids (number
12 is serine), which of the following mutations would be the LEAST likely to
result in a faulty protein?
a) A single base change in codon 12 complementary to nucleotide 36 in
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mRNA
b) A nonsense mutation in the codon for amino acid 37
c) Deletion of three bases of the codon for amino acid 19
d) A single base change such that amino acid 12 is now leucine rather than
isoleucine
e) A single base change such that amino acid 12 is now aspartic acid rather
than leucine
53. In comparing a plasmid vector with a lambda phage vector:
a) Both endow the host with antibiotic resistance
b) Both carry DNA fragments from 3 to 5 kilobases in length
c) Both can reproduce themselves within the host
d) Both contain a selectable marker
e) Both ultimately kill the host
54. The following is employed in DNA sequencing:
a) Plasmids
b) Bacteriophage lambda
c) Dideoxynucleotide triphosphate
d) Reverse transcriptase
e) Ligases
55. The following method is used only to detect RNA and can be used to measure
the difference in levels of specific mRNA in different tissues:
a) Northern blot analysis
b) Polymerase chain reaction
c) Restriction fragment length polymorphism linkage analysis
d) DNA fingerprint analysis
e) Southern blot analysis
56. Transcription of genes that code for proteins is accomplished by:
a) RNA polymerase III in eukaryotes
b) Reverse transcriptase
c) RNA polymerase I in eukaryotes
d) RNA polymerase II in eukaryotes
e) Both A and B are correct
57. The requirements of RNA polymerase for synthesis of RNA include:
a) RNA primer
b) DNA template
c) All four deoxyribonucleoside triphosphates
d) Both A and B
e) Both B and C
58. In PCR:
a) The technique is used for DNA cloning
b) RNA polymerase is needed
c) Primers should be in excess
d) All steps are performed at room temperature
e) Radiolabeled probe is needed
59. Hyperuricemia is a biochemical finding in:
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a) Von Gierke's disease
b) Xanthine oxidase deficiency
c) Leukemia
d) Both A and C
e) Both A and B
60. The major control of de novo purine nucleotides biosynthesis is:
a) Feedback inhibition of PRPP synthase
b) Feedback inhibition of aspartate transcarbomylase
c) Availability of ribose-5-phosphate
d) Feedback inhibition of glutamyl-PRPP amidotransferase
e) A, C and D are correct
61. Which of the following molecules is NOT a component of the 43S preinitiation complex?
a) GTP
b) Eukaryotic initiation factor 2 (IF-2)
c) mRNA
d) Methionyl-tRNA
e) 40S sub-unit
62. The formation of dATP for DNA synthesis occurs primarily by:
a) De Novo synthesis beginning with dPRPP
b) Salvaging adenine using Adenine phosphoribosyl transferase
c) Converting ATP to dATP using thioredoxin
d) Converting of ADP to dADP using ribonucleotide reductase
e) Converting of dIMP to dAMP using N5, N10-methylene THF
63. Which of the following uses ATP directly?
a) Formation of the 40S initiation complex
b) Binding of the amino acyl transfer RNA to the ribosome
c) Synthesis of amino acyl-tRNA
d) Activation of the amino group for peptide bond synthesis
e) Movement of mRNA on the ribosome
64. A mRNA coding for eukaryotic polypeptide chain is attached to seven
ribosomes, which of the following is TRUE for this polyribosome complex?
a) The ribosome nearest to the 5' end of the mRNA is carrying a longer
polypeptide chain than is the ribosome nearest to the 3' end
b) The ribosome nearest to the 3' end of the mRNA is carrying a longer
polypeptide chain than is the ribosome nearest to the 5' end
c) The 60S subunit of one ribosome and the 40S subunit of another ribosome
may be exchanged during the synthesis process
d) All seven ribosomes are cooperating in the synthesis of one copy of the
same polypeptide chain
e) The mRNA contains a series of separate binding sites for each ribosome to
initiate a polypeptide chain
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65. In general, eukaryotic RNA processing can be best described by the
following:
a) All RNA transcripts are finally processed in the nucleus
b) It results in the addition of nucleotides to the primary transcript of
ribosomal RNA
c) It results in the addition of formyl groups to methionine
d) It includes the addition of a tail of polyadenylic acid at the 5' end
e) It includes the modification of nucleotides in transfer RNA
66. Topoisomerase enzymes are important in the replication of DNA because
they:
a) Covalently join Okazaki fragments
b) Relax supercoiled DNA created by helicase action
c) Degrade nucleosomal histones
d) Proofread newly synthesized DNA
e) Synthesize the RNA primer
67. Which of the following is not true for both DNA polymerase and RNA
polymerase?
a) Both require a template
b) Both reactions produce pyrophosphates as a product
c) Both add 5' nucleotides to 3' hydroxyl groups
d) Both utilize 5' nucleoside triphosphates as substrates
e) Both require a primer
68. Codons on mRNA may be accurately described by all of the following except:
a) They are read in a non-overlapping fashion
b) They can form hydrogen bonds with tRNA
c) An amino acid can have more than one codon
d) 6 successive bases along the mRNA can code for 4 amino acids
e) The same codon specifies the same amino acid in almost all species
69. The RNA primer in replication differs from other RNA molecules in that it:
a) Contains T instead of U
b) Is formed by DNA polymerase I
c) Found in a form of DNA-RNA double-stranded hybrid
d) Contains a triphosphate group at the 5' end immediately after synthesis
e) Is synthesized in the 3' 5' direction
70. The role of peptidyl transferase in protein biosynthesis is to:
a) Promote the movement of peptidyl-tRNA from the A site to the P site on
the ribosome
b) Promote the movement of aminoacyl-tRNA from the P site to the A site on
the ribosome
c) Catalyze the ejection of free tRNA from the P site on the ribosome
d) Catalyze the formation of peptide bonds
e) Cause recognition of termination codons by release factors
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71. How does chloramphenicol work to inhibit protein synthesis?
a) It binds to 23S rRNA
b) It causes mutations in mRNA making it unusable
c) It intercalates into the DNA blocking RNA polymerase
d) It binds to the sigma factor preventing initiation
e) It inhibits the peptidyl-transferase activity of 28S (a component of 60S
subunit)
72. Restriction endonucleases:
a) Digest DNA molecules from the 5'-OH ends
b) Mainly attack double-stranded DNA but can attack single stranded DNA
c) Have base sequence specificity
d) Randomly digest double stranded DNA molecules at a rich sequence
(palindrome)
e) Are found only in hepatic cells and placental tissue in human
73. The following is not true about polymerase chain reaction:
a) Requires specific primers to amplify a DNA sequence
b) Involves cyclic thermal denaturation and reannealing of DNA
c) Helps diagnosing sub-clinical infections
d) Exploits Taq polymerase for in vivo replication
e) All of the above is correct
74. The polymerase chain reaction (PCR)
a) Uses flanking primers
b) Uses restriction enzymes
c) Uses varying temperatures
d) All of the above
e) Both A and C
75. For a genetic disease, point mutations are usually first found by:
a) ASO hybridization
b) DNA sequence analysis
c) Microarray
d) Southern Blot
e) PCR
76. Which of the following could be a probable recognition site for a restriction
enzyme:
a) 5' – CTGCAG – 3'
b) 5' – CTAGAC – 3'
c) 5' – GCCTGC – 3'
d) 5' – CCACGG – 3'
e) 5' – CAGCAG – 3'
77. If the PCR reaction is 100% efficient, one copy of template DNA should be
amplified to ..……. copies after n cycles:
a) 2n
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b) n2
c) 2n
d) 10n
e) I can't tell having this information
78. The following is correct about DNA sequencing:
a) Sanger's method involves base specific cleavage
b) The chemical method uses ddNTP's
c) Sanger's method is performed only on single stranded DNA
d) DNA sequence is read on an agarose gel
e) The Maxam-Gilbert method is currently the method of choice
79. All of the following statements concerning replication of DNA in prokaryotes
are true except:
a) Synthesis of new strands occurs in a 5' to 3' direction
b) Template strand is read in a 3' to 5' direction
c) Lagging strand synthesis is discontinuous
d) A primer is not required
e) Synthesis occurs in both strands
80. Select the incorrect statement. Messanger RNA:
a) Is translated in the direction 5'to 3'
b) Is often derived from a large precursor by processing in eukaryotes
c) Is synthesized in the direction 3' to 5'
d) Has a Poly A Tail
e) Is a Heterogeneous Molecule
81. In DNA Replication:
a) The newly synthesized DNA strand is growing in direction 5'3'
b) DNA synthesis by the leading strand is continuous
c) DNA Helicase facilitates processive unwinding of double strands
d) Origin of replication is identified by double strand DNA binding protein
e) All of the above is correct
BIOCHEMICAL TECHNIQUES
1. In gel filteration, biomolecules are separated according to:
a) The net charge
b) The difference in molecular weight
c) Ability of diffusion through porous membranes
d) Polarity
e) Solubility
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2. Radio Immune Assay (RIA):
a) Is used for purification of hormones
b) Involves the use of radioactive elements
c) Is used for quantitative measurements of hormones
d) Requires a pure antigen of known concentration
e) "A" is the only wrong statement
3. Electrophoresis:
a) Involves the use of polyacrylamide gel
b) Can be used for purification of proteins and nucleic acids
c) Is usually followed by Western blotting for proteins
d) A, B and C are all correct
e) Only B is correct
4. The following technique is the most suitable for the separation of a mixture of
the 20 amino acids:
a) Two dimensional electrophoresis
b) Gel filteration
c) Affinity chromatography
d) Dialysis
e) RIA
5. Chromatography:
a) Is a technique for protein sequencing
b) Is a separation technique
c) Involves a mobile phase and stationary phase
d) Is exemplified by gel filteration
e) Only B,C and D are correct
6. Dialysis:
a) Involves separation of molecules according to density
b) Is based on diffusion across a porous membrane
c) Is a type of chromatography
d) Can be used to separate 2 molecules with the same molecular weight
e) The molecular weight is not important in the technique
7. Ion exchange chromatography:
a) Used for sequencing of proteins
b) Useful in separation of proteins
c) Affinity chromatography
d) Dialysis
e) RIA
8. Electrophoresis:
a) Is based on centrifugal force
b) Cannot be used for separation of proteins and DNA
c) Requires electrical power source
d) Is based on passive diffusion of biomolecules
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e) Is a technique for mammalian cell culture
9. A mixture of amino acids can be separated by:
a) ELISA
b) RIA
c) Electrophoresis
d) Dialysis
e) None of the above
10. In electrophoresis, the rate of migration depends on:
a) Net electrical charge of the molecule
b) Size and shape of the molecule
c) Temperature of operation
d) Both A and B are correct
e) A, B and C are correct
11. Chromatography technique can be used to seperate:
a) Proteins
b) Amino acids
c) Lipids
d) Both A and B are correct
e) A, B and C are correct
12. The following method is used only to detect RNA and can be used to measure
the difference in levels of specific mRNA in different tissues:
a) Northern blot analysis
b) Polymerase chain reaction
c) Restriction fragment length polymorphism linkage analysis
d) DNA fingerprint analysis
e) Southern blot analysis
13. Radio Immune Assay:
a) Is based on centrifugal force
b) Is used for quantitative measurement of abundant biomolecules
c) Requires antibodies and radioisotopes
d) Is used for measurement of plasma albumin
e) Has low sensitivity and high specifity
14. Dialysis:
a) Is an ideal separation technique
b) Involves movement of molecules through a porous membrane
c) Depends on the difference in size and concentration
d) Is useful after affinity chromatography
e) B, C and D are correct
15. ELISA:
a) Is a separation technique
b) Involves use of radioisotopes
c) Is ideal for quantitative measurements of hormones
d) Involves change of color in enzymatic reactions
e) Is not specific
16. The following is correct:
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a) Western blotting is for proteins
b) Northern blotting is for RNA
c) Southern blotting is for DNA
d) Transfer follows separation by electrophoresis
e) All of the above is correct
17. The following statements are true regarding Southern blotting except:
a) It is the transfer of DNA from a gel onto a nylon membrane
b) It involves transfer of double stranded DNA from a gel to nylon membrane
c) It is helpful in detection of certain stains of infectious agents
d) Is useful for detection of a mutation in a given gene
e) It uses capillary diffusion for fragment transfer
18. RFLP stands for:
a) Restriction fragment length position
b) Restriction fragment length polyploidy
c) Restriction fragment length phenotype
d) Restriction fragment length polymorphism
e) Restitution fragment loose polymorphism
19. The following statements are true regarding agarose electrophoresis except:
a) DNA migrates towards the negative electrodes
b) Large molecules migrate more slowly than small molecules
c) Ethidium bromide is used to visualize the DNA
d) Bromophenol blue is indicative of the distance migrated by DNA
e) Ultra-violet light is needed
20. The following techniques are used to immobilize the corresponding
biomolecules:
a) Southern blotting for proteins
b) Northern blotting for RNA
c) Southern blotting for DNA
d) Northern blotting for DNA
e) Both B and C are correct
ORAL
WHAT IS CHOLESTEROL?
Cholesterol in mammals is a normal membrane constituent that is classified under
COMPLEX LIPIDS (sterols) and also serves as a precursor for steroid hormones and
bile salts.
WHAT KIND OF STEROID HORMONES?
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- Aldosterone
- Testosterone
- Corticosterone
- Cholic acid
WHERE DOES SYNTHESIS OF CHOLESTEROL TAKE PLACE?
DeNovo synthesis of the cholesterol takes place in the liver and the intestine, adrenal
glands, etc.
WHAT IS THE RATE-LIMITING ENZYME IN CHOLESTEROL
BIOSYNTHESIS?
3- Hydroxy 3- Methylglutamyl CoA Reductase (3-HMG CoA Reductase) which
converts 3-HMG CoA to Mevlonate
WHAT ARE BILE SALTS?
Bile salts are important enhancers in the digestion and absorption of lipids,
synthesized from cholesterol and stored in the gall bladder
WHAT ARE THE 3 TYPES OF COMPLEX LIPIDS?
- Glycerophospholipids
- Sphingolipids
- Sterols
GIVE ANOTHER EXAMPLE OF A COMPLEX LIPID?
Phosphotadylserine
WHAT IS GLYCOGEN?
Glycogen is a branched sugar that is a polymer of glucose.
WHAT IS THE IMPORTANCE OF GLYCOGEN IN THE BODY?
Glycogen is responsible for the maintenance of blood glucose level in between meals
WHERE IS GLYCOGEN SYNTHESIZED?
Glycogen is synthesized in the liver and muscles
HOW LONG IS GLYCOGEN STORED IN THE LIVER?
Glycogen is stored for up to 12 hours in the liver
WHAT IS GLYCOGENESIS?
Synthesis of glycogen
WHAT IS THE FIRST STEP OF GLYCOGENESIS?
Synthesis of UDP-Glucose from (UTP + G1P)
ENZYME: UDP-Glucose Phosphorylase
WHAT IS THE SECOND STEP OF GLYCOGENESIS?
Formation of amylose chains from existing glycogen chains
RATE-LIMITING ENZYME: Glycogen Synthase
WHAT IS GLYCOGENOLYSIS?
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Glycogen Utilization
WHAT IS THE RATE-LIMITING STEP OF GLYCOGENOLYSIS?
The rate-limiting step is GLYCOGEN PHOSPHORYLASE producing
Glucose-1-Phosphate
WHAT HORMONES IN THE MUSCLES CONTROL GLYCOGEN
METABOLISM?
EPINEPHRINE: low Glycogenesis & high Glycogenolysis
INSULIN: high Glycogenesis & low Glycogenolysis
WHAT HORMONES IN THE LIVER CONTROL GLYCOGEN
METABOLISM?
GLUCAGON: low Glycogenesis & high Glycogenolysis
INSULIN: high Glycogenesis & low Glycogenolysis
WHAT CAUSES VON GIERKES'S DISEASE, TYPE 1?
Deficiency of GLUCOSE-6-PHOSPHATASE
WHAT CAUSES POMPE'S DISEASE, TYPE 2?
Deficiency of a-1,4 GLUCOSIDASE
WHAT CAUSES CORI'S DISEASE, TYPE 3?
Deficiency of DEBRANCHING ENZYME
WHAT CAUSES ANDERSON'S DISEASE, TYPE 4?
Deficiency of BRANCHING ENZYME
WHAT CAUSES MCARDLE'S DISEASE, TYPE 5?
Deficiency of GLYCOGEN PHOSPHORYLASE
WHAT ENZYMES NOT FOUND IN GLYCOGENESIS AND
GLYCOGENOLYSIS CAUSE GLYCOGEN STORAGE DISEASES?
Phosphofuctokinase (Glycolysis) and Glucose-6-phosphatase (Gluconeogenesis)
cause accumulation of G6P which is a precursor of G1P which accumulates in
glycogen
HOW DO WE GET HYPOGLYCEMIA?
Deficiency of Debranching enzyme,
Glucose-6-phosphatase
B-Oxidation in liver
Insulin overdose
WHAT IS VITAMIN C?
Water-soluble vitamin
Active form: Ascorbate
Sources: Citrus fruits
Functions: a) Antioxidant against radical cells
b) Biosynthesis of collagen
c) Iron absorption
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d) Synthesis of epinephrine & norepinephrine
Deficiency: Scurvy
WHAT IS BIOTIN?
Water-soluble vitamin
Active form: Biotin
Sources: i) Synthesized by intestinal flora
ii) Liver
iii) Eggs
Functions: a) Coenzyme in carboxylation reactions
WHAT IS VITAMIN B12?
Water-soluble vitamin
Active forms: 1) Methylcobalamine
2) 5-deoxyadenosylcobalamin
Absorbed in ileum with intrinsic factor
Sources: Plants, animals & dairy products
Functions: a) Folate metabolism
b) Coenzyme in amino acid catabolism
c) Development of myelin sheath in nerve cells
Deficiency: Pernicious Anemia & Subacute combined cord degeneration
WHAT IS FOLIC ACID?
Water-soluble vitamin
Active form: Tetrahydrofolate
Sources: i) Synthesized by intestinal flora
ii) Liver
iii) Green vegetables
Functions: a) Transports 1 carbon fragments
b) Purine nucleotide synthesis
c) Development of the neural tube
Deficiency: Megoblastic Anemia
WHAT IS NIACIN?
Water-soluble vitamin
Active form: 1) NAD+
2) NADP+
Sources: i) Catabolism of tryptophan
ii) Cereal
iii) Legumes
iv) Meats
Functions: Precursor for biosynthesis of NAD+ and NADP+
Deficiency: Pellagra (dermatitis, diarrhea, dementia, death)
WHAT IS VITAMIN B5?
Water-soluble vitamin (panothenic acid)
Active form: Co A
Functions: a) Precursor in biosynthesis of Coenzyme A
Deficiency: Unknown
WHAT IS VITAMIN B6?
Water-soluble vitamin (pyridoxine)
Active form: Pyridoxal phosphate
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Sources: Vegetables, meat, poultry, cereals
Functions: a) PLP enzymes catalyze amino acid transformations
b) Cofactor for glycogen phosphorylase
Deficiency: 1) Lesions of skin & mucosa
2) Sideroblastic anemia
3) Neuronal dysfunction
WHAT IS VITAMIN B2?
Water-soluble vitamin (riboflavin)
Active form: 1) Flavin Mononucleotide (FMN)- intestinal cells
2) Flavin Adenine Dinucleotide (FAD)- liver
Sources: Dairy products, meats, vegetables, whole grain
Functions: Coenzymes FMN & FAD needed for a lot of oxidative reactions
Deficiency: Ariboflavinosis (lesions of lips, mouth, skin, genitalia)
WHAT IS VITAMIN B1?
Water-soluble vitamin (thiamine)
Active form: Thiamin Pyrophosphate
Sources: meats, whole-grain, legumes
Functions: Coenzyme for decarboxylation of alpha- keto acid & transketolase
Deficiency: Beriberi ("Dry"= CNS, "Wet"=CVS)
WHAT IS VITAMIN A?
Fat-soluble vitamin (retinol)
Active form: Beta-Carotene
Sources: Green leafy vegetables, milk
Functions: a) Important role in vision
b) Growth of epithelial tissue, reproduction & bone growth
c) Anti-cancer
d) Anti-infection
Deficiency: Defects in vision, skin lesions & gonadal dysfunction
WHAT IS VITAMIN D?
Fat-soluble vitamin (Cholecalciferol)
Active form: 7-dehydrocholesterol
Sources: 1) Synthesized by UV light from the sun in the skin by
1,25-dihydroxycholecalciferol
2) Liver, eggs & milk
Functions: a) Regulation of calcium metabolism
Deficiency: Rickets (children), Osteomalacia (adults)
WHAT IS VITAMIN E?
Fat-soluble vitamin (Tocopherol)
Active form: Tocopherol
Sources: Vegetable & seed oils
Functions: Scavenger of Free Radicals
Deficiency: 1) Hemolysis of erythrocytes
2) Creatinuria
WHAT IS VITAMIN K?
Fat-soluble vitamin
Sources: 1) Synthesized by intestinal flora
2) Widely distributed
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Functions: Plays a major role in blood coagulation
Deficiency: Rare in adults, (baby's placenta)
WHAT ARE PROTEINS?
Proteins are polymers of amino acids linked together by peptide bond
WHAT IS THE MOST IMPORTANT FUNCTION?
Catalysis
OTHER FUNCTIONS OF PROTEINS INCLUDE:
- Hormones
- Immunity
- Transport
- Structural
- Clotting factors
WHAT ARE AMINO ACIDS?
Amino acids are the building blocks of proteins
WHAT ARE THE FUNCTIONS OF AMINO ACIDS?
- Protein synthesis
- Buffers
- Specialized non-proteins
- Energy
WHAT ARE GLOBULAR PROTEINS?
Proteins that are functional & water-soluble (enzymes, hormones, neurotransmitters)
WHAT ARE FIBROUS PROTEINS?
Proteins that are structural (collagen, elastin)
WHAT IS TRANSAMINATION?
Transamination involves the transfer of an amino group from an amino acid to an
alpha-keto acid to form a new amino acid and alpha-keto acid
WHAT ARE THE ENZYMES INVOLVED?
Aminotransferases
HOW DOES TRANSAMINATION WORK?
Alpha amino acid + Alpha-ketogluterate < - - - > Alpha keto acid + Glutamate
WHAT IS OXIDATIVE DEAMINATION?
Glutamate + NADP+) + H2O < - - - > Alpha ketoglutarate + NADPH + H + NH3
WHERE DOES IT OCCUR?
Mitochondrial matrix of liver cells
WHAT IS THE ENZYME CATALYZING THIS REACTION?
GLUTAMATE DEHYDROGENASE
WHAT IS THE UREA CYCLE?
The cycle where the free ammonia ion enters the urea cycle to form urea in the liver
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HOW MUCH ENERGY DOES THE UREA CYCLE NEED?
2 molecules of ATP
WHAT ARE THE STEPS IN THE UREA CYCLE
CO2 & NH3  Carbamoyl phosphate synthase  Carbamoyl Phosphate … (+
Ornithine) Ornithine transcarbamoylase  Citrulline (+ Aspartate)
Argininosuccinate synthetase (-1 ATP)  Arginosuccinate  Arginosuccinate lyase
 Arginine and (Fumerate to TCA cycle)  Arginase  Urea & Ornithine
WHAT IS TYPE 1 HYPERAMMONEMIA?
Defect of Carbamoyl Phosphate Synthase
WHAT IS TYPE II HYPERAMMONEMIA?
Defect of Ornithine Transcarbamoylase
WHAT IS CITRULLINURIA?
Defect of Arginosuccinate Synthetase
WHAT ARE THESE SYMPTOMS?
Hyperammonemia- high serum level of ammonia
WHAT IS THE TREATMENT?
1- Low protein diet
2- Hemodialysis
WHAT ARE KETOGENIC AMINO ACIDS?
Amino acids degraded to Acetyl CoA then give rise to ketone bodies. They are
LEUCINE and LYSINE
WHAT ARE GLUCOGENIC AMINO ACIDS?
Amino acids degraded to pyruvate or TCA cycle intermediates which give rise to
glucose. They are:
1) Alanine (converted to PYRUVATE)
2) Arginine (converted to A-KETOGLUTARATE)
3) Asparagine (converted to OXALOACETATE)
4) Aspartate (converted to OXALOACETATE)
5) Cysteine (convereted to PYRUVATE)
6) Glutamate (converted to A-KETOGLUTARATE)
7) Glutamine (converted to A-KETOGLUTARATE)
8) Glycine (converted to PYRUVATE)
9) Histidine (converted to A-KETOGLUTURATE)
10) Methionine (converted to SUCCINYL-CoA)
11) Proline (converted to A-KETOGLUTARATE)
12) Serine (converted to PYRUVATE)
13) Valine (converted to SUCCINYL-CoA)
WHAT ARE GLUCOGENIC & KETOGENIC AMINO ACIDS?
These amino acids break up into multiple intermediates. They are:
1) Isoleucine (converted to Acetyl CoA & Succinyl CoA)
2) Phenylalanine (converted to Acetoacetyl CoA & Fumarate)
3) Threonine (converted to Acetyl CoA & Pyruvate)
4) Tyrosine (converted to Acetoacetyl CoA & Fumarate)
5) Tryptophan (converted to Acetoacetyl CoA & Pyruvate)
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HOW IS HEME SYNTHESIZED?
Heme is synthesized from GLYCINE and SUCCINYL CoA
WHAT ARE THE STEPS IN HEME SYNTHESIS
Glycine + Succinyl CoA  ALA Synthase  D- Aminolevulinate ALA dehydratase
 Porphobilinogen Uroporphyrinogen Synthase  Uroporphyrinogen 
Uropprphyrinogen III Cosynthase  Uroporphyrinogen III  Uroporhyrinogen
Decarboxylase  Coproporphyrinogen III  Coproporphyrinogen Oxidase 
Protoporphyrinogen IX  Protoporphyrinogen Oxidase  Protoporphyrin 
Ferrochelatase  Heme
WHAT IS AN INHIBITOR OF HEME SYNTHESIS?
Lead
WHAT IS A DISORDER OF HEME BIOSYNTHESIS?
Porphyria
HOW IS HEME DEGRADED?
RBC destruction  Free Heme Heme Oxygenase Bilverdin  NADPH
Bilirubin
HOW IS IRON TRANSPORTED?
Transferrin
HOW IS IRON STORED AS?
Ferritin
HOW IS PRPP FORMED?
5'-Phosphoribosyl-1-Pyrophosphate is formed by Ribose-5-phosphate & ATP
WHAT ARE SOURCES OF R5P?
Glucose metabolism & Nucleoside Degradation
WHAT IS PRPP REQUIRED IN?
1) DENOVO SYNTHESIS of pyrimidine & purine nucleotides
2) SALVAGE PATHWAY for purine nucleotides
3) BIOSYNTHESIS of nucleotide coenzymes
WHAT IS BETA-OXIDATION?
Is the pathway in the mitochondria that oxidizes the Beta-Carbon to form fatty acid
WHAT IS CARNITINE?
Carnitine mediates transfer of fatty acyl groups from long fatty acid chains from the
cytosol to the mitochondrial matrix where they are oxidized
WHAT ARE THE ENZYMES INVOLVED IN THIS TRANSPORT?
Carnitine Palmitoyl Transferase 1 (From cyto to mit.)
Carnitine Palmitoyl Transferase 2 (From mit to cyto)
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WHAT IS THE COMMITED STEP OF B-OXIDATION?
Acyl CoA Acyl CoA Dehydrogenase Enoyl CoA
WHAT IS THE END PRODUCT OF B-OXIDATION
Acetyl CoA (by Thiolase)
HOW MANY MOLES ARE FORMED IN BETA-OXIDATION?
129 Moles are formed
WHAT ARE KETONE BODIES?
Ketone bodies are preferred energy substrates for heart, muscles & kidneys during the
fasting state.
WHAT ARE THE 3 TYPES?
Acetone
Acetoacetone
B-hydroxybutyrate
WHEN DO KETONE BODIES INCREASE?
Ketone bodies increase when there is Prolonged Fasting or uncontrolled Diabetes
Mellitus
HOW IS DIABETIC KETOACIDOSIS FORMED?
Rise in plasma free-fatty acids
HOW MANY MOLES OF ATP ARE YIELDED?
49 moles
WHAT IS GLUCONEOGENESIS?
Gluconeogenesis is the biosynthesis of new glucose from non-CHO molecules
WHERE IS GLUCOSE USUALLY SYNTHESIZED?
Mostly in the liver
(In the kidneys in starvation or Met. Acidosis)
HOW MUCH ENERGY IS YIELDED?
4 moles of ATP
2 moles of GTP
2 moles of NADH
WHEN SHOULD GLUCONEOGENESIS TAKE PLACE
1) Starvation
2) Metabolic Acidosis
3) Exercise
WHAT ENZYME CONVERTS PYRUVATE TO OXALOACETATE?
Pyruvate Carboxylase
WHAT ACTIVATES PHOSPHOFRUCTOKINASE 1?
Activated by AMP & Fructose 2,6 bisphosphate & INSULIN
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Inhibited by ATP & Citrate & GLUCOGEN
GLUCONEOGENESIS REQUIRES THE PARTICIPATION OF WHICH
VITAMIN?
Biotin (enzyme affected PEP carboxykinase)
WHAT DOES A DECIFICENY IN THE ENZYME ALDOLASE B CAUSE?
Hereditary Fructose Intolerance
WHAT IS GALACTOSEMIA?
Galactosemia is the deficiency of the enzyme GALACTOSE-1-PHOSPHATE
URIDYL TRANSFERASE
WHAT ARE ITS SYMPTOMS?
Eye Cataracts, Liver failure & Mental Retardation
HOW CAN IT BE TREATED?
Eliminating galactose from the diet
WHAT IS THE RATE-LIMITING ENZYME IN GLYCOLYSIS?
Phosphofructokinase 1 (F6P  F2,6,BP)
WHAT ARE THE TWO TYPES OF NUCLEIC ACIDS?
1) DNA- genetic material
2) RNA- carrier of information for protein synthesis
Component of ribosomes
Component of enzymes
WHAT IS THE STRUCTURE OF NUCLEOTIDES?
1) Pentose Sugar: either Ribose sugar or Deoxyribose sugar
2) Base: Either Purines (A & G) or Pyrimidines (T & C) U for RNA
3) Phosphate group
WHAT IS THE DIFFERENCE BETWEEN NUCLEIC ACIDS,
NUCLEOSIDES AND NUCLEOTIDES?
1) NUCLEIC ACIDS: Adenine, Guanine, Cytosine, Thymine (Uracil)
2) NUCLEOSIDES: Adenosine, Guanosine, Cytidine, Thymidine (Uridine)
3) NUCLEOTIDES: Adenylate, Guanylate, Cytidylate, Uridylate
(mono-phosphate)
WHAT IS RECOMBINENT DNA?
Recombinant DNA refers to the techniques to manipulate, move, recombine and
propogate DNA
WHAT ARE RESTRICTION ENZYMES?
Restriction enzymes are enzymes isolated from bacteria that restrict the ability of
bacteriophage to infect them and enzymes that modify their own DNA to protect them
WHAT TYPE IS USED MOST OFTEN?
Type 2 Restriction Enzymes
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WHAT DO TYPE 2 RESTRICTION ENZYMES DO?
They recognize specific sequences in double stranded DNA and make 2 specific cuts
WHAT IS DNA-DEPENDENT DNA POLYMERASE?
These enzymes make complementary copies of DNA templates and are useful in:
1) Production of labeled probes
2) DNA sequencing
3) Polymerase Chain Reaction
WHAT IS RNA-DEPENDENT DNA POLYMERASE?
These enzymes make cDNA copies of RNA templates
WHAT IS DNA LIGASE?
Catalyzes formation of phosphodiester bonds between 3' and 5' end of DNA
WHAT ARE THE REQUIREMENTS NEEDED FOR DNA SEQUENCING?
1) Strand of DNA
2) Short Primer
3) DNA Polymerase
4) dNTP's
5) Dideoxynucleoside triphosphate
HOW ARE DNA CHAINS SEPERATED IN DNA SEQUENCING?
Using ACRYL-AMIDE GEL ELECTROPHORESIS
WHAT IS THE PCR?
The Polymerase Chain Reaction is a technique in which repetitive rounds of DNA
synthesis between 2 primers are used to amplify DNA
WHAT IS REQUIRED FOR PCR?
1) Two opposing primers
2) Heat
3) DNA Polymerase
4) Double strand of DNA
WHAT ARE THE STEPS OF THE PCR?
1) DENATURATION: heat denatures the double strand into a single strand
2) ANNEALING: of primers to their complementary strand
3) ELONGATION: synthesis of DNA
WHAT ARE THE MEDICAL USES OF PCR?
1) Diagnose Clinical Disease
2) Diagnose Bacterial of Viral infections
3) Forensic use
WHAT IS THE LAC OPERON?
The lac operon is a group of regulated genes that make enzymes necessary to
metabolize lactose
WHAT IS THE STRUCTURE OF THE LAC OPERON?
The lac operon is a region of DNA in the genome that contains the following:
1) lac Z: codes for B-Galactosidase
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2) lac Y: codes for Galactoside Permease
3) lac A: codes for Thiogalactodise Transacetylase
HOW DOES THE LAC OPERON FUNCTION?
A single PROMOTER directs proper initiation of transcription of the lac genes. The
OPERATOR lies adjacent to it, and is the transcriptional initiation site.
WHAT IS THE LAC REPRESSOR?
The Lac Repressor prevents expression of the lac operon in the absence of lactose by
blocking initiation of transcription of genes.
WHAT IS THE COMMITED STEP IN FATTY ACID SYNTHESIS?
Acetyl CoA Acetyl CoA Carboxylase Malonyl CoA
WHAT IS THE CONTROL OF THE FIRST STEP?
ACTIVATORS: Insulin & Citrate
INHIBITORS: Palmitoyl CoA & Glucagon
COFACTOR: Biotin
WHAT IS THE PRECURSOR OF PALMITIC ACID?
Palmitic-ACP Thioesterase  Palmitic acid + ACP + Fatty Acid synthase complex
WHAT IS THE FUNCTION OF VLDL's?
Transport TAG from liver to tissues
WHAT IS THE FUNCTION OF HDL'S?
Transports cholesterol from tissues to liver
WHAT IS THE FUNCTION OF LDL'S?
Transports cholesteryl esters in the plasma
WHAT IS THE FUNCTION OF CHYLOMICRONS?
Transport TAG and cholesteryl esters from intestines
WHAT IS PHENYLKETONURIA? (mouse odor)
Deficiency in PHENYLALANINE HYDROXYLASE and can be treated by
restriction of Phenylalanine
WHAT IS MAPLE SYRUP URINE DISEASE?
Deficiency in BRANCHED CHAIN A-KETO ACID DEHYDROGENASE and can
be treated by restriction of Valine, Leucine & Isoleucine
WHAT IS ISOVALERIC ACIDEMIA? (sweaty feet)
Deficiency of ISOVALERYL CoA DEHYDROGENASE and can be treated by
restriction of Leucine
WHAT IS ALKAPTONURIA?
Deficiency of HOMOGENTISATE OXIDASE and can be treated by Phenylalanine
and Tyrosine
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WHAT IS TYROSINEMIA TYPE 1?
Deficiency of 4-HYDROXYPHENYLPYRUVATE OXIDASE and can be treated by
Phenylalanine and Tyrosine
WHAT IS TYROSINEMIA TYPE 2?
Deficiency of TYROSINE TRANSAMINASE and can be treated by Phenylalanine
and Tyrosine
HOW DO WE BIOSYNTHESIZE THE NON-ESSENTIAL AMINO ACIDS?
Pyruvate Alanine
Oxaloacetate Aspartate Asparagine
3-Phosphoglycerate Serine1- Glycine 2- Cysteine
a-Ketoglutarate Glutamate 1- Glutamine 2- Proline
Urea Cycle Arginine
Phenylalanine Tyrosine
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PHYSIOLOGY
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BODY FLUIDS
1. Compared to the intracellular fluid, the extracellular fluid has a high
concentration of:
a) Protein
b) Phosphate
c) Calcium
d) Magnesium
e) Potassium
2. Oedema is due to low colloid osmotic pressure of plasma and is caused by:
a) Heart Failure
b) Arteriolar Dilation
c) Liver Disease
d) Venous Obstruction
e) Inflammation
3. Drinking one liter of pure water is expected to:
a) Induce a greater increase in volume of ECF than ICF
b) Induce a greater decrease in osmolarity of ECF than ICF
c) Induce an increase in urine flow
d) Induce a greater increase in volume of plasma than interstitial fluid
e) Induce a greater deacrease in osmolarity of plasma than interstitial fluid
4. The Interstitial Fluid:
a) Can be measured using insulin
b) Is lower in volume than plasma
c) Has a higher sodium concentration than plasma
d) Has the same protein concentration as plasma
e) Has slightly a higher concentration of chloride than plasma
5. The osmolarity of extracellular fluid is likely to increase by:
a) Passing hypertonic urine
b) Infusing half isotonic NaCl solution
c) Infusing 5% glucose solution
d) Evaporating water from mucus membrane of respiratory system
e) Vomitting a hypertonic gastric juice
6. Intravenous infusion of 1 liter of which of the following solutions will lead to
the largest increase in ECF volume?
a) Distilled water
b) Isotonic NaCl
c) Hypotonic NaCl
d) Hypertonic NaCl
e) Isotonic urea
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7. The intracellular osmolarity is mainly due to:
a) Chloride
b) Proteins
c) Potassium
d) ATP
e) Magnesium
8. The chief difference between plasma and interstitial fluid is that plasma
contains more:
a) Na+
b) K+
c) Electrolytes
d) Water
e) Protein ions
9. Body Water:
a) Is mostly found in the interstitial compartment
b) Is heavy water
c) Moves between compartments by solvent drags
d) Is the major constituent of the body
e) Is not lost during expiration in cold weather
10. Osmolality of the extracellular fluid:
a) Is 160-300 msom/L
b) Is not affected by glucose concentration
c) Is more than the osmolality of the intracellular fluid
d) Is mainly due to Na+ salts
e) Is greatly increased by hyperkalaemia
11. The following are major constituents of the intracellular fluid except:
a) Ca2+
b) Phosphates
c) Chloride
d) K+
e) Proteins
12. Movement of fluids from the interstitial space to plasma is due to:
a) Blood pressure in the capillaries
b) Plasma Na+ concentration
c) Plasma K+ concentration
d) Plasma protein concentration
e) Plasma pH
13. The substance that contributes most of the intracellular osmolarity is:
a) Protein
b) Phosphate
c) Potassium
d) Urea
e) Chloride
14. Which of the following combinations of substances is suitable for calculation
of the interstitial fluid volume:
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a) A radioactive sodium & heavy water
b) Heavy water & Inulin
c) Inulin & Evan's blue dye
d) Heavy water & Evan's blue dye
e) Evan's blue dye & Iodine labeled albumin
15. The concentraton of Ca2+ in the ECF is
a) 5 mg/dL
b) 5 mmol/L
c) 5 meq/L
d) 2.5 meq/L
e) 2.5 ug/dL
16. The extracellular fluid differs from the intracellular fluid in that it has:
a) A higher osmolarity
b) No protein
c) A lower calcium concentration
d) A higher chloride concentration
e) A higher magnesium concentration
17. Plasma Osmolarity is:
a) Determined primarily by protein concentration
b) Determined primarily by potassium concentration
c) Determined primarily by sodium concentration
d) Normally higher than that of interstitial fluid osmolarity
e) About 250 mosm/L
18. Infusion of 1 Liter of which of the following solutions will have the greatest
suppressive effect on thirst sensation:
a) Distilled water
b) Isotonic NaCl
c) Hypotonic NaCl
d) Hypertonic NaCl
e) Tonic urea
19. Which of the following favors the development of oedema?
a) An increase in colloid osmotic pressure of plasma
b) A decrease in capillary hydrostatic pressure
c) A decrease in interstitial fluid colloid pressure
d) An increase in venous pressure
e) An increase in arterial blood pressure
20. All of the following substances may be used to measure ECF except:
a) Sucrose
b) Inulin
c) Radioactive sodium
d) Evan's blue dye
e) Thiosulfate
21. The primary force moving water from the plasma to the interstitial space is:
a) Co-transport with sodium
b) Co-transport with H+
c) Facilitated diffusion
d) Filteration
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e) Active transport
22. The main difference between plasma and interstitial fluid is the
concentration of:
a) K+
b) Clc) Mgd) Proteins
e) Phosphates
23. With obstruction of all lymphatics from an extremity:
a) The hydrostatic force favoring filteration is increased
b) Limit edema formation
c) The main cause of edema decreases plasma oncotic pressure
d) Interstitial hydrostatic pressure is markedly increased
e) Interstitial colloid osmotic pressure is decreased
24. In the absence of a hydrostatic pressure gradient, movement of water across
a cell plasmalemmal membrane can occur only:
a) Up its chemical concentration gradient
b) By primary active transport
c) By secondary active transport
d) Down its chemical concentration gradient
e) Through the lipid matrix of the plasmalemmal membrane
25. Intravenous infusion of 1 liter of which of the following solutions will lead to
the largest increase in ECF volume?
a) Distilled water
b) Isotonic NaCl
c) Hypotonic NaCl
d) Hypertonic NaCl
e) Tonic urea
26. The ratio of body water to body weight is highest among:
a) Average adult males
b) Obese adult males
c) Females
d) Newborn children
e) Pregnant women
27. The osmolarity of plasma is determined by the concentrations of:
a) Glucose, protein and urea nitrogen
b) Glucose, sodium and urea nitrogen
c) Sodium, calcium and protein
d) Sodium and bicarbonate
e) Potassium and sodium
28. Low concentration of proteins in the plasma is expected to lead to:
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a) Reduced total body water
b) Increased cardiac output
c) Increased lymph flow
d) Shift of fluid from the interstitium to plasma
e) Decreased interstitial fluid hydrostatic pressure
29. A patient is given a small dose of radioactive sodium, most of this sodium will
distribute in:
a) Plasma
b) Interstitial fluid
c) Intracellular fluid
d) Joint fluids
e) Adipocytes
30. What would be the osmolarity of a solution which is one mole glucose and
one mole NaCl:
a) 1
b) 2
c) 3
d) 4
e) 5
31. The volume of distribution of substance X in an average adult male is found
to be 3.5 liters. This substance could be:
a) Inulin
b) Radioactive sodium
c) Tightly bound to plasma proteins
d) Heavy water
e) Sucrose
32. The colloid osmotic pressure of plasma is mostly due to:
a) Globulins
b) Fibrinogen
c) Albumin
d) Lipoproteins
e) Sodium
33. The solution that is expected to induce the greatest increase in plasma volume
is:
a) Normal saline
b) Hypotonic saline
c) Albumin solution
d) 5% glucose
e) Pure water
34. The volume of distribution of which of the following substances is lower than
the extracellular fluid volume:
a) Sucrose
b) Inulin
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c) Evan's blue dye
d) Heavy water
e) Radioactive sodium
35. The concentraton of Ca2+ in the ECF is
a) 20 mg/dL
b) 5 meq/L
c) 5 mmol/L
d) 2.5 meq/L
e) 10 ug/dL
36. Secondary active transport and facilitated diffusion are similar in that they:
a) Use energy
b) Use carriers
c) Tend to restore equilibrium
d) Transport water
e) Use channels
37. In a normal 70 kg adult male:
a) Total body water is approximately 60 liters
b) About two thirds of total body water is intracellular
c) Most extracellular water is intravascular
d) Intracellular fluid is about 12 liters
e) Interstitial fluid volume is 5% of total body water
38. Oedema may result from all the following except:
a) Arteriolar vasoconstriction
b) Venous obstruction
c) Decrease in the oncotic pressure
d) Increase in the interstitial fluid protein concentration
e) Increase in capillary hydrostatic pressure
39. The osmolarity of plasma:
a) Is lower than interstitial fluid osmolarity
b) Is higher than intracellular fluid osmolarity
c) Is determined mainly by plasma proteins
d) Is determined mainly by sodium
e) Ranges from 300 to 310 mosm/l
40. Which of the following decreases plasma osmolarity?
a) Forming 1 liter of hypertonic urine
b) Secreting 1 liter of sweat (150 mosml/liter)
c) Loosing 1 liter water in expired air
d) Vomitting 1 liter of gastric fluid (300 mosml/liter)
e) Bleeding 1 liter of blood
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EXCITABLE TISSUE
1. The Resting Membrane Potential:
a) Is a property of all cells
b) Depends primarily on sodium influx
c) Magnitude is the same in all excitable cells
d) Is mostly due to Gibbs-Donnan effect
e) Drops immediately to zero if sodium-potassium pump is blocked
2. Active transport differs from facilitated diffusion in that:
a) It requires a carrier
b) It moves substances from high to low concentration
c) It requires energy
d) It occurs through channels
e) It is the only mechanism that moves sodium across cell membranes
3. The following substances may cross cell membranes by simple passive
diffusion except:
a) Potassium
b) Sodium
c) Protein
d) Water
e) Chloride
4. The action potential in skeletal muscles
a) Usually starts in the end plate
b) Causes the release of calcium from sacroplasmic reticulum
c) Has no refractory period
d) Is similar in shape to that of cardiac muscle, but takes less time
e) Is due to auto-rhythmicity of skeletal muscles
5. Contraction of skeletal muscles does not require:
a) Influx of extracellular Ca2+
b) Myosin
c) Troponin
d) An action potential
e) Actin
6. In chemical synapses, the following are needed for proper function except:
a) A neurotransmitter from the presynaptic neuron
b) A receptor for the neurotransmitter in the postsynaptic neuron
c) A mechanism for the removal of the transmitter
d) Ca2+ channels in the synaptic knob
e) Ca2+ channels in the post-synaptic neuron
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7. Smooth muscle is similar to skeletal muscle in that:
a) It forms latch bridges
b) It has myosin
c) It has troponin
d) An action potential is essential for starting contraction
e) Is the property of plasticity
8. When an axon is described with one of the following it means the speed of the
transmission is slow except:
a) Small in diameter
b) Unmyelinated
c) Demyelinated
d) Type C
e) In the peripheral nervous system not CNS
9. In order to initiate skeletal muscle contraction Ca2+ should bind to:
a) Myosin
b) Tropomyosin
c) The Z-Line
d) Actin
e) Troponin
10. The resting membrane potential is generated by the following factors:
a) Selective permeability of cell membrane to K+
b) The high concentration of Na+ in the ECF
c) The high concentration of phosphates in the cell nucleus
d) The low concentration of Ca2+ inside the cells
e) Free movement of bicarbonate across the cell membrane
11. The following is not one of the functions of proteins in the cell membrane:
a) Assists endocytosis
b) Receptor for neurotransmitters
c) Adhesion between cells
d) Enzyme
e) Hormone
12. The following is true about changes in cell membrane potential:
a) The action potential occurs in all tissues
b) Local potentials do not occur in excitable tissues
c) Local potentials are all-or-none
d) Active transport of Na+ is responsible for depolarization
e) Repolarization takes longer than depolarization
13. The following is true about the action potential:
a) An external stimulus is needed for its initiation in the SA node
b) The depolarization phase is due to Ca2+ influx in cardiac muscle property
c) Its duration in cardiac muscle is similar to skeletal muscle
d) It is essential for initiation of contraction in all types of muscles
e) K+ efflux is always the primary cause of repolarization
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14. Which of the following is not essential for a muscle twitch in a skeletal
muscle?
