AFRICAN COLLEGE OF HEALTH (ACH)

MBBS YEAR 1 SEMESTER 3; WEEK 12 NOTES

REVISIONS
MONDAY: Neuroanatomy (pg.2)
TUESDAY:

Physiology (pg.22)

WEDNESDAY: Ethics (pg.37)

THURSDAY: Neuroanatomy(pg.51)
FRIDAY: Physiology (pg.71)

QUESTIONS? Email: africancollegeofht@nokiamail.com

NEUROANATOMY (MONDAY)
1.The optic nerve enters the orbit passing through the
optic canal is accompanied by the:
A.Ophthalmic artery
B.Suspensory ligaments of the eye
C.Ophthalmic vein
D.Trochlear nerve
A

2.What structure in the middle ear separates the

tympanic cavity from the meninges and temporal lobe
of the brain?

A.Floor of the middle ear

B.Anterior wall of the middle ear
C.Tegmen tympani
D.Mastoid antrum
C

3.Inadequate treatment of otitis media can result in

acute mastoiditis due to spread via what structure?

A.Semicircular ducts

B.Mastoid antrum
C.Petrous bone
D.Tegmen tympani
B

4.The spinal cord is anchored vertically to the

coccyx by the:

A.Denticulate ligament
B.Ligamentum flavum
C.Lilum terminale
D.Cauda equina
C

5.The fasciculus cuneatus is found at this spinal

cord segment:

A.Lumbar
B.Sacral
C.Thoracic
D.Cervical
D

6.The lateral corticospinal tract carry these

impulses to the effector organs:

A.Motor
B.Sympathetic
C.Sensory
D.Parasympathetic
A

7.Pain and temperature impulses on the left sole

ascends to the thalamic area via:

A.Ipsilateral lateral spinothalamic tract

B.Ipsilateral posterior column
C.Contralateral lateral spinothalamic tract
D.Contralateral posterior column
C

8.Loss of pain ad temperature sensation at the level

of the umbilicus points to a lesion at this cord
level:

A.T10
B.T8

C.L2
D.T12
B

9.The fiber tract that coordinates the functions of

cranial nerves II, IV and VI:

A.Medial lemniscus
B.Medial longitudinal fasciculus
C.Fasciculus gracilis
D.Lateral meniscus
B

10.The efferent nucleus of the pupillary light reflex

is:

A.Lateral geniculate body

B.Edinger-Westpal
C.Oculomotor nucleus
D.Trouchlear nucleus
B

11.CSF flows from the 3rd ventricle to the 4th

ventricle via:

A.Formina of Monro
B.Cerebral aqueduct
C.Foramina of Magendie
D.Foramina of Luschka
C

12.Pain and temperature sensation from the head is

received in the brainstrem by the:

A.Mesencphalic nucleus of V
B.Motor nucleus of V
C.Trigeminal spinal nucleus
D.Nucleus ambigous
C

13.Which is an INCORRECT statement about an

intervertebral disc?

A. During aging, fluid within the nucleus pulposus is

replaced by fibrocartilage
B. Atlanto-axial joint possesses no disc
C. Nucleus pulposus is most likely to herniate in an
anterolateral direction

D. Disc are thickest in the lumbar region

C

14. After extensive surgical dissection in the

posterior cervical triangle, drooping of the skin in
the neck was noted postoperatively. This is due to
injury of what nerve?

A.Trigeminal
B.Spinal accessory
C.Hypoglossal
D.Facial
D

15.Not found in the CNS:

A. Astrocytes
B. Bipolar cells
C. Schwann cell
D. Brainstem
C

16.Space between the cornea and the iris and lens:

A.Anterior chamber
B.Posterior chamber
C.Vitreous cavity
D. Aqueos humor
A

17.A severe infection that obstructs the middle meatus

would affect drainage from each of the following
sinuses EXCEPT the;

A.Maxillary sinus
B.Frontal sinus
C.Nasolacrimal duct
D.Anterior ethmoid air cells
C

18.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 nerve
B.Vagus nerve
C.Glossopharyngeal nerve
D.Facial

19.When a patient attempts protrusion of the tongue,the

tongue deviates to the right. This would indicate
damage to which of the following nerves?

