FCPS Part 1 Paper of Medicine and Allied 14 August 2015 Online

FCPS 1 MEDICINE AND ALLIED 14 AUGUST 2015 ONLINE by Dr Saqib Hassan

Thanks to all my colleagues who knowingly or unknowingly contributed to this effort J

The keys are made by me. Feel free to question and change them, but with a proper reference, please.

I would greatly appreciate if those of you who gave the exam would add questions so that this effort could reach completion.

Best of luck to all those who have yet to give their exams.

1. ventricles contract from apex to base

2. neoplasia

3. chalmydia

4. loss of ganglion cells of the vagus nerve

5. mean arterial pressure

6. cuboidal epithelium

7. ulnar nerve

8. extends from lower pole of thyroid to 4th costal cartilage

9. located to the left of L2 (?)

10. pretracheal fascia

11. Destroying first order neurons of somatosensory pathway would involve destruction of: A. dorsal column, grey matter of spinal cord, main trigeminal nucleus B. dorsal column, grey matter of spinal cord, main trigeminal nucleus, facial nucleus C. dorsal column, grey matter of spinal cord, main trigeminal nucleus, nucleus of tractus solitrius D. medulla/pons, grey matter of spinal cord, main trigeminal nucleus (?)

12. Question about AIDS(?) A. low cd4 count B. C. D. E. [?]

13. Patient has severe pain in a dermatomal distribution at and around his chin and a skin eruption A. Herpes zoster B. Trigemminal neuralgia C. D. E. [?]

14. Most important role in inflammation (?): A. prostaglandin B. C. D. E.

[?]

15. Most important sign in hypertensive retinopathy: A. AV nipping B. Exudates C. Retinal detachment D. Retinal hemorrhage E. [?]

16. Metaplasia: A. functional change in cell (?) B. C. D. E. [?]

17. The greatest pH gradient across gastric mucosa will be when (?): A. intact mucosal barrier with HCL secretion B. C. D. E. [?]

18. During the night secretion of which hormone is increased: A. ADH B. cortisol C. growth hormone D. E. [?]

19. old lady, bed bound after CVA, has an episode of SOB, develops pleuritic chest pain 2 weeks later, later on has another CVA and dies. at autopsy lung shows wedge shaped infarct/lesion (?). Which is most likely: A. thromboembolism B. C. D. E. [?]

20. Which of the following do not adapt (?) A. cold receptors (?) B. C. D. E.

21. Which of the following will adversely affect the doctor-patient relationship (?) A. …Hurried attitude B. Use of jargon C. D. E.

[?]

22. Which is most important in preventing spread of infection between patients in the ICU: A. frequent hand washing between patients B. C. D. E. [?]

23. A 28 year old (?) female with 12 weeks amenorrhea, frequency of micturition and burning sensation during urination. What is the most likely dx: A. Early pregnancy B. UTI C. D. E.

24. During dissection of the ovary which artery is at risk of damage: A. internal iliac B. uterine C. external iliac artery D. common iliac E. [?]

25. Recurrent serotonin syndrome is most likely to be seen with: A. fluoxetine and TCA B. high doses of chlorpromazine C. (other options included high doses of other CNS active drugs) D. E. [?]

26. Which of the following will cause severe steatorrhea: A. colonic resection B. ileal resection C. pancreatectomy D. E. [?]

27. During moderate stimulation of salivary glands A. Na and K are equal to plasma B. only buccal glands secrete saliva C.

28. Calcitonin: A. useful in hypervitaminosis D B. is a 32 amino acid peptide C. must be administered parenterally D.

29. Deficiency of which amino acid results in cell injury A. tyrosin B. carnitine C. acylcarnitine

D. glycine E. adenine

30. Inguinal canal: A. roof is formed by conjoint tendon B. floor is formed by fascia of thigh C. transmits iliohypogastric nerve D. extends from anterior superior iliac spine to pubic tubercle E.

31. question regarding anatomy of lung root A. bronchus is located superiorly B. pulmonary vein is located superiorly C. D. E.

32. Location of olfactory cortex: A. anterior perforated substance B. calcarine sulcus C. hypothalamus D. lateral olfactory area E. posterior inferior temporal lobe

33. most likely cause of megaloblastic anemia in a 35 year old man A. transcobalamin II deficiency B. intrinsic factor deficiency C. D. E.

34. which of the following is a pre-malignant lesion: A. dysplasia B. condyloma skin C. metaplasia of cervix D. E.




35. most important for metastasis: A. migration B. degradation of extracellular matrix C. deficiency/degradation of “E-cathedrin” (sic) D. loss of attachment of tumor cells with each other E.