a) ATP
b) Myosin
c) Ca2+
d) Myoglobin
e) Troponin
15. Which of the following does not apply to chemical synapses:
a) More than one neurotransmitter may be released
b) Neurotransmitter that opens Cl channels are stimulatory to postsynaptic
neurons
c) The transmitter may be inhibitory
d) Ca2+ is needed for the release of transmitter from presynaptic neurons
e) Activity of postsynaptic neuron is determined by many presynaptic neurons
16. Contraction of a cell:
a) Is due to phospholipids interacting with myosin
b) Requires Ca2+
c) Only muscle cells can contact
d) Is always associated with an action potential
e) Muscle contraction is an "all or none" response
17. Skeletal muscle cells:
a) Depends on extracellular calcium for contraction
b) Have muscarinic cholinergic receptors
c) Have calmodulin instead of troponin
d) Act as a syneytium
e) Can be tetanized
18. The excitability of neurons is increased by:
a) Hypocalcemia
b) Hyponatraemia
c) Hypokalaemia
d) Hypermagnesaemia
e) Hypercalcaemia
19. Myelin:
a) Is important in the peripheral nerves but not the CNS
b) Is formed by microglial cells
c) Is an insulator
d) Decreases the speed of transmission of action potentials
e) Is a carbohydrate in nature
20. The following is not a feature of chemical synapses:
a) Convergence
b) Divergence
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c) Synaptic Delay
d) Transmission of impulse in both directions
e) Postsynaptic inhibitory potential
21. The functions of the proteins of the cell membrane include:
a) Active transport of K+ from inside the cell to outside
b) Facilitated diffusion of proteins from inside the cell to outside
c) Channels for influx of Na+
d) Antibodies
e) Neurotransmitters
22. Components of the reflex arc always include the following except:
a) A receptor
b) An afferent pathway
c) An efferent
d) Contact center
e) The brain
23. The factor that generates the resting membrane potential include:
a) The voltage-gated K+ channels
b) The ligand-gates K+ channels
c) Leak channels
d) Active transport of K+ from the ICF to ECF
e) Diffusion of Cl- from the ICF to ECF
24. The features of an action potential include all the following except:
a) Depolarization
b) Repolarization
c) A refractory period
d) A threshold stimulus
e) Is preceeded by hyperpolarization
25. Myelination of the neurons may be abonormal if there is deficiency of:
a) Vitamin B12
b) Folic acid
c) Iron
d) Erythrope
e) Interleukin-4
26. The function of lipids in the cell membrane is
a) Makes channels for fatty acids
b) Acts as receptors
c) Facilitated Diffusion
d) A barrier to water-soluble substances
e) Adhesion between cells
27. The functions of the proteins of the cell membrane include except:
a) Active transport
b) Ion channels
c) Water channels
d) Enzymes
e) Hormones
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28. The resting membrane potential is mainly due to:
a) Na+ influx
b) Cl- influx
c) K+ influx
d) K+ efflux
e) Ca2+ efflux
29. The Na-K pump:
a) Is the main generator of the resting membrane potential
b) Is the main regulator of cell volume
c) Is found only in nerve and muscle cells
d) Action can be described as facilitated diffusion
e) Action can be described as secondary active transport
30. The following is true about receptors in the cell membrane except:
a) Chemical messangers may have more than one receptor
b) Different receptors explain different effects of chemical messangers
c) Receptors are always on cell membrane
d) Receptors are proteins
e) The chemical messangers cannot work if there are no receptors
31. The most important factor in generating the resting membrane potential is:
a) Ca2+
b) Na- gated channels
c) K- gated channels
d) Aquaponins
e) Leak channels
32. The most important factor in generating an action potential is:
a) Leak channels
b) Electrically gated channels
c) Chemically gated channels
d) The phospholipids of the cell membrane
e) The Na-K pump
33. The following is true about a skeletal muscle cell:
a) At rest it has an endplate potential but not a resting membrane potential
b) It depends on extracellular Ca2+ for its contraction
c) Is often voluntary
d) Needs ATP for contraction but not relaxation
e) Contains creatine phosphate
34. The following is needed for the normal functioning of a chemical synapse
except:
a) A neurotransmitter
b) Gap junctions between pre-synaptic and post-synaptic neurons
c) Ca2+ channels in the synaptic knobs
d) A receptor for the neurotransmitter on the post-synaptic neuron
e) A removal mechanism for the neurotransmitter
35. An action potential can be induced much easier in cases of:
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a) Hypocalcemia
b) Hypernatraemia
c) Hypermagnesaemia
d) Hypoxia
e) Hypokalemia
36. Facilitated Diffusion:
a) Requires energy expenditure
b) Active transport
c) Transported by a protein carrier down its concentration gradient
d) Diffusion down concentration gradient
e) Faster than primary active transport
37. The resting membrane potential will increase (hyperpolarization) when there
is:
a) Hyponatremia
b) Hypercalcemia
c) Hypermagnesimia
d) Hypokalaemia
e) Hypoglycemia
38. Divergence means:
a) The neurotransmitter released by a synaptic knob diffuses to act on
many neurons
b) The presynaptic neuron has dendrites
c) The axon of the presynaptic neuron divides to make synapses
d) Many synaptic knobs are found on the postsynaptic neuron
e) Neurons have different shapes
39. The speed of conduction of an impulse (action potential) is faster when the
axon of the neuron is:
a) Small in diameter
b) Has a low resting membrane potential
c) Is type C not type A
d) Is myelinated
e) Has many Na-K pumps
40. The action potential in skeletal muscles:
a) Is similar in shape to that of cardiac muscle but takes less time
b) Is due to autorythmicity of skeletal muscles
c) Usually starts in the endplate
d) Causes the release of calcium from the sacroplasmic reticulum
e) Has no refractory period
41. An excitatory post-synaptic potential would develop if the neurotransmitter:
a) Opens chloride channels
b) Opens potassium channels
c) Closes sodium channels
d) Opens calcium channels
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e) Enters the postsynaptic cell
42. Which of the following has the slowest conduction velocity:
a) A-alpha fibers
b) A-beta fibers
c) A-gamma fibers
d) C fibers
e) B fibers
43. Hypocalcemia causes tetany because:
a) Ion channels become unstable and open easily
b) It generates a concentration gradient that favors efflux of calcium from
excitable tissue cells
c) It reduces the resting membrane potential
d) It inhibits blood clotting leading to bleeding into muscles with reflex
muscle contraction
e) It stimulates release of neurotransmitters
44. Which of the following is not essential for a muscle twitch in a skeletal
muscle?
a) ATP
b) Myosin
c) Ca2+
d) Myoglobin
e) Troponin
45. Which of the following does not apply to chemical synapses?
a) More than one neurotransmitter may be released
b) Neurotransmitter that opens Cl- channels are stimulatory to postsynaptic
neurons
c) The transmitter may be inhibitory
d) Ca2+ is needed for the release of the transmitter from the presynaptic
neurons
e) The activity of the post-synaptic neuron is determined by many pre-synaptic
neurons
46. The following can diffuse through the lipid bilayer of the cell membrane:
a) Proteins
b) Phosphates
c) Ca2+
d) Water
e) DNA
47. Functions of cell membrane proteins include being:
a) Transporters
b) Antigens
c) Contraction proteins
d) Relaxation proteins
e) Transcription factors
48. The resting membrane potential:
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a) It is a characteristic of excitable tissues
b) It is usually +35 mV
c) It is increased by hypercalcaemia
d) It is increased by hypokalaemia
e) Has the same value in all cells
49. The action potential:
a) Is a graded change in the membrane potential
b) Is a feature of the neuromuscular junction
c) Is a feature of any synapse
d) Is characterized by a refractory period
e) Is a prominent feature of vascular smooth muscle
50. The transmission of impulses across chemical synapses may occur without
the need for:
a) Ca2+
b) Receptors
c) A neurotransmitter
d) Na-K pump
e) An action potential
51. Contraction of a muscle fiber may occur in the absence of:
a) Ca2+
b) Actin
c) Myosin
d) ATP
e) An action potential
52. Which feature is unique to cells of excitable tissues:
a) Their membrane contains sodium potassium ATPase
b) Their membranes contain voltage-gated channels
c) A Na+ gradient exists across their membrane
d) They have a non-zero resting membrane potential
e) Their membranes are selectively permeable to some ions
53. During an isotonic muscle contraction the following is true:
a) The Z-lines move closer together and the A-band remains constant
b) The I-band increases and the A-band remains constant
c) The A-band decreases and the I-band decreases
d) The A-band remains constant and the H-zone increases
e) The Z-lines disappear and the I-band increases
54. The function of calcium during the cross bridge cycle is:
a) To cause detachment of the myosin head and actin complex
b) To induce a conformoational change in the myosin molecule, so it can
perform a power stroke
c) To bind to the thick filament and release the inhibition between myosin and
actin
d) To prevent rigor mortis from occuring
e) To bind troponin and release the inhibition of myosin binding sites on actin
55. Which physical property of a substance would increase the rate of its free
diffusion across a pure lipid bilayer?
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a) It must be charged
b) It must have a high partitioning coefficient
c) It must be water soluble
d) It must have a high molecular weight
e) It must be polar
56. The Sodium-Potassium Pump:
a) Transports potassium against chemical and electrical gradients
b) Transports sodium against electrical gradient
c) Transports sodium against both chemical and electrical gradient
d) Is the main generator of the resting membrane potential
e) Is a form of secondary active transport
57. Which of the following would not affect the rate of diffusion of a substance
across the capillary wall?
a) The pore size of the capillary
b) The concentration difference across the capillary wall
c) The hydrostatic pressure of the interstitial space
d) The surface area of diffusion
e) The molecular size of the diffusing substance
58. When the action potential arrives at the terminal buttons it releases the
neurotransmitter by increasing intracellular:
a) Sodium
b) Potassium
c) Calcium
d) Chloride
e) Magnesium
59. Synaptic transmission:
a) Is facilitated by chloride
b) Is birectional
c) Is mainly electrical in humans
d) Is inhibited by calcium
e) None of the above
60. The resting membrane potential:
a) Is all or none
b) Only occurs in excitable tissues
c) Is due to sodium leaving the cells
d) Is mainly due to anions inside the cell
e) Is a potassium diffusion potential
61. Transmission in nerve fibers:
a) Is slow in type A fibers
b) Is salutatory in non-myelinated fibers
c) Is enhanced in nerve fibers with large diameters
d) Is the same in all fibers
e) Is blocked by atropine
62. Neuromuscular junction transmission:
a) Is chloride dependent
b) Is facilitated by influx of calcium in muscle
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c) Is blocked by beta blockers
d) Is blocked by atropine in striated muscle
e) Is blocked by Botulinum toxin
63. The excitatory postsynaptic potential:
a) Is due to neurotransmitter release from pre-synaptic neurons
b) Is potassium dependent
c) Is calcium dependent
d) Does not summate
e) Is all or none
64. Concerning skeletal muscle contraction:
a) Actin binding sites are covered during contraction
b) ATPase is found in the head of the cross bridge
c) Calcium binds to myosin
d) Isometric muscle contraction is caused by change in the length of the
muscle fiber
e) Tropomyosin covers the binding sites during muscle contraction
65. Repolarization:
a) Is due to active transport K+ out of the cell
b) Is partly due to influx of Clc) 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
66. The excitatory postsynaptic potential:
a) May be due to efflux of Clb) Can be summated to generate an action potential in the dendrites
c) Is usually due to Na+ influx
d) Necessarily leads to generation of an action potential
e) Is also known as the prepotential
67. The speed of transmission of an impulse along an unmyelinated axon
becomes quicker if:
a) The axon becomes shorter
b) The diameter of the axon decreases
c) The number of Na+ channels is doubled
d) The number of K+ channels is reduced
e) The number of mitochondria is increased
68. Red muscle fibers:
a) Are suitable for quick movements
b) Fatigue easily
c) Can store oxygen
d) Are rich in creatinine
e) Have no troponin
69. The receptor potential:
a) Is all or none
b) Is decreased by increasing the frequency of stimulation
c) Is not threshold dependent
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d) Is propagated
e) Is influenced by changing the intensity of stimulation
70. The following substances move through the cell membrane through channels:
a) Bicarbonate
b) Urea
c) Oxygen
d) Water
e) Glucose
71. Active transport is of great importance in:
a) Repolarization
b) Transport of fatty acids across cell membranes
c) Movement of water caused by ADH
d) Movement of glucose between the ECF and ICF
e) Osmotic diuresis
72. It is correct to describe a chemical synapse with the following except:
a) Allows impulses to pass in both directions between the presynaptic
and postsynaptic neurons
b) Can have more than one transmitter released together
c) Increases speed of transmission of action potentials along neural pathways
d) It is enveloped by myelin to isolate it from its surroundings
e) The presynaptic neuron can switch between neurotransmitter to cause either
excitation or inhibition of the postsynaptic neuron
73. When a cell is depolarized it is due to:
a) Opening of Cl- channels
b) Opening of K+ channels
c) Opening of Ca2+ channels
d) Activation of the Na-K pump
e) Absence of aquaproteins
74. During a muscle twitch of a skeletal muscle fiber the following takes place:
a) The action potential that started the muscle twitch continues
throughout the duration of the twitch
b) Ca2+ must enter the cell from the ECF
c) Ca2+ must bind to actin
d) Relaxation will only occur when Ca2+ is actively pumped back to the
sacroplasmic reticulum
e) The high energy molecules creatine phosphate is of critical importance for
the beginning of the twitch
75. Which of the following does not happen at the endplate of a skeletal muscle
cell:
a) Binding of acetylcholine to nicotinic receptors
b) Opening of Na+ channels
c) Depolarization
d) An action potential
e) Destruction of acetylcholine by choline esterase
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IMMUNITY
1. Severe combined immunodeficiency involves:
a) An absence of hypoxanthine phosphoribosyl transferase
b) A deficiency of adenosine deaminase
c) A deficiency of OMP decarboxylase
d) Overproduction of urate
e) A deficiency of adenylate deaminase
2. The Cro gene in bacteriophage lambda:
a) Is overexpressed in prophage
b) Gives a protein product which bind the OR3 to enhance its expression
c) Is expressed in the lytic phase
d) Controls the expression of cl gene
e) Both C and D are correct
3. With regard to Histones:
a) They are basic proteins found only in animal cells
b) They have a high content of lysine and arginine
c) They are found in the mitochondria
d) They form pentameric assembly in nucleosome
e) The amino acid composition show great variability amongst different races
4. In the antibody:
a) Disulphide bridges are formed between the two heavy chains
b) The two light chains are different
c) The two binding sites on each molecule are different
d) The Fc fragment interacts with the antigen
e) The heavy chain is always the gamma type
5. Secondary antibody responses are better because:
a) They have broader specifities
b) They make mainly IgM antibody
c) Complement fixing antibodies are made
d) They do not require T Cells help
e) They are stronger and faster
6. Which of the following statements does not apply to IgG?
a) Appears in primary immune responses
b) Neutralizes bacterial toxins
c) Can fix complements
d) Cannot cross the human placenta
e) Osponizes bacteria
7. HAT medium is used to:
a) Immortalize B lymphocytes
b) Culture B lymphocytes
c) Select for cancerous and non cancerous cell hybrids in the Hybridoma
technology
d) Kill B cell hybridomas
e) Convert B lymphocytes to myeloma cells
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8. Clonal selection occurs when a B lymphocyte encounters:
a) Cytokine
b) Antigen
c) T lymphocyte
d) Complement
e) Chemotactic factor
9. When E. coli bacteria are grown in a medium containing lactose as the sole
carbon source:
a) The lac repressor is able to bind tightly to the lac operator region
b) RNA polymerase is unable to transcribe the lac operon
c) The lac operator binds lactose
d) An inducer-repressor complex detaches from the lac operator region
e) Beta-galactosidase activity will be at a minimal level
10. Energy transformation in the human body involves:
a) Conversion of electrical energy to chemical energy
b) Conversion of chemical energy to electrical energy
c) Conversion of chemical energy to kinetic energy
d) Conversion of electrical energy to heat
e) All of the above is correct
11. Interconversion of biomolecules in living cells is facilitated by:
a) The presence of amphibolic intermediates
b) Reversible reactions
c) Increasing the level of fructose 2,6 bisphosphate
d) Inhibiting fructose 1,6 bisphosphatase
e) None of the above
12. Recurring motifs of metabolic control include:
a) Modulation of transcription rate
b) Phosphorylation and dephosphorylation
c) Allosteric regulation
d) Acetylation of key enzymes
e) D is the only wrong answer
13. Hormones that bind membrane bound receptors include:
a) Epinephrine
b) T3
c) Cortisol
d) Calcitrol
e) Aldosterone
14. Characteristic features of receptors for peptide hormones include:
a) They are all protein in nature
b) They have specificity for the ligand
c) The binding of the ligand is saturable and reversible
d) Intracellular signal is initiated as a result of hormone-receptor interaction at
the cell membrane
e) All of the above is correct
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15. Leptin:
a) Is a peptide hormone produced by adipocytes
b) Binds receptors in the hypothalamus
c) Supresses appetite
d) Stimulates the sympathetic nervous system
e) All of the above is correct
16. The following is correct:
a) Cholera toxin acts through cGMP production
b) Nitroglycerides activate production of cAMP
c) Phorbol esters inhibit protein kinase C
d) Cortisol binds with intracellular receptors
e) All of the above is correct
17. Epinephrine:
a) Inhibits glycogenolysis and gluconeogenesis
b) Enhances glycogen phosphorylase in the liver
c) Binds an intracellular receptor
d) Activates PFK-1 in the liver
e) Activates cAMP phosphodiesterase
18. All the following hormones promote hyperglycemia except:
a) Epinephrine
b) Norepinephrine
c) Insulin
d) Glucagon
e) Glucocorticoids
19. The level of cAMP is increased in adipocytes by:
a) Epinephrine
b) Insulin
c) Growth hormone
d) ANF
e) An increase in the activity of phosphodiesterase
20. The structure of the antibody:
a) Disulphide bridges are formed between the two heavy chains
b) The two light chains are identical
c) The two binding sites on each molecule are identical
d) The Fc fragment mediates effector function of the antibody
e) All of the above is correct
21. Characteristics of the adaptive immune response include:
a) High specifity
b) Differentiation between self and non-self
c) Versatility
d) Brisk secondary response
e) All of the above is correct
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22. Concerning Immunoglobulins:
a) IgM is found mainly in the blood
b) IgA is found only in the blood
c) IgE is found in association with mast cells in the skin
d) Only IgG can cross the placental barrier
e) B is the only wrong answer
23. T Helper 1 produces:
a) IL-2
b) Antibodies
c) IL-2 receptor
d) Interferon gamma
e) A, C and D are correct
24. Antibodies against an individual own body components are called:
a) Autoantibodies
b) Isotypes
c) Autoantigens
d) Anti-idiotypic
e) Idiotypes
25. The complement components:
a) Enhance phagocytosis
b) Are produced by the spleen
c) Induce cytotokine production by T cell
d) Activate cytotoxic T cell
e) Include interferon gamma
26. Cytokines:
a) Include interleukins and interferons
b) Act by autocrine and paracrine mechanisms
c) Promote B cell growth and differentiation
d) Interact with membrane-bound receptors
e) All of the above is correct
27. The following is phase II reaction of a xenobiotic:
a) Hydroxylation
b) Deamination
c) Reduction
d) Glucuronidation
e) Desulfuration
28. Properties of human cytochrome P450s:
a) Some are hemoproteins
b) Extremly versatile catalysts
c) Found only in the liver
d) Include cytochrome C
e) The hydroxylated product are less water-soluble
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29. The following statements are true:
a) Transferrin transports calcium in the circulation
b) Hemochromatosis is characterized by excessive storage of ions in tissues
c) Haptoglobin binds extra corpuscular hemoglobin
d) All of the above is correct
e) B and C are correct
30. Oncogene:
a) Are genes responsible of delaying cancer
b) Are not detected in viruses
c) Products may affect signal transduction in a cell
d) Are not involved in causation of any cancer
e) Are the same as protooncogenes
31. Characteristics of cancer cells include:
a) Loss of contact inhibition
b) Altered membrane permeability
c) Diminished requirement for growth factors
d) Altered cellular enzymes profile
e) All of the above is correct
32. Biochemical changes that occur in transformed (cancer) cells include all of
the following except:
a) Increased pyrimidine catabolism
b) Increased rate of glycolysis and lactate formation
c) Increased activity of ribonucleotides reductase
d) Increased rate of nucleic acid synthesis
e) Inappropriate synthesis and secretion of proteases
33. Which of the following is a possible cause of cancer?
a) Introduction of a novel gene into the cell genome by an oncogenic virus
b) Damage of the cellular DNA by exposure to a radiant energy
c) Alteration of DNA base sequence as a result of exposure to chemical
mutagens
d) Inheritance of defective tumor suppressor gene
e) All of the above is correct
34. The following are considered as phase 1 reactions in xenobiotics metabolism:
a) Hydroxylation and dealogenation
b) Dehalogenation and ulfation
c) Sulfation and Hydroxylation
d) Deamination and aceylation
e) Acetylation and dehalogenation
35. The following are considered as phase 2 reactions in xenobiotics metabolism:
a) Conjugation with bilirubin
b) Conjugation with glutathione
c) Methylation with S-adenosyl methionine
d) Reduction
e) B, C and D are correct
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36. The following are known actions of cytochrome P450:
a) Hydroxylation of foreign hydrophobic compounds in the liver
b) Synthesis of steroid hormones in the adrenal cortex
c) Conversion of procarcinogens into active carcinogens
d) Inactivation of some drugs
e) All of the above is correct
37. Characteristics of cytochrome P450 enzymes include:
a) They are polymorphic hemoproteins
b) They are mainly found in liver and intestine
c) They have overlapping substrate specifities
d) They are rich in phosphatidylcholine (lecithin)
e) All of the above is correct
38. All of the following is correct about xenobiotics metabolism, except:
a) It requires NADPH as a proton donor in hydroxylation reactions
b) It renders non-polar chemicals more water soluble
c) It may occur in the cytochromes of the electron transport chain
d) It may affect drug action in the human body
e) It is affected by genetic constitution of an individual
39. The following is correct about phase 2 reactions in xenobiotics metabolism?
a) They intend to promote excretion of the xenobiotics
b) They involve conjugation with glucuronic acid
c) They involve methylation of xenobiotics with S-adenosylmethionine
d) The acetyl transferase is the main enzyme in phase 2 reactions
e) D is the only wrong statement
40. The following is correct about the regulation of cell division:
a) It is triggered by phosphorylation of various cellular proteins
b) It is mainly regulated by a complex protein called maturation promotion
factor (MPF)
c) The regulatory protein, cyclin is degraded at the end of the mitotic phase
d) DNA is synthesized during the S phase of the cell cycle
e) All of the above is correct
41. The following is incorrect about Ames test:
a) It is used for evaluating the potential carcinogenicity of a chemical
substance
b) It is useful in diagnosis of cancer in human tissues
c) It employs a mutated strain of Salmonella typhimurium
d) It uses the ability of histidine synthesis as an indicator for mutagenicity
e) It is used for screening the carcinogenicity of a chemical compound before
introducing for human use
42. The following is incorrect about cytochrome P450 enzymes
a) There are at least 30 different isoforms of these enzymes
b) They may convert inert procarcinogens into active carcinogens
c) They are essential for the activation of various drugs
d) Their activity is affected by age and sex
e) They are characterized by genetic differences
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43. In comparing a plasmid vector with a lambda phage vector:
a) Both endow the host with antibiotic resistance
b) Both carry DNA fragments from 3 to 5 kilobases in length
c) Both can reproduce themselves within the host
d) Both contain a selectable marker
e) Both ultimately kill the host
AUTONOMIC NERVOUS SYSTEM
1. Acetylcholine:
a) Is synthesized by the enzyme acetylcholine esterase
b) Action in synapses is terminated by re-uptake of presynaptic neurons
c) Is released by some postganglionic sympathetic neurons
d) Is destroyed by monoamine oxidase
e) Reduces the heart rate by acting on nicotinic receptors in the SA node
2. Generalized sympathetic stimulation causes all the following except:
a) Increases the heart rate
b) Increases sweating
c) Relaxes bronchial smooth muscles
d) Tightens GIT sphincters
e) Constriction of pupil
3. The following actions of noradrenaline are mediated by stimulation of alphaadrenergic receptors:
a) Constriction of cutaneous blood vessels
b) Increase of myocardial contractility
c) Dilation of arterioles to the viscera
d) Relaxation of urinary bladder
e) Dilation of systemic veins
4. Noreadrenaline is released by sympathetic nervous system at all the following
except:
a) Cutaneous blood vessels
b) SA Node
c) Sweat glands
d) Cardiac muscles
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e) Renal nerves
5. Nicotinic Receptors are blocked by:
a) Atropine
b) Curare
c) Suxmethonium
d) Propranlol
e) Acetylcholine esterase
6. 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 the heart
e) Is degraded by the enzyme choline transferase
7. The sympathetic system:
a) Has short postganglionic neurons
b) Fibers are carried in the vagus nerve
c) Produces nicotine at its nerve endings
d) Has a thoraco-lumbar outflow from the spinal cord
e) Action is antagonized by atropine
8. The parasympathetic system:
a) Has short preganglionic fibers
b) Secretes dopamine
c) Controls most of the movements and secretions of the gut
d) Brings increase in heart rate during exercise
e) Action is blocked by Beta receptor blocker
9. The nicotinic cholinergic receptors are:
a) Not inhibited by high concentrations of nicotine
b) Inhibited by high concentrations of acetylcholine
c) Blocked by atropine
d) Ligand-gated chloride channels
e) Located in the cell nucleus
10. Cell bodies of preganglionic neurons of the sympathetic nervous system are
found in:
a) The dorsal root ganglion
b) The sympathetic chain
c) Collateral ganglia
d) The dorsal horn cells of the spinal cord
e) The lateral horn cells of the spinal cord
11. Collateral ganglia of the sympathetic nervous system include the:
a) Adrenal medullary cells
b) Coeliac ganglion
c) Paravertebral ganglia
d) The basal ganglia
e) Nucleus of the tractus solitaries
12. The effects of parasympathetic stimulation include:
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a) Ejaculation
b) Secretion of sweat
c) Contraction of the rectum
d) Constriction of gastrointestinal sphincters
e) Dilation of the bronchioles
13. Adrenal medullary cells are stimulated by:
a) Dopamine
b) GABA
c) Adrenaline
d) Acetylcholine
e) Nor-adrenaline
14. Dopamine is:
a) Found in all autonomic ganglia
b) An inhibitory transmitter
c) An acetylcholine derivative
d) Responsible for facilitating autonomic transmission
e) Released by the interneurons of the parasympathetic ganglia
15. The termination of acetylcholine action is mainly due to:
a) Reuptake by preganglionic neurons
b) Diffusion from synaptic cleft
c) Irreversible combination with cholinergic receptors
d) Uptake by postsynaptic cell
e) Cholinesterase in cholinergic synapses
16. Beta-1 adrenergic receptor stimulation causes:
a) Coronary vasodilation
b) Cardiac acceleration
c) Bronchodilation
d) Skin vasoconstriction
e) Constriction of anal sphincter
17. Sweating is served by which of the following receptors?
a) Nicotinic cholinergic receptors
b) Alpha- adrenergic receptors
c) Beta- adrenergic receptors
d) Muscarine cholinergic receptors
e) Dopaminergic receptors
18. Blocking of the nicotinic ganglionic receptors in the ANS supplying the heart
leads to:
a) Inhibition of the sympathetic but not the parasympathetic
b) Inhibition of the parasympathetic but not the sympathetic
c) Inhibition of both sympathetic and parasympathetic
d) Decrease in the heart rate
e) Decrease in the force of contraction
19. Regarding the sympathetic nervous system:
a) Preganglionic fibers release noradrenalin
b) Postganglionic fibers release noradrenalin
c) It is stimulated by food intake
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d) Release of acetylcholine by the pre-ganglionic fibers
e) Has longer pre-ganglionic fibers than post-ganglionic fibers
20. Stimulation of the parasympathetic nervous system leads to:
a) Constriction of pupils
b) Constriction of skin vessels
c) Constriction of gastrointestinal sphincters
d) Constriction of brain vessels
e) Increased blood flow in coronary vessels
21. Muscarinic cholinergic receptors are found:
a) On postganglionic sympathetic neurons
b) On postganglionic parasympathetic neurons
c) In the sweat glands
d) At the end-plate
e) None of the above
22. Preganglionic sympathetic neurons differ from
parasympathetic neurons in that:
a) They are shorter
b) They release acetylcholine
c) They emerge from the lateral horn of the spinal cord
d) They release noradrenaline
e) They are myelinated
preganglionic
23. The action of acetylcholine on its receptors is terminated mainly by:
a) Choline esterase
b) Reuptake into the terminal buttons
c) Diffusion to the blood
d) Pseudocholine esterase
e) Endocytosis by the target tissue that bears its receptors
24. Sympathetic stimulation is expected to lead to:
a) Constriction of the pupil
b) Dilation of the bronchioles
c) Inhibition of sweating
d) Venodilation
e) Copious salivary secretion
25. Atropine will block all the following except:
a) The action of the parasympathetic nervous system on the heart
b) The action of the sympathetic nervous system on the sweat glands
c) The action of the dilator sympathetic nervous system on the muscle blood
vessels
d) The action of the parasympathetic nervous system on the gastric secretion
e) The action of acetylcholine on skeletal muscles
26. Transmitters of the autonomic nervous system include:
a) Acetylcholine at all postganglionic parasympathetic
b) Dopamine in sympathetic ganglia
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c) Adrenaline in most sympathetic postganglionic neurons to the adrenal
medulla
d) Adrenalin and nor-adrenalin in preganglionic neurons to the adrenal
medulla
e) Dopamine in postganglionic sympathetic neurons
27. The sympathetic nerves supply:
a) The external sphincters of the gastrointestinal & urinary tracts
b) Smooth muscle of the constrictor pupillae
c) Smooth muscle of the bronchioles
d) Vasoconstrictor fibers to coronary vessels
e) Vasodilator fibers to skin vessels
28. Which of the following is a characteristic of postganglionic parasympathetic
neurons that make them different from postganglionic sympathetic neurons:
a) They can be excited by dopamine
b) Postganglionic parasympathetic nerve bodies are located in ganglia close to
the spinal cord
c) Most postganglionic parasympathetic nerves release the neurotransmitter
acetylcholine
d) Some postganglionic parasympathetic nerves release the neurotransmitter
norepinephrine
e) They are most active under conditions of stress, such as fight/flight
29. A selective beta adrenergic antagonist:
a) Binds to and activates adrenergic receptors
b) Does not inactivate all beta adrenergic receptors
c) Prevents the binding of all beta adrenergic antagonists
d) Is released from some postganglionic sympathetic nerve terminals
e) May be released from the adrenal medulla
30. A drug that increases the heart rate from 70 to 100 beats per minute could be
a:
a) B1 adrenergic receptor agonist
b) Cholinergic receptor antagonist
c) Dopaminergic receptor agonist
d) B2 adrenergic agonist
e) Non-cholinergic, non-adrenergic agonist
31. Acetylcholine:
a) Is blocked by Propranolol
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
32. Sympathetic stimulation results in:
a) Increased residual volume in the ventricles
b) More rapid peristaltic waves
c) Constriction of the internal anal sphincter
d) Dilation of external urinary sphincter
e) Contraction in bronchiolar smooth muscle
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33. Muscarinic effects of acetylcholine can be inhibited by:
a) Nicotine
b) Muscarine
c) Cholinesterase inhibitors
d) Physostigmine
e) Atropine
34. Tachycardia due to sympathetic stimulation is mediated by:
a) B1 adrenergic receptors
b) B2 adrenergic receptors
c) Alpha adrenergic receptors
d) Both Alpha and Beta receptors
e) Nicotinic receptors
HAEMATOLOGY
Part One
1. For the reticulocyte to develop into a mature red blood cell, it takes:
a) 2 hours
b) 20 hours
c) 2 days
d) 7 days
e) 30 days
2. The mature red blood cell volume is more than 100 femtoliters in:
a) Vitamin B12 deficiency
b) Iron deficiency
c) Blood loss anemia
d) Hemolytic anemia
e) Sickle cell anemia
3. In parasitic infection, there is a marked increase in the count of:
a) Neutrophils
b) Basophils
c) Eosinophils
d) Monocytes
e) Lymphocytes
4. Antigen-presenting cells present antigens to:
a) Neutrophils
b) Monocytes
c) Reticulocytes
d) B- Lymphocytes
e) T- Lymphocytes
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5. Acute hemolytic anemia:
a) Is associated with low MCV
b) Is associated with high reticulocyte count
c) Is associated with low MCH
d) Leads to low urobilinogen in urine
e) Is usually caused by renal failure
6. The extrinsic pathway of coagulation is initiated by factor:
a) I
b) II
c) III
d) IX
e) XII
7. Which of the following substances is used as an anticoagulant in vivo only:
a) Heparin
b) Calcium-chelating agents
c) Vitamin K antagonist
d) Thromboxane A2
e) Interleukin I
8. Urobilinogen
a) Is formed in the liver
b) Is not found in the normal urine
c) Gives the stool its normal color
d) Gives the urine its normal color
e) Its concentration in the blood is high in obstructive jaundice
9. Concerning Hemoglobin S:
a) The alpha-chain is missing
b) The beta-chain is missing
c) The alpha-chain is abnormal
d) The beta-chain is abnormal
e) Is more common in the Mediterranean area
10. The only antibody that can cross the placenta is:
a) IgA
b) IgG
c) IgM
d) IgE
e) IgD
11. The main antibody in the primary immune response is:
a) IgA
b) IgG
c) IgM
d) IgE
e) IgD
12. The vasospasm following the injury of the blood vessel:
a) Is due to sympathetic stimulation
b) Is reduced by pain
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c) Is due to substances released by platelets
d) Lasts up to 5 minutes
e) Is more stronger in longitudinal than transverse injuries
13. Neutrophils:
a) Circulate in the blood for a few hours
b) Have blue granules
c) Are transformed into macrophages in the tissues
d) Have a kidney-shaped nucleus
e) Contain heparin
14. Passive Immunity:
a) Is due to antibodies produced by the body itself
b) Has a long duration
c) Forms the bases of vaccination against childhood diseases
d) Is due to memory cells
e) May be due to transplacental transfer of antibodies
15. The globin part of hemoglobin F consists of:
a) 2 alpha and 2 beta chains
b) 2 beta and 2 gamma chains
c) 2 gamma and 2 delta chains
d) 2 alpha and 2 delta chains
e) 2 alpha and 2 gamma chains
16. The following are natural anticoagulants except:
a) Thromboxane A2
b) Prostacycline
c) Protein C
d) Antithrombin III
e) Plasminogen
17. The main constituent of a blood clot is:
a) Thrombin
b) Fibrin
c) Plasminogen
d) Thrombinogen
e) Thromboplastin
18. Endothelium produces all of the following except:
a) Prostacycline
b) Thromboxane A2
c) Plasminogen
d) Protein C
e) Factor X
19. Cellular immunity is due to:
a) T lymphocytes
b) B lymphocytes
c) Monocytes
d) Neutrophils
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e) Mast cells
20. Action of plasmin is:
a) Calcium chelation
b) Degradation of fibrin
c) Anti-thrombin
d) Stimulation of heparin
e) Release of tissue plasminogen activator
21. Oncotic pressure of plasma is mainly maintained by:
a) Fibrinogen
b) Albumin
c) Alpha-globulin
d) Beta-globulin
e) Gamma-globulin
22. Hematocrit of 45% means that in the sample of blood analyzed:
a) 45% Hb is in the plasma
b) 45% of total blood volume is made up of plasma
c) 45% of Hb is in the RBC
d) 45% of the total blood volume is made up of cells
e) 45% of the red blood cell is made of hemoglobin
23. Iron is absorbed in the:
a) Stomach
b) Duodenum
c) Upper ileum
d) Terminal ileum
e) Colon
24. Which of the following statements concerning the monocyte is incorrect:
a) More common in blood than eosinophils
b) Produced in the adult by the bone marrow
c) Does not leave the circulation
d) Not classified as a granulocyte
e) Has a kidney shaped nucleus
25. Concerning Vitamin B12:
a) Is a fat-soluble vitamin
b) Is found in green vegetables
c) Is absorbed in the duodenum
d) Antagonized folic acid
e) Is required for myelin formation
26. Physiological Jaundice:
a) Is due to rhesus compatibility
b) Appears in the first 24 hours after birth
c) Is treated by exchange transfusion
d) Is due to excessive RBC breakdown
e) Is less common in pre-term babies
27. Vitamin K deficiency leads to the decreased production of the following
factors:
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a) I
b) VII
c) VIII
d) XI
e) XII
28. In a 30 year old man, red bone marrow will be found at all these sites except:
a) Skull
b) Ribs
c) Pelvic bones
d) Shaft of femur
e) Sternum
29. Reticulocyte count in normal blood is:
a) Zero
b) 1%
c) 3%
d) 5%
e) 10%
30. In obstructive jaundice:
a) Bilirubin is excreted in the urine
b) Stool color is dark
c) Urobilinogen in urine is increased
d) Reticulocyte count is increased
e) Van Den Berg test is indirect
31. Reticulocytes:
a) Are found in the blood from a normal person
b) Contain a nucleus
c) Contain 30 picograms of hemoglobin
d) Are produced at a higher rate in a person with folic acid deficiency
e) Takes one week to mature into a RBC
32. Causes of hypochromic anemia include:
a) Removal of the ileum
b) Iron deficiency
c) Folic acid deficiency
d) Sickle cell anemia
e) Vitamin B12 deficiency
33. The following factors help in keeping the blood in the fluid state inside the
circulation:
a) The collagen lining of the endothelium
b) Thromboxane A2
c) Thrombomodulin
d) Flow of the blood
e) Factor XII
34. Antibodies against the Rhesus Factor (anti-D):
a) Are natural occurring antibodies
b) Follows Lansteiner's law
c) Are immunoglobulin D (IgD)
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d) Can cross the placenta
e) Are found in the plasma of all Rhesus negative subjects
35. Most of the iron contents in the body is found in:
a) The skeletal muscles
b) The liver
c) The bone marrow
d) The red blood cells
e) The plasma
36. Vitamin B12 deficiency:
a) Is common among vegeterians
b) Causes microcytic anemia
c) May result from diseases of the duodenum and jejunum
d) Causes defect in myelination
e) Leads to neural tube developmental abnormalitites
37. Hemoglobin A1C:
a) Has a half life of a few days
b) Has iron in the ferric form
c) Is low in folic acid deficiency
d) Is an indicator of diabetes mellitus control
e) Is not found in normal subjects
38. Conjugated Bilirubin:
a) Is filtered by the kidneys
b) Its level is high in obstructive jaundice
c) Is formed in the small intestine
d) Circulates in the blood bound to albumin
e) Gives indirect Van Den Berg test
39 Osponization:
a) Helps the phagocytes recognize foreign antigens
b) Is the process of engulfing foreign bodies
c) Is the process by which neutrophils pass through the capillary membrane
d) Is the opposite of chemotaxis
e) Is due to the perforins secreted by T-lymphocytes
40. Antibodies:
a) Are essential for activation of both complement pathways
b) Are secreted by helper T lymphocytes
c) Circulate in the albumin fraction of plasma proteins
d) Provide cellular immunity
e) Important in osponization
41. Concerning Plasma:
a) Forms 40% of the blood volume
b) Forms 8% of the body weight
c) Has the same composition as serum
d) Fibrinogen is the main plasma protein
e) 90% of its weight is water
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42. Hemoglobin F consists of:
a) Four alpha chains
b) Four beta chains
c) 2 alpha and 2 beta chains
d) 2 alpha and 2 gamma chains
e) 2 alpha and 2 delta chains
43. The shafts of long bones do not contain red bone marrow after:
a) Birth
b) One year
c) 10 years
d) Immediately after puberty
e) 20 years
44. Monocytes:
a) Form 2% of white blood cells
b) Are antigen-presenting cells
c) Have a lobulated nucleus
d) Contain blue granules
e) Cannot leave the circulation
45. Causes of anemia with MCV of about 70 femtoliters is caused by:
a) Removal of ileum
b) Iron deficiency
c) Folic acid deficiency
d) Sickle cell anemia
e) Vitamin B12 deficiency
46. Eosinophils:
a) Have a kidney-shaped nucleus
b) Characterized by blue cytoplasmic granules
c) Forms 0.4% of white blood cells
d) Count is typically high in bacterial infection
e) Count may reach 8% in parasitic infection
47. Regarding iron absorption:
a) Is reduced by increased secretion of HCl
b) Is reduced by absence of intrisinc factor
c) Is reduced by tetracycline admiysteation
d) Iron from meat s better absorbed than iron from plants
e) Absorption takes place mainly in the ileum
48. Hemoglobin A:
a) Forms 90% of hemoglobin in the adult
b) Consists of 2 alpha and 2 gamma chains
c) Has less affinity for oxygen than hemoglobin
d) Contains iron in the ferric form
e) Its amount in each cell is about 20 picograms
49. A person who is group B negative:
a) Has antigen B and antibody B
b) His children may develop Rhesum if wife is Rhetus
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c) He cannot be a father of a child whose group is AB
d) He cannot be a father of a child whose group is O
e) He cannot be a father of a child whose group is A
50. All of the following may cause anemia except:
a) Folic acid deficiency
b) Removal of the stomach
c) Vitamin D deficiency
d) Diseases of the terminal ileum
e) Chronic renal failure
51. Bilirubin:
a) Is a product of globin breakdown
b) Normal plasma level is 10 mg/ 100 mL
c) Is excreted mainly in urine
d) Gives the urine its characteristic colour
e) Excretion is feces is increased in hemolytic anemia
52. Iron:
a) Is found in high amounts in mother's milk
b) Is absorbed mainly in the lower intestine
c) Is transported in plasma with plasma transferrin
d) Is stored in the liver mainly as haemosiderin
e) Deficiency causes anemia with red cell volume typically about 105
femoliters
53. The following factors help keep the blood in the fluid state inside the
circulation:
a) The collagen lining the endothelium
b) Thromboxane A2
c) Thrombomodulin
d) Calcium in the blood
e) Factor XIII
54. The normal range of blood volume in a 60kg male is:
a) 3.5-4.0 liters
b) 4.0-4.5 liters
c) 4.5-5.0 liters
d) 5.0-5.5 liters
e) 5.5-6.0 liters
55. Which of the following might trigger erythropoiesis?
a) Decreased tissue demand for oxygen
b) Increased tissue demand for oxygen
c) An increased number of RBC'S
d) Moving from a higher altitude to a lower altitude
e) Taking large amounts of iron
56. All of the following can be expected with polycythemia except:
a) Low blood viscosity
b) High hematocrit
c) Increased blood volume
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d) High blood pressure
e) Increased resistance to flow
57. The process of WBC's slipping out of the capillaries into tissues is called:
a) Thrombocytopenia
b) Diapedesis
c) Leukopenia
d) Leukocytosis
e) Osponization
58. Which of the following is a characteristic of all leukocytes?
a) They are phagocytic
b) They have cytoplasmic granules
c) They are nucleated
d) They are the most numerous of formed elements of blood
e) They are important in innate immunity
59. Mr. Ali's blood was determined to be AB positive. What does this mean?
a) Antibodies to A and B are present in plasma
b) There are no antibodies to A, B or Rh antigens in the plasma
c) His blood lacks the Rh factor
d) All of the above are correct
e) He has antigen A and B but not antigen D on his RBC's
60. B lymphocytes:
a) Have phagocytic functions
b) Produce helper cells
c) Their maturation is completed in the bone marrow
d) Characterized by a horse-shoe shaped nucleus
e) Constitute the majority of the lymphocytes
61. The red blood cells in males compared to females:
a) Have higher count
b) Live longer in circulation
c) Have more hemoglobin per cell (MCH)
d) Have larger volume (MCV)
e) Are less fragile
62. Rhesus incompatibility of the new born occurs only if:
a) The mother is Rh-, and the baby is Rhb) The father is Rh+, and the baby is Rhc) The new born is Rh+, and the father is Rhd) Cells in the fetus enter the mother's circulation
e) The mother and fetus are ABO incompatible
63. The first factor to be activated in the extrinsic pathway is factor:
a) II
b) V
c) VII
d) X
e) XII
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64. Platelets:
a) Have a lifespan of 7 days
b) Count is 120 000 per mm3
c) Produces prostacyclin
d) Are controlled by erythropoietin
e) Deficiency causes hemophilia
65. Plasma is different from serum in that it contains:
a) More sodium
b) Less calcium
c) More albumin
d) More fibrinogen
e) Less neutrophils
66. The type of white blood cells most likely to increase in parasitic infection are:
a) Neutrophils
b) Eosinophils
c) Basophils
d) Monocytes
e) Lymphocytes
67. T Lymphocytes:
a) Are called T lymphocytes because they mature in the tonsils
b) Are more effective against intracellular antigens
c) Are essential for humoral immunity
d) Can produce antibodies
e) Are important in passive immunization of the fetus
68. Normal blood contains:
a) 3 millions RBC's per mm3
b) 15 000 WBC's per mm3
c) 300 000 platelets per mm3
d) 10 grams Hb per 100 mL
e) 3 grams protein per 100 mL
69. Methemoglobin:
a) Is formed by the reaction of hemoglobin to glucosea
b) Is due to CO toxicity
c) Is due to reducing agents
d) Contains ferric ion instead of ferrous
e) Has higher affinity to O2 than normal Hb
70. Vitamin B12:
a) A fat-soluble vitamin
b) It is not found in green vegetables
c) It is absorbed from the stomach
d) Deficiency causes microcytic anemia
e) Deficiency causes neural tube defect
71. The following cell produces antibodies:
a) Helper- T lymphocytes
b) Cycotoxic- T lymphocytes
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c) Monocytes
d) Plasma cells
e) Eosinophils
72. The antibody found in highest concentration in mother's milk is:
a) IgG
b) IgA
c) IgM
d) IgE
e) IgD
73. The alternative pathway for complement activation is activated by:
a) T-helper cells
b) Antigen-antibody complex
c) Circulating factor in the plasma
d) Histamine
e) Factor XII
74. Eosinophil count of 6% is most likely found in:
a) Normal subjects
b) Bacterial infection
c) Parasitic infection
d) Viral infection
e) Fungal infection
75. The extrinsic pathway of blood coagulation:
a) Is triggered by contact of factor VII with collagen
b) Is slower than the intrinsic pathway
c) Requires factor III
d) Requires factor IX
e) Utilizes all the clotting factors in the blood
76. The following factor favors blood coagulation:
a) Smoothness of the endothelium
b) Thromboxane A2
c) Prostacyclin
d) Calcium chelating agents
e) Vitamin K
77. Blood stored for transfusion:
a) Is stored at -20oC
b) Plasma K+ concentration rises
c) With concentration of 2,3 DPG increases
d) Warfarin can be used as anticoagulant
e) Its affinity for oxygen decrease
78. Reticulocyte count of 4% is most likely found in:
a) Normal subjects
b) Vitamin B12 deficiency
c) Folic acid deficiency
d) Lack of erythropoietin
e) Hemolytic anemia
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79. Packed cell volume in a blood sample was found to be 41% that means:
a) 41% of hemoglobin is in the plasma
b) 41% of the total blood volume is made of plasma
c) 41% of the hemoglobin is in the red blood cells
d) 41% of the total blood volume is made up of all blood cells
e) 41% of the blood cells are made up of red blood cells
80. Tissue plasminogen activator is stimulated by:
a) Factor X
b) Protein C
c) Thrombin
d) Thrombomodulin
e) Factor XIII
81. Vitamin B12:
a) A fat-soluble vitamin
b) Is needed for closure of the neural tube
c) It is absorbed in the stomach
d) Deficiency typically causes anemia of MCV more than 100 femtoliters
e) Is not stored in the body
82. The following is true about iron:
a) Milk is a rich source
b) Absorption needs intrinsic factor secreted by the stomach
c) Is found in hemoglobin in the reduced form
d) Deficiency is more common in males than in females
e) Is stored in the body mainly as hemosidrin
83. Bilirubin:
a) Levels in blood is 10mg/100mL
b) Is produced by the breakdown of the globin part of hemoglobin
c) Is excreted mainly in the urine
d) Excretion in urine is increased in hemolytic jaundice
e) Is converted in the intestine to stercobilinogen
84. Platelets:
a) Normal count is about 40 000/mm3
b) Have a lifespan of 30 days
c) Contain clotting factors
d) Secrete prostacyclin
e) Have receptors for protein C
85. The role of platelets in hemostasis does not include:
a) Release of vasoconstrictor substances
b) Adhesion to injured areas
c) Causing clot retraction
d) Activating the fibrinolytic system
e) Providing phosphoplipids to the clotting reactions
86. Platelets:
a) Normal count in the blood is 75,000- 120,000/uL
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b) Produced in the yellow marrow of long bones
c) Need to be activated in the spleen
d) Can be stored in the refrigerator of the blood bank for 13 days
e) Do not have a nucleus
87. The principal cells that mediate the specific immune response include the:
a) Neutrophil granulocyte
b) Natural killer cells
c) Mast cells
d) Tissue macrophages
e) Oligodendroglial cells
88. The following is not one of the plasma globulins:
a) Angiotensinogen
b) Prothrombin
c) IgM
d) Elastin
e) Proteins of the complement system
89. The following is a characteristic complication of massive blood transfusion:
a) Transmission of the HIV virus
b) Transmission of the malaria parasite
c) Hypocalcemia
d) Massive intravascular hemolysis
e) Myoglobinuria
90. Salah's blood group is AB while the blood group of his wife Anna is B. Their
children will NOT have the following blood group genotype:
a) AB
b) OO
c) AO
d) BO
e) BB
91. A bleeding tendency is NOT usually expected in individuals suffering from:
a) Obstructive jaundice
b) Liver cirrhosis
c) Vitamin K deficiency
d) Vitamin C deficiency
e) Vitamin A deficiency
92. Monocytes:
a) Forms 2% of white blood cells
b) Are precursors of Kuppfer cells
c) Have a lobulated nucleus
d) Contain blue granules
e) Cannot leave the circulation
93. The following is true about red blood cells:
a) Their count ranges between 6-8 million/mm3
b) Polycythemia means a decrease in red blood cell count
c) Red cell production occurs in the spleen
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d) The red cells are biconvex discs
e) The red cells carry myoglobin
94. The following is true about Hemoglobin A:
a) Its concentration in males is about 19 g/dL
b) Is made of two alpha chains and two gamma chains
c) Has four binding sites for combining with O2
d) Does not transport CO2
e) The heme component contains Ferrous
95. Hemolytic anemia is due to all of the following except:
a) Malaria
b) Sickle cell disease
c) Spheroctosis
d) Rhesus incompatibility
e) Iron deficiency
96. Leucopenia:
a) Reduction in white blood cell count
b) Caused by acute bacterial infections
c) Caused by Vitamin B12 deficiency
d) Is normally seen in children
e) Might involve the granular cells
97. The following is a function of neutrophils:
a) Phagocytosis
b) Antibody production
c) Cell mediate immunity
d) Humoral immunity
e) Complement activation
98. The following are true about T-Lymphocytes except:
a) They produce antibodies
b) They are involved in cell mediated immunity
c) They form memory cells when activated
d) They are involved in transplant rejection
e) They are attacked by HIV
99. Hemostasis requires involvement of all of the following except:
a) Activation of factor X
b) Vasospasm
c) Platelets aggregation
d) Intrinsic system activation
e) Extrinsic system suppression
100. Hemophilia is caused by:
a) Deficiency of factor VIII
b) Deficiency of factor IX
c) Thrombocytopenia
d) Thrombocytosis
e) Liver failure
101. The following diseases are transmitted by blood transfusion except:
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a) HIV
b) Hepatitis C
c) Hepatitis B
d) Syphilis
e) Influenza virus infection
102. The bleeding time:
a) Normally equals 15-20 minutes
b) Is abnormal in thrombocytopenia
c) Is abnormal in hemophilia
d) Is abnormal in liver failure
e) Reflects the vascular role in the arrest of bleeding
103. Unconjugated Bilirubin:
a) Is water-soluble
b) Is the main type of bilirubin in hemolytic jaundice
c) Gives direct Van Den Berg Test
d) Appears in urine
e) Is converted in the liver to stercobilinogen
104. The following cell produces heparin:
a) Neutrophil
b) Eosinophil
c) Basophil
d) Lymphocyte
e) Monocyte
105. The following cell is a precursor of kupffer cells:
a) Neutrophil
b) Eosinophil
c) Basophil
d) Lymphocyte
e) Monocyte
106. The count of the following cell is typically raised in parasitic infection:
a) Neutrophil
b) Eosinophil
c) Basophil
d) Lymphocyte
e) Monocyte
107. HLA type 1 is essential for the following cell to recognize foreign antigens:
a) Plasma cells
b) B memory cells
c) T-cytotoxic cells
d) T-helper cells
e) T-memory cells
108. Regarding iron distribution in the body:
a) 50% in hemoglobin
b) 30% as ferritin
c) 10% myoglobin
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d) 5% hemosedrin
e) 3% enzymes
109. Neural tube closure may occur in babies whose mothers were suffering
from:
a) Vitamin B12 deficiency
b) Folic acid deficiency
c) Iron deficiency
d) Protein deficiency
e) Intrinsic factor deficiency
110. Reticulocytes count in normal blood is:
a) 10%
b) 7%
c) 5%
d) 3%
e) 1%
111. In hemolytic jaundice:
a) Bilirubin is excreted in urine
b) Stool color is pale
c) Van Den Berg test is direct
d) Urinary urobilinogen is increased
e) Reticulocyte count typically is < 1%
112. The following cells are tissue macrophages except:
a) Kupffer cells
b) Osteoclasts
c) Parietal cells
d) Microglial cells
e) Mesangeal cells
113. Iron absorption takes place mainly in the:
a) Stomach
b) Duodenum and jejunum
c) First part of ileum
d) Terminal ileum
e) Large intestine
114. Myelination of the neurons may be abnormal if there is deficiency of:
a) Vitamin B12
b) Folic acid
c) Iron
d) Erythropoietin
e) Interleukin 4
115. The cell that is important in all types of immunity is:
a) B-lymphocyte memory cells
b) T-memory cells
c) T-helper cells
d) Neutrophils
e) B-helper cells
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116. All of the following may be a complication of blood transfusion, except:
a) Sodium overload
b) Potassium overload
c) Iron overload
d) Volume overload
e) Allergic reactions
117. Methemoglobin:
a) Is a hemoglobin bound to glucose
b) Is a hemoglobin with oxidized iron
c) Normally forms 30% of the total hemoglobin
d) Is formed when blood is exposed to reducing agents
e) Has a high affinity to O2
118. Plasma:
a) Is 85% water
b) Contains about 5g protein/dL
c) Contains 290 mosmol/liter
d) Volume can be measured by inulin dilution method
e) Constitute about 45% of the blood
119. Compared to other plasma proteins, albumin is the main generator of the
colloid osmotic pressure of plasma because:
a) Of its high concentration and relatively small molecular weight
b) It can bind other substances in blood
c) It can relatively easily cross the capillary membrane
d) It is not ionized
e) It can be made by the liver
120. Which of the following substances has the highest molar concentration in
plasma:
a) Glucose
b) Protein
c) Sodium
d) Calcium
e) Bicarbonate
121. Normal red blood cells:
a) Rupture if suspended in a solution which is 0.9% sodium chloride
b) Are more fragile than sphercytes
c) Count is about 5 million/mm3 in adult females
d) Count about 40 picograms of hemoglobin per cell
e) Volume is about 85 femtoliters
122. During the last month of pregnancy, red blood cells of the fetus are
produced mainly by:
a) Liver
b) Spleen
c) Bone marrow
d) Yolk sac
e) Lymph nodes
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123. An increase in the number of reticulocytes occurs in:
a) Severe hemolysis
b) Folic acid deficiency
c) Iron deficiency
d) Erythropoietin deficiency
e) Vitamin B12 deficiency
124. The main storage protein for iron in the body is:
a) Hemoglobin
b) Transferrin
c) Ferritin
d) Hemopexin
e) Haptoglobin
125. Destruction of red blood cells in the vascular system is associated with:
a) Decreased potassium concentration in plasma
b) Agglutination of red blood cells
c) Increased secretion of hemoglobin in urine
d) Cyanosis
e) High transferring concentration
126. Appearance of the early forms of red blood cells in the blood may indicate:
a) Iron deficiency
b) Folic acid deficiency
c) A high rate of erythropoiesis
d) Bone marrow failure
e) Erythropoietin deficiency
127. Of the total white blood cells, the normal percentages of the different types
of cells is:
a) About 40% neutrophils
b) Less than 1% basophils
c) About 60% lymphocytes
d) About 1% monocytes
e) 8% eosinophils
128. The lifespan of neutrophils
a) Is about one hour in the circulation
b) 4-5 days in tissues
c) Is prolonged in bacterial infections
d) In the circulation is longer than the half life of monocytes
e) Is longer than normal inpatients with hypersplenic function
129. Which of the following means attraction of white blood cells to the site of
infection:
a) Diapedesis
b) Ameboid motion
c) Chemotaxis
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d) Complement fixation
e) Immune tolerance
130. Active immunity:
a) Develop against antigens with molecular weights greater than 8000
b) Does not develop unless a foreign organism or toxin invade the
body
c) Is a function of phagocytes
d) Acquired by the child through the milk of his mother
e) Acquired by the fetus through the placenta
131. Which of the following is not a function of antibodies:
a) Agglutination of antigens
b) Precipitation of antigens
c) Attraction of white blood cells to the site of infection
d) Neutrolization of toxins
e) Lysis of bacteria
132. A baby whose blood group is A+ve and whose mother's blood group is B+ve,
can only mean that the father cannot be:
a) Blood group O-ve
b) Blood group AB+ve
c) Blood group A-ve
d) Blood group AB-ve
e) Blood group A+ve
133. The most important antigen for causing graft rejection is:
a) Human leukocyte antigen
b) The ABO blood group antigens
c) The rhesus factor antigens
d) Cell membrane phospholipase
e) Cell membrane phospholipase A
134. The degree of vascular spasm following injury to a blood vessel depends
mostly on:
a) The degree of trauma to a blood vessel
b) The platelet count
c) The activity of the sympathetic nervous system
d) The concentration of clotting factors
e) The concentration of prostacycline in the blood
135. The Von Willibrand Factor:
a) Directly binds to and activates platelets
b) Is essential for formation of the platelet plug
c) Causes clot retraction
d) Activates the extrinsic pathway of coagulation
e) Deficiency prolongs the clotting time
136. Which of the following steps of coagulation does not require Ca 2+?
a) Activation of prothrombin
b) Activation of factor IX
c) Release of tissue thromboplastin
d) Activation of factor X
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e) Formation of prothrombin activator
137. A patient with obstructive jaundice is likely to develop bleeding tendency
due to:
a) Deficiency of prothrombin
b) Thrombocytopenia
c) Deficiency of von willibrand factor
d) Tissue thromboplastin deficiency
e) Formation of prothrombin activator
138. The tissue stabilizing factor is activated by:
a) Fibrin
b) Thrombin
c) Thrombomodulin
d) Active factor X
e) Plasmin
139. Folic acid:
a) Is a fat-soluble vitamin
b) Is found only in meats
c) Is needed for ana formation
d) Deficiency causes macrocytic
e) Deficiency causes defect in mitochondria
140. The most prevalent blood group is:
a) A
b) B
c) AB
d) O (-ve)
e) O (+ve)
141. Most white blood cells are:
a) Lymphocytes
b) Monocytes
c) Neutrophils
d) Eosinophils
e) Plasma cells
142. A good indicator of hemolysis is:
a) Pale stool colour
b) High reticulocyte count
c) High white blood cell count
d) Macrocytosis
e) Microcytosis
143. Platelets:
a) Are produced in the spleen
b) Have a small nucleus
c) Change their shape when they make contact with collagen
d) Have a normal count of 10, 000 per mm3
e) Produce prostacyclin
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144. The endothelium produces the following substances that helps keep the
blood in the fluid state:
a) Prostacycline
b) Thromboxane A2
c) Plasminogen
d) Protein C
e) Heparin
145. Concerning hemoglobin S, the abnormality is in the:
a) Alpha chain
b) Beta chain
c) Iron molecule
d) Porphyrin ring
e) The red cell enzymes
146. A person whose blood group is AB:
a) Has only antibodies against A antigens
b) Has only antibodies against B antigens
c) Has both antibodies A and B
d) Has no antibodies
e) Acts as a universal donor
147. Iron deficiency anemia is:
a) Due to intrinsic factor deficiency
b) Commoner in women than men
c) An example of hemolytic anemias
d) Typically seen in patients with hemoglobin S
e) Characterized by macrocytic cells
148. Hemophilia is due to deficiency of:
a) Platelets
b) Factor VIII
c) Factor X
d) Factor XI
e) Factor XII
149. The white blood cells that contain blue granules are the:
a) Neutrophils
b) Basophils
c) Eosinophils
d) Lymphocytes
e) Monocytes
150. Which of the following is the primary function of B lymphocytes:
a) Phagocytosis
b) Production of antibodies
c) Production of complement
d) Regulation of red blood cell production
e) Cellular immunity
151. Functions of antibodies include all of the following except:
a) Neutralization of bacterial toxins
b) Osponizing bacteria
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c) Promoting phagocytosis
d) Active inflammatory response
e) Inactivation of viruses
152. Vitamin K-dependent factors include:
a) Fibrinogen
b) Prothrombin
c) Tissue thromboplastin
d) Factor X
e) Factor VIII
153. Plasma is different from serum in that it contains:
a) Contains less albumin
b) Contains more fibrinogen
c) Has higher sodium concentration
d) Does not clot
e) Has no cells
154. The common pathway of coagulation starts with activation of factor:
a) II
b) V
c) VII
d) IX
e) X
HAEMATOLOGY
Part Two
Questions:
1. Blood group antigens (agglutinogens) are
A. Carried on the haemoglobin molecule.
B. Beta globulins.
C. Equally immunogenic.
D. Not present in fetal blood.
E. Inherited as recessive Mendelian characteristics.
2. Breakdown of erythrocytes in the body
A. Occurs when they are 6–8 weeks old.
B. Takes place in the reticulo-endothelial system.
C. Yields iron, most of which is excreted in the urine.
D. Yields bilirubin which is carried by plasma protein to the liver.
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E. Is required for the synthesis of bile salts.
3. A person with group A blood
A. Has anti-B antibody in the plasma.
B. May have the genotype AB.
C. May have a parent with group O blood.
D. May have children with group A or group O blood only.
E. Whose partner is also A can only have children of groups A or O.
4. Blood platelets assist in arresting bleeding by
A. Releasing factors promoting blood clotting.
B. Adhering together to form plugs when exposed to collagen.
C. Liberating high concentrations of calcium.
D. Releasing factors causing vasoconstriction.
E. Inhibiting fibrinolysis by blocking the conversion of plasminogen to plasmin.
5. Plasma bilirubin
A. Is a steroid pigment.
B. Is converted to biliverdin in the liver.
C. Does not normally cross cerebral capillary walls.
D. Is freely filtered in the renal glomerulus.
E. Is sensitive to light.
6. Monocytes
A. Originate from precursor cells in lymph nodes.
B. Can increase in number when their parent cells are stimulated by factors released
from
activated lymphocytes.
C. Unlike granulocytes, do not migrate across capillary walls.
D. Can transform into large multinucleated cells in certain chronic infections.
E. Manufacture immunoglobulin M.
7. Erythrocytes
A. Are responsible for the major part of blood viscosity.
B. Contain the enzyme carbonic anhydrase.
C. Metabolize glucose to produce CO2 and H2O.
D. Swell to bursting point when suspended in 0.9 per cent (150 mmol/litre) saline.
E. Have rigid walls.
8. Human plasma albumin
A. Contributes more to plasma colloid osmotic pressure than globulin.
B. Filters freely at the renal glomerulus.
C. Is negatively charged at the normal pH of blood.
D. Carries carbon dioxide in blood.
E. Lacks the essential amino acids.
9. Neutrophil granulocytes
A. Are the most common leukocyte in normal blood.
B. Contain proteolytic enzymes.
C. Have a lifespan in the circulation of 3–4 weeks.
D. Contain actin and myosin microfilaments.
E. Are present in high concentration in pus
.
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10. Bleeding from a small cut in the skin
A. Is normally diminished by local vascular spasm.
B. Ceases within about five minutes in normal people.
C. Is prolonged in severe factor VIII (antihaemophilic globulin) deficiency.
D. Is greater from warm skin than from cold skin.
E. Is reduced if the affected limb is elevated.
11. Antibodies
A. Are protein molecules.
B. Are absent from the blood in early fetal life.
C. Are produced at a greater rate after a first, than after a second, exposure to an
antigen six weeks later.
D. Circulating as free immunoglobulins are produced by B lymphocytes.
E. With a 1 in 8 titre are more concentrated than ones with a 1 in 4 titre.
12. Circulating red blood cells
A. Are about 1 per cent nucleated.
B. May show an intracellular network pattern if appropriately stained.
C. Are distributed evenly across the blood stream in large blood vessels.
D. Travel at slower velocity in venules than in capillaries.
E. Deform as they pass through the capillaries.
13. Lymphocytes
A. Constitute 1–2 per cent of circulating white cells.
B. Are motile.
C. Can transform into plasma cells.
D. Decrease in number following removal of the adult thymus gland.
E. Decrease in number during immunosuppressive drug therapy.
14. The specific gravity (relative density) of
A. Red cells is less than that of plasma.
B. Plasma is due more to its protein than to its electrolyte content.
C. Plasma decreases as extracellular fluid and electrolytes are lost.
D. Blood is higher on average in women than in men.
E. Urine can fall below 1.000 in a water dieresis
15. Blood
A. Makes up about 7 per cent of body weight.
B. Forms a higher percentage of body weight in fat than in thin people.
C. Volume can be calculated by multiplying plasma volume by the haematocrit
(expressed
as a percentage).
D. Volume rises after water is drunk.
E. Expresses serum when it clots.
16. Antigens
A. Are usually proteins or polypeptide molecules.
B. Can only be recognized by immune system cells previously exposed to that
antigen.
C. Are normally absorbed from the gut via lymphatics and carried to mesenteric
lymph nodes.
D. Induce a smaller immune response when protein synthesis is suppressed.
E. Are taken up by antigen-presenting macrophages which activate the immune
system.
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17. Blood eosinophils
A. Have agranular cytoplasm.
B. Are about a quarter of all leukocytes.
C. Are relatively abundant in the mucosa of the respiratory, urinary and alimentary
tracts.
D. Release cytokines.
E. Increase in number in viral infections.
18. Normal blood clotting requires
A. Inactivation of heparin.
B. Inactivation of plasmin (fibrinolysin).
C. Calcium ions.
D. An adequate intake of vitamin K.
E. An adequate intake of vitamin C.
19. Antibodies (agglutinins) of the A and B red cell antigens (agglutinogens)
A. Are present in fetal plasma.
B. Cause haemolysis of RBCs containing the A and B antigens when added to a
suspension of red cells in saline.
C. Do not normally cross the placental barrier.
D. Have a molecular weight in excess of 500 000.
E. Are monovalent.
20. Lymph
A. Contains plasma proteins.
B. Vessels are involved in the absorption of amino acids from the intestine.
C. Production increases during muscular activity.
D. Does not normally contain cells.
E. Flow is aided by contraction of adjacent skeletal muscles.
21. Blood platelets
A. Are formed in the bone marrow.
B. Are normally more numerous than white cells.
C. Have a small single-lobed nucleus.
D. Increase in number after injury and surgery.
E. Alter shape when in contact with collagen.
22. The conversion of fibrinogen to fibrin
A. Is effected by prothrombin.
B. Involves the disruption of certain peptide linkages by a proteolytic enzyme.
C. Is followed by polymerization of fibrin monomers.
D. Is inhibited by heparin.
E. Is reversed by plasmin (fibrinolysin).
23. Haemolytic disease of the newborn
A. Affects mainly babies of Rh-positive mothers.
B. Occurs mainly in babies who lack D agglutinogen.
C. Causes jaundice which clears rapidly after birth.
D. Can be treated by transfusing the affected baby with Rh-positive blood.
E. Can be prevented by injecting the mother with anti-D agglutinins just after
delivery.
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24. The appearance of centrifuged blood may suggest that
A. Anaemia is present if there is more plasma than packed cells.
B. The plasma lipid level is high.
C. The patient has jaundice.
D. Haemolysis has occurred.
E. The patient has leukaemia.
25. Patients with moderate to severe anaemia have a reduced
A. Cardiac output.
B. Incidence of vascular bruits.
C. 2:3-diphosphoglycerate blood level.
D. Arterial PO2.
E. Capacity to raise oxygen consumption in exercise.
26. Iron deficiency
A. Frequently follows persistent loss of blood from the body.
B. Is more common in men than in women.
C. May cause anaemia by inhibiting the rate of multiplication of RBC stem cells.
D. May cause large pale erythrocytes to appear in peripheral blood.
E. Anaemia should normally be treated by injections of iron
27. Severe reactions are likely after transfusion of blood group
A. A to a group B person.
B. O to a group AB person.
C. A to a group O person.
D. A to a group AB person.
E. O Rh- negative to a group AB Rh-positive person.
28. The haematocrit (packed cell volume)
A. May be obtained by centrifugation of blood.
B. May be calculated by multiplying the mean cell volume by the red cell count.
C. Rises in a patient who sustains widespread burns.
D. Rises following injections of aldosterone.
E. Rises in macrocytic megaloblastic anaemias such as pernicious (B12 deficiency)
anaemia.
29. Red cell formation is increased
A. By giving vitamin B12 injections to healthy people on a normal diet.
B. In blood donors one week after a blood donation.
C. In patients with haemolytic anaemia.
D. By giving injections of erythropoietin to nephrectomized patients.
E. In patients who have a raised blood reticulocyte count.
30. Vitamin B12 deficiency may
A. Result from disease of the terminal part of the ileum.
B. Result in anaemia with small RBCs well filled with haemoglobin.
C. Cause wasting (atrophy) of the gastric mucosa.
D. Cause a reduction in the circulating platelet level.
E. Cause pathological changes in the central nervous system.
31. Rejection of a transplanted organ is made less likely by
A. Treatment which reduces the blood lymphocyte count.
B. Keeping the recipient in a germ-free environment.
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C. Irradiation of the transplanted organ with X-rays.
D. Drugs which interfere with mitosis.
E. Transplanting between identical twins.
32. Reduction in the neutrophil granulocyte count may be
A. Caused by drugs suppressing bone marrow activity.
B. A consequence of tissue damage.
C. Associated with painful throat ulcers.
D. Associated with widespread purulent infections.
E. Caused by high levels of circulating glucocorticoids
33. A fall in plasma sodium concentration
A. May result from excessive production of ADH.
B. Decreases intracellular fluid volume.
C. May occur in people engaged in hard physical work in humid tropical climates.
D. Reduces plasma osmolality.
E. Is likely to cause thirst.
34. Deficiency of factor VIII (antihaemophilic globulin)
A. Increases the bleeding time.
B. Is due to an abnormal gene on the Y chromosome.
C. To 75 per cent of its normal value results in excessive bleeding after tooth
extraction.
D. Causes small (petechial) haemorrhages into the skin to cause purpura.
E. Affects the extrinsic, rather than the intrinsic, pathway for blood coagulation
.
35. In patients with the acquired immune deficiency syndrome (AIDS)
A. Neutrophils are more affected than lymphocytes.
B. Total white cell count is a better indicator of progression than any subset of white
cells.
C. Host DNA is incorporated into the human immunodeficiency (HIV) virus.
D. Occurrence in infancy results from transmission of infection rather than
inheritance.
E. There is increased risk of malignant tumours.
Answers:
1.
A. False They are part of the red cell membrane.
B. False They are glycoproteins.
C. False A, B and D antigens are more immunogenic than the others.
D. False Fetal blood may elicit immune responses if it enters the maternal circulation.
E. False They are Mendelian dominants.
2.
A. False The normal erythrocyte lifespan is 16–18 weeks.
B. True The RES removes effete RBCs from the circulation.
C. False Most of the iron is retained for further use.
D. True The protein makes the bilirubin relatively water-soluble.
E. False Bile salts are synthesized from sterols in the liver.
3.
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A. True This appears about the time of birth.
B. False This would make them blood group AB.
C. True They could inherit an A gene from the other parent to give genotype AO.
D. False B or AB are possible depending on the partner’s genes.
E. True In this case, neither parent has the B gene.
4.
A. True e.g. Thromboplastin, part of the intrinsic pathway.
B. True Vascular leaks are sealed by such platelet plugs.
C. False High Ca2_ levels are not needed for haemostasis; normal levels are
adequate.
D. True e.g. Serotonin (5-hydroxytryptamine).
E. False Serotonin from platelets can release vascular plasminogen activators.
5.
A. False It is a porphyrin pigment derived from haem.
B. False Bilirubin is derived from biliverdin formed from haem, not the other way
about.
C. True The ‘blood–brain barrier’ normally prevents bilirubin entering brain tissue.
D. False The bilirubin–protein complex is too large to pass the glomerular filter.
E. True Light converts bilirubin to lumirubin which is excreted more rapidly;
phototherapy
may be used in the treatment of haemolytic jaundice in children.
6.
A. False They originate from stem cells in bone marrow.
B. True Activated T cells release GMCSF (granulocyte/macrophage colony
stimulating
factor) which stimulates monocyte stem cells to proliferate.
C. False After 4–6 days in the circulation, monocytes migrate out to become tissue
macrophages.
D. True The ‘giant cells’ seen in tissues affected by tuberculosis and leprosy.
E. False Immunoglobulins are made by ribosomes in lymphocytes.
7.
A. True Blood viscosity rises exponentially with the haematocrit.
B. True It catalyses the reaction CO2_H2O_H__HCO3
_.
C. True Glycolysis generates the energy needed to maintain electrochemical
gradients
across their membranes.
D. False This is isotonic with their contents.
E. False The walls deform easily to squeeze through capillaries.
8.
A. True Its greater mass and lower molecular weight provide more osmotically active
particles.
B. False Only a small amount is filtered normally and this is reabsorbed by the
tubules.
C. True Blood pH is well above albumin’s isoelectric point so negative charges
(COO_)
predominate.
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D. True As carbamino protein (R-NH2_CO2_R-NH COOH).
E. False It is a first class protein containing essential and non-essential amino acids.
9.
A. True They comprise 60–70 per cent of circulating leukocytes.
B. True Their granules contain such enzymes, which, with toxic oxygen metabolites,
can
kill and digest the bacteria they engulf.
C. False Less than a day.
D. True Responsible for their amoeboid motility.
E. True Pus consists largely of dead neutrophils.
10.
A. True Due to the effects of tissue damage and serotonin on vascular smooth
muscle.
B. True This is the upper limit of the normal ‘bleeding time’.
C. False Factor VIII increases clotting time, not bleeding time.
D. True Warmth dilates skin blood vessels.
E. True Intravascular pressure is reduced in an elevated limb.
11.
A. True They are made by ribosomes in plasma cells.
B. True Immunological tolerance prevents the fetus forming antibodies to its own
proteins.
C. False The response to the second exposure is greater since the immune system has
been
sensitized by the first exposure.
D. True T lymphocytes are responsible for cell-mediated immunity.
E. True Antibody with a 1 in 8 titre is detected at greater dilution than one with a 1 in
4
titre.
12.
A. False Nucleated red cells are not normally seen in peripheral blood.
B. True Reticulocytes, the most immature circulating RBCs, show this pattern when
stained with certain dyes.
C. False They form an axial stream away from the vessel wall.
D. False The capillary bed has a greater total cross-sectional area than the venular
bed.
E. True Normal cells, around 7 microns in diameter, become bullet-shaped as they
pass
through 5 micron diameter capillaries.
13.
A. False About 20 per cent of leukocytes are lymphocytes.
B. True They migrate by amoeboid movement to areas of chronic inflammation.
C. True As plasma cells they manufacture humoral antibodies.
D. False The thymus is atrophied and has little function in the adult.
E. True Lymphocytes and immune responses are closely linked.
14.
A. False Red cells are heavier and hence sediment on standing.
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B. True The mass of plasma proteins (70–80 grams/litre) far exceeds that of plasma
electrolytes
(about 10 grams/litre).
C. False It increases; plasma specific gravity is an index of ECF volume if protein
levels
are normal.
D. False It is higher in men, who have a higher haematocrit.
E. False The specific gravity of pure water is 1.000; urine is water plus solutes.
15.
A. True For example, 5 kg (about 5 litres) in a 70 kg man.
B. False Since fat tissue is relatively avascular, the reverse is true.
C. False It can be calculated by multiplying plasma volume by 1/1 minus haematocrit
(expressed as a decimal).
D. True The water is absorbed into the blood.
E. True Serum is plasma minus its clotting factors.
16.
A. True Large carbohydrate molecules may also be antigenic.
B. False The ability to recognize foreign antigens is innate and does not depend on
previous
exposure to them.
C. False Antigens, being proteins or carbohydrates, are not normally absorbed; they
are
digested in the gut.
D. True Antibodies are proteins synthesized by ribosomes in activated lymphocytes.
E. True Antigens can also act directly on receptors on lymphocyte membranes.
17.
A. False They have eosinophilic granules (eosinophilic granulocytes).
B. False Only 1–4 per cent of white cells are eosinophils.
C. True They are involved in mucosal immunity.
D. True Interleukin 4 and platelet activating factor (PAF).
E. False Their number increases in parasitic infections and allergic conditions.
18.
A. False The anticoagulant effects of heparin are overwhelmed.
B. False Blood clots in spite of the fibrinolytic system.
C. True Removal of calcium ions prevents clotting.
D. True Vitamin K is needed by the liver for synthesis of prothrombin and other
factors.
E. False The spontaneous bleeding from the gums etc. seen in scurvy is due to
capillary
abnormality, not a clotting defect.
19.
A. False They form shortly after birth, possibly in response to A and B antigens
carried
into the body by invading bacteria.
B. False They cause agglutination (clumping) of A, B and AB cells.
C. True Unlike Rh antibodies which have a smaller molecular size.
D. True Around 1000000.
E. False They are divalent and hence cause red cells to adhere to one another during
agglutination.
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20.
A. True Derived from plasma proteins leaked from capillaries into the tissues; it
returns
these to the blood.
B. False Lymph vessels are involved in the uptake and transport of absorbed fat.
C. True Increased capillary pressure due to muscle vasodilatation increases tissue
fluid
formation.
D. False It contains lymphocytes derived from lymph nodes.
E. True In addition, intrinsic rhythmic contractions in lymphatics help to propel
lymph.
21.
A. True They are formed from megalokaryocytes.
B. True By a factor of 20 or more.
C. False No nucleus – but the cytoplasm contains electron dense granules, lysosomes
and
mitochondria.
D. True This increases the tendency of blood to clot.
E. True They put out pseudopodia and adhere to the collagen and to one another.
22.
A. False It is effected by thrombin; prothrombin is the inactive precursor of thrombin.
B. True Thrombin breaks off the solubilizing end groups.
C. True Polymerized fibrin monomers form the strands of the clot meshwork.
D. True This is a rapidly acting anticoagulant.
E. False Plasmin does not convert fibrin back to fibrinogen, it degrades both fibrin
and
fibrinogen to products which can inhibit thrombin.
23.
A. False It affects babies of Rh-negative mothers when the child’s red cell
membranes
carry the D antigen.
B. False It occurs in Rh-positive babies.
C. False The jaundice deepens rapidly after birth as bilirubin is no longer excreted by
the
maternal liver.
D. False This would be attacked by maternal Rh antibodies in the infant’s blood;
Rhnegative
blood is given.
E. True These destroy fetal Rh-positive cells in the maternal circulation before such
cells
can sensitize her to D antigen.
24.
A. False If the normal percentage of plasma in centrifuged blood is about 55 per cent.
B. True If the plasma is cloudy or even milky.
C. True If the plasma is yellow.
D. True If the plasma is red.
E. True If the buffy coat is greatly thickened.
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25.
A. False Output rises to compensate for the blood’s reduced O2 carrying capacity.
B. False Bruits are common since increased flow velocity and decreased blood
viscosity
increase the likelihood of turbulent flow.
C. False 2:3-DPG is increased, shifting the dissociation curve to the right so that
blood
gives up its oxygen more easily.
D. False Arterial PO2 is normal; it is O2 content which is reduced.
E. True Due to the reduced capacity to deliver O2 to the muscles.
26.
A. True Especially if dietary intake of iron is limited.
B. False It is more common in women due to menstrual blood loss.
C. False It causes anaemia by limiting the rate of haemoglobin synthesis.
D. False In iron deficiency anaemia, RBCs are small and pale due to lack of
haemoglobin.
E. False Oral iron is avidly absorbed in iron deficiency states.
27.
A. True The recipients have anti-A antibody.
B. False Group O people are ‘universal donors’.
C. True The recipients have anti-A antibody.
D. False Group AB persons, ‘universal recipients’, lack anti-A and anti-B antibodies.
E. False The recipients lack anti-A, anti-B and anti-Rh antibodies.
28.
A. True Since red cells are heavier than plasma.
B. True This gives a slightly lower value than centrifugation which traps a little
plasma
between cells.
C. True Due to loss of plasma and interstitial fluid.
D. False It falls as extracellular fluid and hence plasma volume increases.
E. False Though individual RBCs are large, total red cell mass is decreased.
29.
A. False Healthy normal people do not benefit from vitamin B12 supplements.
B. True The RBC deficit is corrected by bone marrow stimulation by erythropoietin.
C. True The reduced oxygen carrying capacity of the blood causes release of
erythropoietin
which stimulates RBC stem cells in the bone marrow.
D. True The anaemia seen in nephrectomized patients is due largely to lack of
erythropoietin.
E. True A raised reticulocyte count is evidence of a hyperactive bone marrow.
30.
A. True The B12/intrinsic factor complex is absorbed in the terminal ileum.
B. False Lack of B12 results in a macrocytic hyperchromic anaemia.
C. False Gastric mucosa atrophy is a cause, not an effect, of B12 lack; gastric mucosa
normally
produces the ‘intrinsic factor’ required for B12 absorption.
D. True B12 is used in the DNA synthesis required by platelet precursor cells.
E. True Maintenance of myelin in neural sheaths also depends on vitamin B12.
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31.
A. True T lymphocytes are responsible for tissue rejection.
B. False This environment may be necessary because of suppression of the recipient’s
immune responses; it has no bearing on the rejection process.
C. False This would not affect the transplant antigens.
D. True These suppress the multiplication of lymphocytic stem cells.
E. True Identical twins have identical antigens and do not reject each other’s tissues.
32.
A. True Granulocytes are formed in the bone marrow.
B. False Production of neutrophils increases following tissue damage.
C. True Neutrophils are not available to kill bacterial invaders.
D. False There will not be much pus since pus consists mainly of dead neutrophils.
E. False These suppress lymphocytes and eosinophils.
33.
A. True Due to excessive reabsorption of water from the collecting ducts of the
nephron.
B. False Water is drawn into cells from the hypotonic extracellular fluid; water
intoxication
may occur.
C. True People sweating heavily may replace their water, but not their salt, deficit;
they
tend to get muscle cramps unless they supplement their salt intake.
D. True Sodium ions are responsible for nearly half of plasma osmolality.
E. False The hypothalamic osmoreceptors responsible for thirst respond to
hypertonicity,
not hypotonicity of the ECF.
34.
A. False Clotting time is increased, but bleeding time is determined by platelets and
by
vascular contraction.
B. False It is due to a recessive abnormality of the X chromosome.
C. False Abnormal bleeding does not occur until the level falls below 50 per cent.
D. False Purpura is caused by capillary or platelet disorders.
E. False It affects the intrinsic pathway.
35.
A. False Lymphocytes are more involved than neutrophils with immunity.
B. False The CD4 (or T4) count is a major indicator and falls markedly as AIDS
progresses.
C. False Viral reverse transcriptase incorporates viral RNA into host DNA.
D. True In contrast to genetic immune disorders such as X-linked
hypogammaglobulinaemia.
E. True The normal immune system suppresses such tumours.
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CARDIOVASCULAR SYSTEM
Part One
1. Which of the following is part of the reflex response to an increase in arterial
pressure?
a) Decreased firing of carotid sinus baroreceptors
b) Increased sympathetic activity to the ventricles
c) Increased parasympathetic activity to the SA Node
d) Increased parasympathetic activity to the arterioles of skeletal muscles &
skin
e) Increased parasympathetic stimulation to the ventricles
2. Correct sequences of steps in short-term compensation for hemorrhage
include:
a) Decreased arterial pressure  Increased baroreceptor firing rate
b) Increased formation of Angiotensin II  Increased renin released by
kidneys
c) Decreased excretion of Na+ and water  Increased aldosterone formation
d) Decreased firing of baroreceptors  Increased sympathetic activity
e) Decreased atrial volume  Increased volume receptor firing rate
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
4. The nerve supply to the heart is as follows:
a) SA Node is innervated by sympathetic only
b) Atrial muscle is innervated by both sympathetic & parasympathetic
c) Right vagus supplies SA node & AV node
d) Left vagus supplies SA node
e) Parasympathetic supplies ventricular muscle
5. Which of the following is not a characteristic of cardiac muscle?
a) It's a syncytium of muscle fibers
b) There are intercalated discs
c) Gap junctions cause spread of depolarization
d) Has myosin and actin muscles
e) There are paracellular spaces
6. The pacemaker prepotential:
a) Is due to a slow decrease in K+ influx
b) Is a slow increase in Resting Membrane Potential
c) Maintained by opening of long acting Ca2+ channels
d) Is augmented by opening of transient Ca2+ channels
e) Occurs only in the SA node
7. Parasympathetic stimulation results in:
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a) Decreases K+ efflux in cardiac muscle
b) Increases Ca2+ influx in SA node
c) Bradycardia
d) Increases Na+ influx
e) Increasing slope of prepotential
8. Which of the following is true of the electrical activity of cardiac muscle?
a) Increased extracellular K+ causes depolarization
b) Repolarization is due to Na+ current
c) Extracellular Na+ affects the pacemaker potential
d) Plateu of action potential is due to Ca2+ influx
e) Initial repolarization is due to delayed K+ efflux
9. The conductive system of the heart does not include:
a) Internodal pathways
b) Bundle of His & its branches
c) Purkinje system of fibers
d) Interventricular septum
e) AV node
10. Which of the following is not true of the ECG?
a) Needs six pairs of electrodes
b) Is useful in detection of arrhythmias
c) It is recorded from limb leads
d) Its amplitude indicates the mass of cardiac muscle
e) The PR interval indicates strength of contraction
11. In a normal ECG:
a) The P wave indicates the condition of the conductive system
b) The P wave represents depolarization of atrial myocardium
c) QRS complex is mainly negative due to spread of depolarization down
d) QRS is due to depolarization in the ventricular septum
e) The T wave is a positive wave in all chest leads
12. Which of the following is true of the cardiac cycle?
a) Ventricular diastole follows atrial systole
b) Ventricular systole causes an immediate rise in aortic pressure
c) The beginning of systole causes closure of AV valves
d) Closure of semi-lunar valves gives rise to first heart sound
e) Isovolumetric relaxation occurs at the end of diastole
13. In the atrial pressure wave:
a) The maximum pressure is about 12 mmHg
b) Pressure remains constant while AV valves are closed
c) The C wave is due to bulging of AV valve during ventricular filling
d) The V wave is due to filling of the ventricles
e) The A wave is due to atrial systole
14. Protodiastole:
a) Is characterized by a rapid rise in aortic pressure
b) Occurs at the onset of diastole
c) Is a period in the cardiac cycle with constant blood pressure
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d) Is the last one-third of diastole
e) Is a period of slow ejection from the ventricles
15. Which of the following statements is true of the heart sounds?
a) The first sound is of high pitch
b) The first sound is of longer duration than the second
c) They are produced by abnormal valves
d) The second sound is heard best at the apex
e) The second sound is due to the closure of AV valves
16. Pressure in the pulmonary artery is:
a) Higher than that in the right atrium
b) About 25 mmHg during systole
c) About 80 mmHg during diastole
d) Is lower than that in the right ventricle
e) Is regulated by parasympathetic innervation
17. The following is not correct about baroreceptors:
a) Found in the wall of carotid sinuses
b) Found in the aortic arch
c) Monitor pressure in the arterial system
d) Send impulses through the glosso-pharyngeal nerve
e) Normally fires during late systole
18. Chemoreceptors are:
a) Found in aortic and carotid sinuses
b) Stimulated best by hypercapnoea
c) Send impulses to vasomotor center through vagus nerve
d) Have a high blood flow rate
e) Are not sensitive to hydrogen ion concentration
19. At rest the LV end-systolic volume is:
a) 10 mL
b) 30 mL
c) 50 mL
d) 120 mL
e) 140 mL
20. The best site to measure mixed venous PO2 is:
a) Superior Vena Cava
b) Right Atrium
c) Pulmonary Artery
d) Pulmonary Vein
e) Left Ventricle
21. The atrial contraction component of ventricular filling is:
a) 5%
b) 10%
c) 30%
d) 50%
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e) 80%
22. The lowest intrinsic discharge activity resides in the:
a) SA Node
b) AV Node
c) Bundle of His
d) Bundle of branches
e) Purkinje fibers
23. The highest oxygen extraction is found in the:
a) Resting skeletal muscles
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
26. The velocity of blood flow is the slowest in:
a) Capillaries
b) Pulmonary vein
c) Small arteries
d) Inferior Vena Cava
e) Arterioles
27. The volume of blood is greatest in:
a) Systemic capillaries
b) Veins
c) Arteries
d) The spleen
e) The heart
28. Which of the following results in increased stroke volume?
a) An increase in end-diastolic volume
b) An increased after-load
c) Parasympathetic stimulation
d) An increase in the heart rate
e) Venodilation
29. During the cardiac cycle, closure of the aortic valve occurs at:
a) The end of isovolumetric contraction
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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
30. SA node is the pacemaker of the heart because:
a) Location in the right atrium
b) Neural control
c) Natural leakiness to Cld) Natural leakiness to K+
e) Fastest rate of discharge
31. Stroke Volume:
a) Is the volume of blood pumped by the heart per minute
b) Decreases by increased end-diastolic volume
c) Is decreased by increased afterload
d) From the left ventricle is more than from the right ventricle
e) Multiplied by heart rate gives cardiac index
32. In the ECG, the T wave denotes:
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
c) Mean Arterial Pressure
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
35. Absolute refractory period of the heart:
a) Corresponds to the duration of relaxation
b) Lasts till half of cardiac contraction
c) Shorter than refractory period in skeletal muscle
d) Lasts till cardiac contraction
e) The heart can be stimulated by very strong stimulus
36. First heart sound occurs at the beginning of:
a) Isometric relaxation
b) Isotonic relaxation
c) Isovolumetric contraction
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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
c) Initial length of cardiac muscle
d) Respiratory rate
e) Vagal stimulation
38. Cardiac muscle has a long refractory period because:
a) The impulse takes about 0.2 s to travel from SA to AV node
b) It obeys the all-or-none law
c) Of the delay in Na+ influx
d) Of Ca2+ influx
e) Is more permeable to K+
39. Stimulation of baroreceptors leads to:
a) Tachycardia
b) Increased stroke volume
c) Stimulation of vasomotor center
d) Vasoconstriction
e) Decreased arterial blood pressure
40. The fourth heart sound is due to:
a) Closure of mitral and tricuspid valve
b) Iso-volumetric contraction
c) Iso-volumetric relaxation
d) Ventricular filling
e) Atrial systole
41. Frank Straling's law of the heart:
a) Explains the tachycardia caused by increased venouse return
b) Explains the tachycardia of exercise
c) Does not operate when the person is at rest
d) Explains the increased venous return when end-diastolic volume is
increased
e) Explains the increased stroke volume when end-diastolic volume is
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
b) Stroke volume is less
c) Preload is less
d) Afterload is less
e) Systolic pressure is less
43. The following are not signs of pure right ventricular failure:
a) Increased central venous pressure
b) Central venous engorgement and pulsations
c) Pulmonary oedema
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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
45. The heart rate is increased by all the following except:
a) Fever
b) Increased venous return
c) Atropine
d) Hypothyroidism
e) Adrenaline
46. Stroke Volume:
a) Increases as a result of increased afterload
b) Equals end-diastolic volume minus end-systolic volume
c) Increases as heart rate is increased by electrical pacing
d) Is increased by parasympathetic stimulation
e) Is increased by Ca2+ channel blocks
47. A drug that increases the heart rate from 70 to 100 beats per minute could
be:
a) Stimulation of B-1 adrenergic receptors
b) Inhibitor of alpha adrenergic receptors
c) Stimulation of muscarinic cholinergic receptors
d) Inhibitor B-2 adrenergic receptors
e) Digitalis
48. A high preload is indicated by:
a) Blood volume
b) Pulmonary pressure
c) End-diastolic volume
d) Systolic blood pressure
e) Diastolic blood pressure
49. Regurgitation of aortic valve leads to:
a) A decrease in diastolic pressure
b) A decrease in oxygen-consumption by the ventricles
c) A decrease in heart rate
d) A systolic murmur
e) A decreased end-systolic volume
50. Which of the following results in a decreased stroke volume?
a) An increase in end-diastolic volume
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b) An increased afterload
c) Parasympathetic stimulation
d) A decrease in total peripheral resistance
e) Increased residual volume
51. An increase in pulse pressure can be caused by:
a) Parasympathetic stimulation
b) Generalized vasodilation
c) Severe hemorrhage
d) Aortic stenosis
e) Heart failure
52. On assuming the upright posture, one would expect:
a) Stimulation of Renin-angiotensin system
b) Increased pulmonary artery pressure
c) A decrease in pulse rate
d) Venodilation
e) An increase in renal blood flow
53. Central venous pressure increases:
a) In hypovolaemia
b) By sympathetic stimulation
c) When total peripheral resistance increases
d) When the cardiac output decreases
e) With increased sodium loss
54. Infusion of nor-adrenaline is expected to produce:
a) A decrease in firing-rate of baroreceptors
b) A reflex brachycardia
c) A decrease in total peripheral resistance
d) Increased myocardial contractility due to B2 receptors
e) An increase in cardiac output
55. Stroke volume is decreased when:
a) The sympathetic nerves are stimulated
b) The arterial blood pressure falls
c) Vagal centers are stimulated
d) The end-diastolic volume is increased
e) A patient stands up
56. Generalized vasoconstriction may be produced by:
a) Exposure to heat
b) Parasympathetic stimulation
c) An increase in vasomotor tone
d) When the depressor center is stimulated
e) An exposure to a large dose of histamine
57. Arterial vasoconstriction in a limb leads to:
a) An increase in capillary pressure
b) A decrease in arteriovenous oxygen difference
c) Diminished filteration in capillary bed
d) An increase in blood pH leaving the limb
e) Venoconstriction
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58. Which of the following is the most important in determining the total
peripheral resistance?
