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  • Question 1 - A 79-year-old has been bedridden for 2 months after suffering from a stroke....

    Correct

    • A 79-year-old has been bedridden for 2 months after suffering from a stroke. She suddenly developed shortness of breath and chest pain, and was diagnosed with a pulmonary embolism. Which of the following is most likely to increase in this case?

      Your Answer: Ventilation/perfusion ratio

      Explanation:

      Pulmonary embolism (PE) is a blockage of an artery in the lungs by an embolus that has travelled from elsewhere in the body through the bloodstream. The change in cardiopulmonary function is proportional to the extent of the obstruction, which varies with the size and number of emboli obstructing the pulmonary arteries. The resulting physiological changes may include pulmonary hypertension with right ventricular failure and shock, dyspnoea with tachypnoea and hyperventilation, arterial hypoxaemia and pulmonary infarction. Consequent alveolar hyperventilation is manifested by a lowered pa(CO2). After occlusion of the pulmonary artery, areas of the lung are ventilated but not perfused, resulting in wasted ventilation with an increased ventilation/perfusion ratio – the physiological hallmark of PE – contributing to a further hyperventilatory state. The risk of blood clots is increased by cancer, prolonged bed rest, smoking, stroke, certain genetic conditions, oestrogen-based medication, pregnancy, obesity, and post surgery.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      17.4
      Seconds
  • Question 2 - Which of the following is true about a patient who has undergone total...

    Correct

    • Which of the following is true about a patient who has undergone total colectomy and ileostomy?

      Your Answer: Following total colectomy and ileostomy, the volume and water content of ileal discharge decreases over time

      Explanation:

      After a patient has undergone total colectomy and ileostomy, the volume of ileal discharge, along with its water content gradually decreases over time. Post surgery, most patients can live a normal life. Iron and vitamin B12 absorption do not take place in the colon and hence are not affected significantly by a colectomy.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      15.9
      Seconds
  • Question 3 - Calculate the total peripheral resistance for a patient with a blood pressure of...

    Correct

    • Calculate the total peripheral resistance for a patient with a blood pressure of 130/70 mm HG and cardiac output of 5 litres / min?

      Your Answer: 18 mmHg × min/l

      Explanation:

      Total peripheral resistance = Mean arterial pressure/Cardiac output. And the mean arterial pressure = Diastolic pressure + 1/3 (Systolic pressure – Diastolic pressure), i.e., 70 + 1/3 (130-70) = 90 mmHg. Therefore, total peripheral resistance = 90 mmHg/5 l per min = 18 mmHg × min/l.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      39.7
      Seconds
  • Question 4 - A neurotransmitter of the nigrostriatal pathway is: ...

    Correct

    • A neurotransmitter of the nigrostriatal pathway is:

      Your Answer: Dopamine

      Explanation:

      Dopamine acts as a neurotransmitter in the brain, activating dopamine receptors. It is also a neurohormone released from the hypothalamus. It plays an important role in the reward system. It is believed that dopamine provides a teaching signal to parts of the brain responsible for acquiring new motor sequences (behaviours), by activation of dopamine neurons when an unexpected reward is presented. Loss of dopamine neurones in the nigrostriatal pathway causes Parkinson’s disease. In the frontal lobes, dopamine controls the flow of information from other areas of the brain, and thus, dopamine disorders in this region can cause a decline in neurocognitive functions, especially memory, attention and problem solving. Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention-deficit disorder and some symptoms of schizophrenia. Dopamine is also the primary neuroendocrine regulator of the secretion of prolactin from the anterior pituitary gland. Dopamine is also commonly associated with the pleasure system of the brain. This plays a key role in understanding the mechanism of action of drugs (such as cocaine and the amphetamines), which seem to be directly or indirectly related to the increase of dopamine.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      1.9
      Seconds
  • Question 5 - Pain in the right upper quadrant of the abdomen on ingestion of a...

    Correct

    • Pain in the right upper quadrant of the abdomen on ingestion of a fatty meal is seen in a condition which involves which of the following substances?