36. which of the following is responsible for preserving the organism “as a whole” in shock state A. sympatho-adrenal discharge B. pulmonary circulation C. CNS ischemic response D. E.

37. red blood cells: A. have greater respiratory quotient than parietal cells B. life span of 30 days C. D.

E.

38. a 45 year old (?) man comes to you as he is concerned about coronary heart disease and his high cholesterol. He is

asymptomatic. What would be the most appropriate advice to him at this time: A. reduce fat intake B. reduce carbohydrate intake C. D. E.

39. body weight is maintained week to week by: A. regulation of food intake B. C. D. E.

40. radiotherapy causes cancer after: A. more than 10 years B. 5 years C. 5-10 years D. E.

41. …lambda light chain deposition: A. amyloidosis B. alport syndrome C. D. E. [A – Big Robbins, 8e, ch6, table 6-15]

42. specific dynamic response (?): A. digestion B. shivering C. muscle activity D. E.

43. 6 year old child (?), “total bilirubin 11.1, conj 10 unconj 1.1”: A. hepatitis B. wilson’s disease C. hemolysis D. gilbert’s syndrome E. criggler-najar syndrome

44. [Question] A. dermatome at junction of costal margin and midclavicular line is T8 (?) B. C. D. E.

45. epithelium of post-terminal bronchiole: A. pseudostratified columnar epithelium B. cuboidal epithelium C. stratified squamous epithelium

D. columnar epithelium E. [A – Junqeira 11e ch17: “In the larger bronchioles, the epithelium is ciliated pseudostratified columnar, which decreases in height and complexity to become ciliated simple columnar or cuboidal epithelium in the smaller terminal bronchioles”]

46. Presence of normal tissue at an abnormal site is known as choristoma. An example of this is: A. Pancreatic tissue in submucosa of stomach B. Thyroid tissue in posterior third of tongue C. Pancreatic tissue in tongue D. E. [A – big robbins 8e ch7: “For example, a small nodule of well-developed and normally organized pancreatic substance may be found in the submucosa of the stomach”]

47. Which of the following is most frequently associated with paraneoplastic syndromes: A. Renal cell carcinoma B. Small cell carcinoma of lung C. D. E. [B – http://www.ncbi.nlm.nih.gov/pubmed/16813730]

48. Which of the following has the lowest clearance: A. glucose B. urea C. creatinine D. HCO3 E. [A – Guyton 13e ch28 p368]

49. Periarticular erosions are a characteristic feature of: A. Osteoarthritis B. Rheumatoid arthritis C. SLE D. E. [B – big robbins 8e ch26 fig 26-45]

50. Libman-Sacks endocaraditis most frequently involves which valce(s): A. Mitral and tricuspid B. Aortic only C. Mitral and aortic D. Tricuspid and pulmonary E. Tricuspid [C – http://emedicine.medscape.com/article/155230-overview#showall]

51. Regarding lymphocytes (?) A. Continue to mature in thymus after birth B. T lymphocytes are mostly present in blood C. B lymphocytes are mostly present in blood D. E. [A – Guyton 13e ch35 p467 “Most of the preprocessing of T lymphocytes in the thymus occurs shortly before birth of a baby and for a few months after birth. Beyond this period, removal of the thymus gland diminishes (but does not eliminate) the T-lymphocytic immune system”

among lymphocytes, T cells have greater conc in peripheral circulation, but mostly, both T and B lymphos are present in lymphoid organs]

52. Amount of iron in a woman’s body: A. 1gm B. 5gm C. 2gm D. 3gm E. 4gm [C – Harrison 18e ch103 table 103-1 and https://books.google.com.pk/books?id=0JV4UwU0TtgC&pg=PA502&dq=total+body+iron+in+women+grams&hl=en&sa=X&redir_esc=y#v=onepage&q=total%20body%20iron%20in%20women%20grams&f=false ]

53. Regarding binding of drugs to plasma proteins (?) A. albumin binds acidic drugs B. albumin binds basic drugs C. does not depend upon available binding sites D. does not depend upon concentration of drug E. [A – Rang&Dale 8e ch8 p106]

54. Crown Rump length during 17th to 20th week: I don’t remember the options, but apparently its 13-17cm according to the internet