a) Blood viscosity
b) Concentration of plasma protein
c) Arteriolar diameter
d) Cardiac Output
e) Metabolic autoregulation
59. Venodilation at rest leads to:
a) A decrease in venous return
b) A drop in arterial blood pressure
c) Flushing of the skin
d) A decrease in peripheral resistance
e) Increased capillary fluid exchange
60. Stroke Volume:
a) Is normally about 90mL
b) Depends on Bainbridge reflex
c) Decreases when the heart rate increases
d) Increases when the end-diastolic volume increases
e) Is mainly controlled by vagal fibers
61. Starling's Law of the heart describes the relationship between:
a) The heart rate and stroke volume
b) The end-diastolic volume cardiac output
c) The blood pressure and heart rate
d) The initial length of cardiac muscle fibers and force of contraction
e) Sympathetic stimulation stroke volume
62. Increased pressure in the carotid sinus leads to:
a) An increase in vasomotor tone
b) Increase in vagal tone
c) Reflex vasoconstriction
d) Venoconstriction
e) Tachycardia
63. In the jugular pulse wave the wave "C":
a) Occurs before the "a" wave
b) Is due to atrial systole
c) Closure of the atrioventricular valve
d) Co-asides with the atrial pulse wave
e) Is due to bulging of tricuspid valves
64. The first heart sound:
a) Is due to vibrations in the aorta on closure of the semilunar valves
b) Is caused by closure of tricuspid valve
c) Occurs at the end of isometric contraction of the ventricle
d) Is caused by closure of both atrioventricular valves
e) Is short of high pitch
65. The Cardiac output is:
a) The volume of blood pumped by the heart in one minute
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b) Equal to the heart rate multiplied by the stroke volume
c) Measured by dilution method
d) Increased on standing up
e) Greater in left ventricle than the right
66. The chemoreceptors are found in:
a) The lungs
b) Glomus bodies
c) Aortic arch
d) Carotid sinus
e) Medulla
67. Local vasodilation can be produced by:
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
c) Moderate rise in environmental temperature
d) A 10 degree rise in body temperature
e) Pregnancy
69. Regarding the cardiac cycle which of the following is incorrect?
a) The first heart sound occurs at the start of isovolumetric contraction
b) The "v" wave of atrial pressure occurs during diastole
c) The third heart sound occurs during ventricular diastole
d) The second heart sound occurs in late systole
e) Ventriculor systole continues after the end of the ECG wave
70. The Frank-Starling law explains all the following except:
a) Increase in cardiac with increase in venous return
b) Maintenance of stroke volume in the phase of increased afterload
c) Matching left ventricular output with right ventricular output
d) The increased contractility induced by sympathetic stimulation
e) The normal cardiac output in hypertensive patients
71. 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
72. Excitation of the ventricles:
a) Proceeds from the subendocardium to the subpericardium
b) Leads to excitation of the atria
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c) Results from the action of norepinephrine on ventricular muscle
d) Occurs 2.2 seconds following atrial excitation
e) Results from pacemaker potentials in ventricular cells
73. AV nodal cells:
a) Exhibit action potentials characterized by rapid depolarization
b) Conduct impulses more slowly than either atrial or ventricular cells
c) Are capable of pacemaker activity at an intrinsic rate of 100 beat per minute
d) Exhibit increased permeability to Na+ during the prepotntial
e) Show a steep pre-potential when exposed to acetylcholine
74. Stroke Volume:
a) Increases as a result of increased afterload
b) Equals end-diastolic volume minus end-systolic volume
c) Increases as the heart rate is increased by electrical pacing
d) Is increased by parasympathetic stimulation
e) Is increased by Ca-channel blockers
75. Coronary blood flow of the left ventricle:
a) Is mainly regulated by sympathetic supply to coronary arterioles
b) Increases when sympathetic nerves to the heart are blocked
c) Is highest during systole because of myocardial activity
d) Increases when myocardial metabolism increases
e) All of the above are correct
76. The strength of myocardial contraction:
a) Increases as a result of increased afterload
b) Equals end-diastolic volume minus end-systolic volume
c) Increases as heart rate increases by electrical pacing
d) Is increased by parasympathetic stimulation
e) Is increased by calcium channel blockers
77. Increased arterial blood pressure leads to:
a) Decreased firing of carotid sinus baroreceptors
b) Increased sympathetic activity to the ventricles
c) Increased parasympathetic activity to the sinoatrial node
d) Increased parasympathetic activity to arterioles of skeletal muscles and skin
e) Increased parasympathetic stimulation to the ventricles
78. Which of the following is likely to cause postural hypotension?
a) Drugs that block muscarinic cholinergic receptors
b) Decreased firing rate of baroreceptors while standing
c) Exposure to cold environment
d) Drugs that block cholinergic receptors in skeletal muscle vessels
e) Drugs that activates cholinergic receptors in autonomic ganglia
79. Stimulation of parasympathetic nerves to the heart:
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
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80. The prepotential of the pacemaker is mainly due to:
a) Calcium influx in the early phase
b) Increased K+ efflux
c) Increased chloride influx
d) Decreased K+ efflux
e) Decreased Na+ influx
81. The vessels responsible for regulation of blood pressure:
a) Medium-size arteries
b) Small veins
c) Capillaries
d) Venules
e) Arterioles
82. The advantage of the Starling mechanism in the heart is to:
a) Decrease fluid loss from the cardiac capillaries
b) Ensure that the ventricles operate at an optimum length
c) Couple the efficiency of muscle contraction to the heart rate
d) Match the output of one ventricle to that of the other
e) Ensure that the right and left arterial pressure are equal
83. An increase in arterial pulse pressure is observed in association with:
a) Exposure to cold
b) An increased peripheral resistance
c) Hypothyroidism
d) An increased vagal activity
e) Muscular exercise
84. A decrease in carotid sinus pressure would lead to a decrease in:
a) Heart rate
b) Myocardial contractility
c) Total peripheral resistance
d) Capacity of venous system
e) Cardiac output
85. In the ECG, the QRS wave is due to:
a) Atrial contraction
b) Atrial depolarization
c) Ventricular depolarization
d) SA node depolarization
e) Ventricular contraction
86. In the ECG, the P wave denotes:
a) Atrial contraction
b) Atrial depolarization
c) Ventricular repolarization
d) SA node depolarization
e) Ventricular contraction
87. Stimulation of sympathetic nerves to the heart:
a) Causes tachycardia via alpha-adrenergic receptors
b) Makes the prepotential more horizontal
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c) Decreases the rate of potassium efflux in the SA node
d) Prolongs the nodal delay
e) Has no effect on the duration of the cardiac cycle
88. Concerning the heart sounds:
a) The first heart sound is due to closure of the atrioventricular valves
b) The second heart sound is due to opening of the aortic and pulmonary
valves
c) The third heart sound is due to atrial systole
d) The first heart sound occurs at the beginning of the isovolumetric relaxation
phase
e) The second heart sound is followed by isovolumetric contraction phase
89. In the normal ECG the duration of PQ interval is usually:
a) 0.10 sec
b) 0.15 sec
c) 0.30 sec
d) 0.45 sec
e) 0.60 sec
90. Starling's Law of the heart:
a) States that at a given end-diastolic pressure, norepinephrine increases the
volume
b) States that increased end-diastolic volume leads to an increased stroke
volume
c) Is primarily the result of changes in the firing rate of sympathetic nerves to
the ventricles
d) Is independent of the venous return
e) Describes the myocardial response to an increased heart rate
91. In the heart, transmission of impulses is fastest in:
a) Atrial muscles
b) Bundle of His
c) Ventricular muscles
d) Purkinje fibers
e) AV nodal fibers
92. The force of contraction of cardiac muscle is a function of:
a) Initial muscle length
b) Body temperature
c) Duration of the action potential
d) End-systolic volume
e) Number of impulses that reach the muscle cell per unit time
93. The second heart sound occurs:
a) During protodiastole
b) During isovolumetric relaxation
c) During isovolumetric contraction
d) 0.5 seconds after the first heart sound
e) At the peak of ejection period
94. The P wave of the ECG:
a) Occurs during rapid atrial inflow
b) Follows the "a" wave of atrial pressure
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c) Is essential for development of normal QRS complex
d) Occurs during ventricular diastole
e) Is prominent in atrial fibrillaton
95. Which is true of cardiac muscle:
a) All cardiac muscle cells have pacemaker potentials
b) The rate of cardiac muscle contraction is always set by nerves to the heart
c) Impulses spread easily from one muscle cell to another
d) Cardiac muscles look smooth under the microscope
e) Cardiac muscles have relatively short refractory periods compared to
skeletal muscles
96. Stimulation of the right vagus nerve:
a) Increases the heart rate
b) Increases arterial blood pressure
c) Has a reduced effect after administration of physostigmine
d) Has a reduced effect after administration of atropine
e) Has a reduced effect after administration of prornaolol
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
98. Which of the following are not innervated by sympathetic nerves?
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
100. Resistance to venous return:
a) Is higher during exercise than at rest
b) Equals to the slope of the venous return curve
c) Is reduced by sympathetic stimulation
d) Increases by increase in circulatory filling pressure
e) Increased by constriction of arterioles
101. Closure of the aortic valve occurs at:
a) The end of isovolumetric contraction
b) The beginning of isometric relaxation
c) The end of systole
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d) The end of rapid filling phase
e) The beginning of rapid ejection phase
102. An increase in the pulse pressure can be caused by:
a) Parasympathetic stimulation
b) Generalized vasodilation
c) Sympathetic stimulation
d) Venodilation
e) Heart failure
103. The contribution of atrial contraction to ventricular filling is greatest:
a) When sympathetic stimulation is pronounced
b) At rapid heart rates
c) When atria and ventricles contract simultaneously
d) During atrial fibrillation
e) During bradycardia
104. The baroreceptor reflex mainly regulates:
a) Stroke volume
b) Heart rate
c) Mean arterial blood pressure
d) Systolic blood pressure
e) Diastolic blood pressure
105. Which of the following is a characteristic of cardiac muscle?
a) It has a long refractory period compared to skeletal muscle
b) There are electrical synapses
c) Gap junctions cause limitation of depolarization
d) Has myosin but no actin molecules
e) There are para cellular spaces
106. Factors affecting the strength of ventricular muscle include:
a) Parasympathetic inhibition
b) The length of muscle fibers
c) The length of plateau phase
d) Sympathetic stimulation
e) End-systolic volume
107. Stimulation of parasympathetic supply to the heart results in:
a) Decrease K+ efflux in cardiac muscle
b) Increases Ca2+ influx in SA node
c) Increased delay in AV node
d) An increase in Cl- influx
e) Opening of sodium channel
108. The following increase the cardiac output except:
a) Sympathetic stimulation
b) Venodilation
c) Fever
d) Anemia
e) Exercise
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109. The cardiac output is increased:
a) By stimulation of sympathetic beta-1 receptors
b) Increased impedance in the aortic arch
c) By high pressure in the arterial system
d) By impulses through the glosso-pharygeal nerve (ix)
e) In hypothyroidisim
110. Ventricular Depolarization:
a) Follows immediately after the closure of atrioventricular valves
b) Occurs during mid systole
c) Depends on sympathetic stimulation
d) Occurs 0.2 sec following atrial excitation
e) Results from pacemaker cells in ventricular cells
111. The isovolumetric relaxation phase of the ventricles:
a) Is associated with rapid filling
b) Occurs during late diastole
c) Ends by opening of the atrioventricular valves
d) Results in falling of ventricular pressure by about 10 mmHg
e) Is marked by the first heart sound
112. Factors that increase the stroke volume include:
a) An increased afterload
b) A high end-diastolic volume
c) An increased heart rate
d) Parasympathetic stimulation
e) Ca2+ channel blockers
113. After a loss of one liter of blood:
a) The heart rate decreases slightly
b) Baroreceptors increase their discharge
c) The chemoreceptors have no role
d) The end diastolic volume increases
e) There is increased vasomotor tone
114. A large infarct affecting the left ventricle causes:
a) Pulmonary capillary hydrostatic pressure to decrease
b) Left ventricular end systolic pressure to increase
c) Heart rate to decrease
d) The systolic blood pressure to decrease
e) Congestion of the liver
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
116. Conduction velocity of cardiac impulse is slowest in:
a) Atrial myocardial fibers
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b) AV nodal fibers
c) Purkinje fibers
d) Ventricular myocardial fibers
e) His bundle fibers
117. The contribution of atrial contraction to ventricular filling is greatest:
a) When vagal activity is pronounced
b) At rapid heart rates
c) When atria and ventricles contract simultaneously
d) During atrial fibrillation
e) Early during ventricular diastole
118. The most important function of the Starling mechanism in the heart is:
a) To decrease fluid loss from the cardiac capillaries
b) To ensure that the ventricles operate at an optimum length
c) To couple the efficiency of muscle contraction to the heart rate
d) To match the output of one ventricle to that of the other
e) To ensure that right and left atrial pressures are equal
119. The highest coronary blood flow occurs:
a) Early during systole
b) When the left ventricular pressure is high
c) At the beginning of isovolumetric contraction
d) Towards the end of ventricular diastole
e) At the beginning of diastole
120. Which of the following results in an increased stroke volume?
a) An increase in end-diastolic volume
b) An increased afterload
c) Parasympathetic stimulation
d) An increase in the heart rate
e) Venodilation
CARDIOVASCULAR SYSTEM
Part Two
Questions:
1. Coronary blood flow to the left ventricle increases during
A. Early systole.
B. Myocardial hypoxia.
C. Hypothermia.
D. Stimulation of sympathetic nerves to the heart.
E. Arterial hypertension.
2. Local metabolic activity is the chief factor determining the rate of blood
flow to the
A. Heart.
B. Skin.
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C. Skeletal muscle.
D. Lung.
E. Kidney.
3. The pressure
A. Drop along large veins is similar to that along large arteries.
B. Drop across the hepatic portal bed is similar to that across the splenic vascular bed.
C. In the hepatic portal vein exceeds that in the inferior vena cava.
D. Drop across the vascular bed in the foot is greater when a subject is in the vertical
than
when he is in the horizontal position.
E. In foot veins is lower when walking than when standing still.
4. The second heart sound differs from the first heart sound in that it is
A. Related to turbulence set up by valve closure.
B. Longer lasting than the first sound.
C. Higher in frequency.
D. Occasionally split.
E. Heard when the ventricles are relaxing.
5. Pulmonary vascular resistance is
A. Less than one-third that offered by the systemic circuit.
B. Decreased when alveolar oxygen pressure falls.
C. Expressed in units of volume flow per unit time per unit pressure gradient.
D. Decreased during exercise.
E. Regulated reflexly by sympathetic vasoconstrictor nerves.
6. Ventricular filling
A. Depends mainly on atrial contraction.
B. Begins during isometric ventricular relaxation.
C. Gives rise to a third heart sound in some healthy people.
D. Can occur only when atrial pressure is greater than atmospheric pressure.
E. Is most rapid in the first half of diastole.
7. Veins
A. Contain most of the blood volume.
B. Have a sympathetic vasoconstrictor innervation.
C. Receive nutrition from vasa vasorum arising from their lumen.
D. Respond to distension by contraction of their smooth muscle.
E. Undergo smooth muscle hypertrophy when exposed to high pressure through an
arteriovenous
fistula.
8. In the heart
A. The left atrial wall is about three times thicker than the right atrial wall.
B. Systolic contraction normally begins in the left atrium.
C. Excitation spreads directly from atrial muscle cells to ventricular muscle cells.
D. Atrial and ventricular muscle contracts simultaneously in systole.
E. The contracting ventricles shorten from apex to base
.
9. Isometric (static) exercise differs from isotonic (dynamic) exercise in that
it causes a greater increase in
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A. Venous return.
B. Pressure in the veins draining the exercising muscle.
C. Muscle blood flow.
D. Mean arterial pressure.
E. Cardiac work for the same increase in cardiac output.
10. The net loss of fluid from capillaries in the legs is increased by
A. Arteriolar dilation.
B. Change from the recumbent to the standing position.
C. Lymphatic obstruction.
D. Leg exercise.
E. Plasma albumin depletion.
11. When measuring blood pressure by the auscultatory method
A. The sounds that are heard are generated in the heart.
B. The cuff pressure at which the first sounds are heard indicate systolic pressure.
C. The cuff pressure at which the loudest sounds are heard indicate diastolic pressure.
D. Systolic pressure estimations tend to be lower than those made by the palpatory
method.
E. Wider cuffs are required for larger arms.
12. The absolute refractory period in the ventricles
A. Is the period when the ventricles are completely inexcitable.
B. Corresponds to the period of ventricular depolarization.
C. Corresponds approximately to the period of ventricular contraction.
D. Is shorter than the corresponding period in atrial muscle.
E. Decreases during sympathetic stimulation of the heart.
13. Vascular resistance
A. Increases by 50 per cent when the vascular radius is halved.
B. Is related to the thickness of the wall of the vessel.
C. Is related to the vessel’s length.
D. Is affected by blood viscosity.
E. Is greater in the capillary bed than in the arteriolar bed.
14. Sympathetic drive to the heart is increased
A. In exercise.
B. In excitement.
C. In hypotension.
D. When parasympathetic drive is decreased.
E. During a vasovagal attack.
15. In an adult subject standing quietly at rest, venous pressure in the
A. Foot is approximately equal to arterial pressure at heart level.
B. Thorax decreases when the subject inhales.
C. Hand is subatmospheric when the hand is raised above the head.
D. Venous sinuses of the skull are subatmospheric.
E. Superior vena cava is an index of cardiac filling pressure.
16. Hyperaemia in skeletal muscle during exercise is normally associated with
A. Release of sympathetic vasoconstrictor tone in the exercising muscles.
B. Capillary dilation due to relaxation of capillary smooth muscle.
C. A fall in arterial pressure.
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D. Reflex vasoconstriction in other vascular beds.
E. An increase in cardiac output.
17. Sinuatrial node cells are
A. Found in both atria.
B. Innervated by the vagus.
C. Unable to generate impulses when completely denervated.
D. Connected to the AV node by fine bundles of Purkinje tissue.
E. Able to generate impulses because their membrane potential is unstable.
18. The first heart sound corresponds in time with
A. Closure of the aortic and pulmonary valves.
B. The P wave of the electrocardiogram.
C. A rise in atrial pressure.
D. A rise in ventricular pressure.
E. The A wave in central venous pressure.
19. Increased sympathetic drive to the heart increases the
A. Rate of diastolic depolarization in sinuatrial node cells.
B. Coronary blood flow.
C. Rate of conduction in Purkinje tissue.
D. Slope of the Frank–Starling (work versus stretch) curve of the heart.
E. Ejection fraction of the left ventricle.
20. The velocity of blood flow
A. In capillaries is low because they offer high resistance to flow.
B. In veins is greater than in venules.
C. Can fall to zero in the ascending aorta during diastole.
D. Is greater towards the centre of large blood vessels than at the periphery.
E. In the circulation falls as the haematocrit falls.
21. The strength of contraction of left ventricular muscle increases when
A. End-diastolic ventricular filling pressure rises.
B. Serum potassium levels rise.
C. Blood calcium levels fall.
D. Strenuous exercise is undertaken.
E. Peripheral resistance is increased as in hypertension.
22. During isometric ventricular contraction
A. The entry and exit valves of the ventricle are closed.
B. Pressure in the aorta rises.
C. Pressure in the atria falls.
D. Left coronary blood flow falls.
E. The rate of rise in pressure is greater in the right than in the left ventricle.
23. In the electrocardiogram, the
A. QRS complex follows the onset of ventricular contraction.
B. T wave is due to repolarization of the ventricles.
C. PR interval corresponds with atrial depolarization.
D. RT interval is related to ventricular action potential duration.
E. R-R interval normally varies during the respiratory cycle.
24. Cardiac output
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A. Is normally expressed as the output of one ventricle in litres/minute.
B. May not increase when heart rate rises.
C. Usually rises when a person lies down.
D. Rises in a hot environment.
E. Does not increase in exercise following denervation of the heart.
25. Arterioles
A. Have a smaller wall:lumen ratio than have arteries.
B. Play a major role in regulating arterial blood pressure.
C. Play a major role in regulating local blood flow.
D. Offer more resistance to flow than capillaries.
E. Have a larger total cross-sectional area than do the capillaries.
26. The Purkinje tissue cells in the heart
A. Conduct impulses faster than some neurones.
B. Are larger than ventricular myocardial cells.
C. Lead to contraction of the base before the apex of the heart.
D. Are responsible for the short duration of the QRS complex.
E. Are responsible for the configuration of the QRS complex.
27. In the brachial artery
A. Pulse waves travel at the same velocity as blood.
B. Pulse pressure falls with decreasing elasticity of the wall.
C. Pressure rises markedly when the artery is occluded distally.
D. Pressure falls when the arm is raised above head level.
E. Pulse pressures have a smaller amplitude than aortic pulse pressures.
28. The tendency for blood flow to be turbulent increases when there is a
decrease in blood
A. Vessel diameter.
B. Density.
C. Flow velocity.
D. Viscosity.
E. Haemoglobin level.
29. Arterioles offer more resistance to flow than other vessels since they have
A. Thicker muscular walls.
B. Richer sympathetic innervation.
C. Smaller internal diameters.
D. A smaller total cross-sectional area.
E. A greater pressure drop along their length.
30. In the denervated heart, left ventricular stroke work increases when
A. The end-diastolic length of the ventricular fibres increases.
B. Peripheral resistance rises.
C. Blood volume falls.
D. Right ventricular output increases.
E. The veins constrict.
31. With increasing distance from the heart, arterial
A. Walls contain relatively more smooth muscle than elastic tissue.
B. Flow has a greater tendency to be turbulent.
C. Mean pressure tends to rise slightly.
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D. Pulse pressure tends to increase slightly.
E. PO2 falls appreciably.
32. In the estimation of cardiac output by an indicator dilution technique, the
A. Indicator must mix evenly with the entire blood volume.
B. Primary dilution curve may be followed by a secondary rise in indicator
concentration.
C. Duration of the dilution curve shortens as cardiac output rises.
D. Mean indicator concentration under the curve increases as cardiac output rises.
E. Injection and monitoring devices may be placed in the pulmonary artery.
33. In the estimation of cardiac output using the Fick principle
A. Pulmonary blood flow is measured.
B. The PO2 of arterial and mixed venous blood are measured.
C. Oxygen uptake is estimated from alveolar PO2 measurements.
D. Pulmonary arterial blood is sampled to measure the oxygen in mixed venous
blood.
E. Pulmonary venous blood is sampled to measure the oxygen in arterial blood.
34. Intravenous infusions of adrenaline and noradrenaline have similar
effects on
A. Skeletal muscle blood flow.
B. Renal blood flow.
C. Skin blood flow.
D. Diastolic arterial pressure.
E. Heart rate.
35. When the heart suddenly stops beating (cardiac asystole)
A. The physical signs are similar to those of ventricular fibrillation.
B. Consciousness is lost after 1–2 minutes.
C. Cardiac compression should be applied at a rate of 10–15 per minute.
D. Artificial ventilation of the lungs should be given.
E. Electric shocks across the thorax should be applied.
36. Vasovagal fainting or syncope
A. Causes loss of consciousness.
B. Is associated with tachycardia.
C. Is associated with skeletal muscle vasodilation.
D. Is more likely to occur when standing than when lying down.
E. Is more likely to occur in a cold than in a hot environment.
37. Systemic hypertension may be caused by
A. Hypoxia due to chronic respiratory failure.
B. Excessive secretion of aldosterone.
C. Excessive secretion of adrenocorticotrophic hormone (ACTH).
D. Myocardial thickening (hypertrophy) of the left ventricle.
E. The rapid cardiac action of ventricular fibrillation.
38. Peripheral differs from central circulatory failure in that
A. Hypovolaemia is unusual.
B. It leads to underperfusion of the tissues.
C. Cardiac output is usually normal.
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D. Central venous pressure is low.
E. Ventricular function is usually normal.
39. In atrial fibrillation
A. The electrocardiogram shows no evidence of atrial activity.
B. Ventricular rate is lower than atrial rate.
C. Respiratory sinus arrhythmia can usually be seen.
D. The ventricular rate is irregular.
E. The QRS complexes have an abnormal configuration.
40. Severe systemic hypertension may result in
A. An increase in the number of myocardial cells in the left ventricle.
B. Increased QRS voltage in certain leads.
C. Increased coronary blood flow.
D. Pulmonary oedema.
E. Impaired vision.
41. Auscultation of the heart can provide evidence of
A. The direction of turbulent flow causing a murmur.
B. Aortic stenosis, if there is a loud pre-systolic murmur in the aortic valve area.
C. Mitral incompetence, if a systolic murmur is heard in the axilla.
D. Ventricular septal defect, if a loud diastolic murmur is heard.
E. Mitral stenosis, if an early diastolic and pre-systolic murmurs are heard.
42. The electrocardiogram shows
A. Irregular P waves in atrial flutter.
B. Regular QRS complexes in atrial fibrillation.
C. Regular QRS complexes in complete heart block.
D. High voltage R waves over the right ventricle in right ventricular hypertrophy.
E. An irregular saw-tooth appearance in ventricular fibrillation.
43. The jugular venous
A. Pulse is not visible in normal healthy people.
B. Pulse has greater amplitude in patients with tricuspid incompetence.
C. Pulse can vary widely in amplitude in patients with complete heart block.
D. Pressure is raised in patients with right ventricular failure.
E. Pressure is commonly raised in patients with mediastinal tumours
.
44. In heart failure
A. The resting cardiac output may be higher than normal.
B. The arteriovenous oxygen difference during exercise is less than in normal people.
C. There is sodium retention.
D. Oedema occurs in dependent parts of the body.
E. Pulmonary oedema occurs when pulmonary capillary pressure doubles.
45. Respiratory failure (low arterial PO2; raised arterial PCO2) leads to
A. Raised pulmonary artery pressure (pulmonary hypertension).
B. Right ventricular failure.
C. Low voltage P waves in the electrocardiogram.
D. Decreased cerebral blood flow.
E. Warm hands and feet.
46. Pain due to poor coronary blood flow (angina) may be relieved by
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A. Cutting the sympathetic nerve trunks supplying the heart.
B. Correcting anaemia if present.
C. Providing the patient with a cold environment.
D. _-adrenoceptor stimulating drugs.
E. Drugs causing peripheral vasodilation.
47. Narrowing of the lumen of major arteries supplying the leg is associated
with
A. Pain in the calf during exercise which is relieved by rest.
B. Growth of collateral vessels.
C. Reduction in the duration of reactive hyperaemias in the calf.
D. Delayed healing of cuts in leg skin.
E. Reduced arterial pulse amplitude at the ankle.
48. Arterial pulse contours that have
A. Sharp peaks indicate rapid left ventricular ejection.
B. Greatly increased pulse pressures are seen in patients with mitral incompetence.
C. Slowly rising systolic phases are seen in patients with aortic stenosis.
D. Varying beat-to-beat amplitude is seen in patients with atrial fibrillation.
E. Rapid run-offs and low diastolic pressure suggest high peripheral resistance.
49. Murmurs (or bruits) may be detected by auscultation over
A. Vessels in which there is turbulence.
B. Large arteries in healthy adults.
C. Dilations (aneurysms) in arteries.
D. Constrictions (stenoses) in arteries.
E. The heart in healthy young adults in early diastole.
50. Factors ensuring that ventricular muscle has an adequate oxygen supply
include the
A. Good functional anastomoses that exist between adjacent coronary arteries.
B. Structural arrangements that prevent vascular compression during systole.
C. High oxygen extraction rate from blood circulating through the myocardium.
D. Sympathetic vasodilator nerve supply to ventricular muscle.
E. Fall in coronary vascular resistance during exercise.
51. When the AV bundle is completely interrupted, as in complete heart
block, the
A. Atrial beat becomes irregular.
B. PR interval shows beat-to-beat variability.
C. Ventricular filling shows beat-to-beat variability.
D. QRS complex shows beat-to-beat variability.
E. Ventricular rate falls below 50 beats/minute.
52. Aortic valve incompetence may cause
A. Increase in arterial pulse pressure.
B. Systolic murmurs in the aortic valve area.
C. Hypertrophy of left ventricular muscle.
D. Decreased myocardial blood flow.
E. Left ventricular failure
.
53. Ventricular extrasystoles
A. Are usually associated with a normal QRS complex.
B. From the same focus have similar QRS complexes.
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C. Usually occur following a compensatory pause.
D. May fail to produce a pulse at the wrist.
E. Indicate serious heart disease.
54. Pulmonary embolism (blood clots impacting in lung blood vessels)
usually decreases
A. Pulmonary vascular resistance.
B. Left atrial pressure.
C. Right atrial pressure.
D. Ventilation to perfusion ratios in the affected lung.
E. PO2 in pulmonary venous blood.
55. Hardening of the arterial walls tends to raise
A. Arterial compliance.
B. Systolic arterial pressure.
C. Diastolic arterial pressure.
D. Peripheral resistance.
E. Arterial pulse wave velocity.
56. The ‘A’ wave of venous pulsation in the neck is
A. Caused by atrial systole.
B. Seen just after the carotid artery pulse.
C. Exaggerated in atrial fibrillation.
D. Exaggerated in tricuspid stenosis.
E. Exaggerated periodically in complete heart block.
57. Left ventricular failure tends to cause an increase in
A. Left atrial pressure.
B. Left ventricular ejection fraction.
C. Pulmonary capillary pressure.
D. Lung compliance.
E. Pulmonary oedema when the patient stands up.
58. In otherwise healthy people, local tissue death follows obstruction of
A. An internal carotid artery.
B. A renal artery.
C. A femoral artery.
D. A retinal artery.
E. The hepatic portal vein.
59. In the measurement of forearm blood flow by venous occlusion
plethysmography
A. A continuous record is made of forearm volume.
B. A collecting cuff is applied to the wrist.
C. It is assumed that venous outflow is arrested by the collecting cuff during
measurement.
D. The collecting cuff pressure should be greater than diastolic but less than systolic
arterial
pressure.
E. The forearm must be kept below heart level during the measurements.
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Answers:
1.
A. False It falls; coronary vessels are compressed by the contracting myocardium.
B. True A fall in PO2 has a potent vasodilator effect on coronary vessels. Adenosine
released from hypoxic myocardium is also a potent vasodilator.
C. False The fall in metabolic rate and cardiac output in hypothermia reduce cardiac
workand lead to a reduction in coronary blood flow.
D. True Sympathetic stimulation increases the rate and force of contraction; the
resulting increase in the rate of production of vasodilator metabolites dilates coronary
vessels.
E. True Myocardial work and metabolism are increased in hypertension.
2.
A. True There is a close relationship between the work of the heart and coronary
flow.
B. False Skin blood flow is geared mainly to thermoregulation and normally exceeds
that needed for skin’s modest metabolic requirements.
C. True Local blood flow is largely determined by the vasoactive metabolites such as
rising PCO2, H_ concentration and falling PO2. The changes produced by
vasomotornerves are small compared with those produced by metabolites.
D. False The entire cardiac output must pass through the lungs regardless of the local
metabolic needs of the pulmonary tissues. It is greatly in excess of the lungs’
metabolic needs.
E. False As in skin, renal blood flow (about one quarter of total cardiac output)
greatly exceeds local metabolic needs. The blood is sent to the kidneys for processing.
3.
A. True About 10 mmHg or less; both offer little resistance to flow.
B. False The drop across the splenic vascular bed (about 60 mmHg) is much larger;
the hepatic portal bed offers little resistance to flow.
C. True Otherwise blood would not flow through the portal bed.
D. False Changing from the horizontal to the vertical position increases arterial and
venous pressures equally.
E. True The muscle pump in the leg decreases venous pressure.
4.
A. False This applies to both heart sounds.
B. False It is about 20 per cent shorter.
C. True About 50 Hz compared with 35 Hz for the first sound.
D. False Both may be split due to asynchronous valve closure.
E. True The first sound is due to ventricular systole; the second occurs during
ventricular relaxation when the aortic valves snap shut as ventricular pressure falls
below aortic.
5.
A. True The pressure head needed to drive cardiac output through the pulmonary
circuit (about 15 mmHg) is much less than that needed in the systemic circuit (about
90 mmHg).
B. False The reverse is true; low alveolar PO2 may cause pulmonary hypertension.
C. False These are conductance units, the reciprocal of resistance units.
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D. True Thus there is little rise in pulmonary arterial pressure during exercise despite
the increased flow rate. Release of nitric oxide from the pulmonary vascular
endothelium may account for the vasodilatation.
E. False Pulmonary vascular resistance is controlled by local rather than by nervous
mechanisms.
6.
A. False Atrial contraction accounts for only about 20 per cent of filling at rest.
B. False During this phase the AV valves are closed and ventricular volume is
constant.
C. True This low-pitched sound is sometimes heard in early diastole.
D. False Filling occurs when atrial pressure exceeds ventricular pressure.
E. True Due to entry of blood accumulated in the atria during ventricular systole.
7.
A. True Around three-quarters; veins are referred to as ‘capacitance’ vessels.
B. True These modulate venous capacity.
C. False Their vasa arise from neighbouring arteries.
D. True This ‘myogenic’ response helps to limit the degree of distension.
E. True Another functional adaptation to resist distension.
8.
A. False Their wall thickness is similar since the workload of the two atria is similar.
B. False It begins at the sinuatrial node in the right atrium.
C. False Excitation can only pass from atria to ventricles via specialized conducting
tissue in the AV bundle.
D. False Delay of excitation in the AV bundle makes atrial precede ventricular
contraction.
E. True Due to the spiral arrangement of some muscle fibres; circular fibres reduce
ventricular circumference.
9.
A. False The muscle pump is more effective in dynamic than in static exercise.
B. True In dynamic exercise, the muscle pump increases venous return and so
decreases venous pressure in dependent veins.
C. False The increase is less since inflow is obstructed by the sustained compression
exerted by the contracting muscle.
D. True There is relatively little fall in total peripheral resistance with static exercise.
E. True The rise in arterial pressure with static exercise increases cardiac work since
cardiac output has to be ejected against a higher aortic pressure.
10.
A. True This increases capillary hydrostatic pressure.
B. True In the standing position, capillary pressure increases by the hydrostatic
equivalent of the column of blood below the heart.
C. False Lymphatic obstruction allows tissue fluid to accumulate; the rise in
interstitial pressure reduces the capillary transmural hydrostatic pressure gradient.
D. True Capillary pressure rises during the exercise hyperaemia.
E. True Hypoproteinaemia decreases the transmural colloid osmotic pressure
gradient.
11.
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A. False Korotkoff sounds are produced locally by the turbulence of blood being
forced past the narrow segment of a partially occluded artery.
B. True The sharp taps of Phase 1 are generated as the systolic pressure peaks force
blood under the cuff.
C. False Sudden muffling (Phase 4) or disappearance (Phase 5) of the sounds indicate
the diastolic pressure point.
D. False They are usually higher since palpation may fail to detect the first tiny
pulses.
E. True Otherwise the full cuff pressure may not be transmitted to the artery.
12.
A. True This is the definition.
B. True Depolarized cells cannot be excited.
C. True This prevents tetanic contraction of the heart.
D. False It is longer, as is the duration of its depolarization.
E. True Shortening the refractory period permits higher heart rates.
13.
A. False By more than 90 per cent; resistance is related to the fourth power of the
radius.
B. False Vascular resistance is not related to wall thickness.
C. True It is directly proportional to length.
D. True Resistance is related to Viscosity_Length/Radius4.
E. False Total arteriolar resistance exceeds total capillary resistance though the
reverse is true for single vessels.
14.
A. True _-adrenergic blocking drugs reduce exercise tachycardia.
B. True The tachycardia during excitement is also reduced by _-blocking drugs.
C. True A reflex response to decreased stretch of arterial baroreceptors.
D. False The two systems can function independently.
E. False Parasympathetic drive slows the heart during a vasovagal attack; sympathetic
drive may stimulate the heart during recovery.
15.
A. True It is about 90 mmHg, due to the column of blood (about 1 metre) between
the heart and the foot.
B. True The negative intrathoracic pressure during inhalation is transmitted to the
veins.
C. False Limb veins collapse above heart level. Negative pressure cannot be
transmitted along a collapsed tube so venous pressure is atmospheric in the raised
hand.
D. True The sinuses are held open by their meningeal attachments and cannot
collapse.
E. True A central venous pressure line is usually placed here.
16.
A. False Exercise hyperaemia occurs normally in sympathectomized muscles.
B. False True capillaries have no smooth muscle; they dilate passively with the rise
in capillary pressure due to active arteriolar dilation.
C. False Arterial pressure usually rises.
D. True Vasoconstriction in kidneys, gut and skin prevent excessive falls in total
peripheral resistance.
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E. True This, together with the reflex constriction above, compensate for the fall in
muscular vascular resistance and thus prevent arterial pressure falling during exercise.
17.
A. False The SA node is in the right atrium near its junction with the superior vena
cava.
B. True Vagal activity slows the rate of impulse generation and thus the heart rate.
C. False The SA node has intrinsic rhythmicity and can generate impulses
independently.
D. False Purkinje tissue is confined to the ventricles; atrial fibres conduct impulses
from the SA to the AV node.
E. True Impulse generation is due to spontaneous diastolic depolarization of the cells.
18.
A. False It is synchronous with mitral and tricuspid closure.
B. False It corresponds with the QRS complex.
C. True The mitral and tricuspid valves bulge back into the atria.
D. True This closes the mitral and tricuspid valves.
E. False It corresponds with the C wave; the A wave is due to atrial contraction which
precedes the first heart sound.
19.
A. True This increases the rate of impulse generation and hence heart rate.
B. True The increase in myocardial metabolism generates vasodilator metabolites.
C. True Rapid spread of excitation in the ventricles results in more forceful
contractions
as the ventricular fibres are activated nearly simultaneously.
D. True This enhances the force of contraction at any given filling pressure.
E. True Due to the increased force of contraction.
20.
A. False It is low because the capillary bed has a large total cross-sectional area.
B. True The venous bed has a smaller total cross-sectional area than the venular bed.
C. True There is a brief period of retrograde flow as the aortic valve closes.
D. True Axial flow occurs in large vessels; near the walls, flow velocity is zero.
E. False It rises due to the compensatory increase in cardiac output.
21.
A. True As seen in the Frank–Starling left ventricular function curve.
B. False High K_ levels decrease cardiac contractility.
C. False Calcium channel blockers decrease cardiac contractility.
D. True Due to increased sympathetic drive to the ventricles and increased venous
return.
E. True Initially by increased ventricular filling: later by ventricular hypertrophy.
22.
A. True Hence no blood leaves the ventricles.
B. False Pressure in the aorta falls as run-off of blood to the tissues continues.
C. False It rises as ventricular pressure causes the AV valves to bulge into the atria.
D. True The blood vessels are squeezed by the contracting myocardium.
E. False The greater force of contraction in the left ventricle gives a greater rate of
rise of pressure.
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23.
A. False The electrical event precedes the mechanical event.
B. True This electrical event corresponds with ventricular relaxation.
C. False It corresponds to the interval between atrial and ventricular depolarization
due to delay of the impulse in the AV bundle.
D. True R indicates the beginning, and T the end, of the ventricular action potential.
E. True Due to the heart rate changes associated with respiratory sinus arrhythmia.
24.
A. True The output from the left and right ventricle is the same.
B. True It depends on what happens to stroke volume.
C. True Lying down normally increases the filling pressure of the heart.
D. True To meet the needs of increased metabolism and increased skin blood flow.
E. False The output does increase due to changes in the filling pressure, level of
circulating hormones, etc
.
25.
A. False In arterioles the ratio is much greater, at about 1:1.
B. True They provide most of the peripheral resistance.
C. True Local flow varies directly with the fourth power of their radii.
D. True The drop in pressure across arterioles is greater than that across capillaries.
E. False It is smaller, so blood flow velocity is higher in arterioles.
26.
A. True They conduct at around 4 metres/second. Small diameter nerve fibres
conduct impulses at about 1 metre per second.
B. True This facilitates rapid conduction.
C. False Purkinje fibres travel to the apex before proceeding to the base of the heart.
D. True They spread depolarization rapidly over the entire ventricular myocardium.
E. True Damage to the cells (as in bundle-branch block) changes the pattern of
spread of ventricular depolarization, and hence the shape of the QRS complex.
27.
A. False Pulse waves travel at about ten times the blood velocity.
B. False It rises; arterial elasticity normally damps the pulse pressure.
C. False Blood flows off rapidly via collaterals so that little pressure change occurs.
D. True By the hydrostatic equivalent of the column of blood between it and the
heart.
E. False Brachial arterial pulse pressures are greater due to the superimposition of
waves reflected from the end of the arterial tree.
28.
A. False The tendency is directly proportional to vessel diameter.
B. False The tendency is directly proportional to fluid density.
C. False The tendency is directly proportional to velocity.
D. True The tendency is inversely proportional to viscosity.
E. True In anaemia, the increase in velocity and decrease in viscosity of blood in the
hyperdynamic circulation promote turbulence; bruits may be heard over peripheral
arteries.
29.
A. False Wall thickness is not a factor determining resistance.
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B. False But it suggests that the resistance they offer may be varied by change in
nerve activity.
C. False Capillaries have even smaller internal diameters.
D. False The aorta has a much smaller total cross-sectional area.
E. True The pressure drop across the arteriolar bed is larger than in other beds
indicating that arterioles are responsible for most of the circulation’s vascular
resistance.
30.
A. True As stated in the Frank–Starling Law.
B. True This impedes ventricular outflow, thus increasing end-diastolic fibre length.
C. False This reduces cardiac filling pressure and hence end-diastolic fibre length.
D. True This tends to increase left ventricular filling pressure and end-diastolic fibre
length.
E. True This also raises cardiac filling pressure
.
31.
A. True The relative amount of smooth muscle increases but that of elastic tissue
falls.
B. False With the decreasing vessel diameter and flow velocity, the tendency
decreases.
B. False It falls slightly; blood will only flow down a pressure gradient.
C. True Distal arterial pulse pressure is increased by the superimposition of waves
reflected back from the end of the arterial tree.
E. False Blood cannot release its oxygen until it reaches the exchange vessels.
32.
A. False Complete mixing with the blood is required for estimation of blood volume.
B. True The secondary peak is due to recirculation of indicator.
C. True Due to the more rapid passage of indicator past the sampling site.
D. False It falls as the indicator is diluted in a bigger volume.
E. True Pulmonary artery blood flow equals cardiac output.
33.
A. True Pulmonary blood flow_right ventricular output_cardiac output.
B. False The O2 content of arterial and mixed venous blood are measured.
C. False To measure O2 consumption, the subject breathes from a spirometer filled
with oxygen with a CO2 absorber in the circuit; an open circuit method may also be
used.
D. True The pulmonary artery is relatively easy to catheterize and the venous blood it
contains is thoroughly mixed.
E. False Pulmonary veins are difficult to catheterize. Blood from any artery may be
used since the O2 content of peripheral arterial blood is the same as that in the
pulmonary vein.
34.
A. False Adrenaline increases, and noradrenaline reduces skeletal muscle blood flow.
B. True Both decrease renal blood flow.
C. True Both cause cutaneous vasoconstriction.
D. False Noradrenaline raises diastolic pressure; adrenaline lowers it.
E. False Adrenaline increases heart rate; noradrenaline raises mean arterial pressure
and causes reflex cardiac slowing.
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35.
A. True In both cases there is no useful cardiac output.
B. False Consciousness is lost within about five seconds.
C. False 60–80 compressions/minute are needed to maintain flow to the brain.
D. True This is needed to maintain oxygenation of the brain.
E. False This treatment (applied with a defibrillator) is given for ventricular
fibrillation.
36.
A. True Due to cerebral ischaemia caused by the abrupt fall in arterial pressure.
B. False Increased vagal activity slows the heart and reduces cardiac output.
C. True This vasodilation reduces peripheral resistance.
D. True Because of gravity, pressure in cerebral arteries is lower when standing than
when lying down.