      Your Answer: Cholecystokinin

      Explanation:

      The clinical scenario described here favours the presence of gallstones. During food ingestion, vagal discharges stimulate gallbladder contraction. Moreover, presence of fat and amino acids in the intestinal lumen stimulates the release of cholecystokinin (CCK) in the duodenum. This causes sustained gallbladder contraction and relaxation of the sphincter of Oddi. If gallstones are present, there will be inflammation in the gallbladder and CCK will aggravate it due to contractions.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      1.4
      Seconds
  • Question 6 - With respect to far accommodation, which of the following is a TRUE statement?...

    Correct

    • With respect to far accommodation, which of the following is a TRUE statement?

      Your Answer: The ciliary muscles are relaxed

      Explanation:

      Myopia or near-sightedness is a disease due to elongated eyeballs or too strong a lens. For far accommodation (focus of a distant object onto the retina), the lens needs to decrease its refractive power, or in other words, increase its focal length. This is done by relaxation of ciliary muscles which tightens the zonular fibres and flattening of the lens. Relaxation of the zonular fibres, rounding of the lens, shortening of the focal length and constriction of the pupil occurs during near accommodation.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      2.7
      Seconds
  • Question 7 - A 49-year-old woman with acute renal failure has a total plasma [Ca2+] =...

    Incorrect

    • A 49-year-old woman with acute renal failure has a total plasma [Ca2+] = 2. 5 mmol/l and a glomerular filtration rate of 160 l/day. What is the estimated daily filtered load of calcium?

      Your Answer: 64 mmol/day

      Correct Answer: 240 mmol/day

      Explanation:

      Calcium is the most abundant mineral in the human body. The average adult body contains in total approximately 1 kg of calcium of which 99% is in the skeleton in the form of calcium phosphate salts. The extracellular fluid (ECF) contains approximately 22 mmol, of which about 9 mmol is in the plasma. About 40% of total plasma Ca2+ is bound to proteins and not filtered at the glomerular basement membrane. Therefore, the estimated daily filtered load is 1.5 mmol/l × 160 l/day = 240 mmol/day. The exact amount of free versus total Ca2+ depends on the blood pH: free Ca2+ increases during acidosis and decreases during alkalosis.

    • This question is part of the following fields:

      • Physiology
      • Renal
      1507.8
      Seconds
  • Question 8 - Which of the following is true regarding factor XI? ...

    Incorrect

    • Which of the following is true regarding factor XI?

      Your Answer: Is a cytokine

      Correct Answer: Deficiency causes haemophilia C

      Explanation:

      Factor XI is also known as plasma thromboplastin and is one of the enzymes of the coagulation cascade. It is produced in the liver and is a serine protease. It is activated by factor XIIa, thrombin and by itself. Deficiency of factor XI causes the rare type of haemophilia C. Low levels of factor XI also occur in other disease states, including Noonan syndrome. High levels of factor XI have been seen in thrombosis.

    • This question is part of the following fields:

      • General
      • Physiology
      5
      Seconds
  • Question 9 - As per the Poiseuille-Hagen formula, doubling the diameter of a vessel will change...

    Incorrect

    • As per the Poiseuille-Hagen formula, doubling the diameter of a vessel will change the resistance of the vessel from 16 peripheral resistance units (PRU) to:

      Your Answer: 4 PRU

      Correct Answer: 1 PRU

      Explanation:

      Poiseuille-Hagen formula for flow in along narrow tube states that F = (PA– PB) × (Π/8) × (1/η) × (r4/l) where F = flow, PA– PB = pressure difference between the two ends of the tube, η = viscosity, r = radius of tube and L = length of tube. Also, flow is given by pressure difference divided by resistance. Hence, R = 8ηL ÷ Πr4. Hence, the resistance of the vessel changes in inverse proportion to the fourth power of the diameter. So, if the diameter of the vessel is increased to twice the original, it will lead to decrease in resistance to one-sixteenth its initial value.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      85.8
      Seconds
  • Question 10 - Which of the following substances is most likely to cause pulmonary vasodilatation? ...

    Incorrect

    • Which of the following substances is most likely to cause pulmonary vasodilatation?

