NE MCQ 2016-2017 Flashcards
Q1. Damage to the sympathetic chains in the abdomen affects the peripheral circulation in the lower limbs. Where do the sympathetic chains pass into the abdomen from the thoracic cavity?
A. Behind the lateral arcuate ligament
B. Behind the medial arcuate ligament
C. Behind the median arcuate ligament
D. By piercing the crura of the diaphragm
E. By piercing the dome of the diaphragm
D. By piercing the crura of the diaphragm
A patient presents with jaundice and scanning reveals multiple metastatic deposits in the liver. What is the most likely route for the spread of these deposits into the liver?
A. Azygos veins
B. Bile duct
C. Hepatic arteries
D. Hepatic veins
E. Portal vein
E. Portal vein
You are asked to assist a consultant operating on a pancreatic tumour. During the surgery, she asks you to identify an artery emerging from underneath the neck of the pancreas and descending over its uncinate process. What is the artery that you are asked to identify?
A. Gastroduodenal artery
B. Hepatic artery
C. Inferior mesenteric artery
D. Marginal artery
E. Superior mesenteric artery
E. Superior mesenteric artery
Part of the small bowel is resected and examined by the pathologist. What are the structures indicated at B?
Brunner’s glands
Oxyntic cells
Peyer’s patches
Plicae circulares
Valvulae conniventes
C. Peyer’s Patches
A neonatologist is asked to review a baby who is having difficulties feeding post-partum (after birth). The nurses say that he is breathing normally, does not appear to be distressed, and has no abdominal cramps. However, every time he tries to drink, the milk comes back up into his mouth within seconds. What is the most likely diagnosis?
A. Annular pancreas
B. Jejunal atresia
C. Oesophageal atresia
D. Omphalocoele
E. Pyloric stenosis
C. Oesophageal atresia
You are asked to review a new-born infant on the ward. He has a very thick umbilical cord, which contains some loops of small bowel. What is the most likely diagnosis?
A. Congenital inguinal hernia
B. Gastroschisis
C. Hiatus hernia
D. Meckel’s Diverticulum
E. Omphalocoele
A. Congenital inguinal hernia
[AM1] Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract which often mimics the signs and symptoms of appendicitis when inflamed. Meckel’s diverticulum is an anomaly attached to what structure?
Caecum
Ileum
Jejunum
Rectum
Transverse colon
[AM1]Only if the student knows this information – I am happy to leave this MCQ as is
ileum
You are investigating the pharmacokinetic profile of a drug administered orally. You have determined the area under the curve (AUC) from the drug plasma concentration vs time curve after oral and IV administration of the same dose of the drug (AUCORAL= 25mg hr/L; AUCIV=100mg hr/L). What is the percentage (%) oral bioavailability of this drug?
- 25%
- 5%
4%
25%
2500%
D. 25%
AUC oral / AUC IV x 100 = % Bioavailability
Q9. Mr Smith has been diagnosed with peptic ulcer disease as a result of H. pylori infection. He is prescribed metronidazole and omeprazole. What is the mode of action of omeprazole?
Blocks H+/K+ ATPase
Blocks H2 receptors
Inhibits bacterial protein translation
Inhibits microbial nucleic acid synthesis
Neutralises gastric acid
The drug inhibits the Blocks H+/K+ ATPase
Mrs Jones, aged 65, has severe rheumatoid arthritis and is taking NSAIDs. She also has recognized risk factors for GI complications associated with NSAID use. She is prescribed a synthetic prostaglandin E1 analog. What drug has she been prescribed, based on your knowledge of its mechanism of action?
Cimetidine
Domperidone
Metoclopramide
Misoprostol
Ranitidine
D. Misoprostol
. In mucopolysaccharidoses, tissues and organs become enlarged, inflamed or scarred. This is as a result of the accumulation of glycosaminoglycans (GAGs) in the tissues. GAGs are composed of repeating disaccharide units. What is the disaccharide unit found in GAGs?