55. Which fluoroquinolone is the preferred drug for treating combined infection with gonorrhea and Chlamydia: A. ofloxacin B. ciprofloxacin C. nalidixic acid D. levofloxacin E. [A/B/D? – CMDT 2013 ch33 p1453 and 1462 (& others) – current recommendations may have changed, according to CMDT quinolones are no longer recommended, previously cipro was used for both and may be the correct answer in the key. CMDT mentions levofloxacin for both gonorrhea and Chlamydia but not in combined form, over the net, you may find that oflox is the preferred drug]

56. Regarding the cricoids cartilage: A. attached to the thyroid cartilage via a fibrous joint B. provides attachment to the inferior constrictor of pharynx C. provides attachment to vocal cords D. is crossed by the isthmus of thyroid gland (?) E. [B – Last’s anatomy 12e ch6 p384]

57. Which of the following is mitogenic for liver cells following hepatectomy A. TNF-alpha B. TGF-beta C. Hepatocyte growth factor (scatter factor) D. VEGF (?) E. PDGF [C – Robbins 8e ch3 “With the exception of the autocrine activity of TGF-α, hepatocyte replication is strictly dependent on paracrine effects of growth factors and cytokines such as HGF and IL-6 produced by hepatic nonparenchymal cells”] not 100% definite, especially as I don’t clearly remember whether TGF-beta or alpha was given.

58. A statistical test to determine whether the difference observed between two means is by chanec is a test of: A. variance B. significance

C. reliability D. validity E. [B – https://books.google.com.pk/books?id=0fKTO9L9eigC&pg=PA194&dq=tests+of+significance+t-test+kaplan&hl=en&sa=X&redir_esc=y#v=onepage&q=tests%20of%20significance%20t-test%20kaplan&f=false ch11 p176 table 11-1]

59. Scenario of allergic reaction, which of the following is the mediator: A. histamine B. C. D. E. [A]

60. Scenario of surgically mass (renal?) which will indicate malignant nature: A. Necrosis B. Invasion C. high nuclear to cytoplasm ratio D. E. [B – Robbins 8e ch7 “Nearly all benign tumors grow as cohesive expansile masses that remain localized to their site of origin and do not have the capacity to infiltrate, invade, or metastasize to distant sites, as do malignant tumors”]

61. Which of the following is the action of acetylcholine/parasymaptheti nervous system: A. relaxation of detrusor B. contraction of intestinal sphincters C. relaxation of sphincter pupillae D. relaxation of intestinal sphincter E. [D – Guyton 13e ch61 table 61-2]

62. Two groups of patients, one exposed to a risk factor and the other unexposed are followed over a period of time, this type of study is known as: A. case-control B. cohort C. D. E. [B – First Aid 2015 p48]

63. Description of a cancer patient with metastatic cancer including TNM staging, the most prominent feature would be: A. cachexia B. C. D. E. [A – Goljan 4e ch9 p218 “very common complication of disseminated cancer”]

64. Regarding sex linked disorders: A. usually causes disease in females B. usually transmitted by males C. usually causes diseases in males D. E. [C – Robbins 8e ch5 “these disorders are expressed in the male”]

65. The parts of bones which develop by secondary centres of ossification after birth are called: A. metaphysis B. diaphysis C. growth plate D. epiphysis E. [D – Last’s anatomy ch1 p6]

66. Which of the following hormones causes vasoconstriction of both arterioles and veins: A. angiotensin 2 B. epinephrine C. angiotensin 3 D. ADH E. [B – Guyton 13e ch19 p235 “(regarding angiotensin 2) Vasoconstriction occurs intensely in the arterioles and much less so in the veins.” Guyton 13e ch76 p949 “Whereas minute concentrations of ADH cause increased water conservation by the kidneys, higher concentrations of ADH have a potent effect of constricting the arterioles” Rang and Dale 8e ch12 table 12.1 – both arterioles and veins bear alpha adrenergic receptors]

67. Deficiency of glucose-6-phosphatase will result in: A. deficiency of glycogen in skeletal muscle B. increased deposition of glycogen in liver C. increased deposition of unbranched glycogen D. hypoglycemia E. [D – CDTP 21e ch36 p1067 “…and severe fasting hypoglycemia. These include glucose 6 phophatase deficiency”]

68. [question] A. if Vd < 10L, drug is mostly present in blood B. C. D. E. [unreliable references over the internet confirm A, but without knowing the other options and question there is no way to be sure]

69. A man injured in an RTA with fractures of humerus, femur and collarbone; pulse 120; BP 90/60 which should be done first: A. fluids B. X ray of fractured bones C. splinting D. reduction and casting E. tracheostomy [A]

70. 6 year old (?) child with history of excessive bleeding from cuts and easy bruising, “no such family history”. Also complains of diarrhea/steatorrhea. What is the cause of bleeding? A. liver failure B. vitamin K deficiency C. Christmas disease D. E. [B?]