E. False The skin vasoconstriction in cold environments raises peripheral resistance.
37.
A. False This constricts blood vessels in the lungs causing pulmonary hypertension
but dilates systemic vessels.
B. True Salt and water retention by the kidneys expands ECF and hence blood
volume and cardiac output.
C. True The resulting secretion of cortisol also causes salt and water retention.
D. False This is a consequence of hypertension, not a cause.
E. False This ineffective pumping in ventricular fibrillation causes severe
hypotension.
38.
A. False Hypovolaemia due to severe haemorrhage is a common cause of peripheral
circulatory failure; blood volume may be normal in central circulatory failure.
B. False Both types of failure lead to underperfusion of the tissues.
C. False It is usually reduced in both types of failure.
D. True It is usually raised in central circulatory failure.
E. True Reduced ventricular function is the cause of central circulatory failure.
39.
A. False Small rapid waves indicate the atrial fibrillation.
B. True Atrial rate is higher than ventricular rate as some impulses are filtered out by
theatrioventricular node.
C. False Sinus arrhythmia indicates normal sinus rhythm.
D. True Due to the irregularity of the impulses passing through the AV node.
E. False QRS complexes are normal since the pattern of ventricular depolarization is
normal.
40.
A. False The cells increase in size (hypertrophy), not in number (hyperplasia).
B. True Due to the left ventricular hypertrophy.
C. True Due to increased left ventricular work.
D. True Due to left ventricular failure.
E. True Due to damage to retinal blood vessels
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.
41.
A. True The direction in which the murmur is conducted indicates the direction of
flow.
B. False The characteristic murmur is a systolic murmur conducted to the neck
vessels.
C. True This is the direction of flow of the regurgitant blood.
D. False The murmur occurs during ventricular contraction and is therefore systolic.
E. True Mitral flow is greatest in early diastole but rises again during atrial systole
.
42.
A. False In atrial flutter, P waves have a high but regular frequency (about
300/minute).
B. False Ventricular beats are irregular in rate and strength since impulses pass
through the AV node in a random fashion.
C. True The beats generated by ventricular pacemakers have slow but regular
frequency.
D. True The increased muscle bulk generates enhanced voltages during
depolarization.
E. True Due to chaotic electrical activity in the ventricles.
43.
A. False It can be seen in healthy people when they lie almost flat.
B. True Systolic regurgitation of right ventricular blood can cause giant waves.
C. True Periodic giant waves are seen when atrial and ventricular systoles coincide.
D. True This is an important sign in right ventricular failure; venous pulsation is
present.
E. True The jugular veins are distended due to venous obstruction but there is little or
no pulsation.
44.
A. True In high output failures; however, the ability to raise cardiac output in
exercise is impaired in all types of failure.
B. False With inadequate output, desaturation of blood in the tissues increases.
C. True This increases extracellular fluid and hence blood volume.
D. True The back pressure in veins raises capillary hydrostatic pressure and results in
oedema in dependent parts where venous pressure is already raised due to gravity.
E. False When pulmonary capillary pressure (about 5 mmHg) doubles, it is still less
than plasma oncotic pressure (25 mmHg) so fluid does not accumulate in the alveoli.
45.
A. True Hypoxia causes generalized pulmonary vasoconstriction.
B. True Pulmonary hypertension can lead to right ventricular failure (‘cor
pulmonale’).
C. False Atrial hypertrophy in cor pulmonale results in prominent P waves.
D. False CO2 dilates cerebral blood vessels.
E. True CO2 is a vasodilator and ‘cor pulmonale’ is a ‘high output’ failure.
46.
A. True Pain sensory fibres from the heart travel with the sympathetic nerves.
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B. True In anaemia, the capacity of the blood to deliver oxygen is decreased but
cardiac work increases due to the rise in cardiac output.
C. False Cold vasoconstriction raises arterial pressure and so increases myocardial
work.
D. False These increase heart rate and force and so increase myocardial work
E. True By reducing arterial pressure, vasodilator drugs such as nitrates reduce
myocardial work
47.
A. True This is ‘intermittent claudication’; pain metabolites accumulate in muscle
during
exercise in ischaemic limbs and stimulate local pain receptors.
B. True When the major arteries are obstructed, collateral vessels open up to help
maintain blood flow to the ischaemic tissues.
C. False Though the hyperaemias have smaller peak values, their durations are
longer.
D. True Cuts and ulcers are slow to heal because the supply of nutrients is impaired.
E. True Pulses may be absent with severe narrowing.
48.
A. True As seen in strenuous exercise.
B. False This is typical of aortic incompetence.
C. True Due to slow expulsion of blood from the ventricle past the stenosed valve.
D. True The variable filling of the ventricle results in variable stroke output.
E. False They suggest a low peripheral resistance.
49.
A. True Turbulent vibrations generate sound waves.
B. False Flow is laminar rather than turbulent in normal large arteries.
C. True Turbulence is set up as blood flows into the dilated segment.
D. True Turbulence is set up as blood squirts through the constricted segment.
E. True Rapid ventricular filling in early diastole can cause turbulence in healthy
young adults and generate a sound (the third heart sound).
50.
A. False Coronary arteries are functional ‘end arteries’ and have few anastomotic
connections; sudden occlusion of an artery usually leads to local muscle death.
B. False Coronary vessels are compressed by the contracting myocardium in systole.
C. True The extraction rate is about 75 per cent.
D. False Reflex vasodilatation is not important in regulating coronary blood flow.
E. True The rise in metabolic activity in the exercising heart provides the vasodilator
metabolites which adapt coronary flow to supply myocardial oxygen needs.
51.
A. False The atria continue to beat regularly at normal sinus rate.
B. True In complete block, atria and ventricles beat independently at different rates.
C. True Due to loss of the normal sequence of the atrial and ventricular contractions.
D. False There is usually a single ventricular pacemaker giving an abnormal but
regular QRS complex.
E. True The ventricular intrinsic rate of beating is 30–40/minute.
52.
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A. True Diastolic pressure is abnormally low due to regurgitation of aortic blood into
the left ventricle in diastole.
B. False Blood regurgitating in diastole causes diastolic turbulence.
C. True The greater stroke volume needed to compensate for regurgitating blood
increases ventricular workload.
D. False Flow increases as ventricular work increases.
E. True A persistent increase in ventricular workload can lead to ventricular failure.
53.
A. False Extrasystoles are associated with a prolonged abnormal QRS complex; the
impulse pathway from the ectopic focus over the myocardium is abnormal and
slow.
B. True If the focus is the same, the pathway for ventricular excitation will be the
same.
C. False They are followed by a compensatory pause; the next normal beat may reach
the ventricles when they are refractory – a beat is lost.
D. True If they occur early in diastole, poor ventricular filling results in weak
contractions and small pulses.
E. False They occur occasionally in many normal hearts.
54.
A. False Vascular obstruction tends to increase pulmonary vascular resistance and
cause pulmonary hypertension.
B. True Due to the fall in pulmonary blood flow, atrial pressure tends to fall.
C. False The obstruction tends to dam back blood in the right heart.
D. False It rises since pulmonary capillary perfusion falls.
E. False Blood that traverses pulmonary capillaries is adequately oxygenated;
cyanosis in patients with pulmonary embolism is usually peripheral cyanosis due to
low cardiac output.
55.
A. False Compliance, the change of arterial volume per unit pressure change,
decreases.
B. True Systolic ejection causes greater pressure rise when arteries are less
distensible.
C. False Poor elastic recoil in diastole allows diastolic pressure to fall further.
D. False Stiffness of the wall is not a factor determining vascular resistance.
E. True Vibrations travel faster in stiff than in lax structures.
56.
A. True The pressure wave due to atrial contraction passes up freely into the neck.
B. False Atrial systole precedes the ventricular systole that generates the carotid
pulse.
C. False It is absent – there is no effective atrial systole in atrial fibrillation.
D. True Right atrial contraction is more forceful to overcome valvular resistance.
E. True If the atrial and ventricular systoles coincide, the A and C waves merge to
give a giant wave.
57.
A. True Due to inadequate emptying of the left ventricle in systole.
B. False Stroke volume falls; end-diastolic volume rises.
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C. True The rise may cause pulmonary oedema if pressure exceeds the colloid
osmotic pressure of the plasma proteins.
D. False It falls; congestion of pulmonary vessels with blood makes the lungs stiffer.
E. False The decrease in venous return on standing up may relieve pulmonary
congestion and hence dyspnoea.
58.
A. False Flow through the circle of Willis normally maintains the viability of the
tissue.
B. True There is no significant collateral circulation.
C. False Normally there is adequate collateral circulation. However, if there is
advanced arterial disease, sudden obstruction may cause gangrene.
D. True The collateral circulation is not good enough to prevent this.
E. False The liver has a dual blood supply; the hepatic artery flow can maintain
viability.
59.
A. True Plethysmography means volume measurement.
B. False It is applied to the upper arm.
C. True When this is the case, the volume increase equals arterial inflow.
D. False It must be below diastolic so as not to interfere with arterial inflow.
E. False Below heart level, the veins fill with blood and are unable to accommodate
more during venous occlusion; the forearm must be above heart level.
RESPIRATORY SYSTEM
Part One
1. The physiological dead space:
a) Is exactly equal to the anatomic dead space in normal people
b) Increases during exercise
c) Is measured by single breath nitrogen analysis
d) Is higher in elderly than young adults
e) Is the same as the physiological shunt
2. A high alveolo-arterial PO2 difference most likely results from:
a) Low fractional concentration of O2 in the inspired air
b) Hypoventilation
c) Arteriovenous shunt
d) Pulmonary edema
e) Polycythemia
3. At 33 feet under water the ambient pressure is:
a) Two atmospheres
b) One and a half atmosphere
c) 33 pounds per square inch
d) Same as the pressure in a tunnel 33 feet below sea level
e) Half the pressure 33 feet above sea level
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4. Which of the following combinations are typical findings in compensated
respiratory alkalosis:
a) Low PaCO2, low bicarbonate level and normal pH
b) Low PaCO2, normal bicarbonate level and high pH
c) Low PaCO2, low bicarbonate level and high pH
d) Low PaCO2, normal bicarbonate level and normal pH
e) Low PaCO2, high bicarbonate level and high pH
5. The partial pressure of oxygen in the alveoli is expected to be least affected by:
a) Fractional concentration of O2 in ispired air
b) Respiratory quotient
c) PCO2 in alveoli
d) Hemoglobin concentration
e) Barometric pressure
6. A veno-arterial shunt is likely to:
a) Decrease the cardiac output
b) Increase the pulse pressure
c) Increase venous return
d) Decrease PaO2
e) Increase the peripheral vascular resistance
7. The arterio-venous difference of O2 is highest across:
a) Liver
b) Kidney
c) Cardiac muscle
d) Skin
e) Brain
8. In a patient, hypoventilation is most likely if:
a) PaO2 is low
b) pH of arterial blood is low
c) PaCO2 is high
d) O2 in arterial blood is low
e) PCO2 of expired air is high
9. A decrease in the recoil force of the lung is likely to:
a) Decrease total lung capacity
b) Increase vital capacity
c) Increase functional residual capacity
d) Decrease the residual volume
e) Decrease compliance of the lung
10. Central chemoreceptors differ from chemoreceptors in that they:
a) Respond to changes in PaCO2
b) Respond to changes in pH
c) Do not respond to changes in PO2
d) Become more sensitive to CO2 with chronic exposure
e) They are less sensitive to changes in PaCO2 than pH
11. Surfactant:
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a) Helps to equalize pressure within interconnected alveoli
b) Reduces surface tension more effectively as alveolus
becomes smaller
c) Increases lung compliance
d) Increases the slope of the pressure-volume curve
e) All of the above
12. One month of an exposure to an inspired CO2 of 5% would result in:
a) Increased ventilatory sensitivity to CO2
b) Reduced ventilatory sensitivity to hypoxia
c) Increased plasma bicarbonate
d) Alkalosis in arterial plasma
e) Increased alveolar PO2
13. In a normal adult man, breathing 100% oxygen:
a) Is likely to double O2 in arterial blood
b) Is likely to reduce alveolar PCO2
c) Is likely to raise PO2 in venous blood to about 200 mmHg
d) Is likely to raise arterial PO2 to about 660 mmHg
e) Increases the affinity of hemoglobin to oxygen
14. At the end of maximum inspiration:
a) Intra-alveolar pressure is zero
b) Intra-pleural pressure is zero
c) Recoil force of the chest is greater than the recoil force of the lung
d) Surface tension is lowest
e) Average alveolar PO2 is lower than at the end of maximum expiration
15. On ascent to a high altitude:
a) The concentration of oxygen in the air decreases
b) The number of oxygen molecules per liter of air decreases
c) Alveolar PCO2 is kept constant despite the high ventilation
d) Density of air increases
e) The PCO2 in air is the same as at sea level
16. Compliance of the lung:
a) Is higher in small children than in adults
b) Is about 500 ml/cm H2O
c) Is normally twice the compliance of the chest
d) Is higher in elderly than young adults
e) Is decreased in emphysematous changes
17. Dennervation of carotid and aortic bodies leads to all the following except:
a) Decreased sensitivity of ventilation to change in PCO2
b) Decreased sensitivity of ventilation to change in pH
c) Complete absence of response of ventilation to change in PO2
d) Absence response of ventilation to exercise
e) Decreased sensitivity of ventilaton to stagnant hypoxia
18. Exchange of which of the following gases across the respiratory membrane is
normally diffusion limited:
a) Oxygen
b) Carbon dioxide
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c) Carbon monoxide
d) Nitrous oxide
e) Nitrogen
19. Minute ventilation is:
a) The volume of air moved in or out of the alveoli per minute
b) The volume of air moved in or out of the lung per breath
c) Alveolar ventilation plus dead space ventilation
d) Invariably increases if the respiratory rate increases
e) Is measured using Bohr's equation (CO2 analysis in expired air)
20. The ventilatory response to hypoxia:
a) Is independent of arterial PCO2
b) Is mediated by the central chemoreceptors
c) Decreases gradually with time
d) Is largely mediated by the aortic bodies in humans
e) None of the above
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 O 2
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 CO 2
e) Per unit volume of arterial blood there is more O 2 than CO2
22. PCO2 in arterial blood:
a) Invariably increases with hypoxia
b) Stimulates ventilation mainly through peripheral
chemoreceptors
c) Is the major controller of ventilation
d) Increases early in exercise
e) Increases on ascent to high altitude
23. The functional residual capacity:
a) Is the volume of air in the lung at the end of normal inspiration
b) Increases with age
c) Is measured by simple spirometry
d) Is about 3 liters in an average adult male
e) Is about 1 liter in average adult male
24. At the end of inspiration at sea level the PO 2 in the anatomic dead space is
approximately:
a) 150 mmHg
b) 100 mmHg
c) 160 mmHg
d) 95 mmHg
e) Above a hundred but less than 150 mmHg
25. Which is true concerning control of ventilation:
a) Ventilation is more sensitive to changes in PO2 than changes in PCO2 in
arterial blood
b) Carbon dioxide stimulates ventilation only through the central
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chemoreceptors
c) At high altitude the primary stimulus to ventilation is high PCO 2
d) The response of ventilation to a sustained rise in PCO2 increases with time
e) Cutting the vagus nerves decreases the depth of breathing
26. Which of the following is likely to decrease airway resistance?
a) Beta-adrenergic blockers
b) Muscarinic cholinergic agonists
c) Breathing at higher lung volumes
d) Leukotrienes
e) Histamine
27. Compared to normal arterial blood, normal mixed venous blood has:
a) Higher PO2, lower PCO2 and higher pH
b) Lower PO2, higher PCO2 and higher pH
c) Lower PO2, higher PCO2 and lower pH
d) Lower PO2, lower PCO2 and higher pH
e) Higher PO2, lower PCO2 and lower pH
28. Deficiency of surfactant is likely to result in:
a) Increased compliance
b) Decreased work of breathing
c) Reduced surface tension of fluid in the alveoli
d) Decreased compliance
e) Asthma
29. For a normal Hb-O2 dissociation curve, the most correct relationship is:
a) PO2 is 40 mmHg, percent saturation 50
b) PO2 is 95 mmHg, percent saturation 97
c) PO2 is 30 mmHg, percent saturation 50
d) PO2 is 60 mmHg, percent saturation 60
e) PO2 is 50 mmHg, percent saturation 50
30. In a normal subject, blood at the end of the pulmonary capillary:
a) Has a PO2 similar to blood in the left ventricle
b) Has a PO2 similar to that in the left atrium
c) Has a PO2 higher than blood from the aorta
d) Has a percent saturation of 95
e) Contains 20 mL of CO2 per 100 mL
31. PCO2 in arterial blood:
a) Invariably increases with hypoxia
b) Stimulates ventilation mainly through peripheral
chemoreceptors
c) Is lower than normal in compensated metabolic acidosis
d) Increases early in exercise
e) Increases on ascent to high altitude
32. In which of the following conditions is the percent saturation of hemoglobin
in arterial blood likely to be normal :
a) Venoarterial shunts
b) Pulmonary edema
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c) Carbon monoxide poisoning
d) Anemia
e) Methemoglobinemia
33. At which of the following points is the intrapleural pressure closest to zero:
a) End of normal expiration
b) End of normal inspiration
c) End of maximum expiration
d) End of maximum inspiration
e) Mid-normal expiration
34. Regarding the vital capacity, all of the following are correct except:
a) It is higher in young adults than small children
b) It is higher in males than females
c) It is normal in pure restrictive lung disease
d) It can be measured by simple spirometry
e) It is related to body size
35. Immediate acclimatization to high altitude is by:
a) Polycythemia
b) Hyperventilation
c) Increased cardiac output
d) Shift of hemoglobin dissociation curve to the left
e) Increase formation of fetal hemoglobin
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
38. Which is true regarding lung and chest wall mechanics:
a) At maximum expiration the lungs have no tendency to collapse but the
chest has a great tendency to expand
b) At end of normal inspiration the recoil tendency of the lung
is greater than that of the chest
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
greater than that of the lung
e) The combined compliance is greater than the individual compliances of the
lung and chest
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39. Which is true concerning the diffusing capacity of the lungs:
a) It increases whenever the partial pressure gradient increases
b) It increases as the alveolar capillary surface area rises
c) It increases as the thickness of the respiratory membrane area rises
d) It is usually measured using carbon dioxide
e) It is usually measured using oxygen
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
41. While repaying the O2 dept:
a) The [H+] is increasing
b) PCO2 is decreasing
c) Muscle blood flow is increasing
d) Respiratory rate is increasing
e) Minute volume is decreasing
42. An average adult male has a vital capacity of:
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
c) Functional residual capacity
d) Total lung 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
e) Functional residual capacity
45. A decrease in the recoil force of the lung is expected to:
a) Increase vital capacity
b) Decrease residual volume
c) Decrease compliance of the lung
d) Increase functional residual capacity
e) Decrease total lung capacity
46. Deficiency of surfactant may lead to:
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a) Increased work of breathing
b) Increased compliance of the lung
c) Decreased recoil force of the lung
d) Bronchial asthma
e) An increase in functional residual capacity
47. Continuous measurement of the concentration of nitrogen in the expired air
can be used to measure:
a) Physiological dead space
b) Alveolar ventilation
c) Anatomic dead space
d) Functional residual capacity
e) Expiratory reserve volume
48. Oxygen consumption of an average adult man per minute is about:
a) 250 ml
b) 350 ml
c) 400 ml
d) 500 ml
e) 550 ml
49. Which of the following is expected to increase function residual capacity:
a) Surfactant deficiency
b) Lung fibrosis
c) Degeneration of lung elastic tissue
d) Pulmonary edema
e) Pulmonary congestion
50. The most likely cause of hypoxic hypoxia together with hypercapnia is:
a) Ascent to a high altitude
b) Mild pulmonary edema
c) Veno-arterial shunt
d) Hypoventilation
e) Slight ventilation perfusion mismatch
51. Which of the following is correct regarding blood in the pulmonary trunk:
a) PO2 of 60 mmHg
b) 50% saturation of hemoglobin
c) PCO2 of 40 mmHg
d) Bicarbonate concentration lower than in the aorta
e) PN2 higher than in aorta
52. Ventilation is most sensitive to changes in:
a) PO2
b) pH of arterial blood
c) PCO2
d) Body temperature
e) % saturation of hemoglobin
53. Inspiration is initiated by discharge from:
a) The dorsal inspiratory group of neurons
b) The ventral group of neurons
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c) The preBottzinger complex
d) Apneustic center
e) Pneumotaxic center
54. Voluntary hyperventilation by a normal person is expected to lead to all the
following except:
a) Alkalosis
b) Hypocapnia
c) Low blood bicarbonate concentration in arterial blood
d) A great increase in oxygen concentration in arterial blood
e) Low ionized plasma calcium
55. The normal diffusing capacity of the respiratory membrane of an average
adult male for oxygen is about:
a) 10 ml
b) 25 ml
c) 50 ml
d) 4 ml
e) 15 ml
56. Cyanosis is unlikely to occur in:
a) Pulmonary edema
b) Hypoventilation
c) Severe anemia
d) Radiation
e) Convection
57. Which is true concerning the diffusing capacity of the lungs:
a) Rises as the partial pressure gradient rises
b) Rises as the effective surface area of the respiratory membrane rises
c) Is not affected by the thickness of the respiratory membrane
d) Is measured using radioactive CO2
e) Is not affected by the diffusion coefficient of the membrane to gases
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
e) B and C are correct
59. Administration of a gas mixture with higher than normal oxygen
concentration at atmospheric pressure would elevate hypoxia due to:
a) Veno-arterial shunt
b) Diffusion impairment
c) Anemia
d) Cyanide poisoning
e) Reduced blood flow to tissues
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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
61. Which is true concerning surface tension in lungs?
a) The normal amount of surfactant reduces surface tension in healthy lungs to
a neglible level
b) In the absence of surfavtant alveoli with small radii collapse into alveoli
with big radii
c) Surfactant is maximally concentrated at liquid-air interface at the end of
inspiration
d) In normal lungs surface tension is responsible for 20% of the recoil force of
the lung
e) Surface tension remains the same throughout the breathing cycle
62. Which is true concerning oxygen transport in the blood?
a) If PO2 is 60 mmHg oxygen concentration is about 18 ml/100 ml blood
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
d) Increase in pH increases the P50
e) P50 reflects the capacity of blood to carry oxygen
63. The physiological shunt:
a) Represents the wasted perfusion
b) Is equal to the physiological dead space
c) Is measured by single breath nitrogen analysis
d) Occurs only in people with respiratory diseases
e) Is about 5% of the cardiac output
64. At the summit of a mountain the barometric pressure was found to be
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
d) Functional residual capacity
e) Physiological dead space
66. Surfactant:
a) Is produced by type I pneumocytes
b) Deficiency decreases lung compliance
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c) Deficiency decreases work of breathing
d) Production starts only after birth in full term babies
e) Production is inhibited by glucocorticoids
67. At the end of normal exporation all the following are correct except:
a) Recoil tendency of the lung as acting inward to collapse the lung
b) Chest recoil is acting outward to expand the lung
c) Alveolar pressure is greater than mouth pressure
d) The average intrapleural pressure is zero
e) Surface tension is less than at the end of normal inspiration
68. Obstructive lung disease is typically characterized by:
a) Reduced total lung capacity
b) Reduced FEV1
c) Reduced functional residual capacity
d) Slightly increased FEV1/FVC ratio
e) Reduced residual volume
69. The following parameters are higher in the elderly than young adults:
a) Vital capacity
b) Basal oxygen consumption per kg body weight
c) Functional residual capacity
d) Anatomical dead space
e) Peak expiratory flow
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
71. Spontaneous respiration ceases after:
a) Transection of the spinal cord below C5
b) Transection of the brain stem between the pons and medulla combined with
bilateral vagotomy
c) Transection of the spinal cord
d) Complete destruction of the peripheral chemoreceptors
e) Transection of the spinal cord at the first cervical segment
72. 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 breathin
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RESPIRATORY SYSTEM
Part Two
Question:
1. In a person breathing normally at rest with an environmental temperature
of 25°C, the partial pressure of
A. CO2 in alveolar air is about twice that in room air.
B. Water vapour in alveolar air is less than half the alveolar PCO2 level.
C. Water vapour in alveolar air is greater than that in room air even at 100 per cent
humidity.
D. O2 in expired air is greater than in alveolar air.
E. CO2 in mixed venous blood is greater than in alveolar air.
2. As blood passes through systemic capillaries
A. pH rises.
B. HCO3
_ ions pass from red cells to plasma.
C. Cl_ ion concentration in red cells falls.
D. Its oxygen dissociation curve shifts to the right.
E. Its ability to deliver oxygen to the tissues is enhanced.
3. The respiratory centre
A. Is in the hypothalamus.
B. Sends impulses to inspiratory muscles during quiet breathing.
C. Sends impulses to expiratory muscles during quiet breathing.
D. Is involved in the swallowing reflex.
E. Is involved in the vomiting reflex.
4. The carotid bodies
A. Are stretch receptors in the walls of the internal carotid arteries.
B. Have a blood flow per unit volume similar to that in the brain.
C. Are influenced more by blood PO2 than by its oxygen content.
D. Generate more afferent impulses when blood H_ ion concentration rises.
E. And the aortic bodies are mainly responsible for the increased ventilation in
hypoxia.
5. Pulmonary surfactant increases
A. The surface tension of the fluid lining alveolar walls.
B. Lung compliance.
C. In effectiveness as the lungs are inflated.
D. In amount when pulmonary blood flow is interrupted.
E. In amount in fetal lungs during the last month of pregnancy.
6. As people age, there is usually a decrease in their
A. Ratio of lung residual volume to vital capacity.
B. Percentage of vital capacity expelled in one second.
C. Lung volume level at which small airways start to close during expiration.
D. Lung elasticity.
E. Resting arterial blood PO2
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.
7. During inspiration
A. Intrapleural pressure is lowest at mid-inspiration.
B. Intrapulmonary pressure is lowest around mid-inspiration.
C. Intraoesophageal pressure is lowest at mid-inspiration.
D. The rate of air flow is greatest at end-inspiration.
E. The lung volume/intrapleural pressure relationship is the same as in expiration.
8. Carbon dioxide
A. Is carried as carboxyhaemoglobin on the haemoglobin molecule.
B. Uptake by the blood increases its oxygen-binding power.
C. Uptake by the blood leads to similar increases in H_ and HCO3
_ ion concentrations.
D. Stimulates ventilation when breathed at a concentration of 20 per cent.
E. Content is greater than oxygen content in arterial blood
.
9. In normal lungs
A. The rate of alveolar ventilation at rest exceeds the rate of alveolar capillary
perfusion.
B. The ventilation/perfusion (V/P) ratio exceeds 1.0 during maximal exercise.
C. The V/P ratio is higher at the apex than at the base of the lungs when a person is
standing.
D. Oxygen transfer can be explained by passive diffusion.
E. Dead space increases during inspiration.
10. Alveolar ventilation is increased by breathing
A. 21 per cent O2 and 79 per cent N2.
B. 17 per cent O2 and 83 per cent N2.
C. 2 per cent CO2 and 98 per cent O2.
D. 10 per cent CO2 and 90 per cent O2.
E. A gas mixture which raises arterial PCO2 by 10 per cent.
11. Bronchial smooth muscle contracts in response to
A. Bronchial mucosal irritation.
B. Local beta adrenoceptor stimulation.
C. A fall in bronchial PCO2.
D. Inhalation of cold air.
E. Circulating noradrenaline.
12. In early inspiration there is a fall in
A. Intrapulmonary pressure.
B. Intrathoracic pressure.
C. Intra-abdominal pressure.
D. Dead space PO2.
E. Pressure in the superior vena cava
.
13. Compliance of the lungs is greater
A. When they are expanded above their normal tidal volume range.
B. In adults than in infants.
C. Than the compliance of the lungs and thorax together.
D. When they are filled with normal saline than when they are filled with air.
E. In standing than in recumbent subjects.
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14. At a high altitude where atmospheric pressure is halved, there is an
increase in
A. Pulmonary ventilation.
B. Alveolar H2O vapour pressure.
C. Arterial PO2.
D. Arterial pH.
E. Cerebral blood flow.
15. During inspiration
A. Venous return to the heart is increased.
B. More energy is expended than during expiration.
C. Lung expansion is assisted by surface tension forces in the alveoli.
D. Lung expansion begins when intrapleural pressure falls below atmospheric.
E. Lung expansion ends when intrapulmonary pressure falls to atmospheric.
16. The residual volume is
A. The gas remaining in the lungs at the end of a full expiration.
B. Greater on average in men than in women.
C. 3–4 litres on average in young adults.
D. Measured directly using a spirometer.
E. Smaller in old than in young people.
17. A rise in arterial PCO2 leads to an increase in
A. Ventilation due to stimulation of peripheral chemoreceptors.
B. Ventilation due to stimulation of central chemoreceptors.
C. Arterial pressure.
D. Cerebral blood flow.
E. The plasma bicarbonate level.
18. Ventilation is increased during
A. Periods when cerebrospinal fluid pH is reduced.
B. Chronic renal failure.
C. Periods when plasma bicarbonate level is raised.
D. Deep sleep.
E. Exercise because of the ensuing fall in arterial PO2.
19. Voluntarily hyperventilation increases the
A. Negative charge on the plasma proteins.
B. Level of ionized calcium in blood.
C. Alveolar PO2 three-fold when ventilation is increased three-fold.
D. Arterial blood oxygen saturation by 10–15 per cent when ventilation is increased
by
10–15 per cent.
E. The renal excretion of bicarbonate.
20. If the carotid and aortic chemoreceptors are denervated
A. Increasing alveolar PCO2 by 25 per cent fails to stimulate ventilation.
B. Halving the alveolar PO2 fails to stimulate ventilation.
C. The resting ventilation rate is depressed by more than 40 per cent.
D. Ventilation does not increase during exercise.
E. The ability to adapt to life at high altitude is impaired
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.
21. Pulmonary
A. Arterial mean pressure is about one-sixth systemic mean arterial pressure.
B. Blood flow/minute is similar to systemic blood flow/minute.
C. Vascular resistance is about 50 per cent that of systemic vascular resistance.
D. Vascular capacity is similar to systemic vascular capacity.
E. Arterial pressure increases by about 50 per cent when cardiac output rises by 50
per
cent.
22. Carbon dioxide is carried in the blood in
A. Combination with the haemoglobin molecule.
B. Combination with plasma proteins.
C. Physical solution in plasma.
D. Greater quantity in red blood cells than in plasma.
E. Greater quantity as HCO3
_ ions than as other forms.
23. A shift of the oxygen dissociation curve of blood to the right
A. Occurs in the pulmonary capillaries.
B. Occurs if blood temperature rises.
C. Favours oxygen delivery to the tissues.
D. Favours oxygen uptake from the lungs by alveolar capillary blood.
E. Increases the P50 (the PO2 value giving 50 per cent blood oxygen saturation).
24. The work of breathing increases when
A. Lung compliance increases.
B. The subject exercises.
C. The rate of breathing increases even though the minute volume stays constant.
D. The subject lies down.
E. Functional residual capacity increases.
25. The compliance of the lungs and chest wall is
A. Expressed as volume change per unit change in pressure.
B. Minimal during quiet breathing.
C. Increased by the surface tension of the fluid lining the alveoli.
D. Increased by surfactant.
E. Changed by parallel displacement of the line relating lung volume to distending
pressure.
26. Respiratory dead space
A. Saturates inspired air with water vapour before it reaches the alveoli.
B. Removes all particles from inspired air before it reaches the alveoli.
C. Decreases when blood catecholamine levels rise.
D. Decreases during a deep inspiration.
E. Decreases during a cough.
27. Vital capacity is
A. The volume of air expired from full inspiration to full expiration.
B. Reduced as one grows older.
C. Greater in men than in women of the same age and height.
D. Related more to total body mass than to lean body mass.
E. The sum of the inspiratory and expiratory reserve volumes.
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28. In pulmonary capillary blood
A. Carbonic anhydrase in erythrocytes catalyses the formation of H_ and HCO3 _.
B. Hydrogen ions dissociate from haemoglobin.
C. The rise in PO2 is of greater magnitude than the fall in PCO2.
D. The oxygen content is linearly related to alveolar PO2.
E. The pH is lower than in blood in the pulmonary artery.
29. Oxygen debt is
A. The amount of O2 consumed after cessation of exercise.
B. Incurred because the pulmonary capillary walls limit O2 uptake during exercise.
C. Possible since skeletal muscle can function temporarily without oxygen.
D. Associated with a rise in blood lactate.
E. Associated with metabolic acidosis.
30. The CO2 dissociation curve for whole blood shows that
A. Its shape is sigmoid.
B. Blood saturates with CO2 when PCO2 exceeds normal alveolar levels.
C. Blood contains some CO2 even when the PCO2 is zero.
D. Oxygenation of the blood drives CO2 out of the blood.
E. Adding CO2 to the blood drives O2 out of the blood.
31. The oxygen content of mixed venous blood is
A. Measured using blood sampled from the right atrium.
B. Increased during generalized muscular exercise.
C. Increased in a warm environment.
D. Increased in cyanide poisoning.
E. Decreased in circulatory failure.
32. Bronchial asthma is likely to be relieved by
A. Stimulation of cholinergic receptors.
B. Stimulation of beta adrenoceptors.
C. Histamine aerosols.
D. Drugs which stabilize mast cell membranes.
E. Glucocorticoids.
33. Air in the pleural cavity (pneumothorax)
A. Allows intrapleural pressure to rise to atmospheric pressure.
B. Causes the underlying lung to collapse by compressing it.
C. Increases the functional residual capacity.
D. Leads to a slight outward movement of the chest wall.
E. Reduces vital capacity.
34. A patient with chronic respiratory failure
A. Shows an enhanced respiratory sensitivity to inhaled carbon dioxide.
B. Shows little or no respiratory response to hypoxia.
C. Is likely to have a low blood bicarbonate level.
D. Responds well when given 100 per cent oxygen to breathe.
E. Must have been breathing oxygen-enriched air if alveolar PCO2 is 150 mmHg (20
kPa).
35. Loss of pulmonary elastic tissue in ‘emphysema’ reduces
A. Physiological dead space.
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B. Anatomical dead space.
C. Residual volume.
D. Vital capacity.
E. The percentage of the vital capacity expired in one second.
36. Complete obstruction of a major bronchus usually results in
A. Collapse of the alveoli supplied by the bronchus.
B. A rise in local intrapleural pressure.
C. An increase in physiological dead space.
D. An increase in blood flow to the lung tissue supplied by the bronchus.
E. Cyanosis.
37. A shift of the oxygen dissociation curve of blood to the left
A. Decreases the O2 content of blood at a given PO2.
B. Impairs O2 delivery to the tissues at the normal tissue PO2.
C. Occurs in blood perfusing cold extremities.
D. Occurs in blood stored for several weeks.
E. Is characteristic of fetal blood when compared with adult blood.
38. Obstructive airways disease (COPD) is similar to restrictive lung disease
(RLD) in that it reduces
A. Vital capacity (VC).
B. The forced expiratory volume in one second (FEV1).
C. The ratio FEV1/VC.
D. Residual volume.
E. Peak expiratory flow rate to the same degree.
39. A diver breathing air at a depth of 30 metres under water
A. Is exposed to a pressure of about four times that at the surface.
B. Has a raised pressure of nitrogen in the alveoli.
C. Has a four-fold increase in the oxygen content of blood.
D. Has a four-fold increase in alveolar water vapour pressure.
E. Expends less energy than normal on the work of breathing.
40. Cyanosis
A. May be caused by high levels of carboxyhaemoglobin in the blood.
B. May be caused by high levels of methaemoglobin in the blood.
C. Is seen in fingers of hands immersed in iced water.
D. Occurs more easily in anaemic than in polycythaemic patients.
E. Is severe in cyanide poisoning.
41. A patient with carbon dioxide retention is likely to have
A. Metabolic acidosis.
B. Alkaline urine.
C. Cool extremities.
D. Raised cerebral blood flow.
E. Raised plasma bicarbonate
.
42. Surgical removal of one lung reduces the
A. FEV1 by about 10 per cent.
B. Percentage saturation of arterial blood with oxygen.
C. Exercise tolerance.
D. Residual volume.
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E. Ventilation/perfusion ratio by about 50 per cent.
43. Coughing
A. Is reflexly initiated by irritation of the alveoli.
B. Is associated with relaxation of airways smooth muscle.
C. Depends on contraction of the diaphragm for expulsion of air.
D. Differs from sneezing in that the glottis is initially closed.
E. Is depressed during anaesthesia.
44. The severity of an obstructive airways disease is indicated by the degree
of change in the
A. Total ventilation/perfusion ratio.
B. Peak expiratory flow rate.
C. Respiratory quotient.
D. Tidal volume.
E. Work of breathing.
45. A 50 per cent fall in the ventilation/perfusion ratio in one lung would
A. Lower systemic arterial oxygen content.
B. Have effects similar to those of a direct right to left atrial shunt.
C. Increase the physiological dead space.
D. Lower systemic arterial carbon dioxide content.
E. Be compensated (with respect to oxygen uptake) by a high ratio in the other lung.
46. In the forced expiratory volume (FEV1) measurement, an adult patient
A. With normal lungs should expire 95 per cent of vital capacity (VC) in 1 second.
B. With restrictive disease may expire a greater than predicted per cent of VC in the
first second.
C. Who is female would be expected to expire a greater per cent of VC in 1 second
than a male of the same age.
D. With obstructive disease may take more than 5 second to complete the expiration.
E. With normal lungs should achieve a peak flow rate of at least 200 litres/minute.
47. The hypoxia in chronic respiratory failure
A. May cause central cyanosis.
B. May cause peripheral cyanosis.
C. Leads to increased formation of erythropoietin.
D. Raises pulmonary vascular resistance.
E. May lead to right heart failure.
48. ‘Blue Bloaters’ (patients with chronic obstructive pulmonary disease
showing marked cyanosis and oedema) differ from ‘Pink Puffers’
(patients with chronic obstructive pulmonary disease showing dyspnoea
but not cyanosis) by having a lower
A. Forced expiratory volume in one second.
B. Peak expiratory flow rate.
C. Arterial blood pH.
D. Sensitivity to carbon dioxide.
E. Pulmonary arterial pressure
.
49. The total amount of O2 carried by the circulation to the tissues/min.
(oxygen delivery or total available oxygen)
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A. Normally equals the rate of O2 consumption by the body/min.
B. Is normally more than 95 per cent combined with haemoglobin.
C. Must fall by about half if haemoglobin concentration is halved.
D. Is more closely related to PO2 than to percentage saturation of the blood with O2.
E. Must double if body oxygen consumption doubles.
Answers:
1.
A. False Room air PCO2 (0.2 mmHg; 0.03 kPa) is negligible compared with alveolar
air PCO2 (40 mmHg; 5.3 kPa).
B. False Alveolar H2O vapour pressure at 37oC is 47 mmHg (6.3 kPa).
C. True Alveolar air is saturated with water vapour at 37˚C. At 25˚C saturated vapour
pressure is 24 mmHg (3.2 kPa), about half that at 37˚C.
D. True Expired air is alveolar air plus dead space air.
E. True This is necessary for CO2 excretion by diffusion.
2.
A. False It falls, due largely to CO2 uptake.
B. True Incoming CO2 is converted to HCO3 _ (carbonic anhydrase in RBCs
catalyses the reaction CO2_H2O_H__HCO3
_; HCO3 _ migrates out as its concentration rises.
C. False It rises as Cl_ moves in to replace departing HCO3 _ in the ‘chloride shift’.
D. True Due largely to the rise in blood PCO2.
E. True Due to the shift of the oxygen dissociation curve.
3.
A. False It is in the medulla oblongata.
B. True Causing expansion of the thorax cage.
C. False Expiration at rest is passive.
D. True It is inhibited during swallowing so preventing aspiration of food.
E. True Expiratory, including abdominal muscle contraction with the oesophagus
relaxed and the glottis closed helps expel gastric contents in vomiting.
4.
A. False The stretch receptors in internal carotid arteries are carotid sinus
baroreceptors; the carotid bodies are separate structures nearby.
B. False They have the greatest flow rate/unit volume yet described in the body.
C. True They are not excited in anaemia where PCO2 is normal but O2 content is
low.
D. True Acidosis stimulates ventilation.
E. True When carotid and aortic bodies are denervated, hypoxia depresses
respiration.
5.
A. False It decreases surface tension.
B. True It permits the lungs to be more easily inflated.
C. False The decreasing effect as lungs inflate helps prevent overinflation.
D. False It decreases; this may lead to local collapse of the lung.
E. True Premature babies may have breathing problems due to surfactant deficiency.
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6.
A. False Residual volume increases and vital capacity decreases.
B. True This gradually falls with normal ageing.
C. False The ‘closing volume’ increases with age.
D. True This increases residual and closing volumes.
E. True There is, however, little change in oxygen saturation.
7.
A. False It is lowest at the end of inspiration.
B. True After mid-inspiration, intrapulmonary pressure rises as air is drawn into the
lungs.
C. False Its pattern is similar to that of intrapleural pressure.
D. False It is greatest at mid-inspiration; it depends on the mouth:alveoli pressure
gradient.
E. False Volume changes lag behind pressure changes to give a hysteresis loop.
8.
A. False It is carried as carbaminohaemoglobin; carboxyhaemoglobin is the
combination of haemoglobin with carbon monoxide.
B. False It decreases as the oxygen dissociation curve is shifted to the right.
C. False HCO3 _ ions increase more; H_ ions are largely buffered by haemoglobin.
D. False Breathing 20 per cent CO2 causes respiratory depression; stimulation of
respiration by CO2 is maximal when breathed at concentrations of around 5 per cent.
E. True CO2 content in arterial blood is about 500 ml/l; O2 content is about 200 ml/l.
9.
A. False Alveolar ventilation at rest is about 4 l/min; perfusion is about 5 l/min.
B. True In maximal exercise, alveolar ventilation may rise to about 80 l/min whereas
alveolar perfusion (cardiac output) rises to about 25 l/min.
C. True Perfusion decreases from base to apex; ventilation does also but to a lesser
extent.
D. True There is no evidence of O2 secretion in the lungs.
E. True The trachea and bronchi expand as the lungs expand.
10.
A. False This is the normal composition of air.
B. False The O2 level must fall to around 15 per cent before breathing is stimulated.
C. True The stimulating effect of high PCO2 is little affected by high PO2 levels.
D. False This level of carbon dioxide depresses breathing.
E. True This is enough to double the volume breathed per minute.
11.
A. True Via a reflex with a parasympathetic efferent pathway.
B. False This leads to relaxation.
C. True This tends to limit local overventilation.
D. True This is minimized normally by the warming of air in the upper airways.
E. False This causes relaxation via beta receptors.
12.
A. True This creates a pressure gradient between mouth and lungs.
B. True Due to an increase in the dimensions of the thoracic cage.
C. False It rises due to descent of the diaphragm.
D. False It rises as inspired air replaces alveolar air.
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E. True It falls as intrathoracic pressure falls.
13.
A. False Compliance is maximal in the tidal volume range.
B. True Compliance is extremely small in infants.
C. True It is nearly twice as great.
D. True There are no surface tension forces to overcome in fluid-filled lungs.
E. True Lungs are less stiff when their blood content falls.
14.
A. True Due to stimulation of chemoreceptors by oxygen lack.
B. False This remains at the saturated pressure at body temperature.
C. False The fall in arterial PO2 stimulates the carotid bodies to increase ventilation.
D. True Hyperventilation causes respiratory alkalosis.
E. False The fall in PCO2 causes cerebral vasoconstriction.
15.
A. True By decreasing intrathoracic venous pressure.
B. True Expiration is assisted by the elastic recoil of the lungs and thoracic cage.
C. False Surface tension is a force to be overcome in inspiration.
D. False Expansion begins when intrapulmonary pressure falls below atmospheric.
E. True There is no pressure gradient at this point to drive air.
16.
A. True This is its definition.
B. True Men, on average, have bigger thoracic cages than women.
C. False It is around 1–1.5 litres
D. False Residual air cannot be exhaled; it is measured indirectly by a dilution
technique.
E. False It increases with age since the elastic recoil of the lungs decreases with age.
17.
A. True Via the carotid and aortic bodies.
B. True The central effect predominates.
C. True Reflex vasoconstriction and cardiac stimulation predominate over the direct
vasodilator effects of CO2.
D. True The cerebral vessels are little affected by sympathetic reflexes so the direct
vasodilator effect of CO2 predominates.
E. True To compensate for the respiratory acidosis.
18.
A. True CO2 acts centrally by reducing the pH of CSF.
B. True Because of the ensuing metabolic acidosis.
C. False The metabolic alkalosis depresses ventilation.
D. False Ventilation falls during deep sleep.
E. False Arterial PO2 is well maintained in exercise.
A. True It makes it more negative by raising blood pH.
B. False It decreases as protein binding of calcium increases.
C. False Alveolar PO2 cannot exceed the PO2 of the air being breathed (160 mmHg,
21 kPa).
D. False The blood is normally almost fully saturated (95–98 per cent).
E. True To compensate for the respiratory alkalosis.
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19.
A. False Raised PCO2 can still stimulate breathing by acting on central
chemoreceptors.
B. True In fact, hypoxia depresses ventilation by its action on the respiratory centre.
C. False Normal ventilation is driven mainly by the effect of CO2 on central
chemoreceptors.
D. False Central and other peripheral effects increase respiratory drive in exercise.
E. True The individual is unable to increase ventilation in response to hypoxia.
20.
A. True About 15 compared with 90 mmHg in the systemic circuit.
B. True Otherwise blood would accumulate in one or other bed.
C. False From (A) and (B) above, it is only about 17 per cent of systemic resistance.
D. False Its capacity is about one-third of systemic capacity.
E. False Pulmonary vascular resistance falls when cardiac output rises, due possibly
to endothelial release of nitric oxide.
21.
A. True Attached to amino groups as carbaminohaemoglobin (Hb-NH.COOH).
B. True Attached to amino groups as carbaminoprotein (Pr-NHCOOH).
C. True It is the CO2 in solution that exerts the PCO2 and is diffusible.
D. False Plasma carries the greater quantity, mainly as bicarbonate.
E. True Bicarbonate accounts for 80–90 per cent of the total CO2 in blood.
22.
A. False It occurs in the systemic capillaries.
B. True This occurs when tissue metabolic activity increases.
C. True More oxygen is released at any given PO2.
D. False Less oxygen is taken up at any given PO2.
E. True For example, a rise in temperature raises the P50.
23.