A.Right glossopharyngeal
B.Left accessory
C.Right hypoglossal
D.Left hypoglossal
C

20.If a patient presented with a permanently dilated

pupil, which one of the following nerves could be
assumed to be involved?

A.Optic
B.Sympathetic trunk
C.Ophthalmic
D.Occulomotor
D

21.Following a tonsillectomy, a patient noted loss of

general sensation and taste from the posterior 1/3 of

the tongue. It could be assumed that the

was a branch of the;

injured nerve

A.Glossopharyngeal nerve
B.Facial nerve
C.Lingual nerve
D.Vagus nerve
A

22. A stab wound on the neck which injures the spinal

root of CN XI results in the following signs and
symptoms EXCEPT:

A loss of pain sensation on the shoulder and upper

chest
B. drooping of the shoulder
C. inability to elevate the shoulder
D. weakness and atrophy of the trapezius
A

23. The cerebral aqueduct is located in the:

A. cerebrum
B. midbrain

C. diencephalons
D. pons
B

24. Damage to the anterior division of the middle

meningeal artery may results in what type of
intracranial hemorrhage:

A. extradural hemorrhage
B. subdural hemorrhage
C. subarachnoid hemorrhage
D. weakness and atrophy of the trapezius
A

25. In which bone is the inner ear located?

A. Sphenoid
B. Temporal
C. Parietal
D. Occipital
B

26. Regarding the tympanic cavity, which of the

following statements is/are true?

A. an airfilled space in the petrous portion of the

temporal bone
B. communicates with the pharynx via the eustachian
tube
C. houses the incus, malleus and stapes
D. All of the above
D

27. All are supplied by the oculomotor nerve, EXCEPT;

A. Superior rectus
B. Medial rectus
C. Inferior oblique
D. Lateral rectus
D

28. The inability to focus horizontally or vertically

is a problem inherent to the;

A. Cornea
B. Lens
C. Vitreous humor
D. Retina

29. Neurologic examination of a 37-year old alcoholic

man with clumsiness of his right hand revealed poor
dorsiflexion of the hand at the wrist. He most likely
injured his:

A. Median nerve
B. Brachioradialis nerve
C. Musculocutaneous nerve
D. Radial nerve
D

30. Which of the following statement is true regarding

transection of the optic nerve?

A. Direct pupillary light reflex would be unaffected

B. The affected eye will be blind
C. There would be bitemporal hemianopsia
D. Consensual light reflex would be lost on the
affected eye
B

31. Which of the following reflexes is a monosynaptic

reflex?

A. Achilles reflex
B. Pupillary light reflex
C. Corneal reflex
D. Extensor plantar reflex
A

32. Which of the following blood vessels would be most

likely involved in patient showing homonymous
hemianopia with macular sparing?

A. Internal carotid artery

B. Posterior cerebral artery
C. Middle cerebral artery
D. Anterior cerebral artery
B

33. Which of the following statements are/is true of

the middle cerebral artery?

A. It supplies the occipital and posterior portion of

the temporal lobe
B. It is the continuation of the internal carotid
artery

C. It supplies the portion of the motor cortex

corresponding to the legs
D. It gives rise to the medial striate artery
B

34. Which of the following centers is located in the

frontal lobe?

A. Brocas speech area

B. Wernikes speech area
C. Primary visual area
D. Primary auditory area
A

35. Which tendon of the following muscles is tapped to

illicit the knee-jerk reflex?

A. Quadriceps femoris
B. Sartorius
C. Tibialis anterior
D. Popliteus
A

36. A laboratory technician not aware of the gluteal

anatomy gave his friend a flu shot at the lower aspect
of the right gluteus. Afterwards, his friend noted
decreased sensation over the anterolateral aspect of
the right leg and foot. Also his right foot was noted
to drop and drag to the floor. Which of the nerves was
probably injured?