71. Which of the following irreversibly impairs platelet function: A. Aspirin

B. C. D. E. [A – Katzung 12e ch36 p641 “… the irreversible platelet inhibition induced by aspirin”]

72. Most important step for metstasis: A. migration B. loss of attachment of neoplastic cells with each other C. breakdown of “E-cathedrin” (sic) D. breakdown of extracellular matrix E.

73. Purkinje cells are present in which “organ(?)”: A. Cerebellum B. Cerebellar cortex C. Cerebellar nuclei D. Cerebrum E. [B – Junqueira 11e ch9 “The cerebellar cortex has three layers (Figures 9–19 and 9–20): an outer molecular layer, a central layer of large Purkinje cells, and an inner granule layer”]

74. Which of the following anions is present in greater concentration intracellularly: A. HCO3- B. Na C. K D. Ca E. Cl+ [A – Guyton 13e ch4 fig 4-1]

75. Which of the following will not affect respiratory centre: A. CO2 B. Na+ C. H+ D. HCO3- E. pH

76. Connections between cells involved in the transfer of ions: A. Gap junctions B. C. D. E. [A – Junqueira 11e ch2]

77. Dilation of coronary vessels is caused by: A. NO B. adenosine C. D. E. [B – Guyton 13e ch17 p205]

78. Epicardium is supplied by: A. coronary arteries

B. pericardiophrenic arteries C. D. E. [B – Last’s anatomy 12e ch4 p197 which describes blood supply of pericardium and Snell’s anatomy which mentions that visceral pericardium is also known as epicardium]

79. Which of the following will be seen in Diabetes Insipidus: A. increased urine specific gravity B. reduced urine osmolality C. reduced plasma osmolarity D. E. [Davidson 21e ch20 p793 “This is of low specific gravity and osmolality”]

80. Loss of 8% blood volume gradually over 30 minutes(?), without fall in BP, greatest amount of blood is lost from: A. veins B. arterioles C. capillaries D. arteries E. [A – Guyton 13e ch15 p180 “Enhancement of sympathetic tone, especially to the veins, reduces the vessel sizes enough that the circulation continues to operate almost normally even when as much as 25 percent of the total blood volume has been lost.”]

81. Joint between two pubic bones is a type of: A. primary cartilaginous joint B. secondary cartilaginous joint C. gomphosis D. syndesmosis E. [B – Last’s anatomy 12e ch1 p6]

82. Joint between two pubic bones which, in the female, may spread apart during pregnancy: A. symphysis B. C. D. E. [A – Last’s anatomy 12e ch1 p6]

83. Number of brochopulmonary segments in upper, middle and lower lobes of right lung3,2,5 A. 3,2,5 B. C. D. E. [A – Last’s anatomy 12e ch4 p216]

84. Which of the following groups of cranial nerves carry parasympathetic fibers: A. 3,7,9,10 B. 2,9,10,11 C. 2,3,7,9 D. 3,7,9,11 E. [A – Guyton 13e ch61 fig 61-3]

85. Deficiency of which factor predisposes to thrombosis: A. II B. V C. VIII D. XII E. X [B – Davidson 21e ch24 p1049]

86. Side effect of estrogen containing OCPs A. thromboembolism B. breast cancer C. vaginal cancer D. E. [A – Rang and Dale 8e ch35 p434 “there is a small increase in diagnosis of breast cancer, possibly attributable to earlier diagnosis, and of cervical cancer. There is an increased risk of thromboembolism…” other books also lay a greater emphasis on thromboembolic effects compared to breast cancer]

87. Feco-oral route is the primary means of spread of: A. Hepatitis E B. C. D. E. [Robbins 8e ch18 table 18-4. Hep A was not included among options]

88. Viruses are classified based on: A. characteristics of capsid protein and “cone” (sic) DNA and RNA B. C. D. E. [

89. Long term effect of angiotensin II on blood pressure is: A. increases production of aldosterone B. vasoconstriction C. D. E. [A? Guyton 13e ch19 p236 “Angiotensin has several direct renal effects that make the kidneys retain salt and water. One major effect is to constrict the renal arterioles, thereby diminishing blood flow through the kidneys.” “Thus both the direct effect of angiotensin on the kidney and its effect acting through aldosterone are important in long-term arterial pressure control. However, research in our laboratory has suggested that the direct effect of angiotensin on the kidneys is perhaps three or more times as potent as the indirect effect acting through aldosterone, even though the indirect effect is the one most widely known.”]