A. False Compliant lungs are easier to inflate.
B. True Since the rate and depth of ventilation are increased.
C. True The work of breathing is minimal around the normal rate of breathing.
D. True The increase in pulmonary blood volume increases lung stiffness and
abdominal pressure on the diaphragm rises.
E. True Lung compliance falls at higher lung volumes.
24.
A. True The normal value is about 0.1 litre/cm H2O (1 litre/kPa).
B. False It is maximal over this range of chest movement.
C. False The surface tension of alveolar fluid decreases compliance.
D. True This decreases the surface tension.
E. False The slope of this line indicates compliance and is unchanged by a parallel
shift.
25.
A. True This prevents drying of the alveolar surface.
B. False Particles less than about two microns can reach the alveoli.
C. False Catecholamines relax airway muscle and constrict mucosal vessels.
D. False Expansion of the lungs expands airways as well as alveoli.
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E. True This allows air to be expelled at high airway velocity.
26.
A. True This is how it is usually measured.
B. True It falls on average by about a litre between age 20 and age 70.
C. True By half to one litre.
D. False It is related closely to lean body mass.
E. False The tidal volume must be added.
27.
A. False It catalyses the conversion of H2CO3 to CO2 and H2O.
B. True Oxygenation of haemoglobin favours this dissociation.
C. True PO2 rises by at least 40 mmHg whereas PCO2 falls by only 6 mmHg.
D. False It follows the sigmoid oxygen dissociation curve.
E. False It is higher due to the diffusion of CO2 out of the blood to the alveoli.
28.
A. False It is the amount of O2 in excess of resting needs consumed after exercise
stops.
B. False O2 uptake across pulmonary capillary walls is not usually diffusion limited.
C. True The O2 debt incurred during anaerobic metabolism is repaid later.
D. True This is generated during anaerobic metabolism.
E. True Due to the lactic acid, blood HCO3_ falls as the lactic acid is buffered.
29.
A. False The curves start and finish differently. The CO2 curve has a steep initial
slope which gradually decreases, but there is no plateau. It is the O2 curve which is
sigmoid in shape.
B. False Content continues to rise as PCO2 rises above normal alveolar levels.
C. False CO2 content is zero when PCO2 is zero.
D. True Oxyhaemoglobin is a stronger acid than reduced haemoglobin; the liberated
H_.ions drive the reaction H__HCO3
E. False This is shown by the oxygen dissociation curve, not the carbon dioxide
dissociation curve.
30.
A. False For adequate mixing, pulmonary artery blood is needed.
B. False It falls due to increased oxygen extraction by the active muscles.
C. True Due to large volumes of well oxygenated blood returning from skin.
D. True Cyanide blocks uptake of oxygen by tissue enzyme systems.
E. True Oxygen extraction is increased in stagnant hypoxia.
31.
A. False This causes bronchoconstriction.
B. True This causes relaxation of bronchial muscle.
C. False Histamine is a bronchoconstrictor.
D. True The chromoglycate drugs are thought to work like this and reduce release of
bronchoconstrictor agents from mast cells.
E. True These suppress bronchoconstrictor and inflammatory mechanisms.
32.
A. True Air flows in since the pressure in the cavity is normally subatmospheric.
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B. False Except in tension pneumothorax, pleural pressure does not exceed
intrapulmonary pressure (atmospheric); collapse is due to elastic recoil of the lungs.
C. False It decreases as the lung collapses.
D. True The elastic recoil of the lung is no longer applied to the chest wall.
E. True The lungs cannot be fully inflated.
33.
A. False There is increased tolerance of high PCO2 levels.
B. False Sensitivity to low PO2 remains and is important in maintaining ventilation.
C. False HCO3 _ levels rise to compensate for the raised PCO2 in respiratory
acidosis.
D. False This could arrest ventilation by removing hypoxic drive; 24–28 per cent O2
would do.
E. True When breathing air, PO2_PCO2 equal about 140 mmHg (19 kPa).
34.
A. False It increases as the walls between alveoli break down to form large sacs.
B. True Destruction of elastic fibres holding airways open allows them to narrow.
C. False It is increased as airways close more readily than usual during expiration.
D. True It decreases as the residual volume increases.
E. True Thus it is a typical obstructive airways disease.
35.
A. True This ‘atelectasis’ is due to absorption of trapped air.
B. False Local collapse of the lung lowers local intrapleural pressure.
C. False Since the affected lung is collapsed it does not count as dead space.
D. False Local hypoxia in the unventilated segment causes local vasoconstriction.
E. False Vasoconstriction in the collapsed segment prevents deoxygenated blood
passing through to the systemic circulation.
36.
A. False It increases content, especially at tissue PO2.
B. True The blood does not release its oxygen adequately.
C. True Cold shifts the curve to the left and may reduce O2 delivery to cold tissues.
D. True Such blood when transfused may not release its O2 content adequately.
E. True Fetal blood can thus take up O2 at the low PO2 levels seen in the placenta
but fetal tissue PO2 has to be low to permit its release.
37.
A. True In COPD by air trapping and in RLD by reducing total lung volume.
B. True In COPD by slowing flow and in RLD by restricting volume.
C. False Only COPD which slows flow reduces it.
D. False It rises in COPD and falls in RLD.
E. False COPD typically causes marked reduction, RLD typically has little effect.
38.
A. True 10 metres of water_approximately one atmosphere.
B. True Total alveolar pressure_four atmospheres.
C. False Haemoglobin is already saturated with O2 at sea level and cannot take up
more; the amount of dissolved oxygen increases raising total O2 content by less than
10 per cent.
D. False This depends on temperature alone.
E. False More energy is needed to move air made more viscous by compression.
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39.
A. False Carboxyhaemoglobin is pink and gives the skin a pinkish colour.
B. True This blue pigment is a rare cause of central cyanosis.
C. False The fingers are red; cold inhibits oxygen dissociation and reduces
metabolism.
D. False Cyanosis occurs when arterial blood contains more than 5 g/dl reduced
haemoglobin; low haemoglobin values in anaemia make it difficult to reach this level.
E. False Cyanide poisons the enzymes involved in O2 uptake by the tissues; in
cyanide poisoning the blood remains fully oxygenated and the skin is pink.
40.
A. False CO2 retention causes respiratory acidosis.
B. False In respiratory acidosis there is increased secretion of H_ ions in urine.
C. False Carbon dioxide dilates peripheral blood vessels.
D. True The vasodilator effect of high PCO2 on cerebral vessels may lead to cerebral
oedema and headaches.
E. True The kidney manufactures bicarbonate to compensate the respiratory acidosis.
41.
A. False It reduces it by at least half.
B. False A single lung can maintain normal oxygenation at rest.
C. True Maximum ventilation and maximum oxygen uptake are reduced.
D. True It leads to a restrictive lung disease pattern.
E. False The ratio is little affected.
42.
A. False It is initiated by irritation of the trachea and bronchi.
B. False Contraction narrows airways and increases velocity of flow.
C. False It depends on expiratory muscles, particularly abdominal muscles.
D. True Thus it is more explosive than sneezing.
E. True This may lead to retention of mucous secretions.
43.
A. False It may well be normal.
B. True It is a sensitive indicator.
C. False RQ is related to the mixture of substrates being metabolized.
D. False This also may be normal.
E. True This is related to the increased airway resistance.
44.
A. True It constitutes a physiological shunt.
B. True This would be an anatomical shunt.
C. False Physiological dead space is relatively overventilated.
D. False It would tend to raise it.
E. False Increased ventilation cannot increase oxygen saturation; compensation for
carbon dioxide retention can occur.
45.
A. False The normal is about 85 per cent at age 20, falling to about 70 per cent at age
60–70.
B. True The airways are not obstructed and vital capacity volume is reduced.
C. True Females have, on average, smaller vital capacities than males.
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D. True This is typical of moderately severe obstructive airways disease.
E. True 200 litres/min is a low figure; most subjects, other than small elderly
females, should do better.
46.
A. True Reduced V/P ratios allow deoxygenated blood to be shunted to the left side
of the heart.
B. False The peripheral circulation in chronic respiratory failure is usually adequate.
C. True This in turn leads to the secondary polycythaemia typical of the condition.
D. True Hypoxia constricts pulmonary vessels and may cause pulmonary
hypertension.
E. True Persistent pulmonary hypertension can lead to right heart failure.
47.
A. False This is not a differentiating feature.
B. False This tends to parallel the FEV1.
C. True They have a respiratory acidosis due to CO2 retention.
D. True They do not respond adequately to their high PCO2.
E. False Pulmonary hypertension in ‘Blue Bloaters’ leads to heart failure and oedema.
48.
A. False At rest, O2 consumption (about 250 ml/min) is about 25 per cent of the total
available.
B. True All but 3 of the 200 ml/l is combined with haemoglobin, the rest is dissolved.
C. False In anaemic hypoxia, cardiac output rises to compensate for the reduced
oxygen content per litre of blood.
D. False If PO2 falls by 25 per cent from normal, there is relatively little change in
the blood oxygen content.
E. False The extraction ratio rises as oxygen consumption rises, e.g. during exercise.
GASTROINTESTINAL SYSTEM
Part One
1. The physiological actions of CCK include:
a) Increased oesophageal motility
b) Closing the sphincter of oddi
c) Increased bile synthesis
d) Contraction of pancreatic acini
e) Increased enzyme secretion from the pancreas
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
e) Control centers in the medulla oblongata
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3. Saliva does not contain:
a) Blood group antigens
b) Lysozymes
c) Immunoglobulins
d) Platelets
e) Chloride
4. The functions of saliva include the following except:
a) Cleaning the mouth
b) Killing bacteria
c) Digestion of proteins
d) Facilitation of speech
e) Digestion of lipids
5. The pharyngeal phase of swallowing:
a) Is partially voluntary
b) Includes opening of the upper oesophageal sphincter
c) Includes the peristaltic activity of the upper third of the oesophagus
d) Is associated with the opening of the glottis
e) Is preceded by deep inspiration
6. The enzymes produced by the exocrine pancreas include the following except:
a) Proelastase
b) DNase
c) Amylase
d) Enteropeptidase
e) Lipase
7. The secretion of the exocrine pancreas is increased by the following except:
a) Vagal stimulation
b) Acetylcholine
c) Secretin
d) CCK
e) Atropine
8. Bile production by the liver cells is increased by:
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
10. The functions of the colon include the following except:
a) Absorption of water
b) Absorption of sodium
c) Absorption of chloride
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d) Absorption of calcium
e) Absorption of potassium
11. The intestinal flora is:
a) Mainly viruses
b) Mainly found in the duodenum
c) Needed for normal digestion
d) Mainly found in the colon
e) Mainly pathogenic bacteria
12. The following is true about the small intestine:
a) Stores food for several hours
b) Is the main source of digestive enzymes
c) Has haustrae
d) Has segmentation contractions
e) Secretes the intrinsic factors
13. The defaecation reflex:
a) Is initiated by stretching the anal canal
b) Is integrated in a control center in the lumbar spinal cord
c) Is integrated in a control center in the sacral spinal cord
d) Is controlled by the vagus nerve
e) Involves contraction of the sigmoid colon
14. A tumor producing large amounts of gastrin DOES NOT include:
a) Hyperplasia of gastric epithelium
b) Hyperplasia of gastric mucosal lymphocytes
c) Excessive gastric acid secretion
d) Histamine secretion in the gastric mucosa
e) Recurrent peptic ulcers
15. Which of the following is likely to fail to reduce secretion of hydrochloric acid
in the stomach:
a) A H2 receptor blocker
b) A nicotinic cholinergic receptor blocker
c) A muscarinic cholinergic receptor blocker
d) An inhibitor of the hydrogen-potassium pump
e) A gastrin 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
e) Hyperacidity in the stomach
17. The following statements are true about bile except:
a) 25% is produced by bile duct cells
b) The bile stored in the gall bladder contains secondary bile acids
c) Its secretion is increased by secretin
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d) Bile pigments are needed for micelle formation
e) Some lipids will be digested and absorbed in the absence of bile
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
b) Common bile duct
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
e) Control centers in the medulla oblongata
20. The secretion of the exocrine pancreas is increased by the following except:
a) Vagal stimulation
b) Acetylcholine
c) Secretin
d) CCK
e) Noradrenaline
21. The jejunum is the main site for absorption of except:
a) Glucose
b) Amino acids
c) Fatty acids
d) Vitamin B12
e) Water
22. Functions of the human stomach include:
a) Absorption of iron
b) Absorption of Vitamin B12
c) Absorption of 50% of water intake
d) Storage of food for 24 hours
e) Limited digestion of proteins
23. The presence of bilirubin in bile is important because:
a) It gives bile its color
b) It leads to production of stercobilinogen in the intestine
c) It facilitates absorption of lipids
d) It gives faces their color
e) It means a waste product is being excreted
24. Relating to carbohydrate digestion:
a) Cellulose can be digested by human amylases
b) About one-third of starch digestion occurs in the mouth and two-thirds
occurs in the small gut
c) It can only occur in the complete absence of protein digestion
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d) It occurs only if bile salts are present
e) Sucrose is split by amylase action
25. 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 "flickering clusters" of cholesterol and fatty acids coated with bile salts
and 2 mono-glycerides
e) Are the triglyceride particles formed by enterocytes and transported in the
lymphatic system
26. The neurons of the intrinsic enteric nervous system do NOT perform the
following functions:
a) Detect distension of the stomach
b) Control intestinal mucosal cell secretions
c) Coordinate muscle contraction in the large intestine
d) Control lower oesophageal sphincter
e) Contract the gall bladder
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
c) Right hepatic lobectomy
d) Total oroclocolectomy
e) Subtotal small intestinal resection
29. After a cholecystoctomy, patients may have problems with fat-rich foods
becuase:
a) The liver stops producing enough bile
b) Bile pigments are reduced in amount
c) The enterohepatic circulation has stopped
d) Bile is not well concentrated
e) The sphincter of Oddi fails to open in response to a fatty meal
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
31. The colonic mucosal cells are very efficient in:
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a) Converting primary bile acids into secondary bile acids
b) Converting bilirubin into stercobilinogen
c) Absorption of aromatic amino acids
d) Absorption of sodium
e) Absorption of phosphates
32. Contraction of the gallbladder may be due to:
a) Secretin
b) VIP
c) Bile salts
d) Atropine
e) Paraympathetic stimulation
33. Saliva does not contain:
a) Blood group antigens
b) Lysozymes
c) Immunoglobulins
d) Pepsin
e) Chloride
34. The actions of secretin include:
a) Increased salivary secretion
b) Relaxation of the oesophageal sphincters
c) Stimulation of gastric secretion
d) Stimulation of secretion of bicarbonate by pancreatic duct cells
e) Stimulation of secretion of bicarbonate by pancreatic acinar cells
35. Saliva is needed for:
a) Digestion of sucrose
b) Digestion of phospholipids
c) Ability to speak
d) Breaking food down into small pieces
e) Absorption of chloride
36. The pharyngeal phase of swallowing includes:
a) A deep breath
b) Elevation of the tongue against the hard palate
c) Contraction of the upper oesophageal sphincter
d) Contraction of the pharyngeal constrictors
e) Elevation of the epiglottis
37. If the stomach is removed (gastrectomy), the patient is unlikely to suffer
from:
a) Iron deficiency anemia
b) Ca2+ deficiency
c) Macrocytic anemia
d) Malnutrition
e) Inability to absorb water
38. Functions in the liver include production of:
a) Digestive enzymes
b) Secondary bile acids
c) Stercobilinogen
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d) CCK
e) Taurocholic acid
39. The small intestine:
a) Is shorter than the large intestine
b) Its internal surface area is smaller than the large intestine
c) It absorbs less water than the large intestine
d) It contains bacteria as found in the large intestine
e) It produces the enzymes needed for lipid digestion
40. Bile contains all of the following except:
a) Alkaline phosphatase
b) K+
c) Cholesterol
d) CCK
e) Water
41. The functions of gastrin include the following except:
a) Increased production of histamine in the gastric mucosa
b) Stimulation of the growth of intestinal mucosa
c) Increased secretion of pepsinogen
d) Contraction of the gastro-oesophageal junction
e) Increased secretion of HCO3 - by biliary duct cells
42. Major constituents of feces include all of the following except:
a) Water
b) Cellulose
c) Bacteria
d) Calcium salts
e) Glycogen
43. The exocrine pancreas secretes the following enzymes except:
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
45. If the submandibular salivary gland stops functioning:
a) The volume of salivary secretion will be reduced by 20%
b) There would be severe deficiency of alpha-amylase
c) There would be no mucins in saliva
d) There would be difficulty in swallowing
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e) Parasympathetic stimulation would not increase salivary secretion
46. If the oesophageal muscles are not working:
a) Swallowing in the upright position is not affected because of gravity
b) Water swallowing is not affected
c) There will be dysphagia to solids and liquids
d) There will be frequent attacks of vomiting
e) Gastro-oesophageal reflex becomes less common
47. Atrophy of the gastric mucosal glands is likely to result in:
a) Diminished digestion of starch
b) Failure of digestion and absorption of proteins
c) High gastrin levels in the blood
d) High secretin levels in the blood
e) Normochromic normocytic anemia
48. The brush border enzymes of the small intestine digest:
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
50. The stomach has the ability to absorb:
a) Ca2+
b) Alcohol
c) Glucose
d) Aromatic amino acids
e) Fe2+
51. The effects of parasympathetic stimulation on the GIT include:
a) Constriction of the pylorus
b) Contraction of the internal anal sphincter
c) Contraction of the external anal sphincter
d) Contraction of the gall bladder
e) Decreased mucus secretion
52. Pancreatic exocrine secretion is stimulated by the following except:
a) CCK
b) Secretin
c) Vagal stimulation
d) Presence of food in stomach
e) Entropeptidase
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53. Absorption of iron:
a) The stomach absorbs 55% of dietary iron due to the presence of HCl
b) The small intestine absorbs most of the iron in the diet
c) Iron absorption is mainly at the terminal ileum
d) The amount of iron absorbed changes according to body stores and rate of
erythropoiesis
e) The amount of iron absorbed is adjusted to balance iron excretion by the
kidney
54. Saliva does not normally contain:
a) Isozyme
b) IgA
c) Lactoferrin
d) Intrinsic factor
e) Hydrogen ions
55. The oesophageal phase of swallowing:
a) Cannot proceed when the mouth is open
b) Is primarily a reflex controlled by the myenteric plexus
c) Is primarily controlled by the swallowing center in the brain
d) Starts when a bolus enters the oropharynx
e) Takes less time in patients with achalasia of the cardia
56. Vomitting is not usually caused by:
a) Irritation if the duodenal mucosa
b) Diseases of the inner ear
c) Microbial toxins in the blood
d) Severe exercise
e) Bad smell
57. The function of the migrating motor complex (MMC) is to:
a) Empty non-digestable material from stomach and small intestine during
fasting
b) Initiate mass movements in the large intestine
c) Increase intestinal peristalsis in response to overfeeding
d) Increase ileal motility in response to entry of chyme into the stomach
e) Overcome intestinal obstruction
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:
a) Converting primary bile acids into secondary bile acids
b) Converting bilirubin into stercobilinogen
c) Absorption of Na+
d) Absorption of aromatic amino acids
e) Digestion of cellulose
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60. It is true to say the following about the motility of the gastrointestinal system:
a) It is regulated neurally but not by hormones
b) Emptying of the stomach is mainly by segmentation contractions
c) Movement of chyme along the small intestine is mainly by the migrating
motor complex
d) Peristalsis is seen in most parts of the GIT
e) The gallbladder is contracted by sympathetic stimulation
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
GASTROINTESTINAL SYSTEM
Part Two
Questions:
1. Bile
A. Contains enzymes required for the digestion of fat.
B. Contains unconjugated bilirubin.
C. Salts make cholesterol more water-soluble.
D. Pigments contain iron.
E. Becomes more alkaline during storage in the gallbladder.
2. Saliva
A. From different salivary glands has a similar composition.
B. Contains enzymes essential for the digestion of carbohydrates.
C. Has less than half the ionic calcium level of plasma.
D. Has more than twice the iodide level of plasma.
E. Has a pH between 5 and 6.
3. Swallowing is a reflex which
A. Has its reflex centres in the cervical segments of the spinal cord.
B. Includes inhibition of respiration.
C. Is initiated by a voluntary act.
D. Is dependent on intrinsic nerve networks in the oesophagus.
E. Is more effective when the person is standing rather than when lying down.
4. Appetite for food is lost when
A. Certain hypothalamic areas are stimulated.
B. Certain hypothalamic areas are destroyed.
C. The stomach is distended.
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D. The stomach is surgically removed.
E. Blood glucose falls.
5. Secretion of saliva increases when
A. Touch receptors in the mouth are stimulated.
B. The mouth is flushed with acid fluids with a pH of about 4.
C. A subject thinks of unappetizing food.
D. Vomiting is imminent.
E. Their sympathetic nerve supply is stimulated.
6. Defaecation is a reflex action
A. That is coordinated by reflex centres in the sacral cord.
B. Whose afferent limb carries impulses from stretch receptors in the colon.
C. Whose efferent limb travels mainly in sympathetic autonomic nerves.
D. Which is more likely to be initiated just after a meal than just before it.
E. Which can be voluntarily inhibited or facilitated.
7. Thirst sensation occurs when
A. Osmoreceptors in the sensory cortex are activated.
B. Blood osmolality is raised but blood volume is normal.
C. Blood volume is reduced but blood osmolality is normal.
D. The mouth is dry.
E. A patient has severe diabetic keto-acidosis.
8. In the stomach
A. pH rarely falls below 4.0.
B. Pepsinogen is converted to pepsin by hydrochloric acid.
C. Ferrous iron is reduced to ferric iron by hydrochloric acid.
D. Acid secretion is inhibited by pentagastrin.
E. There is a rise in the bacterial count after histamine H1 receptor blockade.
9. Intestinal secretions contain
A. Potassium in a concentration similar to that in extracellular fluid.
B. Enzymes that are released when the vagus nerve is stimulated.
C. Enzymes that hydrolyze disaccharides.
D. Enzymes that hydrolyze monosaccharides.
E. Enzymes that activate pancreatic proteolyic enzymes.
10. Pancreatic secretion
A. In response to vagal stimulation is copious, rich in bicarbonate but poor in
enzymes.
B. In response to acid in the duodenum is scanty but rich in enzymes.
C. In response to secretin secretion is low in bicarbonate.
D. Contains enzymes that digest neutral fat to glycerol and fatty acids.
E. Contains enzymes that convert disaccharides to monosaccharides.
11. The liver is the principal site for
A. Synthesis of plasma albumin.
B. Synthesis of plasma globulins.
C. Synthesis of vitamin B12.
D. Storage of vitamin C.
E. Storage of iron.
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12. In the colon
A. A greater volume of water is absorbed than in the small intestine.
B. Mucus is secreted to lubricate the faecal contents.
C. Faecal transit time is normally about 7 days.
D. Faecal transit time is inversely related to its fibre content.
E. Bacteria normally account for about three quarters of the faecal weight.
13. Gastric juice
A. Is secreted when the vagus nerves are stimulated.
B. Is secreted in vagotomized animals when food is chewed but not swallowed.
C. Inactivates the digestive enzymes secreted with saliva.
D. Does not digest the gastric mucosa because it is protected by a pepsin inactivator.
E. Irritates the oesophageal mucosa if regurgitated from the stomach.
14. An increase in body fat increases the
A. Percentage of water in the body.
B. Survival time during fasting.
C. Survival time in cold water.
D. Specific gravity of the body.
E. Probability of increased morbidity and premature mortality.
15. The respiratory quotient
A. Is the ratio of the volume of O2 consumed to the volume of CO2 produced.
B. Depends essentially on the type of substrate being metabolized.
C. Is 1.0 when glucose is the substrate metabolized.
D. Is between 0.9 and 1.00 in the second week of fasting.
E. For the brain is around 1.0.
16. Oxygen consumption tends to increase when the
A. Concentration of oxygen in inspired air rises.
B. Metabolic rate falls.
C. Body temperature rises.
D. Environmental temperature falls.
E. After a meal is ingested.
17. Saliva is necessary for
A. Digestion of food.
B. Swallowing of food.
C. Normal speech.
D. Antisepsis in the mouth.
E. Taste sensation.
18. The stomach
A. Is responsible for absorbing about 10 per cent of the ingested food.
B. Contains mucosal cells containing high concentrations of carbonic anhydrase.
C. Peristaltic contractions start from the pyloric region.
D. Motility increases when fat enters the duodenum.
E. Relaxes when food is ingested so that there is little rise in intra-gastric pressure.
19. Brown fat is
A. Relatively more abundant in adults than in infants.
B. Richer in mitochondria than ordinary fat.
C. More vascular than ordinary fat.
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D. Stimulated to generate more heat when its parasympathetic nerve supply is
stimulated.
E. Is more important than shivering in neonatal thermoregulation.
20. Nitrogen balance
A. Is the relationship between the body’s nitrogen intake and nitrogen loss.
B. Is positive in childhood.
C. Becomes more positive when dietary protein is increased.
D. Becomes negative when a patient is immobilized in bed.
E. Becomes less negative in the final stages of fatal starvation.
21. The normally innervated stomach
A. Is stimulated to secrete gastric juice when food is chewed, even if it is not
swallowed.
B. Cannot secrete HCl when its H1 histamine receptors are blocked.
C. And the denervated stomach can secrete gastric juice after a meal is ingested.
D. Empties more quickly than the denervated stomach.
E. Is stimulated to secrete gastric juice by the hormone secretin
22. The passage of gastric contents to the duodenum may cause
A. Copious secretion of pancreatic juice rich in bicarbonate.
B. Decreased gastric motility.
C. Contraction of the gallbladder.
D. Contraction of the sphincter of Oddi.
E. Release of pancreozymin.
23. Bile salts
A. Are the only constituents of bile necessary for digestion.
B. Have a characteristic molecule, part water-soluble and part fat-soluble.
C. Are reabsorbed mainly in the upper small intestine.
D. Are derived from cholesterol.
E. Inhibit bile secretion by the liver.
24. Absorption of
A. Fat is impaired if either bile or pancreatic juice is not available.
B. Undigested protein molecules can occur in the newborn.
C. Laevo-amino acids occurs more rapidly than absorption of the dextro-forms.
D. Iron is at a rate proportional to body needs.
E. Sodium is at a rate proportional to body needs.
25. The specific dynamic action of food
A. Is the increase in metabolic rate that results from ingestion of food.
B. Persists for about an hour after a meal is ingested.
C. Is due to the additional energy expended in digesting and absorbing the food.
D. Results in about 30 per cent of the energy value of ingested protein being
unavailable for other purposes.
E. Results in about 20 per cent of the energy value of ingested fat and carbohydrate
being unavailable for other purposes.
26. Secretion of gastric juice
A. Increases when food stimulates mucosal cells in the pyloric region.
B. Is associated with a decrease in the pH of venous blood draining the stomach.
C. In response to food is reduced after vagotomy.
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D. Is essential for protein digestion.
E. Is essential for absorption of vitamin B12.
27. In the small intestine
A. The enzyme concentration in intestinal juice is lower in the ileum than in the
jejunum.
B. Vitamin B12 is absorbed mainly in the jejunum.
C. Water absorption is dependent on the active absorption of sodium and glucose.
D. Absorption of calcium occurs mainly in the terminal ileum.
E. Glucose absorption is dependent on sodium absorption.
28. The cells of the liver
A. Help to maintain the normal blood glucose level.
B. Deaminate amino acids to form NH4_ which is excreted as ammonium salts in the
urine.
C. Synthesize Vitamin D3 (cholecalciferol).
D. Manufacture most of the immune globulins.
E. Inactivate steroid hormones manufactured in the gonads.
29. Absorption of dietary fat
A. Can only occur after the neutral fat has been split into glycerol and fatty acids.
B. Involves fat uptake by both the lymphatic and blood capillaries.
C. Is impaired following gastrectomy.
D. Is required for normal bone development.
E. Is required for normal blood clotting.
30. One gram of
A. Carbohydrate, metabolized in the body, yields the same energy as when oxidized
in a bomb calorimeter.
B. Fat, metabolized in the body, yields 10 per cent more energy than 1g of
carbohydrate.
C. Protein, metabolized in the body, yields the same energy as when oxidized in a
bomb calorimeter.
D. Carbohydrate, metabolized in the body, yields about the same energy as 1g of
protein.
E. Protein per kg body weight is an adequate daily protein intake for a sedentary
adult.
31. Cholesterol
A. Can be absorbed from the gut by intestinal lymphatics following its incorporation
into chylomicrons.
B. Can be synthesized in the liver.
C. In the diet comes mainly from vegetable sources.
D. Is eliminated from the body mainly by metabolic degradation.
E. Is a precursor of adrenal cortical hormones.
32. Free (non-esterified) fatty acids in plasma
A. Account for less than 10 per cent of the total fatty acids in plasma.
B. Are complexed with the plasma proteins.
C. Decrease when the level of blood adrenaline rises.
D. Can be metabolized to release energy in cardiac and skeletal muscle.
E. Can be metabolized to release energy in the brain.
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33. The risk of developing gallstones increases
A. When cholesterol micelles are formed in the gall bladder.
B. As the bile salt:cholesterol ratio increases.
C. As the lecithin:cholesterol ratio increases.
D. When supplementary bile salts are taken by mouth.
E. In patients with haemolytic anaemia.
34. Modifying gastric function
A. By cutting vagal fibres to the pylorus increases the emptying rate.
B. By enlarging the pyloric orifice increases the emptying rate.
C. By making a side-to-side anastomosis between the stomach and jejunum may
cause peptic ulceration in the jejeunum.
D. To allow rapid gastric emptying may lead to low blood glucose levels after a meal.
E. To allow rapid gastric emptying may lead to a fall in blood volume and blood
pressure after a large meal.
35. Impaired intestinal absorption of
A. Iron occurs frequently following removal of most of the stomach.
B. Iodide leads to a reduction in size of the thyroid gland.
C. Water occurs in infants who cannot digest disaccharides.
D. Calcium may occur following removal of the terminal ileum.
E. Bile salts may occur following removal of the terminal ileum.
36. Peptic ulcer pain is typically relieved by
A. Raising the pH of the fluid bathing the ulcer.
B. Oral administration of sodium bicarbonate.
C. Oral administration of a non-absorbable antacid.
D. A drug which interferes with the action of acetylcholinesterase.
E. A drug which blocks the gastric proton pump.
37. Fat stores in the adult
A. Make up less than 5 per cent of average body weight.
B. Make up a smaller percentage of body weight in women than in men.
C. Release fatty acids when there is increased sympathetic nerve activity.
D. Release fatty acids when insulin is injected.
E. Enlarge by increasing the number of adipocytes they contain.
38. Metabolic rate can be estimated from measurements of
A. Total heat production.
B. The calorific value of the food consumed in the previous 24 hours.
C. Oxygen consumption provided the type of food being metabolized is known.
D. Oxygen consumption and the respiratory quotient.
E. Carbon dioxide production and the respiratory quotient.
39. Intestinal obstruction causes
A. Constipation.
B. Crampy pain due to intermittent vigorous peristalsis.
C. Distension due to fluid and gas proximal to the obstruction.
D. Hypotension.
E. Vomiting which is more severe with low than with high bowel obstruction.
40. The cause of jaundice is likely to be
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A. Liver disease, if albumin is low and bilirubin mainly unconjugated.
B. Bile duct obstruction, if the urine is paler than normal.
C. Haemolysis, if the prothrombin level is below normal.
D. Haemolysis, if the urine is darker than normal.
E. A post-hepatic cause, if the bilirubin level in the blood is high.
41. Complications that may arise after total gastrectomy include
A. Inadequate food intake.
B. Depletion of vitamin B12 stores in the liver.
C. Malabsorption of fat due to rapid intestinal transit.
D. Impaired defaecation due to loss of the gastrocolic reflex.
E. Inability to digest protein.
42. Severe diarrhoea causes a decrease in
A. Body potassium.
B. Body sodium.
C. Extracellular fluid volume.
D. Total peripheral resistance.
E. Blood pH.
43. Diminished liver function may result in an increase in the
A. Albumin to globulin ratio in the blood.
B. Size of male breasts.
C. Level of unconjugated bilirubin in the blood.
D. Tendency to bleed.
E. Variability of the blood glucose level.
44. Peptic ulceration tends to heal after
A. Division of the vagal nerve supply to the stomach.
B. Surgical removal of the pyloric antrum.
C. Glucocorticoid drug treatment.
D. Elimination of the bacterium Helicobacter pylori from the stomach.
E. Treatment with histamine H2 blocking drugs.
45. Urobilinogen is
A. A mixture of colourless compounds also known as stercobilinogen.
B. Formed in the reticuloendothelial system from bilirubin.
C. Converted into the dark pigment, urobilin, on exposure to air.
D. Absorbed from the intestine.
E. Excreted mainly in the urine.
46. Surgical removal of 90 per cent of the small intestine may cause a
decrease in
A. The fat content of the stools.
B. Bone mineralization (osteomalacia).
C. Extracellular fluid volume.
D. Blood haemoglobin level.
E. Body weight.
47. Lack of pancreatic juice in the duodenum may lead to
A. The presence of undigested meat fibres in the stools.
B. An increase in the fat content of the faeces.
C. Faeces with a high specific gravity.
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D. A tendency for the faeces to putrefy.
E. A high prothrombin level in blood.
48. In liver failure there is likely to be
A. Salt and water retention.
B. Oedema in dependent extremities such as the feet and ankles.
C. Raised blood urea.
D. Impaired absorption of fat.
E. Intoxication after eating a high protein meal.
49. Gastric
A. Acid secretion in response to a lowered blood sugar is mediated by the hormone
gastrin.
B. Emptying is facilitated by sympathetic nerve activity.
C. Acid secretion increases when histamine H2, muscarinic M1 or gastrin receptors
are activated.
D. Acid secretion is inhibited by the presence of food in the duodenum.
E. Contraction waves pass over the stomach at a rate of about ten per minute.
50. In portal hypertension
A. The total vascular resistance of the hepatic sinusoids is increased.
B. Portal blood flow through the liver is increased.
C. The volume of fluid in the peritoneal cavity increases.
D. A porto-caval shunt (anastomosis between portal vein and inferior vena cava) can
decrease the tendency to bleed into the alimentary tract.
E. A porto-caval shunt increases the risk of coma after bleeding into the alimentary
tract.
51. Constipation is a recognized consequence of
A. Sensory denervation of the rectum.
B. Psychological stress.
C. Abnormality of the autonomic nerve supply to the colon.
D. A diet that leaves little unabsorbed residue in the gut.
E. Over-activity of the thyroid gland as in thyrotoxicosis.
52. Absorption of glucose by intestinal mucosal cells
A. Relies on a carrier mechanism in the cell membrane.
B. Is blocked by the same agents that block renal reabsorption of glucose.
C. Is enhanced by blockade of active sodium transport in the cells.
D. Involves the same carriers that are used for the absorption of galactose.
E. Takes place mainly in the ileum.
53. Vomiting
A. Is caused by violent rhythmic contractions of gut smooth muscle.
B. Is coordinated by a vomiting centre in the mid brain.
C. Of green fluid suggests that duodenal contents have regurgitated into the stomach.
D. May be accompanied by a fall in arterial blood pressure.
E. Is more marked in low intestinal obstruction than in high intestinal obstruction.
54. Obesity
A. Is unlikely to occur on a high protein diet even if the calorific value of the food
exceeds daily energy expenditure.
B. Is associated with increased demands on pancreatic islet beta cells.
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C. Can be assessed by multiple measurements of skin fold thickness.
D. Can be assessed by weighing the body in air and in water.
E. Is not diagnosed until body weight is 40 per cent above normal.
55. Muscle tone in the lower oesophagus is
A. Greater than tone in the middle oesophagus.
B. A major factor in preventing heartburn.
C. Increased in pregnancy.
D. Increased by gastrin.
E. Increased by anticholinergic drugs
Answers:
1.
A. False Bile contains no digestive enzymes; its bile salts assist in the emulsification
and absorption of fat.
B. False The bilirubin is conjugated by the hepatocytes before excretion.
C. True By forming cholesterol micelles.
D. False Iron is removed from haem in the formation of bilirubin.
E. False It becomes more acid, which improves the solubility of bile solids
.
2.
A. False Serous glands such as the parotids produce a watery juice; mucous glands
such as the sublinguals produce a thick viscid juice.
B. False The functions of salivary amylase (ptyalin) can be affected by enzymes from
other digestive glands.
C. False It is saturated with calcium ions; calcium salts are laid down as plaque on the
teeth.
D. True Saliva is an important route of iodide excretion; its concentration in saliva is
20–100 times that in plasma.
E. False Saliva has a neutral pH; acidity in the mouth tends to dissolve tooth enamel.
3.
A. False The reflex centres lie in the medulla oblongata.
B. True This plus closure of the glottis prevents food being aspirated into the airways.
C. True The voluntary act is propulsion of a bolus of food onto the posterior
pharyngeal wall.
D. True These are essential for the peristaltic phase.
E. True Gravity can assist the reflex; tablets are more difficult to swallow when lying
down.
4.
A. True For example, when the ‘satiety’ centres are stimulated.
B. True For example, when the ‘hunger’ centres are damaged.
C. True Appetite is relieved after a meal before the food products of digestion are
absorbed into the blood.
D. False The drive to eat does not depend on an intact stomach.
E. False It increases as hypothalamic ‘glucostats’ detect the low glucose and excite
the ‘hunger’ centres to generate the emotional drive to eat.
5.
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A. True Food, foreign bodies and the dentist are effective stimuli.
B. True E.g. lemon juice; saliva is a useful buffer to protect teeth from acid.
C. False Thinking of appetizing food results in salivary secretion by a conditioned
reflex; conversely, thinking of unappetizing food inhibits secretion.
D. True Saliva helps to buffer the acid vomitus when it reaches the mouth.
E. True Sympathetic stimulation produces a scanty viscid juice; parasympathetic
stimulation produces a copious watery juice.
6.
A. True Reflex defaecation can occur after complete spinal cord transection.
B. False The stretch receptors triggering the reflex are in the rectal wall.
C. False Parasympathetic nerves are the main motor nerves for defaecation.
D. True The wish to defaecate that follows a meal is attributed to a ‘gastrocolic
reflex’.
E. True Forced expiration against a closed glottis facilitates the reflex by raising
intraabdominal pressure and pushing faeces into the rectum; contraction of the
voluntary muscle of the external sphincter can inhibit it.
7.
A. False The emotional drive to drink depends on ‘thirst centres’ in the
hypothalamus.
B. True Presumably due to stimulation of hypothalamic osmoreceptors.
C. True Presumably due to stimulation of vascular volume receptors.
D. True Afferents from the upper alimentary tract can influence ‘thirst centre’
activity.
E. True Probably due to osmoreceptor stimulation by the hyperglycaemic blood and a
reduction in the activity of vascular volume receptors.
8.
A. False Values around pH 2–3 are normal.
B. True Pepsin is the active proteolyic form of pepsinogen.
C. False HCl reduces trivalent ferric iron to the divalent ferrous form in which it can
be absorbed in the small intestine.
D. False Pentagastrin is a powerful pharmacological stimulant of mucosal cells to
produce HCl.
E. False But it rises markedly after H2 blockade which blocks gastric acid secretion.
9.
A. False The concentration is higher, due partly to potassium released from cast off
cells.
B. False Intestinal secretion is not under vagal control; its enzymes are thought to be
constituents of the mucosal cells and released when these are cast off into the lumen.
C. True The mucosal cell brush border contains these enzymes, e.g. maltase and
lactase.
D. False Monosaccharides are end-products of digestion and absorbed as such.
E. True For example, enterokinase which converts trypsinogen to trypsin.
10.
A. False It is scanty and rich in enzymes; it is secreted reflexly in the ‘cephalic’ phase
of pancreatic secretion when food is thought about or chewed.
B. False It is copious, bicarbonate rich and poor in enzymes; it buffers the acid
secretions entering the duodenum from the stomach.
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C. False This is the hormone released when acid enters the duodenum that stimulates
the pancreas to produce the juice described in (B) above.
D. True Pancreatic lipase.
E. False Pancreatic amylase breaks down carbohydrates to dextrins and
polysaccharides.
11.
A. True Plasma albumin concentration falls in liver failure.
B. False Immunoglobulins are produced by ribosomes in lymphocytes.
C. False Vitamin B12 is ingested in food, absorbed complexed with intrinsic factor in
the terminal ileum and stored in the liver.
D. False Vitamin C is not stored; any in excess of requirements is excreted in urine.
E. True Iron released from haem from broken down RBCs is stored in the liver for
future haemopoiesis.
12.
A. False The colon absorbs 1–2 litres/day; 8–10 litres is absorbed per day in the small
intestine.
B. True Mucous cells are the predominant cells on the colonic mucosal surface.
C. False The average transit time from caecum to pelvic colon is about 12 hours but
passage from the pelvic colon to the anus may take days.
D. True Fibre (cellulose, lignin etc.) in the colonic contents stimulates peristaltic
movements by adding ‘bulk’ to the food residues.
E. False But bacteria such as Escherichia coli make up about a third of faecal weight.
13.
A. True Vagal stimulation increases acid and pepsinogen secretion; this action is
mediated by acetylcholine and gastrin-releasing peptide released from the vagal nerve
endings.
B. False After vagotomy, food must enter the stomach to stimulate gastric secretions.
C. True Salivary enzymes are not effective at the low pH of gastric juice.
D. False But mucosal cells are protected by a coat of mucus impregnated with
bicarbonate.
E. True This is normally prevented by the cardiac sphincter.
14.
A. False The reverse is true, since fat tissue contains little water
B. True Fat is the main energy store of the body.
C. True It favours survival by increasing skin insulation.
D. False Fat has a lower specific gravity than the lean body mass.
E. True Actuarial tables show this to be true.
15.
A. False It is the inverse of this ratio.
B. True The respiratory quotients for carbohydrate, fat and protein metabolism are
different.
C. True C6H12O6_6O2_6CO2_6H2O; each molecule of O2 consumed results in the
production of one molecule of CO2.
D. False It approaches 0.7, the value when fat is the main substrate being
metabolized.
E. True Carbohydrate is the main substrate for brain metabolism.
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16.
A. False The concentration of oxygen in the air breathed is not a determinant of
oxygen consumption.
B. False It rises; metabolic rate is the prime determinant of oxygen consumption.
C. True This increases metabolic rate by increasing the rate of cellular metabolism.
D. True More thermogenesis is required to maintain body temperature.
E. True Due to the specific dynamic action of the food, particularly protein.
17.
A. False Other digestive tract enzymes can take over if salivary enzymes are absent.
B. False But swallowing solids is difficult without saliva’s moisturizing and lubricant
effects.
C. True Nervous orators with dry mouths continually sip water.
D. True In the absence of saliva, the mouth becomes infected and ulceration occurs.
E. True Substances must go into solution before they can stimulate taste receptors.
18.
A. False Little food is absorbed in the stomach other than alcohol.
B. True This is needed to generate the H_ ions required for HCl secretion; carbonic
anhydrase inhibitors reduce acid secretion.
C. False They begin at the other end, the fundus.
D. False Fat in the duodenum inhibits gastric motility.
E. True This ‘receptive relaxation’ allows the stomach to store large volumes of food
without discomfort.
19.
A. False The reverse is true.
B. True It has a higher metabolic rate than ordinary fat.
C. True Its higher metabolic rate merits a higher rate of blood flow.
D. False Metabolic activity in brown fat is stimulated by sympathetic nerve
stimulation.
E. True Infants do not shiver well.
20.
A. True It is positive when more nitrogen is taken in than is lost.
B. True Nitrogen intake is greater than nitrogen loss during active tissue growth.
C. False The additional nitrogen intake is balanced by additional nitrogen loss as the
extra protein is metabolized and its nitrogen excreted in the urine.
D. True Muscles waste and the protein released is metabolized.
E. False It becomes more negative when little but protein remains to be metabolized.
21.
A. True This depends on a vagal reflex.
B. False Blockade of histamine H2 receptors blocks gastric acid secretion.
C. True The denervated stomach is still affected by gastrin released from the gastric
mucosa when food enters the stomach.
D. True Gastric motility is more effective when it is coordinated by vagal nerve
activity.
E. False Secretin, which stimulates pancreatic secretion, decreases gastric secretion.
22.
A. True This is caused by the hormone secretin released from the duodenal mucosa.
B. True This postpones further gastric emptying.
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C. True Due to the action of cholecystokinin released from the mucosal cells.
D. False The sphincter of Oddi must relax to allow bile to enter the gut.
E. True Pancreozymin stimulates the pancreas to secrete a scanty, enzyme rich juice.
23.
A. True They emulsify fat creating a greater surface area for lipase to act on.
B. True This property allows them form to micelles for fat transport.
C. False They are absorbed in the terminal ileum.
D. True They are synthesized from cholesterol in the liver.
E. False They are ‘choleretics’, substances which stimulate bile secretion.
24.
A. True If either is absent, undigested fat appears in the faeces.
B. True Maternal antibodies (globulins) in colostrum are so absorbed.
C. True Transport mechanisms are isomer-specific.
D. True An active carrier-mediated transport mechanism is involved which reduces
the danger of iron toxicity with excessive intake.
E. False Most ingested sodium is absorbed; if absorption is above the body
requirements, the excess is excreted by the kidneys.
25.
A. True This is its definition.
B. False It persists for about six hours.
C. False It is due mainly to the additional energy expended on processing absorbed
material for detoxification, metabolism and storage.
D. True Mainly because of the energy required to deaminate amino acids.
E. False The figures are around 4 per cent for fat and 6 per cent for carbohydrate.
26.
A. True Cells in the pylorus release gastrin when food enters the stomach.
B. False Venous blood pH rises as bicarbonate enters the circulation in the ‘alkaline
tide’.
C. True Vagal activity plays an important role in gastric juice secretion.
D. False Pancreatic trypsin and chymotrypsin can digest proteins.
E. True Without gastric ‘intrinsic factor’, Vitamin B12 is not absorbed from the gut.
27.
A. True Being proteins, enzymes are digested by proteolytic enzymes as they pass
down the gut.
B. False It is absorbed mainly in the terminal ileum.
C. True Water is absorbed passively down the osmotic gradient set up by active
sodium and glucose absorption.
D. False It occurs mainly in the duodenum.
E. True Sodium is required at the luminal surface for glucose to be absorbed by an
active carrier-mediated process.
28.
A. True When blood glucose falls, liver glycogen is broken down to form glucose;
when glucose levels rise above normal, glucose is taken up by the liver and stored as
liver glycogen.