      Your Answer: Catecholamines

      Correct Answer: Nitric oxide

      Explanation:

      In the body, nitric oxide is synthesised from arginine and oxygen by various nitric oxide synthase (NOS) enzymes and by sequential reduction of inorganic nitrate. The endothelium of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, so dilating the artery and increasing blood flow. Nitric oxide/oxygen blends are used in critical care to promote capillary and pulmonary dilation to treat primary pulmonary hypertension in neonatal patients post-meconium aspiration and related to birth defects.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      10.5
      Seconds
  • Question 11 - Evaluation of a 60-year old gentleman, who has been a coal miner all...

    Incorrect

    • Evaluation of a 60-year old gentleman, who has been a coal miner all his life and is suspected to have pulmonary fibrosis reveals the following: FEV1 of 75% (normal > 65%), arterial oxygen saturation 92%, alveolar ventilation 6000 ml/min at a tidal volume of 600 ml and a breathing rate of 12 breaths/min. There are also pathological changes in lung compliance and residual volume. Calculate his anatomical dead space.

      Your Answer: 50 ml

      Correct Answer: 100 ml

      Explanation:

      Dead space refers to inhaled air that does not take part in gas exchange. Because of this dead space, taking deep breaths slowly is more effective for gas exchange than taking quick, shallow breaths where a large proportion is dead space. Use of a snorkel by a diver increases the dead space marginally. Anatomical dead space refers to the gas in conducting areas such as mouth and trachea, and is roughly 150 ml (2.2 ml/kg body weight). This corresponds to a third of the tidal volume (400-500 ml). It can be measured by Fowler’s method, a nitrogen wash-out technique. It is posture-dependent and increases with increase in tidal volume. Physiological dead space is equal to the anatomical dead space plus the alveolar dead space, where alveolar dead space is the area in the alveoli where no effective exchange takes place due to poor blood flow in capillaries. This physiological dead space is very small normally (< 5 ml) but can increase in lung diseases. Physiological dead space can be measured by Bohr’s method. Total ventilation per minute (minute ventilation) is given by the product of tidal volume and the breathing rate. Here, the total ventilation is 600 ml times 12 breaths/min = 7200 ml/min. The problem mentions alveolar ventilation to be 6000 ml/min. Thus, the difference between the alveolar ventilation and total ventilation is 7200 – 6000 ml/min = 1200 ml/min, or 100 ml per breath at 12 breaths per min. This 100 ml is the dead space volume.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      6.8
      Seconds
  • Question 12 - Which of the following will increase blood pressure and cause hypokalaemia? ...

    Incorrect

    • Which of the following will increase blood pressure and cause hypokalaemia?

      Your Answer: Endorphin

      Correct Answer: Angiotensin II

      Explanation:

      Angiotensin is a peptide that is released in response to a decrease in blood volume and blood pressure. It has multiple functions but mainly acts to cause vasoconstriction, increase BP and release aldosterone from the adrenal cortex. It is a powerful vasoconstrictor and release of aldosterone causes increased retention of sodium and excretion of potassium.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      13.1
      Seconds
  • Question 13 - Which of the following is the cause of flattened (notched) T waves on...

    Correct

    • Which of the following is the cause of flattened (notched) T waves on electrocardiogram (ECG)?

      Your Answer: Hypokalaemia

      Explanation:

      The T-wave is formed due to ventricular repolarisation. Normally, it is seen as a positive wave. It can be normally inverted (negative) in V1 (occasionally in V2-3 in African-Americans/Afro-Caribbeans). Hyperacute T-waves are the earliest ECG change of acute myocardial infarction. ECG findings of hyperkalaemia include high, tent-shaped T-waves, a small P-wave and a wide QRS complex. Hypokalaemia results in flattened (notched) T-waves, U-waves, ST-segment depression and prolonged QT interval.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      4.8
      Seconds
  • Question 14 - Post-total gastrectomy, there will be a decreased production of which of the following...

    Incorrect

    • Post-total gastrectomy, there will be a decreased production of which of the following enzymes?