A. Common peroneal nerve

B. Sciatic nerve
C. Tibial nerve
D. Obturator nerve
A

37. A 20 year old patient sustains a deep cut on the

volar surface of right wrist. Median nerve injury would
affect which of the following muscles?

A. Medial lumbricals
B. Thenar
C. Dorsal interossei
D. Palmar interossei
B

38. Which of the following ligaments is traversed by

the needle in performing a lumbar tap?

A. Posterior longitudinal
B. Cruciate
C. Anterior longitudinal
D. Ligamentum flavum
D

39. When a persons neck and trunk are flexed, as in

preparation for a spinal tap, the spinous process of C7
becomes visible and it is for this reason that it is
called:

A. Spina bifida
B. Vertebra prominen
C. Atlas
D. Intervertebral disc herniation
B

40. In patient with fracture of the middle humerus ;

the following muscles will be denervated EXCEPT:

A. Triceps brachii
B. Extensior digitorum communis
C. Abductor pollicis

brevis

D. Supinator
C

41. Which branch of the brachial plexus DOES NOT give

off branch(es) to the upper arm and shoulder?

A. Musculocutaneous nerve
B. Radial nerve
C. Ulnar nerve
D. Circumflex nerve
C

42. Which of the following muscles of mastication

protracts the jaw?

A. masseter
B. lateral pterygoid
C. temporalis
D. medial pterygoid
B

43. Optic nerves are formed by axons of neurons found

in the ___ layer of the retina.

A. Ganglion
B. Inner nuclear
C. Outer nuclear
D. Photoreceptor
A

44. Which of the following structures forms part of the

vascular coat of the eyeball?

A. Choroid
B. Retina
C. Conjunctiva
D. Sclera
A

45. Which of the following nerves subserve/s taste

sensation from the posterior third of the tongue?

A. Vagus
B. Glossopharyngeal
C. Facial
D. All of the above
B

46. An intern is trying to elicit the presence of

corneal blink reflex on a patient. Which of the
following cranial nerves is the afferent arm of this
reflex?

A. II
B. V
C. III
D. VII
B

47. A patient with tertiary syphilis has impairment of

his sense of orientation and position in space. This is
indicative of a damage to the:

A. Pyramidal tract
B. Antero-lateral spinothalamic tract
C. Dorsal column pathway
D. Corticospinal tract
B

48. Special somatic afferent fibers are found in which

of the following cranial nerves?

A. II

B. VIII
C. VI
D. IX
A

49. A blind-folded woman was made to guess the letter

written on her palm. The second-order neuron of the
involved sensory pathway is located at the:
A. Dorsal horn
B. Nucleus cuneatus
C. Fasciculus cuneatus
D. Nucleus gracilis
B

50.In cases of nerve fiber injury, what structure in the

perikaryon will be decreased in number?
A.Mitochondria
B.Nissl body
C.Golgi apparatus
D.Ribosome
B

PHYSIOLOGY (TUESDAY)
1. A 62 old man with COPD presents to the ER in
respiratory distress. The physician uses
succniylecholine to produce muscle relaxation prior to
tracheal intubation. Soon after infusion he developed
severe bradycardia. Which drug would counteract the
bradycardia without affecting muscle relaxation:

A.Curare
B.Atropine
C.Epinephrine
D.Acetylcholine
B

2.When a pheochromocytoma suddenly discharges a large

amount of epinephrine into the circulation the
patients heart rate would be expected to:

A.Increase because epinephrine has a direct

chronotropic effect on the heart
B.Increase because of increased parasympathetic
discharge to the heart
C.Decrease because the increase in blood pressure
stimulates the carotid and aortic baroreceptor
D.Decrease because of increased tonic parasympathetic
discharge to heart
A

3.Loss of fear and emotion is often observed in the

lesion at:

A.Subthalmic

nucleus

B.Thalamus
C.Amygdaloidal nucleus
D.Substantia nigra
C

4.Which of the following will require the smallest

increase in oxygen consumption by the heart:
A.Generating an increase in left ventricular
pressure.
B.Severe hypertension.
C.Generating an increase in stroke volume.
D.Aortic stenosis
C
5.A 53 year old man complains of mild chronic
cough and heart burn. Esophageal manometric and
endoscopic evaluation reveals a lower esophageal
sphincter [LES] pressure and mild gastro
esophageal reflux. Which of the following is the
primary genesis of LES pressure in adult?
A.Tonic excitatory sympathetic nerve input to
the smooth muscles
B.Tonic excitatory parasympathetic nerve input
to the smooth muscle
C.Circulating gastrin
D.Myogenic properties of LES smooth muscle

D
6.A 16 years old girl complains of being tired
more than usual, she also complains Of muscle
cramps in her legs and generalized weakness
after exercise. Her BP 160/100 mmHg. Her ECG
showed prolong QT interval and U wave. Blood
analysis showed hypokalemia and metabolic
acidosis. Plasma rennin activity and
aldosterone level are lower than normal. Her
clinical condition reversed after she is placed
on diuretic amiloride, which blocks tubular
epithelial channels. Based on this finding,
which of the following renal transport processes
is major defect causing her metabolic disorder?
A.Greater than normal
proximal tubules
B.Greater than normal
distal tubules
C.Inability of distal
potassium ions
D.Inability of distal
ions
B

sodium reabsoption by the

sodium reabsoption by the
nephron to secret
nephron to secret hydrogen

7.In starvation which of the following is

reduced:
A.Plasma T4
B.PlasmaT3
C.Tri-iodothyroxine
D.Thyroxin
B
8. What effect does urine pH have on salicylate
clearance?

A. Stomach: Low pH, acidic. Salicylate will be

unionized, therefore absorbed across stomach. Stomach
has small surface area, so not much will be absorbed
B. Intestines:pH 7-8:Salicylate will be more ionized,
therefore harder to cross membrane o Intestines have
large surface area and some salicylate will be
unionized still, so significant amount will be absorbed
C. Kidney:Ultrafiltrate of plasma passes through
kidneys from circulation. Blood is well buffered, and
hence cant change pH.The glomerulus filters the
plasma. Drug is filtered out, and some cross membrane
D. All of the above
D
9. Salicylate clearance;
A. In an overdose, give patient something alkali to
drink to make urine more alkali, and increase rate of
clearance
B. Increased clearance rate, a problem when you want to
maintain drug in a therapeutic range (i.e. plasma
concentrations where drugs work). E.g. cardiac
glycoside has narrow range
C. A & B
D. None of the above
C
10-Enterogastric nervous reflexes from the duodenum:
A.Promotes antral contraction
B.Are activated by isotonic antral fluid

C.Are activated by increase PH of antral mucosa

D.Produce inhibitory effect on gastric contraction
D
11.A young woman is found comatose, having taken
unknown number of sleeping pills an unknown time
before. An arterial blood sample yields the following
values: pH 7.0 2HCO314 meq/L PaCO2 68 mmHg. This
patient's acid-base status is most accurately described
as:

A.Uncompensated metabolic acidosis

B.Uncompensated respiratory acidosis
C.Simultaneous respiratory and metabolic acidosis
D.Respiratory acidosis with partial renal compensation
C
12.A 20-monthes old baby presented to the pediatrician
for check up. On examination Babinski sign was
elicited, this may indicate damage to which of the
following:
A.Spinal cord
B.Cerebellum
C.Brainstem
D.Pyramids
D
13.The upstroke of ventricular action potential is
primarily due to which one of the following actions:
A.An inward flux of Ca2
B.An inward flux of K+ current

C.An inward flux of Na+

D.An outward flux of K+ current
C
14.You are asked to assess a patient in ICU who is
ventilated at frequency of 12/min and a Tidal volume of
0.6L. His arterial PH> 7.6, to correct his condition
you should:
A.Decrease
B.Decrease
C.Increase
D.Increase
B