90. Deficiency of pulmonary surfactant: A. increases surface tension, increases compliance B. increases surface tension, reduces compliance C. decreases surface tension, decreases compliance D. decreases surface tension, increases compliance E. increases surface tension, no effect on compliance [B – Ganong 23e ch35 p596-7]

91. 35 year oldA woman complains of chronic cough for 3 months, cough is relieved after she goes on vacation, it restarts upon her return when she starts taking care of her pet birds again. CXR shows pattern diffuse interstitial and nodular shadowing. What is the cause of this pattern: (?) A. Mycobacterium kansasii B. diffuse interstitial fibrosis C. D. E. [B? Davidson 21e ch19 p710-11 and table 19.86 “Hypersensitivity pneumonitis/Bird fancier’s lung” see also Robbins 8e ch15 “Hypersensitivity pneumonitis/Bird breeder’s lung”]

92. Construction worker… X ray shows pleural plaques… most likely cause: (?) A. asbestosis B. silicosis C. D. E. [A – Robbins 8e ch9 and 15]

93. Which of the following drugs would you prescribe in a patient with cardiogenic shock: A. epinephrine B. acetylcholine C. dopamine D. E. (Dobutamine not an option) [C? Davidson 21e ch8 p194]

94. CVP may be reduced in: A. pericardial tamponade B. restrictive cardiomyopathy C. septic shock D. pneumothorax E. positive pressure ventilation [C – Schwartz 9e ch5 table 5-2; Davidson 21e ch8 p180 box 8.1]

95. Young male with raised red-purple nodular lesions on arms, also has watery diarrhea, oral thrush. Causative agent: A. human herpesvirus 8 B. C. D. E. [A? Robbins 8e ch11 Kaposi’s sarcoma?]

96. Which of the following cancers is associated with virus: A. T cell leukemia B. renal cell carcinoma C. small cell carcinoma D. E. [A – Robbins 8e ch13 table 13-6]

97. [clinical scenario of goiter] which would confirm the diagnosis of Hashimoto’s thyroiditis (?) A. anti-thyroglobulin and anti-microsomal antibodies B. anti TSH antibodies C.

D. E. [A – Davidson 21e ch20 table20.8]

98. Regarding second heart sound which of the following is true: A. s2 has shorter duration than s1 B. it has lower pitch than s1 C. it is of longer duration than s1 D. it occurs after atrial contraction (?) E. splitting of second heart sound can occur occasionally in otherwise healthy persons [A – Guyton 13e ch23 p282 “The duration of each of the heart sounds is slightly more than 0.10 second, with the first sound about 0.14 second and the second about 0.11 second” “The second heart sound normally has a higher frequency than the first heart sound…” E (?)]

99. Splitting of the second heart sound is due to A. late closure of the aortic valve B. early closure of aortic valve C. early closure of the pulmonic valve D. closure of AV valves(?) E. late closure of mitral valve [B – Ganong 21e ch29 “during inspiration, the aortic valve closes slightly before the pulmonary”]

100. An ABG report from a patient shows pO2 8kPa pCO26kPa pH 7.4, diagnosis/cause: [normal values were NOT given] A. resident at high altitude B. compensated respiratory alkalosis C. metabolic acidosis D. respiratory alkalosis E. alveolar hypoventilation [E – Davidson 21e ch28 table 28.2 – partial pressure of oxygen is markedly reduced, while other values are within normal ranges]

101. Physiologic dead space: A. increased in lung disease B. equal to the anatomical dead space C. D. E. [A/B (?) – Guyton 13e ch38 p504 “In a normal person, the anatomical and physiological dead spaces are nearly equalbecause all alveoli are functional in the normal lung, but ina person with partially functional or nonfunctional alveoli in some parts of the lungs, the physiological dead space may be as much as 10 times the volume of the anatomical dead space, or 1 to 2 liters”]

102. Absence of red cones is known as: A. deutranopia B. tritanopia C. protanopia D. E. [Guyton 13e ch51 p654 “A person with loss of red cones is called a protanope”]

103. A woman cuts her finger, the bleeding stops after a few seconds, which mechanism is responsible: A. vasoconstriction B. platelet aggregation

C. clot formation D. E. [A (?) – Robbins 8e ch4 “After initial injury there is a brief period of arteriolar vasoconstriction…. The effect is transient, however, and bleeding would resume if not for activation of the platelet and coagulation systems.”