      Your Answer: Trypsin

      Correct Answer: Pepsin

      Explanation:

      Pepsin is a protease that is released from the gastric chief cells and acts to degrade proteins into peptides. Released as pepsinogen, it is activated by hydrochloric acid and into pepsin itself. Gastrin and the vagus nerve trigger the release of pepsinogen and HCl when a meal is ingested. Pepsin functions optimally in an acidic environment, especially at a pH of 2.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      20.4
      Seconds
  • Question 15 - The majority of gallstones are mainly composed of: ...

    Correct

    • The majority of gallstones are mainly composed of:

      Your Answer: Cholesterol

      Explanation:

      Bile salts are formed out of cholesterol in the liver cells. Occasionally, precipitation of cholesterol occurs resulting into cholesterol stones developing in the gall bladder.

      These cholesterol gallstones are the most common type and account for 80% of all gallstones. Another type, accounting for 20% gallstones is pigment stones which are composed of bilirubin and calcium salts. Occasionally, stones of mixed origin are also seen.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      31.1
      Seconds
  • Question 16 - Renal function is an indication of the state of the kidney, measured by glomerular...

    Incorrect

    • Renal function is an indication of the state of the kidney, measured by glomerular filtration rate (GFR). In a healthy person, GFR would be greatly increased by: 

      Your Answer: Vasoconstriction of glomerular afferent arterioles

      Correct Answer: Substantial increases in renal blood flow

      Explanation:

      An increase in the rate of renal blood flow (RBF) greatly increases the glomerular filtration rate (GFR). The more plasma available (from increased RBF), the more filtrate is formed. Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time. Central to the physiologic maintenance of GFR is the differential basal tone of the afferent and efferent arterioles.

    • This question is part of the following fields:

      • Physiology
      • Renal
      25.2
      Seconds
  • Question 17 - A lesion involving the lateral portion of the dorsal columns at the level...

    Incorrect

    • A lesion involving the lateral portion of the dorsal columns at the level of the nape of the neck will most likely affect:

      Your Answer: Motor control of the contralateral foot

      Correct Answer: Vibratory sensations from the ipsilateral arm

      Explanation:

      At the level mentioned in the question, the lateral portion of dorsal columns comprises of the fasciculus cuneatus. Axons carrying the sensations of touch, vibration and proprioception from the ipsilateral arm enter the spinal cord and ascend in the fasciculus cuneatus, synapsing in the nucleus cuneatus of the caudal medulla. Secondary neurons from this nucleus give rise to internal arcuate fibres, which decussate and ascend to the thalamus as the medial lemniscus. Tertiary neurons from there project to the ipsilateral somatosensory cortex. Thus, any damage to the fasciculus cuneatus will result in a deficit in tactile, proprioceptive and vibratory sensations in the ipsilateral arm, and not the contralateral arm.

      Fine motor control of the fingers is mainly carried by the ipsilateral lateral corticospinal tract in the lateral funiculus of the cord. Motor control of the contralateral foot is carried by the ipsilateral corticospinal tract in the lateral funiculus of the cord. Lack of sweating of the face could be produced by interruption of sympathetic innervation. Proprioception from the ipsilateral leg is carried by the fasciculus gracilis in the medial part of the dorsal columns.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      17.1
      Seconds
  • Question 18 - A 45-year old gentleman presents with diarrhoea for two weeks. He has no...

    Incorrect

    • A 45-year old gentleman presents with diarrhoea for two weeks. He has no history of fever and the diarrhoea stops on fasting. Which is the most likely type of diarrhoea that he is suffering from?

      Your Answer: Inflammatory

      Correct Answer: Osmotic

      Explanation:

      The different types of diarrhoea are:

      1. Secretory diarrhoea – Due to increased secretion or decreased absorption. There is minimal to no structural damage in this type. The most common cause is cholera toxin which stimulates secretion of anions (especially chloride), with sodium and water.

      2. Osmotic diarrhoea – Due to increased osmotic load, there is water loss. This occurs in cases of maldigestion syndromes, such as coeliac or pancreatic disease.

      3. Motility-related diarrhoea – Occurs in cases of abnormal gastrointestinal motility. Due to increased motility, there is poor absorption and this leads to diarrhoea. This is seen post-vagotomy or in diabetic neuropathy.