Dead space
Tidal volume
oxygen fraction
mint ventilation

15. If the FSH producing cells were selectively

destroyed this would lead to:
A.Decrease
B.Decrease
C.Decrease
D.Increase
C

level
level
sperm
level

of testosterone
of LH
count
of testosterone

16. If natural Killer cells are selectively destroyed

by irradiation then:
A.Adaptive immunity will be affected
B.Lyses of tumor cells will be accelerated
C.Host rejection of bacteria infected cells will be
impaired
D.Host rejection of tumor cells will be impaired
D
17.If electron transport chain is inhibited, which of
the following cells will be least or not affected:

A.Cardiac muscle cells

B.Parietal cells of the stoma

C.Proximal convoluted tubule cells
D.Red blood cells
D
18. A 23 years old female presents with fatigue and
found to have higher than normal COP, most likely she
has:

A.Hypertension
B.Aortic regurgitation
C.Anemia
D.Hyperthyroidism
C
19. If the patient is unable to hear high frequency
sounds, the damage to the basilar membrane is closest
to which of the following:

A.Oval window
B.Cochlea
C.External meatus
D.Schala Media
A

20. The following values are measured for potassium ion

in a human subject.Plasma K+ 5 meq/liter, Urine K+ 50
meq/liter,Renal creatinine clearance 80 ml/min,Urine
formation rate 1.5 ml/minute.This patient's potassium
clearance is closest to which of the following?

A.5 ml/minute
B.7.5 ml/minute
C.15 ml/minute
D.50 ml/minute
C

Question 21- 25; Match the following lesion in the

pyramidal tract of one side with their respective
effects:
A

B
21. In crus of the
midbrain
C
22.In the cerebral
cortex in the left
side
A

A.Monoplegia and
aphasia
B.Hemiplegia and
sensory disturbances
in the opposite side

23.In the internal

capsule
B

C.Contralateral
hemplegia and
ipsilatral eye is
fixed downward and
outward

24.In the medulla

above motor
decussation

D.Contralateral
hemplegia and
ipsilatral facial

pulsy

25.In the pons

D

E.Contralateral
hemplegia and
ipsilatral lingual
muscle paralysis

Question 26- 30;For each of the intravenous

fluids, select the most appropriate option:
A

B
26. 50 glucose
C
27. 1.8% saline
D
28. 5 % glucose
B
29. Normal saline
A
30. 8.4% sodium
bicarbonate
E

A.Isotonic solution
mainly expands the
ECV
B.Isotonic solution
mainly expands ICV
& ECV
C.Major nutrient
used in IV
nutrition
D.Hypertonic fluid
with about twice
the osmolarity of
plasma
E.Occasionally used
in severe acidosis

31. A patient with a traumatic aortic rupture undergoes

aortic repair. The patient presents with hoarseness
after surgery. The most likely cause of hoarseness is?
A.
B.
C.
D.
C

Postoperative viral infection

Damage to phrenic nerve
Trauma to recurrent laryngeal nerve
injury to sympathetic chain

32. A 35 year old male is involved in a head on motor

vehicle accident. On arrival to the emergency room, he
has severe bruises to his chest but is otherwise
stable. The chest X ray reveals a widen mediastinum. An
angiogram is ordered which reveals a traumatic aortic
rupture. The most common site of aortic rupture after
severe blunt trauma to the chest is ?
A.
B.
C.
D.
D

Ascending aorta
Abdominal aorta
Aortic arch
Descending aorta distal to left subclavian artery

33. Failure to develop the 3 and 4th pharyngeal pouches

are linked to what immune disorder?
A.
B.
C.
D.
C

AIDs
SCIDs
DiGeorge
CGD

34. Which of the following is false about bombesin?

A.
B.
C.
D.
D

It is an autocrine growth factor

It is found in the gi tract
Contracts gall bladder
Functions as an endocrine hormone

35. Which lung cancer is commonly associated with

hypercalcemia?
A.
B.
C.
D.
B

Small cell
Squamous cell
Adenocarcinoma
Carcinoid

36. Which lung cancer is most commonly associated with

the SIADH SYNDROME?
A.
B.
C.
D.