104. Formation of crescents in glomeruli is associated with: A. fibrin B. C. D. E. [Robbins 8e ch20 “Fibrin, which leaks into the urinary space, often through ruptured basement membranes, has been long thought to be the molecule that elicits the crescentic response”]

105. Question about lupus nephritis…: A. immune-complex deposition B. C. D. E. [A – Robbins 8e ch6 – “The principal mechanism of injury is immune complex deposition”]

106. Grave’s disease shows which type of hypersensitivity reaction? A. type 3 B. type 2 C. type 1 D. type 4 E. [B – Robbins 8e ch6 table 6.4]

107. The volume of plasma that would be necessary to supply the amount of substance excreted in the urine per unit of time is known as: A. Clearance B. C. D. E. [A – Guyton 13e ch28 p365 “Thus, clearance refers to the volume of plasma that would be necessary to supply the amount of substance excreted in the urine per unit of time.”]

108. Most abundant antibody: A. IgG B. IgA C. IgM D. IgE E. IgD [A – Guyton 13e ch34 p470 “…IgG, which is a bivalent antibody and constitutes about 75 percent of the antibodies of the normal person…”

109. Patient has RTA and blunt trauma to the abdomen, cells will enter G1 from G0 to begin regeneration, which will remain in G0: A. Hepatocytes B. Gut epithelium C. Skeletal muscle D. Endothelial cells

E. [C – Robbins 8e ch3 “Nondividing tissues contain cells that have left the cell cycle and cannot undergo mitotic division in postnatal life. To this group belong neurons and skeletal and cardiac muscle cells”

110. Kallman’s syndrome: A. hyperosmia B. hypergonadism C. arcuate nucleus D. E. [C – http://www.britannica.com/science/gonadotropin-releasing-hormone]

111. Dissociative anesthesia; loss of pain and temperature but intact touch and vibration (?) A. tabes dorsalis B. syringomyelia C. D. E. [B – Davidson – 21e ch26 p1157 “Lesions in the centre of the spinal cord (such as syringomyelia (see Box 26.108 and Fig. 26.56 (p. 1225)) spare the dorsal columns but affect the spinothalamic fibres crossing the cord from both sides over the length of the lesion. The sensory loss is therefore dissociated (in terms of the modalities affected)…”]

112. Most fibers of the optic tract terminate in: A. lateral geniculate body B. medial geniculate body C. visual cortex D. E. [A – Last’s anatomy; 12e ch7 p464-5]

113. Which of the following will be present in someone whose brainstem is dead(?) A. withdrawal from painful stimulus at toe B. nystagmus on instillation of cold water into ear canal C. doll’s eye response D. (other reflexes centred in the brainstem) E. [A – Ganong 23e c9 p164]

114. Inversion and eversion takes place at A. subtalar joint B. ankle joint C. tarsometatarsal joints D. E. [A – Snell 8e ch10 p638 “The important movements of inversion and eversion of the foot take place at the subtalar and transverse tarsal joints”

115. Scenario of sciatica. The doctor informs the patient that the “longest nerve in the body” is involved. Fro where does this arise: A. lumbosacral plexus B. brachial plexus C. sacral plexus (?) D. E. [C (/A?) – Last’s anatomy 12e c5 p327 “the sciatic nerve is the largest branch of the sacral plexus…”

116. During the last 7 months of pregnancy, estrogen and progesterone are secreted by : A. placenta B. corpus luteum C. pituitary D. ovary E. [A – Guyton 13e ch83 p1060 “If the corpus luteum is removed before approximately the seventh week of pregnancy, spontaneous abortion almost always occurs, sometimes even up to the 12th week. After that time, the placenta secretes sufficient quantities of progesterone and estrogens to maintain pregnancy for the remainder of the gestation period. The corpus luteum involutes slowly after the 13th to 17thweek of gestation.”]

117. Infection with which of the following is associated with the development of gastric cancer: A. helicobacter pylori B. C. D. E. [A – Robbins 83 ch17]

118. A mass(?) is found 2 feet from the iliocolic junction on the antimesenteric border of the small intestine, this is likely to be: A. meckel’s diverticulum B. C. D. E. [A – Snell’s anatomy 8e ch5 p238]

119. Bullet passes through axilla and exits at shoulder, loss of sensation over lateral aspect of palm: A. median nerve B. C. D. E. [A – Snell 8e ch9 p468 fig9-38]

120. question regarding anatomy of the kidney: A. left renal vein passes anterior to left renal artery and aorta B. kidney and suprarenal gland are enclosed in different fasciae C. perinephric fat is located within renal capsule D. E. [A – Last’s anatomy, 12e, p277 and 284]

121. middle thyroid vein drains into: A. external jugular vein B. internal jugular vein C. anterior jugular vein D. E. [B – Last’s anatomy 12e ch6 p340]

122. Cardiac output is “increased” in which of the following: A. anemia B. pericardial tamponade C.

D. E. [A – Davidson 21e ch18 p545 “Conditions such as large arteriovenous shunt, beri-beri (p. 126), severe anaemia or thyrotoxicosis can occasionally cause heart failure due to an excessively high cardiac output.”