An acidic sugar linked to an acidic sugar
An acidic sugar linked to an amino sugar
An acidic sugar linked to a ribose sugar
An amino sugar linked to an amino sugar
A ribose sugar liked to an amino sugar
B. An acidic sugar linked to an amino sugar
Q12. A range of human degenerative conditions, including Alzheimer’s and Parkinson’s disease, is associated with the deposition of protein in brain tissue[AM1] . What structure best describes the folding of a protein into a single globular form?
Bilayer
Primary
Quaternary
Secondary
Tertiary
[AM1]MCQ 12 & 13 reviewed and approved
quaternary
Q13. A researcher is trying to quantify the amount of low density lipoprotein (LDL) that is taken up by liver cells in a tissue culture experiment. Radioactive LDL is added to the cells. A few hours later, the LDL is found to be inside the cells. What is the name of the specific process that transports [SO1] LDL across the liver cell membrane?
Facilitated diffusion
Pinocytosis
Primary active transport
Receptor mediated endocytosis
Secondary active transport
[SO1]May I suggest changing this to ‘moves’ as transport is part of some of the options?
D. Receptor mediated endocytosis
Collagen is the single most abundant protein in the animal kingdom. It is the major insoluble fibrous protein in the extracellular matrix and in connective tissue. What vitamin is essential for the synthesis of collagen?
Vitamin A
Vitamin B2
Vitamin C
Vitamin D
Vitamin E
Vitamin C - scurvy is a disease of collagen that results from no available vitamin C
. Body Mass Index (BMI) is a person’s weight in kilograms divided by the square of height in meters. It correlates with percentage of body fat and body fat mass. BMI is used to identify adults at increased risk for morbidity and mortality due to obesity. What is an ideal, healthy BMI for an adult?
- 0 to 18.4 kg/m2
- 5 to 24.9 kg/m2
- 0 to 29.9 kg/m2
- 0 to 34.9 kg/m2
- 0 to 39.9 kg/m2
B. 18.5-24.9
Carbohydrate intolerance is the inability to digest certain carbohydrates due to a lack of one or more intestinal enzymes. Symptoms include diarrhoea, abdominal distention, and flatulence. What are the major carbohydrate products of the digestion of a piece of cake that contains milk, sucrose and flour as its main ingredients in the gastrointestinal tract?
A. a-limit dextrins galactose and glucose
B. Fructose, galactose and trehalose
C. Fructose, galactose, and glucose
D. Fructose, glucose, and maltose
E. Glucose, maltose and maltotriose
C. Fructose, Galactose, and Glucose
Q17. A patient with xerostomia or a dry mouth has a decreased secretion of saliva and has a low oral pH due to a lack of buffering. What is the most important buffer in saliva?
Alpha-amylase
Ammonia
Bicarbonate
Haemoglobin
Phosphate
C. Bicarbonate
Q18. A patient with a thrombotic disorder is prescribed the anti-coagulant Warfarin. Due to its narrow therapeutic index, interaction of Warfarin with other drugs can cause overdose and toxic side effects, particularly haemorrhage. What is the therapeutic index of a drug defined as?
ED50 divided by the TD50
ED50 minus the TD50
ED50 multiplied by the TD50
TD50 divided by the ED50
TD50 minus the ED50
C. TD50 divided by ED50- the closer to 1, the more dangerous the drug is
Q19. As an EMA medical reviewer, you receive an application for a new drug. The drug is a new class of immune modulator. The receptor for this drug is described as a seven transmembrane domain receptor. Hormone binding to immune cells that express this receptor causes an increase in IP3 and DAG levels. How does IP3 mediate its effects?
Activating an ion channel
Activating protein kinase A
Activating protein kinase C
Inhibiting protein kinase A
Inhibiting protein kinase C
A. Activating an ion channel
Q20. You have been contracted by a pharmaceutical company to advise on the clinical development programme for a new drug. What is the primary purpose of the phase I study for this drug?
Confirm the efficacy of the drug in a patient population
Confirm the safety of the drug in a patient population
Determine the pharmacokinetics of the drug in a healthy population
Determine the pharmacokinetics of the drug in a patient population
Estimate the appropriate dosing of the drug
C, Determine the pharmacokinetics of the drug in a healthy population
Q21. A 46-year-old woman is experiencing bouts of anxiety and she is prescribed a short course of the benzodiazepine diazepam to help her cope.