Squamous cell
Carcinoid
Small cell
Adenocarcinoma

C
37. In ethanol drinking, the typical enzymatic pattern
of liver enzymes is?
A.
B.
C.
D.

AST> ALT
ALT> AST
elevated alkaline phosphatase
elevated bilirubin

A
38. Aspirin allergy is related to?
A.Arachidonic acid
B.Bradykinin
C.Leukotrienes
D.Histamine
C
39. The slow releasing substance of anaphylaxis is?

A.
B.
C.
D.
D

Histamine
Bradykinin
Serotonin
Leukotrienes

40. Parafollicular cells of the thyroid secrete:

A.
B.
C.
D.
A

Calcitonin
Amyloid
Thryoglobulin
Parathyroid hormone

41. A 55 year old previously healthy male has been

complaining of palpitations for the past 3 months. He
was seen in the cardiology clinic. After a quick
physical exam, the ECG reveals that he has atrial
fibrillation. Five minutes later, you noticed that the

patient is not responsive and has a Blood Pressure of

60/20. The next step in his management is?
A.
B.
C.
D.
D

Amiodarone
Quinidine
Lidocaine
Cardioversion

42. Which of the following is false about Amiodarone?

A.
B.
C.
D.
D

is used for both atrial and ventricular arrhythmias

blocks sodium, calcium and potassium channels
can cause corneal deposits
Has a very short half life

43. Which of the following is false about beta

blockers?
A. Metoprolol is useful in the treatment of patients
after an MI
B. Metoprolol can depress the cardiac output
C. Beta blockers reduce arrhythmias
D. Oral Esmolol is effective for outpatient treatment
of hypertension
D
44. Which of the following is false about Adenosine?
A. Adenosine is a normal component of body tissues
B. The drug is effective is treating atrial arrhythmias
C. It has a very short duration of action

D. It depolarizes the AV node to decrease the nodal

arrhythmias
D
45. Which of the following is false about calcium
channel blockers?
A.
B.
C.
D.
D

can be used to treat hypertension and arrhythmias

block L calcium type channels
PR interval is typically shortened by these agents
Effective in patients with congestive heart failure

46. Digoxin induced arrhythmias can be decreased by?

A.Calcium
B.Sodium
C.Magnesium
D.Uranium
C
47. The beta blocker which is classified as a class 3
anti-arrhythmic agent is?
A.Metoprolol
B.Atenolol
C.Esmolol
D.Sotalol
D
48. The major mechanism of class 3 anti arrhythmic
agents is?
A.Inhibition of Sodium influx
B.Inhibition of l type Calcium channels

C.Reducing outward phase of Potassium current

D.Inhibiting Na K ATPase
C
49. The agent which can sometimes be used to treat
digoxin induced arrhythmias is?
A.Quinidine
B.Amiodarone
C.Phenytoin
D.Sotalol
C
50. The diuretic used in the treatment of mountain
sickness is?

A.Acetozolamide
B.Furosemide
C.Thiazide
D.Spironolactone
A

ETHICS (WEDNESDAY)
1. A newborn needs cardiac surgery for cyanosis due to
congenital heart disease.Surgeon discussed the
procedure with the mother. She understood the
procedure. Can she give the consent?
Answer: Yes, because she understood the procedure.
2. A newborn is diagnosed with either trisomy 18 or 13
with TE (tracheoesophageal) fistula which requires
suregery. Mother request surgeon to repair the TEfistula. What should a surgeon do?
Answer: Surgeon should refuse to do the reparative
surgery because these conditions (trisomy 18 or 13) are
nonviable. If the patient survives, surgeon can put a
gastrostomy feeding tube for nutrition. However, please
remember that a patient with trisomy 21
(Down syndrome) with TE fistula should be operated on.
3. A surgeon wanted to perform cholecystectomy on a
patient. The surgeon is not sure whether the patient
has decision-making capacity. What is the next
appropriate step?
Answer: Consultation with a psychiatrist or neurologist
may be helpful. Sometimes it is
necessary to discuss the case with hospital attorneys,
ethic committees, or ethic consultants. In a difficult
case, the ultimate judge of a patients competency is a
court.
4. Should a bus driver hide history of epilepsy from
his employer? (Important)
Answer: No. He has requested his physician not to
mention his epilepsy to the employer because this would
result in the loss of his job. The physician is
obligated not only to his patient but to the community.
The patient should notify his employer and try to find