123. Universal recipient blood group: A. O- B. O+ C. AB+ D. AB- E. [C – Ganong 21e ch27 “Persons with type AB blood are “universal recipients”…”]

124. Lesion of the right optic tract will cause: A. left homonymous hemianopia B. C. D. E. [A – Last’s anatomy 12e ch7 p501]

125. A young boy with pallor; skull x-ray shows “crew-cut appearance”; which investigation will be diagnostic: A. hemoglobin electrophoresis B. C. D. E. [A – Robbins 8e ch14 – “crew-cut” has been described in sickle cell anemia and thalassemia. Both are hemoglobinopathies best diagnosed by Hb electrophoresis]

126. Pregnant female with anemia; peripheral smear shows microcytosis and hypochromia: A. iron deficiency B. volume expansion C. D. E. [A – Robbins 8e ch14 “Whatever its basis, iron deficiency produces a hypochromic microcytic anemia”]

127. Drug of choice for gas gangrene: A. penicillin B. clindamycin C. D. E. [A – Bailey 26e c5 p57 “Once gas gangrene infection is established, large doses of intravenous penicillin and aggressive debridement of affected tissues are required.”

128. Central tendon of digastrics muscle is attached to: A. hyoid bone B. styloid process C. D. E. [A – Snell 8e ch11 table 11-5]

129. Hormone secreted by sertoli cells which inhibits secretion of FSH from pituitary

A. inhibin B. relaxin C. D. E. [A – Junqueira 11e ch21 “They also secrete a peptide called inhibin, which suppresses synthesis and release of FSH in the anterior pituitary gland”]

130. Cells present on the base of seminiferous tubules (?): A. primary spermatocytes B. spermatogonia C. secondary spermatocytes D. spermatozoa E. spermatid [B – Junqueira 11e ch21 fig 21-5]

131. Regarding posterior interventricular artery: A. commonly two in number and supply the diaphragmatic surface of heart B. C. D. E. [A – Gray’s anatomy 39e ch60 p1016 “Up to three small posterior ventricular branches, commonly two, arise from the second segment of the right coronary artery (between the right border and crux); they supply the diaphragmatic aspect of the right ventricle”]

132. Sympathetic supply to the lower airways comes from: A. T2-4 B. C. D. E. [A – Last’s anatomy 12e ch1 p20 fig 1.14]

133. Denticulate ligament: A. lies between dura and vertebra B. extension of dura C. between anterior and posterior nerve roots D. E. [C – Last’s anatomy 12e ch6 p453 “This flange crosses the subarachnoid space between anterior and posterior nerve roots”]

134. Most sensitive/screening test for SLE: A. ANA B. C. D. E. [A – Davidson 21e ch25 p1108 “Patients with active SLE almost always test positive for ANA”

135. Non-fluent aphasia: A. broca’s area B. wernicke’s area C. angular gyrus D.

E. [A – Davidson 21e ch26 p1160 fig26.19 “Broca aphasia: non-fluent aphasia”]

136. Eversion of foot is by: A. peroneus longus B. tibialis anterior C. D. E. [A – Snell 8e ch10 table 10-6]

137. Which of the following would most likely require modification of the dose of warfarin: A. cimetidine B. C. D. E. [A – http://reference.medscape.com/drug/coumadin-jantoven-warfarin-342182#3 “cimetidine will increase the level or effect of warfarin by affecting hepatic/intestinal enzyme CYP3A4”]

138. Ranitidine differs from cimetidine because it has: A. less CNS effects B. causes acid secretion C. D. E. [A – Katzung 12e ch62 p1085]

139. Clinical scenario or statement suggestive of strep pneumoniae, which of the following is appropriate about it: A. frequent cause of meningitis B. beta hemolysis C. D. E. [A – Medical Microbiology 7e ch19 p199 (it exhibits alpha hemolysis) and 203 “…is now a leading cause of disease (meningitis) in children and adults”]

140. Associated with bladder cancer(?): A. schistosoma hematobium B. C. D. E. [A – Robbin 8e ch21 “Schistosoma haematobium infections in endemic areas (Egypt, Sudan) are an established risk”]

141. Scleroderma: A. progressive fibrosis throughout the body B. C. D. E. [A – Robbins 8e ch6 “…it is characterized by excessive fibrosis throughout the body”]

142. Tender lymphadenitis, fever sore throat, after the fever settled it took the patient a couple of weeks to recover fully (?) A. infectious mononucleosis

B.