      4. Inflammatory diarrhoea – Due to damage to the mucosa or brush border, there is a loss of protein-rich fluids and poor absorption. Features of all the above three types can be seen in this type. Aetiology includes bacterial, viral, parasitic infections or autoimmune problems including inflammatory bowel disease.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      34.4
      Seconds
  • Question 19 - A 23-year-old woman decides to donate a kidney through a kidney chain. Which...

    Incorrect

    • A 23-year-old woman decides to donate a kidney through a kidney chain. Which of the following indices would be expected to be decreased in the donor after full recovery from the operation?

      Your Answer: Plasma creatinine concentration

      Correct Answer: Creatinine clearance

      Explanation:

      Since medication to prevent rejection is so effective, donors do not need to be similar to their recipient. Most donated kidneys come from deceased donors; however, the utilisation of living donors is on the rise. Most problems encountered with live donation are associated with the donor. Firstly, there are the potentially harmful investigative procedures carried out in the assessment phase, the most hazardous being renal angiography, where there is cannulation of the artery and injection of a radio-opaque dye to determine the blood supply to the kidney. Secondly, there are the short-term risks of nephrectomy surgery. According to the literature, there is a mortality rate of between 1 in 1600 and 1 in 3000, but this is no more than is associated with any anaesthetic. In the initial postoperative period creatinine clearance may be decreased but this recovers fully over a few weeks to months. Long-term complications include prolonged wound pain.

    • This question is part of the following fields:

      • Physiology
      • Renal
      36.8
      Seconds
  • Question 20 - A 76-year-old man with a urinary tract obstruction due to prostatic hyperplasia develops...

    Incorrect

    • A 76-year-old man with a urinary tract obstruction due to prostatic hyperplasia develops acute renal failure. Which of the following physiological abnormalities of acute renal failure will be most life threatening for this patient?

      Your Answer: Fluid overload

      Correct Answer: Acidosis

      Explanation:

      Acute renal failure (ARF) is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. This accumulation may be accompanied by metabolic disturbances, such as metabolic acidosis and hyperkalaemia, changes in body fluid balance and effects on many other organ systems. Metabolic acidosis and hyperkalaemia are the two most serious biochemical manifestations of acute renal failure and may require medical treatment with sodium bicarbonate administration and antihyperkalaemic measures. If not appropriately treated these can be life-threatening. ARF is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient amounts of urine.

    • This question is part of the following fields:

      • Physiology
      • Renal
      32.4
      Seconds
  • Question 21 - A 65-year old patient with altered bowl movement experienced the worsening of...

    Correct

    • A 65-year old patient with altered bowl movement experienced the worsening of shortness of breath and exertional chest pains over the course of 8 weeks. Examination shows pallor and jugular venous distension. Furthermore, a test of the stool for occult blood is positive. Laboratory studies show:

      Haemoglobin 7.4 g/dl

      Mean corpuscular volume 70 fl Leukocyte count 5400/mm3

      Platelet count 580 000/mm3 Erythrocyte sedimentation 33 mm/h

      A blood smear shows hypochromic, microcytic RBCs with moderate poikilocytosis. Which of the following is the most likely diagnosis?

      Your Answer: Iron deficiency anaemia

      Explanation:

      Iron deficiency anaemia is the most common type of anaemia. It can occur due to deficiency of iron due to decreased intake or due to faulty absorption. An MCV less than 80 will indicated iron deficiency anaemia. On the smear the RBC will be microcytic hypochromic and will also show piokilocytosis. iron profiles tests are important to make a diagnosis. Clinically the patient will be pale and lethargic.

    • This question is part of the following fields:

      • General
      • Physiology
      18.5
      Seconds
  • Question 22 - Whilst snorkelling, a 30-year old gentleman has the respiratory rate of 10/min, tidal...

    Incorrect

    • Whilst snorkelling, a 30-year old gentleman has the respiratory rate of 10/min, tidal volume of 550 ml and an effective anatomical dead space of 250 ml. What is his alveolar ventilation?

      Your Answer: 3500 ml/min

      Correct Answer: 3000 ml/min

      Explanation:

      Alveolar ventilation is the amount of air reaching the alveoli per minute. Alveolar ventilation = respiratory rate × (tidal volume – anatomical dead space volume). Thus, alveolar ventilation = 10 × (550 − 250) = 3000 ml/min.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      8.9
      Seconds
  • Question 23 - Diuretics that act on the ascending limb of the loop of Henle produce:...