a non-driving job in the company. If the patient

disagrees, physician may notify the appropriate
authority for the safety of the patient and the
community.
5. A 50-year old make is diagnosed with stomach cancer.
He requested the physician not to tell his wife. The
following day, the wife calls to inquire about her
husbands diagnosis.
Answer: The physician should not divulge the husbands
diagnosis. However, the physician should encourage the
patient to reveal his diagnosis to his wife.
6. A 29-year old man is diagnosed with presymptomatic
Huntingtons disease. This disease is an autosomal
dominant (50% chance of having the disease in each
pregnancy). He requested his physician not to tell the
diagnosis to his wife. The wife wants to have
children.
Answer: Physician should ask the patient to seek
genetic counseling and to urge him to discuss the
matter with his wife. Since there is a risk of harm to
the future children, physician can divulge the
diagnosis to protect the future children.
7. A 18-year old man is diagnosed to have suspected
bacterial meningitis. He refuses therapy and returns to
the college dormitory. What should a physician do in
this situation?
Answer: Physician should report to the college
authority and recommend that the suspected individual
should be isolated during the course of his illness.
8. A 39-year old nurse is diagnosed with hepatitis B
antigen-positive. She is working in a dialysis unit.
She told her doctor. However, she did not tell the

hospital authority because she is afraid to lose her

job.
Answer: Physician should ask the nurse to divulge her
medical condition to the hospital authority. If she
refuses, physician should notify the hospital authority
for the protection of patients.
9. A 20-year old man with severe head injury was
admitted to a small hospital. The patient needs
neurosurgical intervention which is available in a
nearby university hospital. Hospital refused to accept
a patient who has no medical insurance.
Answer: University hospital must accept the patient.
10. A 30-year old man needs a second prosthetic valve.
He is a drug addict. Surgeon does not want to perform
surgery because the patient does not take care of
himself. Is this the right decision?
Answer: No. Surgery should be performed if it is
medically indicated.
11. A newborn male is diagnosed with anencephaly. His
1-year old sibling needs a kidney. His parents
requested the physician to remove the kidney from the
anencephalic child and to transplant that kidney in the
1-year old sibling. What should a physician do?
Answer: Surgeon should perform the kidney transplant.
12. A 50-year old man is in a persistent vegetative
state. Physician decided to discontinue nutrition and
hydration for that patient.Is this the right decision?
Answer: Yes. This is an acceptable practice in most
states. Few states require clear evidence that the
patient would have chosen this course.

13. A medical student requested his attending to

perform a pelvic examination on a patient who is
anaesthetized for appendectomy. Is this ethically
acceptable?
Answer: No. The patient did not give consent to perform
a pelvic examination.
14. A 20-year old woman slashed her wrists and wanted
to die. She was unconscious and was brought to the ER.
What should a physician do?
Answer: Physician should take care of the patient.
Psychiatric consultation and social worker evaluation
are indicated. A suicide attempt is very often a cry
for help.
15. A 90-year old man was diagnosed with having
Alzheimers disease 10 years ago. It is difficult to
feed him. He cannot recognize his family members. He
developed recurrent aspiration pneumonia. What should a
physician do?
Answer: Physician should discuss this with the family
and should respect their decision.
16. A 1-day-old infant was diagnosed with hypoplastic
left heart syndrome. The patient is stabilized with the
use of prostaglandin. Physician discussed this case in
detail with the parents. What should the parents decide
in this situation?
Answer: The parents can choose a staged surgical repair
of the heart, a final heart transplantation if the
organ is available, or allow the infant to die.
17. A 55-year old woman with severe developmental
disability is recently diagnosed with breast cancer.
Her mental age is estimated to be at 2-year-old level.