B. False The NH4_ is converted into urea and excreted in the urine; NH4 _ is toxic.
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C. False Cholecalciferol in produced in skin by the action of sunlight; the liver
converts it to 25-hydroxycholecalciferol and the kidney completes its activation by
further hydroxylation.
D. False They manufacture most of the plasma proteins but lymphocytes manufacture
immune globulins.
E. True The failure to inactivate oestrogens in men with liver failure can lead to
breast enlargement.
29.
A. False Unsplit neutral fat can be absorbed if emulsified into sufficiently small
particles.
B. True The smaller fatty acids pass directly into blood; the larger ones are esterified,
packaged into chylomicrons and taken into lymphatics.
C. True The loss of gastric storage capacity results in rapid transit of food through the
small intestine and insufficient time for complete digestion and absorption of fat.
D. True Vitamin D is required for normal bone development; it is a fat-soluble
vitamin and absorbed along with the fat.
E. True Vitamin K which is needed for the synthesis of certain clotting factors in the
liver is also a fat-soluble vitamin.
30.
A. True In both cases the carbohydrate is oxidized to carbon dioxide and water.
B. False Fat yields approximately 125 per cent more energy.
C. False It yields about 40 per cent less when metabolized in the body, urea derived
from protein is excreted in the urine and its free energy is not released to the body.
D. True The free energy released by carbohydrate and protein in the body is similar.
E. True This is probably a high figure; protein requirements increase with increasing
levels of energy expenditure.
31.
A. True Most of it is incorporated into very low density lipoproteins(VLDL) and
circulates as such.
B. True Its synthesis is determined mainly by saturated fat intake.
C. False The main sources are egg yolk and animal fat.
D. False It is eliminated mainly by excretion in the bile.
E. True It is a precursor of a number of steroid hormones.
32.
A. True Most are esterified to glycerol and cholesterol.
B. True This is necessary for solubility.
C. False They rise due to release from adipose tissue.
D. True They are an important source of energy for contraction.
E. False Glucose is the only normal substrate for energy production here.
33.
A. False This is a vital solubilizing mechanism.
B. False This favours formation of micelles.
C. False Lecithin also contributes to the formation of micelles.
D. False This can decrease the risk temporarily.
E. True Excess bilirubin can give rise to pigment stones.
34.
A. False Emptying is slowed as vagal coordination of gastric motility is lost.
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B. True This may compensate for the slowing effects of vagotomy.
C. True Acid-pepsin can cause a jejunal stomal ulcer.
D. True Rapid glucose absorption leads to excessive insulin secretion and a
consequent fall in blood glucose.
E. True This is a further feature of the ‘dumping syndrome’. The sudden arrival of
osmotically active particles in the intestine draws extracellular fluid into the gut.
35.
A. True Due to loss of gastric acid which reduces ferric to the ferrous iron, the form
in which it is absorbed. Another problem affecting iron absorption is rapid intestinal
transit.
B. False The size increases to cause ‘goitre’ due to increased TSH stimulation.
C. True The unabsorbed disaccharides such as lactose cause osmotic diarrhoea.
D. False Calcium is absorbed mainly in the duodenum.
E. True The terminal ileum is the main site of bile salt absorption.
36.
A. True Acid is the cause of pain in these ulcers.
B. True But this is absorbed and may cause alkalosis.
C. True This also reduces acidity, but for a short time only.
D. False This would increase vagal acid production.
E. True This can give long lasting relief.
37.
A. False The normal value is around 15–20 per cent.
B. False Fat, as a percentage of body weight, is 5–10 per cent higher in women than
in men.
C. True This is mediated via beta adrenergic receptor stimulation.
D. False Insulin favours deposition of fat in the fat stores.
E. False In obesity, adipocytes increase in size rather than number.
38.
A. True Total energy expenditure must eventually appear as heat.
B. False Energy production is related to the metabolism of food, not its intake.
C. True Since oxygen is consumed only in metabolism, total oxygen consumption is
an index of metabolic rate; the energy produced per unit of oxygen consumed varies
somewhat with different substrates.
D. True Respiratory quotient indicates the mix of substrates used.
E. True Metabolic rate is proportional to carbon dioxide formation.
39.
A. True This is complete when the bowel below the block is empty.
B. True Intermittent colic is typical of early obstruction.
C. True This may be severe when the obstruction is in the lower gut.
D. True Due to hypovolaemia as secretions accumulate in the lumen of the intestines
above the obstruction.
E. False Vomiting is worse with high obstruction since the copious upper alimentary
secretions cannot be absorbed from the intestines below the obstruction where
most absorption normally takes place.
40.
A. True Both indicate impairment of liver function.
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B. False Urine is dark in jaundice due to bile duct obstructions since conjugated
bilirubin can pass the glomerular filter.
C. False A low prothrombin suggests impaired liver function.
D. False Haemolysis raises the level of unconjugated bilirubin which is protein-bound
and not excreted in the urine (acholuric jaundice).
E. False It is high with all causes of jaundice.
41.
A. True Due to loss of the ‘reservoir’ function of the stomach.
B. True Due to loss of gastric ‘intrinsic factor’, required for absorption of the
vitamin.
C. True The mechanism regulating food delivery to the small intestine is lost.
D. False This ‘reflex’ is not essential for defaecation.
E. False Pancreatic enzymes can make up for the loss of pepsin.
42.
A. True Due to loss of secretions rich in potassium.
B. True Sodium is the main cation lost in diarrhoea.
C. True Body sodium is the ‘skeleton’ of extracellular fluid volume.
D. False This is raised to maintain arterial blood pressure as plasma volume falls.
E. True Loss of intestinal bicarbonate causes metabolic acidosis.
43.
A. False Albumin, which is manufactured in the liver tends to fall relative to globulin
in plasma.
B. True Due to loss of the liver’s ability to conjugate oestrogens and progestogens.
C. True The liver normally conjugates bilirubin with glucuronic acid.
D. True Due to reduced synthesis of clotting factors such as prothrombin by the liver.
E. True Due to the liver’s reduced ability to store and mobilize glycogen.
44.
A. True This reduces gastric acidity.
B. True Gastrin which stimulates acid secretion is produced in the pyloric antrum.
C. False Glucocorticoids by inhibiting tissue repair may make the ulceration worse.
D. True This bacterium appears to play an important part in the pathogenesis of
peptic ulcers.
E. True These reduce acidity and are widely used in the treatment of peptic
ulceration.
45.
A. True It is present in both urine and faeces.
B. False It is formed in the intestine.
C. True Urine rich in urobilinogen (due to haemolysis) darkens on exposure to light.
D. True And carried back to the liver in the enterohepatic circulation.
E. False It is excreted mainly in the bile.
46.
A. False Fat absorption is incomplete and this causes steatorrhoea.
B. True There is poor absorption of fat-soluble vitamin D.
C. False Adequate salt and water absorption still occur.
D. True Vitamin B12 and iron absorption are impaired and this may cause anaemia.
E. True Due to the malabsorption of food.
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47.
A. True Due to lack of the proteinases trypsin and chymotrypsin.
B. True Due to impaired fat digestion and absorption caused by lack of pancreatic
lipase.
C. False A high fat content lowers specific gravity; stools may float.
D. True Due to the high level of nutrients in the faeces, bacteria flourish.
E. False It is reduced; malabsorption of fat reduces absorption of fat-soluble vitamin
K that is needed for prothrombin production.
48.
A. True Due in part to the liver’s failure to conjugate salt-retaining hormones such as
aldosterone.
B. True Due to the above plus depletion of plasma albumin.
C. False It falls due to impaired urea synthesis from NH4
_ released in deamination.
D. True Due to impaired formation and excretion of bile salts.
E. True Due to inadequate detoxification of toxins derived from proteins in the diet.
49.
A. False It is mediated through a vagal reflex and is absent in vagotomized stomachs.
B. False This delays gastric emptying.
C. True Histamine from mast-like cells activates H2 receptors, acetylcholine from
parasympathetic nerve endings activates M1 receptors and gastrin activates gastrin
receptors.
D. True The neural/hormonal mechanisms responsible for the inhibition are not
certain.
E. False The normal rate is around 3/minute.
50.
A. True This is the cause of the hypertension.
B. False It is decreased as blood is diverted to alternative routes back to the great
veins.
C. True Raised hydrostatic pressure increases filtration from visceral capillaries; fluid
accumulates in the peritoneal cavity to cause ascites.
D. True By diverting blood away from oesophageal varices.
E. True The failure of the liver to detoxicate toxic end-products of protein
metabolism in liver failure can lead to hepatic encephalopathy; bypassing the liver
with a portocaval shunt may aggravate the condition, especially after an intestinal
bleed.
51.
A. True This breaks the reflex arc on which defaecation depends.
B. True Stress may modify the reflex to cause either constipation or diarrhoea.
C. True In children this may cause megacolon.
D. True Frequency of defaecation is related to the bulk of food residues.
E. False This leads to increased frequency of defaecation.
52.
A. True This facilitates transport from the lumen.
B. True Phloridzin has this action; the carrier mechanisms at the two sites are similar.
C. False It is impaired, suggesting that sodium absorption facilitates glucose
absorption.
D. True But different carriers are involved in fructose absorption.
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E. False It takes place mainly in the duodenum and jejunum.
53.
A. False Forced expiratory efforts by skeletal muscles in the presence of a closed
glottis and pylorus are responsible for compressing the stomach.
B. False It is coordinated by a vomiting centre in the medulla oblongata.
C. True Bile pigments enter the gut in the duodenum.
D. True This is one of several types of associated autonomic disturbance.
E. False It is more marked in high obstruction because the copious digestive secretion
cannot be absorbed by the gut below the obstruction.
54.
A. False If food energy intake exceeds energy expenditure, obesity develops
regardless of the predominant food in the diet.
B. True Mild maturity-onset diabetes mellitus may be relieved by decreasing body
weight.
C. True Subcutaneous fat is a good indicator of the severity of obesity.
D. True Body specific gravity which is inversely related to body fat content can be
calculated from these values.
E. False The conventional threshold is 10 per cent.
55.
A. True The high-pressure zone indicates the ‘cardiac sphincter’.
B. True It prevents reflux of acid into the oesophagus.
C. False It is decreased and heartburn is common in pregnancy.
D. True This prevents reflux during gastric contractions.
E. False These reduce tone, suggesting that cholinergic nerves have a role in
maintaining normal tone.
RENAL PHYSIOLOGY
Part One
1. Total body water
a. Form about 40% of the body of an adult
b. Is about 40 liters in adult male 70 kg weight
c. Is more in females
d. Is less in old people
e. Percent increases during starvation
2. In a normal adult male of 70 kg weight
a. Extracellular compartment is about 25 liters
b. Interstitial fluid volume is larger than the plasma
c. Plasma volume is a one third of the blood volume
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d. Volume of spread of Evans blue is about 3 liters
e. CHO forms 10 % of the body weight
3. Functions of the lipid bilayer of the cell membrane include
a. Selective permeability
b. Formation of aquaporins
c. Act as receptors for hormones
d. Attach cells together
e. stopping water from entering the cells
4. Hydrostatic pressure
a. depends on the number of osmoles/liter of a solution
b. in the arteriolar end of a capillary favors filtration
c. of the glomerular capillaries is about 60 mm.Hg
d. increases with the increase in plasma proteins
e. in the afferent arteriole s more than the efferent arteriole
5. Oedema
a. is accumulation of fluids in the interstitial space
b. dehydration is not a cause
c. can be caused by malnutrition
d. is seen in patients of chronic liver diseases
e. commonly seen in patients of hypertension
6. Normal urine should contain
a. glucose
b. urea
c. albumen
d. white blood cells
e. potassium
7. Glomerular filtration rate
a. is about 125 ml/minute
b. can be measured using creatinine
c. is best measured with inulin
d. is highly sensitive to small changes of arterial pressure
e. increases when the oncotic pressure decreases
8. The movement of fluids across the capillary membrane normally depends on
a. the high oncotic pressure of the interstitium
b. crystalloid osmotic pressure of the plasma
c. colloid osmotic pressure of the plasma
d. the low hydrostatic pressure of the interstitium
e. the hydrostatic pressure of the capillaries
9. The glomerular filtrate differs from the plasma in that it has less
a. glucose
b. sodium
c. proteins
d. urea
e. calcium
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10. Renin secretion is stimulated by
a. hypovolemia
b. low blood pressure
c. sympathetic stimulation
d. hyperosmolarity
e. angiotensin II
11. In the micturition reflex
a. stimulated by stretching receptors in the bladder wall
b. centre is in the brain
c. is intact (healthy) in children
d. damage of the centre will cause automatic bladder
e. external sphincter is under voluntary control
12. The kidney secretes
a. ADH
b. erythropoietin
c. angiotensin II
d. prostaglandins
e. 1,25 dihydroxy cholecalciferol
13. Inhibition of carbonic anhydrase enzyme in the kidney produces
a. a decrease in urine volume
b. acidosis
c. a decrease in bicarbonate reabsorption
d. failure to secrete hydrogen
e. antidiuretic effect
14. In the thick ascending limb of loop of Henle
a. Water is reabsorbed passively
b. Na is absorbed actively
c. No reabsorption of urea
d. Frusemide will act to increase urine volume
e. Fluid will undergo dilution
15. The renal blood flow
a. Is about 1.2 liters/minute
b. Is measured by PAH clearance
c. More than 90% of it supplies the cortex
d. Is increased by sympathetic stimulation
e. Is increased when the subject lies down
16. GFR can be increased by
a. Increasing the renal blood flow
b. Constriction of the mesangial cells
c. Increasing glomerular capillaries hydrostatic pressure
d. Increasing capsular pressure
e. Efferent arteriolar constriction
17. Infusion of 3 liters 2 % NaCl in a normal subject will
a. Increases the osmolarity of the plasma
b. Decreases intracellular fluid volume
c. Increases intracellular fluid osmolarity
d. Increases the outward filtration of fluid in the capillaries
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e. Stimulates ADH secretion
18. Fluid in the efferent arteriole differs from that in the afferent in that it has
more
a. albumen
b. calcium
c. sodium
d. PCV
e. Osmolarity
19. ADH
a. is steroid hormone
b. secretion can be stimulated by angiotensin II
c. can works in the loop of Henle
d. is produced by the posterior pituitary
e. is a vasoconstrictor through V1 receptors
20. Sympathetic stimulation in the kidneys produces
a. afferent arteriolar constriction
b. if maximal decreases the GFR
c. contract the mesangial cells
d. stimulates rennin secretion
e. decreases sodium reabsorption
21. Clearance
a. Can be used to measure GFR
b. If more than the GFR means that the substance is secreted
c. Of glucose is 100
d. Of urea is more than inulin
e. Is expressed in mg/minute
22. Water reabsorption in the kidney
a. Is an active process in the proximal tubules
b. Is increased by ADH
c. Is greater in the ascending limb compared with the descending one
d. About 30 % occurs in the collecting ducts
e. Is increased by hyperosmolarity
23. In the proximal convoluted tubules
a. 50 % of filtered glucose is reabsorbed
b. all filtered sodium is reabsorbed
c. most water is reabsorbed
d. creatinine concentration increases
e. about 65% of filtered potassium is reabsorbed
24. In the proximal convoluted tubules
a. Hydrogen ion secretion is coupled with sodium reabsorption
b. Osmolarity of the fluid is not changed
c. Water reabsorption is regulated by ADH
d. Glucose reabsorption can be increase with insulin
e. There is a density of Na- K pumps in the basolateral membrane
25. Urine output can be increased by
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a.
b.
c.
d.
e.
Stimulation of the carbonic anhydrase enzyme
Inhibition of sodium reabsorption in the loop
ADH
Presence of a non reabsorbable solutes in the tubular fluid
Increasing the plasma oncotic pressure
26. In compensated respiratory acidosis
a. PCO2 is increased
b. Bicarbonate level in the plasma is increased
c. NH4 synthesis in the kidney is inhibited
d. pH of the blood is normal
e. pH of urine is increased
27. The substance that is used to measure the GFR should be
a. tightly bound to plasma proteins
b. actively secreted
c. have a diameter less than 4 micron
d. easily metabolized
e. have a high osmotic activity
28. In a urine sample from a patient of severe acidosis
a. the ratio between H2PO4:HPO4 will increase
b. potassium concentration will decrease
c. pH can reach 3
d. pH of the urine determines the degree of acidosis
e. adding an alkali will immediately increase the pH
29. Juxtaglomerular apparatus
a. can be considered as a baroreceptor
b. can be considered as a chemoreceptor
c. can be considered as osmoreceptor
d. secretes angiotensin
e. maintain acid base balance
30. The counter current mechanism for urine concentration
a. has the loop of Henle and vasa recta as components
b. maintains high Osmolarity in the medulla
c. is partially due to urea trap
d. depends on the high blood flow to the medulla
e. depends on the high permeability of the cortical collecting duct to urea
RENAL PHYSIOLOGY
Part Two
Questions:
1. Hydrostatic pressure in renal glomerular capillaries
A. Is lower than pressure in efferent arterioles.
B. Rises when afferent arterioles constrict.
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C. Is higher than in most capillaries at heart level.
D. Falls by 10 per cent when arterial pressure falls by 10 per cent.
E. Falls along the length of the capillary.
2. Tubular reabsorption of a filtered substance is likely to be active rather
than passive if its
A. Concentration in the tubular fluid is lower than in peritubular capillary blood.
B. Excretion is increased by cooling the kidney.
C. Renal clearance is lower than that of inulin.
D. Renal clearance rises at high plasma levels.
E. Urinary excretion rate:plasma concentration ratio is the same as for glucose.
3. The renal clearance of a substance
A. Is inversely related to its urinary concentration, U.
B. Is directly related to the rate of urine formation, V.
C. Is directly related to its plasma concentration, P.
D. Is expressed in units of volume per unit time.
E. Must fall in the presence of metabolic poisons.
4. In fluid in the distal part of the proximal convoluted tubule
A. Urea concentration is higher than in Bowman’s capsule.
B. pH is less than 6 when the kidneys are excreting an acid urine.
C. Glucose concentration is similar to that in plasma.
D. Osmolality is about 25 per cent that of glomerular filtrate.
E. Bicarbonate concentration is lower than in plasma.
5. Renal tubules normally reabsorb
A. More water every hour than the entire plasma volume.
B. All filtered HCO3_ in respiratory acidosis.
C. All filtered amino acids.
D. All filtered plasma proteins.
E. More K_ than Cl_.
6. As plasma glucose concentration rises above normal, glucose
A. Filtration increases linearly.
B. Transport maximum Tm increases linearly.
C. Clearance increases linearly.
D. Reabsorption increases and then levels off.
E. Excretion increases and then decreases.
7. A substance is being secreted by the renal tubules if its
A. Clearance rate is greater than 250 ml/minute.
B. Concentration is higher in arterial than in renal venous blood.
C. Excretion rate is increased by tubular enzyme poisons.
D. Concentration rises along the proximal convoluted tubule.
E. Concentration in urine is greater than in plasma.
8. In the nephron, the osmolality of fluid in the
A. Tip of the loop of Henle is less than that of plasma.
B. Bowman’s capsules is less than that in the distal tubules.
C. Collecting duct rises when vasopressin is being secreted.
D. Proximal convoluted tubule rises along its length.
E. Medullary interstitium can exceed one osmole per litre.
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9. Transport maximum (Tm) – limited reabsorption of a substance implies
that its
A. Reabsorption is active.
B. Reabsorption is critically related to tubular transit time.
C. Reabsorption is complete below a certain threshold load.
D. Renal clearance falls with its plasma concentration.
E. Excretion rate is zero until its Tm value is reached.
10. When a patient’s mean arterial blood pressure falls by 50 per cent
A. Renal blood flow falls by less than 10 per cent.
B. Glomerular filtration falls by about 50 per cent.
C. There is an increase in the circulating aldosterone level.
D. Renal vasoconstriction occurs.
E. Urinary output ceases.
11. The cells of the distal convoluted tubule
A. Reabsorb about 50 per cent of the water filtered by the glomeruli.
B. Secrete hydrogen ions into the tubular lumen.
C. Form NH4_ ions.
D. Reabsorb sodium in exchange for hydrogen or potassium ions.
E. Determine the final composition of urine.
12. If, during an infusion of para-aminohippuric acid, peripheral venous
plasma PAH level is 0.02 mg/ml (not above renal threshold), urinary PAH
level is 16 mg/ml and urinary flow rate 1 ml/min, then the
A. PAH level in renal venous blood must exceed 0.02 mg/ml.
B. PAH level in renal arterial blood must be about 0.02 mg/ml.
C. PAH level in glomerular filtrate must be about 0.02 mg/ml.
D. Renal plasma flow is nearer 800 than 1000 ml/minute.
E. Renal blood flow is nearer 1300 than 1500 ml/minute if the haematocrit is 0.40.
13. Renal blood flow falls
A. About 10 per cent when arterial pressure falls 10 per cent below normal.
B. About 5 per cent when metabolic activity in the kidney falls by 5 per cent.
C. During emotional stress.
D. After moderate haemorrhage.
E. Gradually from the inner medulla to the outer cortex per unit weight of tissue.
14. Urea
A. And glucose have similar molar concentrations in normal blood.
B. Concentration rises in tubular fluid as the glomerular filtrate passes down the
nephron.
C. Is actively secreted by the renal tubular cells into the tubular fluid.
D. Concentration in blood may rise ten-fold after a high protein meal.
E. Causes a diuresis when its blood concentration is increased.
15. Voluntary micturition
A. Depends on the integrity of a lumbar spinal reflex arc.
B. Is not possible after sensory denervation of the bladder.
C. Involves stimulation of the detrusor muscle in the bladder by autonomic
sympathetic nerves.
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D. Is normally accompanied by some reflux of bladder contents into the ureters.
E. Is inhibited during ejaculation.
16. The proximal convoluted tubules
A. Reabsorb most of the sodium ions in glomerular filtrate.
B. Reabsorb most of the chloride ions in glomerular filtrate.
C. Reabsorb most of the potassium ions in glomerular filtrate.
D. Contain juxtaglomerular cells which secrete rennin.
E. Contain the main target cells for antidiuretic hormone.
17. The renal clearance of
A. Inulin provides an estimate of glomerular filtration rate.
B. Chloride increases after an injection of aldosterone.
C. PAH falls when the PAH load exceeds the Tm for PAH.
D. Urea is lower than that of inulin.
E. Inulin is independent of its plasma concentration.
18. The collecting ducts in the kidney
A. Can actively transport water molecules into the urine.
B. Are the site of most of renal water reabsorption.
C. Are rendered impermeable to water by antidiuretic hormone (ADH).
D. Pass through a region of exceptional hypertonicity.
E. Determine to a large extent the final osmolality of urine.
19. Aldosterone
A. Is a steroid hormone secreted by the adrenal medulla.
B. Production ceases following removal of the kidneys and their juxtaglomerular
cells.
C. Production decreases in treatment with drugs which block angiotensin-converting
enzyme.
D. Secretion results in increased potassium reabsorption by the nephron.
E. Secretion results in a fall in urinary pH.
20. As fluid passes down the proximal convoluted tubule, there is a fall of
more than 50 per cent in the
A. Concentration of sulphate ions.
B. Concentration of sodium ions.
C. Concentrations of amino acids.
D. Concentration of potassium ions.
E. Rate of filtrate flow in the tubules.
21. In normal healthy people, urinary
A. Specific gravity ranges from 1.010–1.020.
B. Osmolality ranges from 200–400 mosmol/litre.
C. Colour is due to small quantities of bile pigments.
D. pH falls as dietary protein rises.
E. Calcium excretion is increased by parathormone.
22. Aldosterone secretion tends to raise the volume of
A. Plasma.
B. Interstitial fluid.
C. Intracellular fluid.
D. Urine.
E. Cerebrospinal fluid.
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23. The renal clearance of
A. Bicarbonate is similar to that of glucose.
B. PAH is nearer 600 than 1200 ml/minute in the average adult.
C. Creatinine provides an estimate of renal plasma flow.
D. Phosphate is decreased by parathormone.
E. Protein is normally zero.
24. Potassium
A. Is actively secreted in the distal convoluted tubule.
B. Is reabsorbed in the proximal convoluted tubule.
C. Deficiency favours hydrogen ion secretion in the distal tubule.
D. Excretion is determined largely by potassium intake.
E. Blood levels tend to rise in patients with acute renal failure taking a normal diet.
25. Secretion of renin
A. Occurs in the stomach during infancy.
B. Is stimulated by the hormone angiotensin I.
C. Leads to raised levels of angiotensin II in the blood.
D. Is stimulated by a fall in extracellular fluid volume.
E. Inhibits ACTH secretion by the pituitary gland.
26. In chronic renal failure
A. Glomerular filtration rate may fall by 70 per cent before the condition gives rise to
symptoms.
B. The specific gravity of the urine tends to be elevated, e.g. about 1.030.
C. Blood PCO2 tends to be low.
D. Ionized calcium levels in the blood tend to be high.
E. Anaemia is common.
27. Diabetes insipidus (deficiency of antidiuretic hormone) causes a fall in
the
A. Osmolality of the urine.
B. Reabsorption of water from the proximal tubules.
C. Extracellular but not intracellular fluid volume.
D. Extracellular fluid osmolality.
E. Intracellular fluid osmolality.
28. The cystometrogram shows
A. A plot of bladder pressure on the ordinate axis against bladder volume on the
abscissa.
B. Little rise in pressure with rise in volume at low bladder volumes.
C. A steep rise in pressure when volume rises above 100 ml.
D. That females generate higher pressures during micturition than males.
E. That patients with chronic urinary tract obstruction can generate higher than
normal micturition pressures.
29. Treatment with an aldosterone antagonist causes a fall in
A. Urine volume.
B. Body potassium.
C. Body sodium.
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D. Blood volume.
E. Blood viscosity.
30. Dialysis fluid used in the treatment of renal failure should contain the
normal plasma levels of
A. Urea.
B. Potassium.
C. Osmolality.
D. Plasma proteins.
E. Hydrogen ions.
31. Long-standing obstruction of the urethra may cause
A. Enlargement of the prostate gland.
B. Hypertrophy of the bladder muscle.
C. Dilation of the ureters.
D. Reduction of the glomerular filtration rate.
E. An increase in residual volume in the bladder.
32. Emptying of the bladder may be less effective if
A. The sympathetic nerves carrying afferent information from bladder to spinal cord
are cut.
B. The pelvic nerves are cut.
C. Anticholinergic drugs are administered.
D. Alpha-adrenergic receptor antagonists are administered.
E. Beta-adrenergic receptor agonists are administered.
33. Renal transplantation for chronic renal failure in adults should
A. Be covered by immunosuppression even when the donor is the recipient’s identical
twin.
B. Raise postoperative glomerular filtration rate to the 10–20 ml/minute level.
C. Correct abnormal calcium metabolism.
D. Correct anaemia.
E. Abolish the need for further renal dialysis.
34. Drugs which interfere with active transport of sodium in the proximal
tubule tend to increase
A. Urine production.
B. Plasma osmolality.
C. Chloride excretion.
D. Interstitial fluid volume.
E. Plasma specific gravity.
35. A drug which inhibits carbonic anhydrase decreases
A. Bicarbonate formation and reabsorption in the kidney.
B. Plasma bicarbonate levels.
C. Blood pH.
D. Urinary loss of potassium ions.
E. Urinary volume and pH.
36. A patient with chronic renal failure usually has an increased
A. Blood urea.
B. Blood uric acid.
C. Creatinine clearance.
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D. Acid–base disturbance when he or she vomits.
E. Acid–base problem on a high protein diet.
37. Cutting the sympathetic nerves to the bladder may cause
A. Difficulty in emptying the bladder.
B. Loss of tone in the internal sphincter of the bladder.
C. Loss of tone in the external sphincter of the bladder.
D. Loss of pain sensation in the bladder.
E. Infertility in the male
.
38. Sudden (acute) renal failure differs from gradual (chronic) renal failure
in that
A. Potassium retention tends to be more severe.
B. Blood urea levels tend to be higher.
C. Depression of bone marrow activity is unlikely to occur.
D. Metabolic acidosis is usually not a problem.
E. Dietary protein restriction is unnecessary.
39. In the treatment of someone with progressive renal failure
A. Protein should be excluded from the diet.
B. Water intake should be restricted to about 0.5 litre/day.
C. The diet should be potassium-free.
D. Adequate dietary iron intake prevents anaemia.
E. The calorific value of the diet should be gradually reduced.
40. A long-standing increase in arterial PCO2 (respiratory acidosis) leads to an
increase in
A. Renal bicarbonate formation.
B. Urinary ammonium salts.
C. Plasma potassium concentration.
D. The ratio of monohydrogen to dihydrogen phosphate in urine.
E. Urinary bicarbonate excretion.
Answers:
1.
A. False It must be higher to maintain blood flow.
B. False The pressure drop across the afferent arterioles increases as they constrict.
C. True The afferent arterioles offer relatively little resistance.
D. False Redistribution of renal vascular resistance due to autoregulation tends to
maintain
glomerular hydrostatic pressure and hence filtration.
E. True Hydrostatic pressure falls due to vascular resistance; oncotic pressure rises
due to loss of protein-poor filtrate; both these factors reduce filtration pressure along
the length of the glomerular capillary.
2.
A. True This suggests transportation into the blood against a concentration gradient.
B. True Cooling impairs active metabolic processes.
C. False This indicates reabsorption but not whether it is active (e.g. glucose) or
passive (e.g. urea).
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D. True This suggests saturation of a carrier system.
E. True Anything filtered in glomeruli and having zero clearance must be actively
reabsorbed.
3.
A. False It is directly related to urinary concentration.
B. True Clearance tends to fall at low urinary flow rates.
C. False It is inversely related to plasma concentration.
D. True Clearance_UV/P in units of volume/unit time.
E. False It rises if the substance is normally reabsorbed by an active process.
4.
A. True Due to reabsorption of water.
B. False Acidification occurs mainly in the distal convoluted tubule.
C. False Most or all of the glucose is reabsorbed before the end of the proximal
tubule.
D. False Osmolality changes little in the proximal convoluted tubule.
E. True Like glucose, HCO3 _ is usually completely reabsorbed in the proximal
tubule.
5.
A. True About 99 per cent of the glomerular filtrate (about 8 litres/hour).
B. True This plus HCO3
_ manufactured in the kidney compensates the respiratory acidosis.
C. True These are filtered but do not appear in normal urine.
D. True Again some are filtered but do not appear in urine.
E. False About 20 times as much chloride as potassium is filtered (this is the ratio of
their plasma concentrations).
6.
A. True Filtration rate is directly proportional to concentration.
B. False Transport maxima are constants.
C. False It remains at zero until the Tm is reached and then it rises linearly.
D. True It levels off after Tm glucose is reached.
E. False It is initially zero and then rises linearly.
7.
A. True A clearance value above the glomerular filtration rate (about 140 ml/minute)
indicates secretion.
B. True Some of the unfiltered fraction must have been secreted.
C. False This suggests that the substance is normally reabsorbed by an active process.
D. False This can be explained by water reabsorption.
E. False Again, this can be explained by a relatively greater reabsorption of water
.
8.
A. False This fluid is hypertonic because of countercurrent concentration.
B. False Distal tubular fluid is hypotonic.
C. True Vasopressin (ADH) promotes water, but not salt, reabsorption in collecting
ducts.
D. False The fluid remains isotonic with plasma.
E. True It can be about four times that of plasma.
9.
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A. True Tm limited reabsorption is one type of active tubular reabsorption.
B. False This applies to the other type of active tubular reabsorption, gradient-time
limited reabsorption.
C. True As with glucose.
D. False Clearance is zero at all levels below the threshold.
E. True The concept applies also to amino acids and proteins.
10.
A. False Autoregulation cannot compensate for such large falls.
B. False It falls to about zero when glomerular capillary pressure falls below the sum
of intracapsular pressure plus plasma oncotic pressure – around 30–40 mmHg.
C. True Due to release of renin and angiotensin formation, aldosterone is secreted.
D. True Reflex sympathetic vasoconstriction due to greatly decreased baroreceptor
stimulation.
E. True When glomerular filtration stops, urinary output stops.
11.
A. False About 80 per cent of the filtered water is reabsorbed before it reaches the
distal tubules.
B. True The rate is related to acid–base requirements.
C. True By conversion of glutamine to glutamate; NH3 is a buffer for the H_ being
excreted.
D. True H_ secretion is related to the body’s acid–base balance.
E. False Further modification takes place in the collecting ducts.
12.
A. False The renal venous blood level would be negligible.
B. True Since PAH is excreted only by the kidneys, the PAH level in peripheral
venous blood determines the level entering the arterial system, and hence the renal
arteries.
C. True Since PAH is freely filtered.
D. True Flow_PAH clearance_UV/P_16_1/0.02_800 ml/minute.
E. True Blood flow_plasma flow/0.6_1333 ml/minute.
13.
A. False Due to autoregulation, flow changes little with small changes in perfusion
pressure.
B. False Normal renal blood flow is vastly in excess of its metabolic requirements.
C. True Due to sympathetic vasoconstrictor nerves and circulating catecholamines.
D. True A reflex response to the fall in blood pressure so caused.
E. False Cortical flow is 10–20 times higher than medullary flow.
14.
A. True Both are around 5 mmol/litre.
B. True The urinary concentration of urea is many times that in plasma.
C. False 50 per cent of the filtered urea is passively reabsorbed; the rise in tubular
concentration can be explained by the reabsorption of water.
D. False It rises but would not double in concentration.
E. True It causes an osmotic diuresis.
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15.
A. False The reflex centres are in the sacral cord; their activity is modulated by higher
centres.
B. True This breaks the reflex arc.
C. False Parasympathetic nerves are motor to the detrusor muscle.
D. False Valves where the ureters enter the bladder do not allow such reflux.
E. True During ejaculation, sympathetic activity constricts the bladder neck sphincter
and prevents retrograde ejaculation of semen into the bladder.
16.
A. True More than half of the filtered sodium is actively absorbed in the proximal
tubules.
B. True Negatively charged chloride ions follow the positively charged sodium.
C. True Most of the potassium is reabsorbed in the proximal tubule; some is reexcreted in the distal tubules in exchange for sodium.
D. False Rennin is an enzyme found in gastric juice that causes milk to clot. The
juxtaglomerular cells that secrete renin are found where the distal tubule makes
contact with the afferent arteriole.
E. False This hormone acts mainly on distal parts of the nephron
.
17.
A. True Inulin is freely filtered but not reabsorbed or secreted in the tubules;
therefore the amount excreted in the urine equals the amount filtered at the
glomerulus.
B. False Aldosterone increases Na_ and Cl_ reabsorption and so reduces their
clearance.
C. True At high plasma levels, the Tm for PAH is exceeded and PAH is not
completely cleared in one passage through the kidney.
D. True About 60 compared with 120 ml/minute; half the filtered urea is passively
reabsorbed.
E. True The amount filtered is the amount excreted.
18.
A. False Active transport of water has not been described in the body.
B. False More than half of the water in glomerular filtrate is reabsorbed in the
proximal tubules.
C. False Conversely, they are rendered permeable to water by ADH which induces
water channels in the collecting ducts.
D. True Osmolality in the inner medullary interstitium can exceed 1 osmol/litre.
E. True By determining the amount of water reabsorbed as the glomerular filtrate
passes through the hypertonic medullary interstitium.
19.
A. False It is a steroid as its name suggests but is secreted by the adrenal cortex.
B. False Some aldosterone is secreted in response to ACTH secretion, high K_ intake,
heart failure, etc. in addition to activity in the renin/angiotensin system.
C. True ACE inhibitor drugs tend to reduce the level of angiotensin II which
stimulates the adrenal cortex to produce aldosterone.
D. False It increases potassium secretion in exchange for sodium.
E. True It increases H_ secretion also in exchange for sodium.
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20.
A. False Sulphate concentration rises since relatively more water than sulphate is
reabsorbed.
B. False It is little changed, since similar proportions of sodium and water are
reabsorbed.
C. True These are completely reabsorbed by active transport.
D. False Potassium is reabsorbed in proportion to water.
E. True Due to reabsorption of about 80 per cent of the water.
21.
A. False It may range from 1.004 to 1.040.
B. False It may range from 100 to 1000 mosmol/litre.
C. False It is due to ‘urochrome’, a pigment of uncertain origin.
D. True Dietary proteins lead to acid residues such as sulphates and phosphates.
E. True More calcium is filtered due to the raised blood level, so more is excreted.
22.
A. True By retention of sodium chloride and water in the extracellular fluid
compartment.
B. True This, like plasma, is a subcompartment of the extracellular fluid.
C. False The sodium chloride/water retention is confined to the extracellular
compartment.
D. False It reduces it by retaining salt and water.
E. False CSF is a secretion classified as transcellular fluid; it is not a subcompartment
of ECF.
23.
A. True Both are usually totally reabsorbed so their renal clearance is about zero.
B. True PAH clearance is a measure of renal plasma flow, not renal blood flow.
C. False It provides an estimate of the glomerular filtration rate since the amount
filtered is close to the amount excreted.
D. False Phosphate clearance is increased by parathormone and lowers the blood
phosphate level.
E. True Small amounts of protein are filtered but reabsorbed.
24.
A. True In exchange for sodium ions.
B. True It is reabsorbed passively down the gradient created by Na_ and H2O
reabsorption.
C. True Potassium and hydrogen compete for secretion in exchange for sodium.
D. True Thus potassium balance is maintained.
E. True In acute renal failure, the failure to excrete the potassium intake leads to high
blood levels which can compromise the performance of the heart.
25.
A. False Rennin is the enzyme secreted by infant’s gastric mucosa which curdles
milk.
B. False Renin promotes angiotensin I formation from a circulating precursor.
C. True Angiotensin I is converted to angiotensin II by a converting enzyme in the
lungs.
D. True Renin’s action helps to restore this volume.
E. False There is no direct feedback between the two systems.
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26.
A. True The kidneys have a large functional reserve.
B. False Renal ability to concentrate urine is impaired; the range of specific gravity
decreases, converging towards that of protein-free plasma, 1.010.
C. True Poor excretion of acid residues causes metabolic acidosis which stimulates
ventilation.
D. False Ionized calcium levels fall due to retention of phosphate ions and failure of
renal activation of vitamin D.
E. True Due mainly to deficiency of erythropoietin.
27.
A. True Due to failure of the kidneys to reabsorb sufficient water.
B. False Reabsorption of water in proximal tubules is normal since it depends on the
active reabsorption of sodium; reabsorption in the collecting ducts is affected.
C. False Both fluid compartments are depleted in volume.
D. False It rises due to depletion of water but not salt.
E. False Both compartments show the same raised osmolality; osmotic gradients are
effective in moving water at cell membranes.
28.
A. True Bladder pressure is measured while known volumes of fluid are run into it.
B. True An example of receptive relaxation like that seen in the stomach.
C. False The deflection usually occurs when around 500 ml is introduced.
D. False The male urinary tract offers a higher ‘peripheral resistance’.
E. True The increased work load causes muscular hypertrophy which allows
generation of higher micturition pressures.
29.
A. False It increases due to increased salt and water loss.
B. False Body potassium rises since aldosterone normally increases its excretion.
C. True Due to decreased sodium reabsorption.
D. True Due to decreased extracellular fluid volume.
E. False The viscosity increases as the haematocrit increases.
30.
A. False It should be urea-free to provide a high concentration gradient for urea loss.
B. False It should be lower to favour loss of potassium, which is elevated in renal
failure.
C. False It should be higher to reduce extracellular fluid volume and hence blood
pressure.
D. False Fluid transfer is governed by hydrostatic pressure and crystalloid osmolality
gradients, not by colloid osmotic pressure gradients.
E. True It should be buffered to prevent large pH changes.
31.
A. False Prostatic enlargement is a cause, not a consequence, of urethral obstruction.
B. True Due to the increased work it has to do.
C. True Long-standing obstruction leads to urinary reflux when the uretero-vesical
valves become incompetent.
D. True Back-pressure in the ureters is transmitted to the nephrons and raises
capsular pressure in the glomerulus.
E. True This encourages urinary tract infection.
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32.
A. False Sympathetic trunks carry pain afferents, not stretch receptor afferents to the
cord.
B. True These carry the stretch receptor afferents from the bladder and
parasympathetic motor fibres to the bladder; the micturition reflex is lost.
C. True These block the parasympathetic motor fibres to the detrusor muscle.
D. False Alpha receptor antagonists relax bladder sphincter muscle: they are used to
facilitate bladder emptying in patients with benign prostatic hypertrophy.
E. True They tend to relax the detrusor muscle.
33.
A. False Donor and recipient have identical genes and immunological characteristics.
B. False It should raise it to near normal, 120–150 ml/minute.
C. True This reverses the tendency to demineralization of bone.
D. True The transplanted kidney should supply the missing erythropoietin.
E. True A healthy transplanted kidney should return all aspects of renal function to
normal.
34.
A. True By increasing salt and hence water loss.
B. False This is regulated by ADH and the collecting ducts.
C. True Chloride passively follows the sodium being excreted.
D. False This falls with the loss of salt and water.
E. True Due to concentration of the proteins by removal of water.
35.
A. True Carbonic anhydrase in tubular cells catalyses the combination of CO2 and
H2O to form H2CO3 which ionizes into H_ and HCO3 _ ions.
B. True This is determined mainly by renal bicarbonate formation.
C. True This falls as the plasma bicarbonate level falls.
D. False More K_ is secreted by the tubules in exchange for sodium since there are
fewer H_ ions to compete with K_ in the sodium/potassium exchange pump.
E. False Failure to reabsorb HCO3 results in an osmotic diuresis of alkaline urine.
36.
A. True A high blood urea is usually the first sign of renal failure.
B. True As with other end products of protein digestion.
C. False Creatinine clearance, a measure of GFR, is reduced in proportion to the
severity of the renal failure.
D. False Loss of the acid vomitus would improve the typical acidosis.
E. True Proteins are a major source of the acid residues and toxic substances which
accumulate in renal failure.
37.
A. False It may cause increased frequency of micturition.
B. True Sympathetic activity tends to raise sphincter tone.
C. False This sphincter is supplied by somatic nerves.
D. True Afferent pain fibres run with the sympathetic nerves.
E. True Sympathetic fibres are necessary for closure of the internal sphincter of the
bladder during ejaculation to prevent reflux of seminal fluid.
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38.
A. True Potassium retention is one of the greatest hazards of acute renal failure and
may
cause death from myocardial depression.
B. False The blood urea level is determined by the severity of the condition, not by its
rate of progression.
C. False Both may depress the marrow and lower RBC, polymorph and platelet
counts.
D. False Both impair renal bicarbonate production.
E. False Protein restriction is advisable in both cases.
39.
A. False A low protein diet is helpful but some protein is needed to provide essential
amino acids for tissue maintenance.
B. False This would not cover insensible loss plus urine volume; also in some stages
of renal failure urine volume is increased.
C. False Potassium intake is required to replace potassium lost in urine.
D. False Anaemia is due to bone marrow depression, not iron deficiency.
E. False Sufficient dietary intake is needed to prevent excessive tissue protein
catabolism.
40.
A. True This raises plasma bicarbonate to compensate for the raised PCO2 in
respiratory acidosis.
B. True In acidosis, tubular cells excrete more to buffer the additional H_ ions being
secreted.
C. True The increased secretion of H_ ions in exchange for Na_ results in decreased
secretion of K_ ions.
D. False The ratio decreases as hydrogen ions are taken up by the phosphate buffer
system.
E. False The urine remains bicarbonate-free.
SPORT AND EXERCISE PHYSIOLOGY
Questions:
1. In athletes, physical fitness is more closely correlated with
A. Maximal oxygen uptake than with resting oxygen uptake.
B. Maximal pulse rate than with resting pulse rate.
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C. Maximal minute ventilation than with maximal cardiac output.
D. Blood oxygen saturation than with blood lactate level during strenuous exercise.
E. Resting vagal tone than with resting sympathetic tone to the heart.
2. The muscle fibres adapted to endurance running
A. Are classified as slow rather than fast.
B. Have a relatively high myoglobin content.
C. Are red rather than white.
D. Have a relatively high mitochondria content.
E. Are classified as anaerobic rather than aerobic.
3. The oxygen consumed per minute
A. Is greater than the carbon dioxide produced per minute during long distance
running.
B. In the resting adult is nearer 100 than 150 ml.
C. During intense mental activity can rise to twice the resting level.
D. During brisk walking is nearer five times than twice the resting level.
E. In an Olympic athlete can rise to 50 litres
.
4. The increase in blood flow to muscle in an exercising limb is related to a
rise in
A. Local PCO2.
B. Local H_ concentration.
C. Local muscle temperature.
D. Arterial pressure.
E. Vasodilator nerve activity.
5. During muscular training
A. Neural control factors improve performance before there is evidence of skeletal
muscle hypertrophy.
B. Repeated stretching of skeletal muscle fibres leads to their hypertrophy.
C. There is a gradual decrease in the size of the heart in diastole.
D. There is a gradual increase in the O2 extraction rate from blood perfusing
exercising skeletal muscle.
E. The increase in skeletal muscle blood flow for a given work load decreases.
6. Blood lactic acid is
A. Normally undetectable in resting subjects.
B. A product of anaerobic metabolism.
C. Increased by a 100-metre dash.
D. Not increased during steady state running in a marathon race.
E. Raised to about 5–10 moles/litre during maximal exercise.
7. Isotonic (dynamic) exercise differs from isometric (static) exercise in that
there is less
A. Increase in systolic arterial pressure.
B. Increase in diastolic arterial pressure.
C. Assistance to the circulation by the muscle pump.
D. Use of slow-twitch muscle fibres.
E. Reliance on anaerobic glycolysis.
8. Electrocardiological danger signs during incremental treadmill exercise
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include
A. A heart rate equal to the maximal predicted for the person’s age.
B. An R-R interval of about 500 milliseconds.
C. R waves with an amplitude greater than one millivolt.
D. Ventricular tachycardia.
E. ST depression of one millimetre.
9. Exercising in a hot chamber may induce
A. Fainting due to a decreased total peripheral resistance.
B. Heat stroke when core temperature rises above 40oC.
C. A rise in alveolar PCO2.
D. A decrease in the osmolality of extracellular fluid.
E. Heat adaptation if performed daily for several weeks.
10. Cold
A. Injury to feet exposed for long periods to 5–10oC is due to frostbite.
B. Injury to the extremities is made less likely by increased affinity of haemoglobin
for O2 at low temperatures.
C. Environments may induce a five-fold rise in resting metabolic rate.
D. Water immersion causes death from hypothermia more rapidly in fat than in thin
people.