    Incorrect

    • Diuretics that act on the ascending limb of the loop of Henle produce:

      Your Answer: Reduced passive transport of sodium

      Correct Answer: Reduced active transport of sodium

      Explanation:

      The loop of Henlé leads from the proximal convoluted tubule to the distal convoluted tubule. Its primary function uses a counter current multiplier mechanism in the medulla to reabsorb water and ions from the urine. It can be divided into four parts:

      1. Descending limb of loop of Henlé – low permeability to ions and urea, while being highly permeable to water

      2. Thin ascending limb of loop of Henlé – not permeable to water, but it is permeable to ions

      3. Medullary thick ascending limb of loop of Henlé – sodium (Na+), potassium (K+) and chloride (Cl–) ions are reabsorbed by active transport. K+ is passively transported along its concentration gradient through a K+ channel in the basolateral aspect of the cells, back into the lumen of the ascending limb.

      4. The cortical thick ascending limb – the site of action where loop diuretics such as furosemide block the K+/Na+/2Cl− co-transporters = reduced active transport.

    • This question is part of the following fields:

      • Physiology
      • Renal
      96.1
      Seconds
  • Question 24 - Which of these substances is secreted by pericytes in the juxtaglomerular cells? ...

    Incorrect

    • Which of these substances is secreted by pericytes in the juxtaglomerular cells?

      Your Answer: Aldosterone

      Correct Answer: Renin

      Explanation:

      The juxtaglomerular cells synthesise, store and secrete the enzyme renin in the kidney. They are specialised smooth muscle cells in the wall of the afferent arteriole that delivers blood to the glomerulus and thus play a critical role in the renin– angiotensin system and so in renal autoregulation.

    • This question is part of the following fields:

      • Physiology
      • Renal
      14.7
      Seconds
  • Question 25 - Routine evaluation of a 38 year old gentleman showed a slightly lower arterial...

    Incorrect

    • Routine evaluation of a 38 year old gentleman showed a slightly lower arterial oxygen [pa(O2)] than the alveolar oxygen [pA(O2)]. This difference is:

      Your Answer: Is due to reaction time of O2 with haemoglobin

      Correct Answer: Is normal and due to shunted blood

      Explanation:

      Blood that bypasses the ventilated parts of lung and enters the arterial circulation directly is known as shunted blood. It happens in normal people due to mixing of arterial blood with bronchial and some myocardial venous blood (which drains into the left heart). Diffusion limitation and reaction velocity with haemoglobin are immeasurably small. CO2 unloading will not affect the difference between alveolar and arterial p(O2). A large VSD will result in much lower arterial O2 as compared to alveolar O2.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      23.4
      Seconds
  • Question 26 - Which of the following brings about a reduction in gastric blood flow? ...

    Correct

    • Which of the following brings about a reduction in gastric blood flow?

      Your Answer: Vasopressin

      Explanation:

      Gastric blood flow is increased by vagal stimulation, gastrin, histamine and acetylcholine as they stimulate gastric section and the production of vasodilator metabolites. Acetylcholine and histamine also have a direct action on the gastric arterioles. Similarly, gastric blood flow is reduced by inhibitors of secretion – catecholamines, secretin and vasopressin.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      11.2
      Seconds
  • Question 27 - A 42-year old woman presents to the doctor with jaundice. Her investigations show...

    Incorrect

    • A 42-year old woman presents to the doctor with jaundice. Her investigations show conjugated hyperbilirubinemia, raised urine bilirubin levels and low urine urobilinogen levels. What is the likely cause of her jaundice?

      Your Answer: Primary shunt hyperbilirubinemia

      Correct Answer: Blockage of the common bile duct

      Explanation:

      The description of the patient here fits the diagnosis of obstructive jaundice or cholestasis, which results in conjugated hyperbilirubinemia. Cholestasis occurs due to impairment of bile flow, which can be anywhere from the liver cell canaliculus to the ampulla of Vater. Causes can be divided into intrahepatic and extrahepatic.