C. D. E. [A – Davidson 21e ch13 p316 “In most cases fever resolves over 2 weeks, and fatigue and other abnormalities settle over a further few weeks”]

143. Puberty is initiated by: A. increased gonadotrophin release B. C. D. E. [A – Guyton 13e ch82 p1039 “At age 9 to 12 years, the pituitary begins to secrete progressively more FSH and LH, which leads to the onset of normal monthly sexual cycles beginning between the ages of 11 and 15 years. This period of change is called puberty…”

144. In mature follicles, the ovum is surrounded by a mass of cells called the: A. corona radiata B. zona pelucida C. antrum D. cumulus oophorous E. [D – Langman 12e ch2 p23 “Granulosa cells surrounding the oocyte remain intact and form the cumulus oophorus”]

145. Regarding the heart: A. Left atrium has a thicker wall than right atrium B. Ventricles contract from apex to base C. Right ventricle has thicker wall than left ventricle D. E. [A – Gray’s Anatomy 39e ch60 p1004 “Although smaller in volume than the right, the left atrium has thicker walls” B – Gray’s anatomy 39e ch60 p1014 “Hence, papillary muscles contract first, followed by a wave of excitation and ensuing contraction that travels from the apex of the ventricle to the arterial outflow tract”]

146. Digoxin is the drug of choice for: A. Heart block B. Atrial fibrillation C. Ventricular tachycardia D. E. [B – (although it may not be the drug of choice for it, I recall Digoxin was not indicated in any of the other options]

147. Macrocytic anemia/symptoms of B12 deficiency in a fisherman (?) A. diphylobothrium latum B. C. D. E. [A – Medical Microbiology 7e ch85 p811 “A small percentage (0.1% to 2%) of people infected with D. latum develop clinical signs of vitamin B12 deficiency”]

148. Which of the following stimulate erythroid stem cells to proliferate and differentiate: A. erythropoietin B. growth factors C. androgens D. growth hormone

E. hypoxia (?) [A – Guyton 13e ch33 p448 “…the important effect of erythropoietin is to stimulate the production of proerythroblasts from hematopoietic stem cells in the bone marrow. In addition, once the proerythroblasts are formed, the erythropoietin causes these cells to pass more rapidly through the different erythroblastic stages than they normally do…” E is incorrect – Guyton 13e ch33 p448 “…hypoxia has little or no effect to stimulate RBC production…”]

149. Regarding renal blood vessels: A. left renal vein lies anterior to aorta and left renal artery B. right renal vein is longer than the left C. D. E. [A – Last’s anatomy 12e ch5 p277 “The renal veins lie in front of the renal arteries … The left renal vein is three times as long as the right … and usually crosses in front of the aorta”]

150. Most of the active form of thyroid hormone released into the circulation is: A. T3 B. TSH C. thyroxine D. E. [C – Guyton 13e ch77 p951 “About 93 percent of the metabolically active hormones secreted by the thyroid gland is thyroxine, and 7 percent is triiodothyronine”]

151. True about the thyroid gland: A. poles reach upto thyroid cartilage B. C. D. E. [A – Last’s anatomy 12e ch6 p339 “…extending from the oblique line of the thyroid cartilage to the sixth tracheal ring.”]

152. True regarding vertebrae: A. all cervical vertebrae have bifid spines B. all thoracic vertebrae have articular facets for ribs C. D. E. [B – Last’s anatomy 12e ch6 p433-4 “the distinctive feature of a thoracic vertebra is the presence of costal facets”]

153. Which of the following is an anti-oxidant: A. Vit E B. C. D. E. [A – Guyton 13e ch72 p900 “Vitamin E is believed to play a protective role in the prevention of oxidation of unsaturated fats”]

154. Mitochondria are concentrated in the apical portions of: A. ciliated cells B. gastric parietal cells C. steroid secreting cells D. E.

[A – Junqueira 11e ch2 “They tend to accumulate in parts of the cytoplasm at which the utilization of energy is more intense, such as the apical ends of ciliated cells”]

155. A patient has AIDS but does not wish to inform his wife and asks you not to tell her, you should: A. perusade him to tell his wife, and if he doesn’t tell her your self B. advise contraception C. D. E. [A?]

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