What is the mechanism of action of diazepam?
It blocks the Cl- channel
It enhances Na+ influx
It is a competitive GABA antagonist
It is an allosteric inducer of GABA binding
It is a non-competitive GABA antagonist
D. it is an allosteric inducer of GABA binding
- A key outcome of the pre-clinical investigation of a drug is to determine the toxicity of the drug which is important in deciding the dose to use in clinical trials. There are a number of parameters that can be measured in the toxicity studies but which one is the most important in calculating the maximum recommended starting dose?
A. LD50
B. LOAEL
C. MTD
D. NOAEL
E. TD50
D. NOAEL
Q23. When taking a case history a patient indicates that she is using a homeopathic remedy. What is the basis of homeopathy?
The use of herbal remedies
The use of highly concentrated extracts of active agents
The use of highly dilute extracts of active ingredients
The use of immunizations
The use of active pharmaceutical agents
The use of highly dilute extracts of active ingredients
Q24. You have been asked to conduct a phase I clinical trial for a new drug. Preliminary toxicology studies in rats found that the NOAEL is 30mg/kg and the LOAEL is 100mg/kg (human equivalent dosing). What is the recommended maximum starting dose for the trial?
3mg/kg
6.5mg/kg
10mg/kg
65mg/kg
100mg/kg
recommended maximum starting dose is based on NOAEL not LOAEL -
take 10% of the NOAEL
Q25. Jane, a 19-year-old student, is referred for investigation because of a history of skeletal muscle weakness and decreased exercise tolerance. The referring clinician suggests a presumptive diagnosis of Glycogen Storage Disease Type I [Von Gierke’s Disease]. A muscle biopsy shows high levels of glycogen with normal structure and, unexpectedly, normal levels of activity of glucose-6-phosphatase. However, despite normal glucose-6-phosphatase activity, further biochemical investigations show that Jane’s cells are incapable of releasing glucose during glycogenolysis and so she remains hypoglycaemic in the fasting state. What enzyme is most likely to be deficient in this case?
A. Glucokinase
B. Glucose-6-phosphate dehydrogenase
C. Glucose-6-phosphate translocase
D. UDP-Glucose pyrophosphorylase 1
E. Uridine-monophosphate synthetase
C. Glucose-6-phosphate translocase
Q26. At laparoscopy for a right inguinal hernia you note the lateral umbilical ligament. What structure is responsible for raising this fold in the peritoneum?
Inferior epigastric artery
Pudendal artery
Umbilical vein
Urachus
Vas deferens
A. The inferior epigastric artery
Q27. A child is found to have retractile testes. What nerve supplies the muscle that retracts them?
A. Genito-femoral
B. Ilio-hypogastric
C. Ilio-inguinal
D. Pudendal
E. Sacral sympathetic
A. Genito-femoral
Q28. During a surgical procedure you pass your finger through the epiploic foramen. What vascular structure now lies directly anterior to your finger?
A. Coeliac trunk
B. Cystic artery
C. Hepatic vein
D. Inferior vena cava
E. Portal vein
E. Portal Vein
Q29. A 32-year-old man receives regular care from his general practitioner for one of the porphyria disorders. Porphyrias result from a partial failure in the haem biosynthetic pathway. In the first step of this pathway, what are the two substrates required for the generation of delta-aminolevulinic acid (ALA)?
A. Glutamine and acetyl CoA
B. Glutamine and succinyl CoA
C. Glutamic acid and acetyl CoA
D. Glycine and acetyl CoA
E. Glycine and succinyl CoA
E. Glycine and Succinyl CoA
Q30. A baby born prematurely at 34 weeks is visibly jaundiced and has unconjugated bilirubin levels of 189μmol/L. The baby is extremely lethargic and unresponsive to touch. Deposition of unconjugated bilirubin in the brain is suspected. What neurological condition is this associated with?