      – Intrahepatic causes include hepatitis, drug toxicity, alcoholic liver disease, primary biliary cirrhosis, cholestasis of pregnancy and metastatic cancer.

      – Extrahepatic causes include common duct stone, pancreatic cancer, benign stricture of the common duct, ductal carcinoma, pancreatitis and sclerosing cholangitis.

      There is absence of bile constituents in the intestine, which causes spillage in the systemic circulation. Symptoms include pale stools, dark urine, pruritus, malabsorption leading to steatorrhea and deficiency of fat-soluble vitamins. Chronic cases can result in osteoporosis or osteomalacia due to vitamin D deficiency and Ca2+ malabsorption. Cholesterol and phospholipid retention produces hyperlipidaemia despite fat malabsorption (although increased liver synthesis and decreased plasma esterification of cholesterol also contribute); triglyceride levels are largely unaffected. The lipids circulate as a unique, low-density lipoprotein called lipoprotein X.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      32.8
      Seconds
  • Question 28 - For calculation of cardiac output by Fick's principle, which of the following vessels...

    Incorrect

    • For calculation of cardiac output by Fick's principle, which of the following vessels is the best source of venous blood to determine the arterial-to-venous oxygen tension difference?

      Your Answer: Pulmonary vein

      Correct Answer: Pulmonary artery

      Explanation:

      Fick’s principle states that the total uptake (or release) of a substance by peripheral tissues is equal to the product of the blood flow to the peripheral tissues and the arterial– venous concentration difference (gradient) of the substance. It is used to measure the cardiac output, and the formula is Cardiac output = oxygen consumption divided by arteriovenous oxygen difference. Assuming there are no shunts across the pulmonary system, the pulmonary blood flow equals the systemic blood flow. The arterial and venous blood oxygen content is measured by sampling from the pulmonary artery (low oxygen content) and pulmonary vein (high oxygen content). Peripheral arterial blood is used as a surrogate for the pulmonary vein.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      235.1
      Seconds
  • Question 29 - Which of the following associations is correctly matched with the body's defence mechanism...

    Incorrect

    • Which of the following associations is correctly matched with the body's defence mechanism in fighting infection?

      Your Answer: First line of defence → neutrophils

      Correct Answer: Specific cellular mechanism → cytotoxic T cells

      Explanation:

      The immune system has certain levels of defence against pathogens. First line includes simple barriers such as skin, mucosa and stomach acid that prevent the pathogen from entering into the body. If this barrier is breached then the innate immune system is activated which includes leukocytes (macrophages, neutrophils, mast cells, eosinophils, basophils, natural killer cells). If the pathogens invade the second layer of defence then the third layer, adaptive immunity is activated, which includes B and T lymphocytes. B cells provide a humoral response whereas cytotoxic T cells have specific cellular mechanisms. They maintain a memory of past infections and are activated faster following a recurrence.

    • This question is part of the following fields:

      • General
      • Physiology
      132.5
      Seconds
  • Question 30 - A medical student is told a substance is freely filtered but is not...

    Correct

    • A medical student is told a substance is freely filtered but is not metabolised, secreted, or stored in the kidney. It has a plasma concentration of 1000 mg/l and its urine excretion rate is 25 mg/min, and the inulin clearance is 100 ml/min. What is the rate of tubular reabsorption of the substance?

      Your Answer: 75 mg/min

      Explanation:

      Reabsorption or tubular reabsorption is the process by which the nephron removes water and solutes from the tubular fluid (pre-urine) and returns them to the circulating blood. To calculate the reabsorption rate of substance Z we use the following equation: excretion = (filtration + secretion) – reabsorption. As this substance is freely filtered, its filtration rate is equal to that of inulin. So 25 = (100 + 0) – reabsorption. Reabsorption = 100 – 25 therefore reabsorption = 75 mg/min.

    • This question is part of the following fields:

      • Physiology
      • Renal
      14.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Physiology (25/30) 83%
Respiratory (5/5) 100%
Gastroenterology (7/7) 100%
Cardiovascular (5/5) 100%
Neurology (2/3) 67%
General (2/3) 67%
Renal (4/7) 57%
Passmed