E. Water immersion of the hand at 5oC is painless.
11. The maximum possible metabolic rate during exercise is
A. Reached when the blood lactate level starts to fall.
B. Reached when the respiratory exchange ratio starts to fall.
C. Reached when ventilation reaches the maximum breathing capacity.
D. Reduced by about half if the haemoglobin level falls by half.
E. About 50 times the resting rate in an athlete.
12. Asthma can interfere with exercise by
A. Increasing the work of breathing.
B. Cold-induced bronchial muscle spasm.
C. Limiting alveolar ventilation.
D. Reducing the diffusing capacity of the lung alveoli.
E. Reducing the oxygen carrying capacity of the blood.
13. In someone with diabetes mellitus being treated by injected insulin
A. Omission of an insulin injection causes a rise in the blood glucose level.
B. Regular daily exercise increases insulin requirements.
C. Unaccustomed exercise leads to a low blood glucose level.
D. Carbohydrate intake should be decreased if daily exercise is increased.
E. Tremor may occur if the blood glucose level falls.
14. During maximal exercise, a 75 kg athlete aged 25 would have a
A. Heart rate nearer 200 than 150 beats/minute.
B. Stroke volume nearer 70 ml than 140 ml.
C. Tidal volume nearer 2 litres than 1 litre.
D. Blood lactate nearer 50 than 10 times the resting level.
E. Mixed venous blood oxygen content nearer 100 than 150 ml/litre.
15. Secondary amenorrhoea
menstruation)
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in a 25-year-old female athlete is associated with
A. A strenuous daily training schedule.
B. Weight loss rather than weight gain.
C. Direct depression of the ovaries rather than loss of gonadotrophins and their
releasing hormone.
D. Reversal of the condition when strenuous exercise is discontinued and normal
body weight regained.
E. A body fat content of 25 per cent.
16. The metabolism of
A. Glycogen by exercising muscle leads to a respiratory quotient nearer 0.7 than 0.8.
B. Fat liberates more than twice the energy liberated by the same weight of
carbohydrate.
C. Fatty acids by skeletal muscle plays no part in normal exercise.
D. Amino acids for energy is decreased by cortisol.
E. An 80 kg male athlete in training requires nearer 2000 kcal (8.4 MJ) than 3000 kcal
(12.6 MJ)/day.
17. Hypoxia in
A. Exercising muscle decreases the rate of lactate formation.
B. Life at high altitudes leads to a respiratory acidosis.
C. Patients with cardiac failure is of the hypoxic variety.
D. Patients with asthma is alleviated by treatment with adrenoceptor _ blocking drugs.
E. Smokers is due partly to carboxyhaemoglobin formation in blood.
18. During strenuous exercise (12 METS, where one MET is the resting
metabolic
rate, corresponding to an oxygen consumption of 3.5 ml per
minute) as compared with moderate (6 METS) dynamic exercise, there is
a higher
A. Carbon dioxide production in the body.
B. Systolic arterial blood pressure.
C. Blood lactate level.
D. Arterial blood pH.
E. Respiratory exchange ratio.
19. The elastic recoil of muscles and tendons in the legs
A. Increases jumping height when someone jumps from a height immediately before
take off.
B. Improves performance during sprinting.
C. Contributes more to performance when sprinting on a cinder track than on a
concrete surface.
D. Can be improved by training.
E. Is greater in weight lifters than in skiers.
20. The risk of osteoporosis is increased
A. In people between 60 and 90 years of age as compared with people between 40 and
50 years of age.
B. In males as compared with females.
C. During prolonged periods of bedrest.
D. When both ovaries are removed in a premenopausal woman.
E. During treatment with adrenal glucocorticoids.
21. During a hospital treadmill exercise test, cardiac abnormality is suggested
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by
A. A heart rate greater than 150 beats per minute.
B. A systolic arterial pressure greater than 150 mmHg.
C. ST depression greater than 5 mm in the ECG.
D. Inability to follow the usual protocol because of discomfort in the legs.
E. A falling systolic arterial pressure during the test.
22. For the average healthy, normal male aged 20, the
A. Body fat is about 30 per cent of total body weight.
B. Skin-fold thickness is higher than in a female.
C. Heart rate during maximal exertion is about 200 beats per minute.
D. Cardiac output during maximal exertion is about 10 litres per minute.
E. Maximal oxygen consumption is about 10 ml/kg/minute.
23. Heat
A. Load during maximal exertion should not exceed three times resting heat load.
B. Syncope is caused by an inappropriately high cardiac output.
C. Stroke is a less serious condition than heat syncope.
D. Adaptation results in the subject having a smaller rise in core temperature for a
given level of work.
E. Adaptation takes about six days rather than six weeks to develop.
24. Pain is produced by
A. Potassium ions more than by sodium ions.
B. Occluding the circulation to an exercising limb for five minutes.
C. Occluding the circulation to a resting limb for five minutes.
D. Raised tissue endorphin levels.
E. Thawing of tissue frozen during frostbite.
25. Heart disease may limit exercise tolerance by
A. Reducing the patient’s maximal cardiac output.
B. Increasing the left ventricular ejection fraction.
C. Depriving cardiac muscle of an adequate blood supply.
D. Decreasing heart rate through increased vagal tone.
E. Changing the relationship between cardiac work and fibre length.
26. Respiratory disease can limit exercise by halving the
A. Vital capacity.
B. Airway conductance.
C. Body’s resting oxygen consumption.
D. Oxygen-carrying capacity of the blood.
E. Rate of pulmonary blood flow.
27. Olympic level endurance fitness is associated with an exceptionally high
A. Haemoglobin level.
B. Oxygen saturation of the blood.
C. Vital capacity.
D. Cardiac vagal tone during maximal exercise.
E. Resting stroke volume.
28. Exercise at high altitudes is hindered by
A. Increased resistance by the atmosphere to athletic activity.
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B. A fall in the total oxygen supply available to muscle during maximal effort.
C. Respiratory alkalosis.
D. The compensatory fall in blood bicarbonate level.
E. High blood lactate levels during severe exertion.
29. Malnutrition can limit exercise tolerance by
A. Reducing muscle bulk and hence strength.
B. Depleting stores of glycogen and fat.
C. Causing hypoxic rather than anaemic hypoxia.
D. Causing iron deficiency.
E. Depleting energy stores even though daily food energy intake exceeds 2500 kcal
(10.5 MJ).
30. Increased arousal during competitive sport is indicated by
A. Dilation of the pupils.
B. A high resting heart rate.
C. Increased muscle blood flow.
D. Decreased sweating.
E. Tremor.
31. In someone whose activities are limited by a recent stroke
A. Weakness is more of muscular than neurological origin.
B. Voluntary movements are better preserved than reflex movements such as the knee
jerk.
C. Speech difficulties are usually worse when the weakness is left-sided.
D. Weakness usually affects both legs.
E. The main area of nervous system damage is usually in the cerebellum.
32. Exercise at a level of 10 METS
A. Implies a rate of energy consumption ten times that of the basal metabolic rate.
B. Requires an oxygen uptake of 2 to 3 litres per minute in the average adult.
C. Requires an oxygen uptake of less than 2 litres per minute in a 20 kg child.
D. Is not suitable for a person on insulin treatment for diabetes mellitus.
E. Is probably too much for a fit 90-year-old person to maintain for one hour.
33. An environmental temperature of 40°C
A. Is thermoneutral if there is a strong wind.
B. Leads to a generalized release of sympathetic vasoconstrictor tone.
C. Leads to an increase in heat loss by convection and radiation from the skin.
D. May lead to heat stroke if relative humidity is 100 per cent.
E. Is appropriate for people in training for heat adaptation in a climatic chamber.
34. A feeling of anxiety before a sporting event may be associated with an
increase in
A. Heart rate.
B. Parasympathetic activity.
C. Beta adrenoceptor blockade.
D. Circulating levels of adrenaline.
E. Resting respiratory rate.
35. An appropriate daily dietary energy intake for a 70 kg adult
A. Who is sedentary and wishes to lose weight is nearer 1500 than 3000 kcal (6.3
versus 12.6 MJ).
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B. Convalescing from a wasting illness would be nearer 3000 than 2000 kcal (12.6
versus 8.4 MJ).
C. In training averaging 10 METS for 6 hours/day is more than twice that required for
sedentary conditions.
D. Athlete should be sufficient to avoid ketoacidosis.
E. Should contain as little carbohydrate as possible.
36. The increase in ventilation during maximal exercise
A. May exceed 100 litres/minute in a young 70 kg adult.
B. Is smaller when the exercise is performed at high altitudes.
C. Is related in part to a fall in pH due to lactic acidosis.
D. Is related in part to stimulation of receptors in muscle (‘metaboreceptors’) by
metabolic products of exercise.
E. Does not involve the brain above the level of the brain stem (pons, midbrain and
medulla).
37. Glycogen stores in skeletal muscle
A. Are beyond the resolution of the electron microscope.
B. Help the body to avoid ketoacidosis during exercise.
C. Increase during endurance training.
D. Are replaced more completely if carbohydrate is ingested immediately, rather than
hours, after exercise.
E. Are depleted in people with inadequately treated diabetes mellitus.
Answers:
1.
A. True Maximal oxygen uptake is the ‘gold standard’ of fitness.
B. False Maximal pulse rate is related to age; a slow pulse indicates fitness.
C. False Cardiac output is the usual limiting factor in exercise.
D. False Saturation changes little during exercise; a relatively low lactate level during
strenuous exercise is an indication of fitness.
E. True A high resting vagal tone is the cause of the low resting heart rate.
2.
A. True The time course of their twitch is relatively long.
B. True This provides an intracellular store of oxygen.
C. True This is due to their myoglobin content.
D. True They generate energy by oxidative phosphorylation.
E. False Their high rate of oxygen consumption classifies them as aerobic.
3.
A. True The respiratory quotient is less than 1.0 during long distance running.
B. False It is around 250–300 ml.
C. False Brain oxygen consumption increases in relatively small active areas, but the
total changes little.
D. True This is a useful way of maintaining fitness, particularly in older people.
E. False The maximum recorded is less than ten litres.
4.
A. True This causes local vasodilation.
B. True Acidosis also favours vasodilation.
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C. True Heat dilates blood vessels.
D. False Exercising a limb causes little change in mean arterial pressure.
E. False Vasomotor nerves are not involved in exercise hyperaemia.
5.
A. True Neural factors account for most of the early improvement in performance.
B. True This is a potent factor causing hypertrophy.
C. False There is an increase due to increased diastolic filling with the lower resting
heart rate.
D. True This results in a lower blood lactate level for a given workload.
E. True A consequence of the greater oxygen extraction rate.
6.
A. False The resting level is around one millimole per litre.
B. True It is a marker for anaerobic metabolism.
C. True Almost all the energy used in the 100-metre dash comes from anaerobic
metabolism.
D. False Even though the lactic acid level is steady, it is still raised during steady state
exercise.
E. False It rises to 5–10 millimoles per litre.
7.
A. False There is a greater increase during isotonic exercise.
B. True Diastolic pressure rises more with isometric exercise.
C. False The muscle pump does not function during static exercise.
D. False In dynamic exercise more use is made of endurance fibres.
E. True Isotonic exercise relies mainly on aerobic metabolism, whereas isometric
exercise relies mainly on anaerobic glycolysis.
8.
A. False It is normal to reach one’s predicted maximal heart rate.
B. False This implies a heart rate of about 120 beats/minute, well within the normal
range.
C. False This is also a normal finding.
D. True Stroke volume is impaired and ventricular fibrillation may develop.
E. False Depression of 2–3 millimetres is the borderline level for danger.
9.
A. True Vasodilation in skin in addition to that in muscle may reduce arterial
pressure to fainting point.
B. True There is a serious risk of a progressive rise to fatal levels due to positive
feedback.
C. False It falls due to the hyperventilation induced by the rise in core temperature.
D. False Osmolality rises due to the high output of hypotonic sweat.
E. True By improving the efficiency of heat losing mechanisms, heat adaptation
allows
the subject to have a smaller rise in core temperature for a given workload.
10.
A. False The tissues do not freeze at this temperature; ‘trench foot’ injury can occur.
B. False Hypoxia is an increased risk due to poor release of oxygen to the tissues.
C. True Increased muscle tone and shivering account for this.
D. False Fat people have much better insulation of their body core.
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E. False It is very painful, a warning of the danger of such temperatures.
11.
A. False The lactate level keeps rising with increasing severity of exercise.
B. False Increasing lactate acid increases ventilatory elimination of CO2; a rising
respiratory
exchange ratio suggests that exercise is approaching maximal.
C. False The level of ventilation in exercise does not reach the maximum breathing
capacity.
D. True Oxygen delivery depends crucially on the haemoglobin level.
E. False The limit is about half of this.
12.
A. True Due to the increased resistance of the airways.
B. True Some people respond to increased ventilation of cold air in this way.
C. True Ventilatory capacity falls as resistance increases.
D. False The problem is in the bronchial tree, not the alveoli.
E. False Asthma does not produce this effect.
13.
A. True There is impaired uptake and storage of glucose in muscle fibres.
B. False Exercise facilitates uptake of glucose in muscles and less insulin is needed.
C. True The normal insulin dosage is now excessive.
D. False Exercise increases carbohydrate requirements.
E. True Tremor is part of the sympathetic response to the hypoglycaemia; included in
this response is a tendency to oppose the fall in blood glucose by mobilizing glucose
from hepatic glycogen.
14.
A. True The predicted rate (220 minus age in years) is 195.
B. False A heart rate of 195 and stroke volume of 70 would give a cardiac output of
13.65 litres/minute; maximal output in an athlete is about twice that value.
C. True A tidal volume of 2 litres and respiratory rate of 60/minute gives a total
ventilation of 120 litres/minute.
D. False It should be five to ten times the resting level.
E. True It would be below 100 ml/litre (less than 50 per cent saturated); most of the
circulation passes through exercising muscles and gives up considerably more than
half its oxygen to the muscles.
15.
A. True This is a recognized adverse effect of strenuous training over weeks or
months.
B. True Amenorrhoea is likely when body weight falls markedly below the normal
value.
C. False It is usually a hypothalamic response to a reduction in the body’s energy
stores which are sensed in the hypothalamus.
D. True As at the menarche, reproductive activity, including ovulation and
menstruation, generally depend on attaining a normal adult body mass, including fat
stores.
E. False This is the normal female body fat level.
16.
A. False The respiratory quotient for carbohydrate is 1.0.
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B. True The ratio is about 9:4.
C. False Muscle energy is normally derived about equally from carbohydrate and fat.
D. False Cortisol favours this catabolic process by converting amino acids into
glucose.
E. False Training greatly increases energy needs, up to 4000 kcal (16.8 MJ)/day, or
more.
17.
A. False Lack of oxygen leads to anaerobic glycolysis and increases lactic acid
formation.
B. False It stimulates ventilation and leads to a respiratory alkalosis.
C. False It is ‘stagnant’ hypoxia due to inadequate tissue blood flow.
D. False But beta-receptor stimulation leads to relaxation of airway smooth muscle
and
should relieve hypoxia when caused by asthma.
E. True Due to the carbon monoxide content of the smoke.
18.
A. True Like O2 consumption, CO2 production is a precise index of metabolic rate.
B. True Systolic pressure rises with the level of exercise as cardiac output increases.
C. True With exercise at twelve times resting metabolic rate, the lactate level is high
and rising.
D. False pH falls due to the lactic acid production.
E. True This rises as the maximal level (10–15 METS for most people) is approached
as buffering of lactic acid leads to CO2 production
.
19.
A. True The elastic tissue in extensor muscles is stretched by the initial downward
jump.
B. True Elastic recoil aids the activity independently of muscular contractions.
C. False The concrete surface ‘reflects’ more of the energy stored during landing the
foot on the surface.
D. True Training which stretches the muscles achieves this.
E. False Compared with skiers, weight lifters produce little muscle stretch and
rebound during training.
20.
A. True Bone density declines, particularly after 60.
B. False The risk is considerably greater in females, especially after the menopause.
C. True Normal calcification requires exposure of the bone to gravitational and other
stress.
D. True This leads to an artificial menopause and a considerably increased risk.
E. True These lead to breakdown of bone collagen thereby reducing bone strength.
21.
A. False This would be the predicted normal for someone of 70 years of age.
B. False Systolic pressure rises to 200 mmHg in fit young people.
C. True This level indicates severely inadequate blood flow (ischaemia) – the
threshold for definite abnormality is around 3 mm (0.3 mV) depression.
D. False The abnormality (inadequate flow, muscle fatigue etc.) is in the legs.
E. True This means the heart is failing to pump adequately and is a serious sign.
22.
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A. False The normal is around 15 per cent.
B. False Females normally have greater deposits of fat in the skin.
C. True This is the predicted value (220 minus age in years).
D. False It is around 20–25 litres/minute.
E. False Average values are around 30–40 ml/kg/minute.
23.
A. False It normally increases ten to fifteen-fold in a fit individual.
B. False It is caused by cardiac output not rising sufficiently to compensate for the
fall in peripheral resistance due to the skin vasodilation.
C. False Unlike heat syncope, heat stroke is likely to be fatal unless treated promptly
and effectively.
D. True Due to the development of more efficient heat-losing mechanisms.
E. False Six weeks gives useful and fairly complete adaptation.
24.
A. True Injections of isotonic potassium but not sodium into the skin are extremely
painful.
B. True Due to the accumulation of pain-producing metabolites when blood flow is
inadequate to clear the metabolites generated by muscle exercise.
C. False Accumulation of such metabolites is very slow in the resting limb; with
more prolonged occlusion, anaesthesia due to nerve hypoxia usually occurs before
metabolite retention in the tissues rises to the levels needed to stimulate pain
nerve endings.
D. False Endorphins inhibit pain pathways.
E. True Thawing releases pain mediators and restores function to numbed nerves.
25.
A. True This is the main mechanism limiting exercise.
B. False It decreases ejection fraction and hence stroke volume and cardiac output.
C. True This causes temporary (angina) and potentially permanent (myocardial
infarction) dysfunction.
D. False It may decrease heart rate by blocking impulses from the sinoatrial node to
the ventricles.
E. True It decreases work done at a given fibre length on the left ventricular function
curve.
26.
A. True This may occur in severe obstructive or restrictive disease.
B. True This may occur in obstructive disease such as asthma.
C. False Unless resting oxygen requirements are met, death results immediately.
D. False The oxygen carrying capacity of blood often rises in respiratory disease
because of polycythaemia; desaturation of haemoglobin is the usual cause of hypoxia
in respiratory disease.
E. False Pulmonary blood flow equals cardiac output, which tends to rise in
respiratory disease.
27.
A. False Not unless the individual has been training at high altitude; for some
activities a maximal haematocrit is set to discourage artificial means of raising the
oxygen carrying ability of blood.
B. False This also is likely to be normal (around 98 per cent in arterial blood).
C. False Ventilation is not usually a limiting factor for endurance activity.
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D. False There will only be sympathetic tone to the heart at maximal exercise.
E. True This permits a low resting pulse rate and a high maximal cardiac output.
28.
A. False Atmospheric drag is reduced at high altitudes.
B. True Due to impaired saturation of the blood with oxygen (hypoxic hypoxia).
C. True Due to increased ventilation induced by hypoxia; this limits ability to further
increase ventilation.
D. False This compensates for the low PCO2 and allows increased ventilation.
E. True Lactate levels tend to rise rapidly and fall slowly, leading to intense fatigue
and collapse.
29.
A. True Due to shortage of amino acids to repair loss due to normal turnover.
B. True Thus the substrates for energy production in exercise are missing.
C. False A reduced haemoglobin level is common and causes anaemic hypoxia.
D. True This is the commonest cause of anaemia (haemoglobin contains iron).
E. True High activity requires more energy than this so there would be negative
energy balance.
30.
A. True Due to stimulation of radial dilator fibres by sympathetic nerves.
B. True Another sympathetic effect.
C. True Due partly to circulating adrenaline.
D. False Sweating increases as part of the fight or flight response.
E. True Another beta sympathetic adrenoceptor response.
31.
A. False The weakness is of neurological origin.
B. False Voluntary movements are weak, but spinal reflexes such as the knee jerk are
usually increased.
C. False The muscles on the right side and speech are usually controlled by the left
side of the brain; both are usually impaired when the left side of the brain is damaged
by a stroke.
D. False A stroke usually affects just one side of the body.
E. False The damage is usually in one cerebral hemisphere, where the main motor
fibres pass from the cerebral cortex to the brainstem.
32.
A. False Conventionally it is ten times the resting rate (higher than the basal rate).
B. True 10 METS require 10 times the resting oxygen consumption of around
250 ml/minute.
C. True Resting metabolic rate is roughly proportional to body mass.
D. False Such people should exercise at this level, but advice is needed on dietary and
insulin needs.
E. True The world record for the mile at this age is between ten and fifteen minutes,
implying much less than ten METS for about a quarter of an hour.
33.
A. False The maximal thermoneutral temperature is around 30 degrees.
B. False Thermoregulatory release of vasoconstrictor tone is confined to skin blood
vessels.
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C. False Since the ambient temperature is higher than blood temperature, the only
avenues left for heat loss are evaporation of sweat and fluid lining the respiratory
tract.
D. True Exercise in such environments is inadvisable.
E. True Provided the relative humidity is low.
34.
A. True An increased heart rate is a feature of increased sympathetic drive.
B. False This tends to produce a relaxed, drowsy state as after a large meal.
C. False Beta blocking drugs reduce the tachycardia and tremor which exacerbate
anxiety.
D. True This produces tachycardia and tremor.
E. True This is another physical correlate of anxiety.
35.
A. True This gives a daily deficit of about 500 kcal which would be supplied by
metabolizing fat stores.
B. True This provides a positive energy balance and allows replenishment of body
protein and fat, assuming an adequate protein content of the diet.
C. True Metabolizing at 10 METS for 6 hours (60 MET hours) would itself use up
more than the daily sedentary requirement (e.g. sleeping for 8 hours, about 8 MET
hours; average 2 METS for 16 hours, 32 MET hours).
D. True Ketoacidosis impairs muscle function.
E. False A moderate carbohydrate intake is required to avoid ketoacidosis; a
relatively high carbohydrate intake is required for exercise.
36.
A. True This is necessary to maintain a normal alveolar oxygen level and full blood
oxygen saturation.
B. False It is increased due to the low oxygen content at low atmospheric pressures;
ventilator ability can then be a limiting factor.
C. True This occurs above the anaerobic/lactate threshold.
D. True Ventilation is somewhat reduced if this input to the brain is blocked.
E. False The precise matching of ventilation to exercise requirements is postulated to
take place in an ‘exercise centre’ which receives an input from the cortical neurones
initiating the exercise.
37.
A. False Glycogen granules are readily identifiable in sections of biopsied muscle.
B. True By providing an adequate source of glucose.
C. True This is an important effect of training; muscle glycogen stores may then
exceed 1 kg.
D. True This has been confirmed in studies involving muscle biopsies.
E. True Insulin promotes glucose uptake by muscle for replenishment of glycogen
stores.
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
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d) VMA
e) Calcium
2. The following hormone is secreted by the anterior pituitary gland:
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
4. Stimuli for aldosterone regulation includes:
a) High sodium in the distal renal tubule
b) High serum potassium
c) Hypervolaemia
d) ACTH as a potent stimulator
e) Increased renal blood flow
5. Thyroid hormone actions include:
a) Augmentation of sympathetic effect on GI motility
b) Release of insulin
c) Lipogenesis
d) Increasing the numbers of Beta adrenergic receptors
e) Increasing diastolic arterial blood pressure
6. Release of oxytocin by the posterior pituitary gland is controlled by:
a) Oxytocin releasing hormone
b) Neural signals from hypothalamus
c) Neural signals from the thalamus
d) Changes in body temperature
e) Changes in arterial blood pressure
7. The following can be observed in a patient who has Grave's disease
(hyperthyroidism):
a) Drop of the upper eyelid
b) High level of TSH
c) Intolerance to cold
d) High systolic blood pressure
e) Constipation
8. The thyrotropin releasing hormone, stimulates the secretion of:
a) Growth hormone
b) Prolactin
c) Adrenocorticotrophic hormone
d) Melanocyte stimulating hormone
e) Luteinizing hormone
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9. The following is true about estrogen:
a) It is essential for development of female external genitalia
b) Is released only during the follicular phase of the ovarian cycle
c) Is released from granulosa cells
d) Its secretion is decreased by inhibin
e) Its receptors are located on cell membranes
10. The most sensitive regulatory mechanism of ADH secretion is dependent on:
a) The volume receptors
b) Renin-angiotensin system
c) Hypothalamic osmoreceptors
d) Renal glomerulotubular feedback
e) Renal principal cells
11. Clinical uses of Oxytocin include:
a) Stimulation of milk ejection in breastfeeding women
b) Stimulation of ejaculation in infertile men
c) Stimulation of uterine contraction in pregnant women
d) Induction of breast development in adolescent girls
e) Induction of vasoconstriction in hypotension
12. All the following is true about control of secretion if 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 in TRH
e) Has no marked diurnal rhythm
13. The actions of ACTH include the following except:
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
14. A most effective method of treating type I diabetes mellitus is:
a) The patient should not eat any carbohydrates
b) Exercise
c) Reduce weight
d) Drugs to stimulate the B cells of the pancreas
e) Daily injections of insulin
15. The following are actions of insulin, except:
a) Inhibition of protein degradation
b) Inhibition of gluconeogenesis
c) Inhibition of ketogenesis
d) Reduction of extracellular K+
e) Increased renal tubular absorption of glucose
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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
e) High levels of ACTH
17. A major regulator of bone growth is:
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:
a) Excessive bleeding due to failure of clotting
b) Paralysis of skeletal muscles due to failure of interaction between actin and
myosin
c) Uncontrolled contraction of skeletal muscles due to hyperexcitability of
nerves and muscles
d) Failure of the SA node to generate impulses
e) Hypo-osmolality
19. Primary hyperaldosteronism leads to:
a) Moderate hyperglycemia
b) Sodium natriuresis
c) Oedema
d) Alkalosis
e) Increased rennin secretion
20. Which of the following is a manifestation of Addison's disease:
a) Hypopigmentation
b) Good appetite
c) Hypoglycemia
d) Obesity
e) Hypertension
21. Excess cortisol in Cushing's syndrome is associated with:
a) Hypotension
b) Protein depletion
c) Hypoglycemia
d) Dry thick skin
e) Increased body hair
22. Insulin secretion is inhibited by:
a) Alpha adrenergic receptor stimulation
b) Vagal stimulation
c) Amino acids
d) GIP
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e) Gastrin
23. Calcitonin:
a) Increases serum calcium by stimulation of osteoclasts
b) Prevents postprandial hypercalcemia
c) Is important in long-term regulation of serum ionized calcium
d) Is stimulated by a hypothalamic releasing hormone
e) Is released during stress
24. Hypomagnesemia is a recognized cause of:
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
26. Products of the anterior pituitary gland include:
a) Melatonin
b) Acetylcholine
c) Beta endorphin
d) Inhibin
e) Somatomedins
27. Secretion of gonadotropins is ordinarily inhibited by which of the following
a) Estradiol
b) Testosterone
c) Calcium
d) Oxytocin
e) A or B
28. Testosterone action on target cells below the neck leads to increases un which
of the following?
a) Spermatogenesis
b) Prostate size
c) Penile size
d) None of the above
e) A, B and C are correct
29. In humans, each of the following facilitates ovulation except:
a) Pulsatile secretion of gonadotropin-releasing hormone
b) Positive feedback effect of estradiol on LH secretion
c) Negative feedback effect of estradiol on LH secretion
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d) Action of FSH on granulose cells
e) Secretion of LH in a surge pattern
30. Ionized calcium:
a) Forms 60% of total blood calcium
b) Cannot be filtered by the kidneys
c) Low levels stimulate calcitonin secretion
d) Levels in blood are increased by increase in H+ concentration
e) Concentration inside the cell is the same as the interstitial fluid
31. Insulin can be described as:
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:
a) Inhibition of the secretion of growth hormone
b) Stimulation of glucagon secretion
c) Inhibition of gastric acid secretion
d) Inhibition of insulin secretion
e) Relaxation of the sphincter of Oddi
33. 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
34. The following effects can be caused by cortisol except:
a) Excessive loss of K+ in urine
b) Hypertension
c) Hyperglycemia
d) Increased production of CRH by the hypothalamus in cases of Cushing's
syndrome
e) Immunosuppression
35. T3 is different from T4 in that:
a) It binds to receptors located on cell membranes
b) Its concentration increases in starvation
c) Its volume of distribution is high
d) It increases the efficiency of energy utilization
e) Most of it in plasma is bound to TBG
36. Known effects of ACTH include all of the following except:
a) Increased secretion of adrenal androgens
b) Increased secretion of aldosterone transiently
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c) Increased pigmentation of body tissues
d) Stimulation of growth of zona reticularis of the adrenal cortex
e) Direct stimulation of surfactant secretion
37. Prolactin secretion:
a) Has diurnal rhythm
b) Can be inhibited by L-dopa
c) Is inhibited by chlorpromazine
d) Is stimulated by bromocriptine
e) Is continuously stimulated by prolactin releasing hormone
CENTRAL NERVOUS SYSTEM
1. All of the following reflexes are monosynaptic except:
a) The knee jerk
b) The biceps jerk
c) The triceps jerk
d) The abdominal reflex
e) The supinator reflex
2. The following is true regarding the muscle spindle:
a) Acts as a receptor for only monosynaptic reflexes
b) Has gamma nerve fibers as afferents
c) Has Beta B fibers as efferents
d) Is stimulated by touching the muscle fibers
e) Acts as a receptor for pressure stimuli
3. Medullary postural reflexes include:
a) The positive supporting reaction
b) The placing reaction
c) The tonic neck reflex
d) The stretch reflex
e) The hopping reaction
4. The following is true about the basal ganglia:
a) Control balance
b) Control equilibrium
c) Control conjugate eye movement
d) Initiate movement
e) In disease, power is lost
5. Concerning cerebellar disorders:
a) Tone increases
b) Reflexes are exaggerated
c) The gait becomes wide-base
d) Consciousness is lost
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e) Sever memory loss might follow
6. Pain sensation:
a) Is not a good sign
b) It’s a perception occurs in the hypothalamic nuclei
c) Fast pain is carried by the C-Fibers
d) Referred pain is usually from somatic to visceral receptors
e) Its receptors are free nerve endings
7. The following is true about the frontal lobe:
a) Controls gait
b) Is the centre for intelligence
c) Is the centre for memory
d) Is one of the centers for sensation of smell
e) Controls all human emotions
8. The following is true about receptors:
a) Pain receptors are rapidly adaptive
b) Pressure receptors are slowly adaptive
c) Touch receptors are non-adaptive
d) Might be stimulated by chemical changes
e) Their stimulation generates an action potential
9. Concerning vision:
a) The cons are responsible for scotopic vision
b) The intraocular pressure ranges between 15-25 mmHg
c) Myopia is corrected by glasses having concave lenses
d) The cortex is the center for the light reflex
e) The association visual area is responsible for the primary perception of the
visual pathway
10. Regarding the visual pathway:
a) Optic nerve lesions cause homonomous hemianopia
b) Optic chiasm lesions result in complete blindness of one eye
c) Is tested by visual evoked potentials
d) Test retinal lesions
e) Maybe of help in diagnosing temporal lobe lesions
11. Concerning hearing sensation:
a) The receptors are found in the middle ear
b) The center is located in the parietal lobe
c) Conductive deafness might follow hair cell destruction
d) Nerve deafness is diagnosed by obtaining audiometry curves of intensity
more than 20 decibels
e) The normal hearing frequency ranges between 500-6000 Hz
12. Which of the following statements is true?
a) Rhythm of theta in the EEG ranges between 1-3 C/S
b) Alpha activity normally appears after the age of 4 years
c) Recall from sensory memory centers takes only a few seconds
d) Rapid eye movement sleep lasts for 30 minutes
e) Dopamine is one of the neurotransmitters for sleep
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13. All of the following are motor areas in the brain, except:
a) The promotor area
b) The association motor area
c) The temporal motor area
d) The occipital motor area
e) The frontal motor area
14. Gamma efferent discharge is NOT controlled by:
a) Extreme change of behavior
b) Anxiety
c) Scratching of the skin
d) Extrapyrimidal descending tracts
e) Descending reticulocspinal tracts
15. All of the following are medullary postural reflexes, except:
a) The optical righting reflex
b) The tonic labyrinthine reflex
c) The tonic neck reflex
d) When the head moves to one side
e) When the head moves up
16. Sensation of pain:
a) Is carried by the posterior column tracts
b) Is carried by the lateral spinothalamic tract
c) Is carried by the 9th cranial nerve
d) Perception only occurs in the sensory cortex
e) The sharp pain is carried by the slow C-Fiber
17. The following are pyramidal signs except:
a) Hypertonia
b) Hyprflexion
c) Upgoing big toe
d) Absence of the abdominal reflexes
e) Wasting
18. Concerning pain sensation:
a) Pain impulses are transmitted only by myelinated fibers
b) Its perception occurs in the cortex
c) Referral of pain is from visceral to somatic structures
d) Antero-lateral cordotomy offers long lasting relief of pain
e) Allodynia is caused by cytokines and growth factors
19. Ipsilateral cervical cord compression at C6/C7 level causes:
a) Absence of the triceps reflex on the same side
b) Hyperalgesia below C6/C7
c) Loss of vibration sense over the contra-lateral side of the lesion
d) Sluggish knee jerk bilaterally
e) Up going big toe on the same side of the lesion
20. Receptive aphasia:
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a) Is due to a lesion in the frontal lobe
b) Is due to a lesion in the Sylvian fissure
c) Is differentiated from motor aphasia by the fact that patients do not obey
commands
d) The cause may be infarction involving the parietal lobe
e) Carries a good prognosis if compared to Brocha's aphasia
21. Which of the following is a mid brain postural reflex:
a) The stretch reflex
b) The tonic neck reflex
c) The hopping reaction
d) The positive supporting reaction
e) The body on body righting reflex
22. The following are signs of cerebellar dysfunction:
a) Hypertonia
b) Tremors at rest
c) Dysphasia
d) Hyperflexia
e) Muscle weakness
23. The spinothalamic tract:
a) Transmit sensation of pressure
b) Transmit sensation of temperature
c) Terminates in the thalamus
d) Its integrity is tested by the tuning fork
e) Its lesion results in dissociated loss of pain
24. Bitemporal hemianopia is caused by:
a) Optic nerve lesions
b) Optic tract lesions
c) Pituitary tumors
d) Occipital lobe lesions
e) None of the above
25. Which of the following reflexes is polysynaptic:
a) The knee jerk
b) The ankle jerk
c) The abdominal reflex
d) The supinator reflex
e) The triceps jerk
26. Postion sense:
a) Is tested by the tuning fork
b) Is transmitted to the brain through the lateral spinothalamic tract
c) Is defective in pyramidal tract lesions
d) Is defective in sensory ataxia
e) Its center lies in the pre-central gyrus
27. Which of the following is a basal ganglia function:
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a) Effective control of skillful movement
b) Initiation of movements
c) Control of equilibrium
d) Motor control of speech
e) Coordination of pyramidal corticospinal activity
28. Concerning color blindness:
a) Is due to diseased rods
b) Is an autosomal dominant disorder
c) Is a female disease
d) Affects one color
e) Is transmitted by the x chromosome
29. The fastest conduction of impulses occurs in nerves of type:
a) C
b) A alpha
c) A beta
d) A delta
e) B
30. The dorsal column tracts are concerned with:
a) Crude touch
b) Temperature sensation
c) Fast pain
d) Sense of vibration
e) Sexual sensations
31. The localization of sensation is a function of:
a) Adequate stimulus
b) Primary sensory cortex
c) Specific receptors
d) Medullary centers
e) Hypothalamus
32. The intensity (strength) of a stimulus is coded by:
a) The receptor specificity
b) The voltage of the generator potentials
c) The amplitude of the action potential
d) Stimulation of columns of cells in the sensory cortex
e) The frequency of impulses
33. Adaptation to sensory modalities:
a) Can be explained by receptor fatigue
b) Occurs at the same rate in different receptors
c) Is due to inactivation if Na+ channels
d) Is due to release of inhibitory transmitter
e) Is defined as decreased firing of receptors when a stimulus is increased
34. Pyramidal diseases is characterized by:
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a) Tremor
b) Muscle wasting
c) Muscle weakness
d) Hypotonia
e) Presence of the abdominal reflexes
35. Lower motor neuron disease is characterized by:
a) Muscle wasting
b) Hypertonia
c) Hyperflexia
d) Clonus
e) Disturbance of coordination
36. Signs of cerebellar dysfunction include:
a) Increase muscle tone
b) Past pointing
c) Shuffling gait
d) Resting tremor
e) Muscle weakness
37. The climbing fibers of the cerebellum:
a) Terminate directly in the deep cerebellar nuclei
b) Inhibits the purkinje cell layer
c) Excite directly the deep cerebellar nuclei
d) Stimulate the granular cell layer
e) None of the above
38. The following is true about fast pain:
a) Is carried by type C fibers
b) Is dull in nature
c) Is due to activity in the A and B myelinated fibers
d) Is transmitted in dorsal column tracts
e) Is sharp and localized in nature
39. Concerning sensation vision:
a) The rods are specialized for daylight vision
b) The cones are specialized only for colour vision
c) Hypermeteropia is corrected by using bioconcave lens
d) Parasympathetic inhibition dilates the eye pupil
e) Lesions in the pituitary fossa cause complete loss of vision in one eye
40. The following is true about the frontal lobe of the brain:
a) Has centers for control of taste sensation
b) It controls behaviour
c) Has major control centers for control of upper & lower limb activity
d) If destroyed the subject develops marked loss of memory
e) Is the center for control of vision
41. Concerning the electroencephalogram (EEG):
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a) Alpha waves are best seen over the temporal areas
b) Beta waves have a slow frequency
c) Theta waves range from 4-7 cycles per second
d) The EEG is 100% diagnostic in epilepsy
e) Generalized slow waves are signs of epilepsy
42. Concerning control of posture:
a) The hopping reaction is controlled in the midbrain
b) The tonic neck reflexes are controlled in the spinal cord
c) The optical righting reflex is controlled in the cerebral cortex
d) The stretch reflex is controlled in the medulla
e) The positive supporting reaction is controlled in the midbrain
43. The following is true about the vestibular system:
a) Controls muscle tone
b) The semicircular canals are stimulated by linear acceleration movement
c) The utricle hair cells are stimulated by rotational movement
d) If damaged results in vertigo
e) The saccule hair cells stimulated by vertical sudden change of direction
44. A 70 year old man suddenly developed loss of consciousness and right sided
upper and lower limb weakness. On clinical examination, the following is true:
a) Power is completely lost over both sides
b) Reflexes are exaggerated over both sides
c) Sensations are lost over both sides
d) The abdominal reflexes are absent
e) Upgoing big toe is elicited on the right side
45. A 75 year old man gradually presented with left sided tremor especially at
rest, and poverty of movement and a festinant gait. On clinical examination of
this patient the following is true:
a) Hypotonia
b) The patient exhibits a mask face
c) Power is severly affected
d) Reflexes are absent
e) All sensory modalities are lost
46. Impulses generated in the taste buds of the tongue reach the cerebral cortex
via the:
a) Thalamus
b) Internal capsule
c) Trochlear nerve
d) Hypoglossal nerve
e) Dorsal roots of the first cervical spinal nerve
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BODY TEMPERATURE
1. The part of the brain that regulates body temperature is:
a) Pituitary
b) Thalamus
c) Hypothalamus
d) Pons
e) Cerebral cortex
2. Sudden exposure to a cold environment will cause all the following except:
a) Cutaneous vasoconstriction
b) Contraction of the erector pili muscles
c) Increase arterial blood pressure
d) Cutaneous vasodilation
e) Shivering
3. Whenever the body temperature is lower than the set point the following are
present except:
a) Sweating
b) Cutaneous vasoconstriction
c) Contraction of erector pili muscles
d) Accelerated metabolism
e) Shivering
4. The metabolic rate is increased by all of the following except:
a) Catabolism of lactate
b) Saturation of myoglobin with O2
c) Saturation of hemoglobin with O2
d) Replenishing ATP stores
e) Replenishing phosphocreatine stores
5. Features of a heat stroke include all the following except:
a) Hypotension
b) Dehydration
c) Low Cardiac Output
d) Excessive sweating
e) Confusion
6. At an environmental temperature of 37o C most of the heat is lost from the
body by:
a) Radiation
b) Evaporation
c) Conduction
d) Convection
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e) Conduction and Convention
7. The metabolic rate is increased by all of the following except:
a) Rise in body temperature
b) Rise in environmental temperature
c) Increased sympathetic outflow
d) Starvation
e) Hyperfunction of the thyroid gland
8. Responses to cold exposure include:
a) Opening of cutaneous vascular shunts
b) Increased cardiac output
c) Decreased cardiac output
d) Cutaneous vasoconstriction
e) Tachycardia
9. Responses to heat and cold are:
a) Stimulation of cutaneous thermoreceptors
b) Hypothalamic centers
c) Integration of central & cutaneous receptor inputs
d) Monitoring of the core temperature
e) Mainly regulated by the posterior hypothalamus
10. Heat exposure may lead to:
a) Heat syncope due to damage to hypothalamus
b) Heat cramps due to raised core temperature
c) Heat stroke due to excess water loss
d) Heat exhaustion due to excess water & electrolyte loss
e) Dehydration due to failure of ADH secretion
11. Sudden exposure to a cold enviornment would lead to all the following
except:
a) Cutaneous vasoconstriction
b) Decreased peripheral vascular resistance
c) Contraction of pili-erector muscle
d) Peripheral cyanosis
e) Decreased skin temperature
12. The body temperature of a patient is 38oC and observed to be rising. The
following is true regarding this patient:
a) He is unlikely to be sweating
b) His metabolic rate will be higher than normal
c) He is unlikely to be shivering
d) He is unlikely to have respiratory alkalosis
e) His temperature set point is 38oC
13. A thermoregulatory response controlled primarily by sympathetic
cholinergic nerves is:
a) Shivering
b) Cutaneous vasodilation
c) Sweating
d) Cutaneous vasoconstriction
e) Piloerection
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14. Which of the following is the main customer of energy under basal
conditions?
a) Heart beat
b) Respiratory muscle activity
c) Sodium-potassium pump
d) Skeletal muscle activity
e) Pancreas
15. A patient with a body temperature of 34oC is expected to have:
a) High metabolic rate
b) Low oxygen consumption
c) Tachycardia
d) High stroke volume
e) High lung ventilation
16. The body temperature of a febrile patient is found to be 38 oC and it has been
observed that his body temperature is still rising. Regarding this patient, all of
the following are correct except that there will be:
a) Cutaneous vasoconstriction
b) A set point higher than 38oC
c) Sweating
d) High metabolic rate
e) Piloerection
17. The most important factor determining the insensible water loss is:
a) Enviornmental temperature
b) Humidity of the enviornment
c) Relative humidity of the enviornment
d) Activity of the sweat glands
e) Respiratory rate
18. Stimulation of which of the following is expected to decrease heat loss from
the body:
a) Alpha-adrenergic receptors
b) B1-adrenergic receptors
c) B2-adrenergic receptors
d) Muscarinic cholinergic receptors
e) Nicotinic cholinergic receptors
19. The body temperature of a febrile patient is observed to be decreasing. This
subject is expected now to:
a) Be sweating
b) Be shivering
c) Have lower than normal metabolic rate
d) To have piloerection
e) Bradycardia
20. The basal metabolic rate:
a) Is about 50 kcal/m2/hour in males
b) Per kg lean body mass is equal in males and females
c) Increases with age
d) Is low in febrile patients
e) Is best measured when the subject is sleeping
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21. In the thermal balance equation the following is always positive:
a) Conduction
b) Evaporation
c) Metabolic heat production
d) Radiation
e) Convection
22. Evaporating one liter of sweat glands leads to:
a) Increased osmolarity of the ECF
b) Decreased osmolarity of plasma
c) Loss of 1000 kcal of heat
d) Decreases plasma viscosity
e) None of the above
23. The basal metabolic rate (per m2 surface area) is expected to be higher in:
a) Obese females than lean females
b) Lean males than obese males
c) Elderly than young adults
d) Elephants than rats
e) Adults than children
24. The thermoregulatory response that can be blocked by atropine is:
a) Shivering
b) Cutaneous vasodilation
c) Sweating
d) Cutaneous vasoconstriction
e) Piloerection
25. A patient with a body temperature of 39oC is expected to have:
a) A low metabolic rate
b) Low oxygen consumption
c) Tachycardia
d) Low stroke volume
e) Hypoventilation
26. The respiratory quotient:
a) For fats is greater than for carbohydrates
b) Of the human brain is about 0.7 at rest
c) Of skeletal muscle is close to 1 at rest
d) Of carbohydrates is 1
e) Is equal to amount of oxygen consumed divided by carbon dioxide
produced
27. Heat exhaustion differs from heat stroke in that in heat exhaustion there is:
a) Hypotension
b) Tachycardia
c) Moist skin
d) Low cardiac output
e) Extensive cutaneous vasoconstriction
28. All of the following statements about brown fat are true except:
a) It has numerous mitochondria and a rich blood supply
AlNeelain University
MCQs TextBook
Batch XIV
463
b) It produces a lot of heat but little ATP
c) It is important for heat production in adults
d) It is abundantly innervated by the sympathetic nervous system
e) It is abundant in the upper part of the body
29. Shivering and vasoconstriction best describe which of the following:
a) Hypotension
b) Onset of fever
c) Sustained fever
d) Rapid reduction of temperature set point
e) Hyperthyroidism
30. Which of the following is not at core body temperature:
a) The brain
b) The hypothalamus
c) The blood
d) The testes
e) The liver
31. The body temperature of a febrile patient is observed to be gradually
declining. This subject:
a) Unlikely to be sweating
b) Heat production is greater than heat loss
c) Is likely to be shivering
d) Is likely to have cutaneous vasodilation
e) Is expected to complain of chills
32. Sweat:
a) Is a filtrate
b) Is usually isotonic to plasma
c) Has low sodium concentration when flow rate is slow
d) Has low sodium concentration in un-acclimatized compared to acclimatized
people
e) Evaporation depends primarily on air temperature
33. The basal metabolic rate:
a) Is about 40 kcal/m2/hour in an average adult man
b) Is higher than normal in hypothermic people
c) Is higher in obese than lean subjects per unit body weight
d) Should be measured when the subject is asleep
e) Should be measured at room temperature of 37oC
AlNeelain University
MCQs TextBook
Batch XIV
464
Our best wishes for a great success
Ahmed Jihad Mahmoud
Alla Yasir Badawi
Batch XIV Family
AlNeelain University
MCQs TextBook
Batch XIV