Epilepsy
Hypoxic-ischaemic encephalopathy
Intra-ventricular haemorrhage
Kernicterus
Tay-Sachs disease
Kernicterus
Q31. During intense exercise (e.g. sprinting), glycolysis in muscle occurs under anaerobic conditions to generate energy. The chemical reactions of glycolysis rely on a constant supply of NAD+ to remain active but, in the absence of oxygen, all of the NAD+ will be converted to NADH so that the muscle should run out of energy eventually. However, under anaerobic conditions, a reaction prevents this by regenerating NAD+. What is the product of this reaction?
Acetyl-CoA
Ketone bodies
Lactate
Pyruvate
Triglyceride
Lactate
Q34. A 50-year-old woman is brought to hospital vomiting blood. Endoscopy reveals oesophageal varices. What is the arterial blood supply to the part of the oesophagus with the varices[AM1] ?
Hepatic
Left gastric
Left gastro-epiploic
Right gastric
Splenic
[AM1]Thank you: changes made
B. Left Gastric
Q32. During Grand Rounds, one of your colleagues presents a patient that he is investigating currently. The patient is a 6-year-old boy. He is one of three children within the same family affected by Type I Hyperlipoproteinaemia, an extremely rare genetic defect. When this patient is on a normal diet, a massive hyperchylomicronaemia is observed (i.e. abnormally high levels of chylomicrons in the circulation) which clears in several days once the patient is switched to a fat-free diet. What enzyme is likely to be deficient in this patient?
Acyl-CoA dehydrogenase
Carnitine-palmitoyltransferase
Hormone-sensitive adipose tissue lipase
Lipoprotein lipase
Pancreatic lipase
Lipoprotein Lipase
Q33. In a 45-year-old man both vagal trunks were severed at the oesophageal hiatus of the diaphragm during a surgical procedure. What part of the gut would still receive parasympathetic innervation?
A. Appendix[AM1]
B. Foregut
C, .Hindgut
D. Midgut
E. Stomach
[AM1]Thank you change made: appendix replaces liver
C. Hindgut
Q35. A young man has a group II metabolic disorder that affects energy production[AM1] in one of the complexes in the electron transport chain. Oxidative phosphorylation requires the transport of electrons to a final electron acceptor. What is the final electron acceptor in oxidative phosphorylation that is required for energy production?
FAD+
FMN
haem
NAD+
Oxygen
[AM1]Thank you: change made
Oxygen
Q36. A 55-year-old man that you are assessing has metabolic syndrome which is characterized by increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels. Lipid levels in the body are determined by fat intake as well as de novo lipid biosynthesis. Palmitic acid is the most common fatty acid. What is the precursor for palmitic acid biosynthesis?
Acetyl CoA
Alpha ketoglutarate
Fumarate
Lactate
Lipoic acidf v
Acetyl CoA
Q37. A mother brings her baby to you and explains that the baby has been lethargic, feeding poorly and vomiting frequently. She also says that the baby’s nappies have an odd smell. You suspect the baby may have maple syrup urine disease which leads to a characteristic maple syrup smell in the urine. What amino acid metabolism is defective in patients with MSUD?
Branched chain amino acid
Cysteine
Methionine
Phenylalanine
Tyrosine
branched chain amino acid
Q38. A newborn that you are assessing appears lethargic, and is not feeding well. The biochemical test results suggest that the baby may have pyruvate dehydrogenase deficiency. What biochemical molecule is increased in patients with pyruvate dehydrogenase deficiency?
Acetyl CoA
Lactate
Malate
Oxaloacetate
Phosphoenolpyruvate
lactate
Q39.The gastrointestinal tract secretes a wide range of hormones, local hormones and neurotransmitters. What G.I.T. hormone is implicated in vomiting?
5-hydroxytryptamine (serotonin)
Histamine
Secretin
Somatostatin
Vasoactive inhibitory polypeptide (VIP)
5-hydroxytryptamine (serotonin)
Q40. The process of digestion is controlled and coordinated by the enteric nervous system and by a number of G.I.T. hormones. How does cholecystokinin mainly inhibit gastric acid secretion?
Activation of sympathetic ganglia
Direct actions on oxyntic cells
Direct inhibition of gastrin release
Direct inhibition of histamine release
Stimulation of somatostatin release
Stimulation of somatostatin release