Her family members do not want any more intervention.

What should physician do?
Answer: Physician should discuss this case with the
hospital ethics committee members. The usual consensus
is not to do anything because of her severe mental
disability.
18. A 49-year old woman with cervical cancer has a
history of noncompliance. She had surgery a month ago.
She missed several appointments. Can a physician force
her for chemotherapy?
Answer: No. Physician can talk to her regarding the
importance of chemotherapy. However, the patient must
make the final decision.
19. An internist has been managing a diabetic patient
for the last 10 years. The patients condition is
progressively getting worse. The patient is also not
happy with the physicians management. What should a
physician do in this situation?
Answer: Physician should find another physician (e.g.,
endocrinologist) who might be more successful with the
patient in this particular circumstance.
20. An internist recently refused to see a patient who
he has been seeing for the last 5 years. Internist
stated that the patient was rude to him. The patient
went to see another physician who requested the
patients medical record. What should the internist do
in this situation?
Answer: Internist should provide the medical records of
the patient to the new physician.
21. An internist refused to see a complicated
hypertensive patient who he has seen for the

last 10 years. Internist did not give any notice to

that patient. The patient was angry with the physician.
The patient was recently admitted to a hospital with
the diagnosis of stroke. Is the internist responsible
for the patients condition?
Answer: Yes. The legal charge of abandonment can arise
when the physician without giving timely notice, ceases
to provide care for a patient who is still in need of
medical attention. Internist is not obligated to find
him another physician. However, patient should
have sufficient time to arrange for another physician.
22. A physician went to vacation for 2 weeks. He did
not find another physician to cover him. He is very
sincere. One of his patients with hypertension
developed severe headache. The patient has an
appointment with the doctor as soon as he comes back
from vacation. The patient did not look for another
physician and decided to wait. The patient suddenly
collapses and was diagnosed to have intracranial
hemorrhage. Is the physician to be held responsible?
Answer: Yes. The physician has a legal obligation to
arrange for coverage by another physician.
23. An ophtalmologist performed a cataract surgery on a
patient who went home after the operation. In the
evening, the patient started vomiting and complained of
severe headache. The ophtalmologist refused to accept
that the symptoms were due to postoperative
complications. The patient wanted to see the doctor
immediately but he refused to see that patient. The
patient went to the nearest ER and was diagnosed to
have dislocation of the lens and partial retinal
detachment. Is the physician responsible for the
patients condition?

Answer: Yes, ophtalmologist failed to judge the

patients condition seriously enough to warrant
attention.
24. A 70-year old Chinese man is diagnosed to have
severe osteoarthritis. He told his doctor that he is
using Chinese herbal medicine. He is feeling better.
However, he had two episodes of dizzy spells since he
started that herbal product. What should a doctor
suggest to this patient?
Answer: The doctor should suggest to discontinue the
herbal product which may be causing the dizzy spells.
25. A 35-year old woman is diagnosed to have chronic
throat infection. She is frustrated with the
conventional medicine. She told her doctor that she is
using an alternative homeopathic medicine. She is
feeling much better and she has no other complications.
What should a doctor suggest to this patient?
Answer: The patient can continue an alternative
homeopathic medicine. Alternative medicine therapy is
accepted in the society and is also used along with
conventional therapy.
26. A 45 year old woman is diagnosed to have UTI
(urinary tract infection). She told her doctor that she
could not afford to purchase antibiotics. However, she
is using herbal medicine that is cheaper. She is
complaining of fever and dysuria. What should a doctor
suggest to this patient?
Answer: The patient should discontinue the herbal
medicine immediately and should start antibiotics as
soon as possible.
27. A 13-year old boy with suspected meningitis refuses
therapy. His parents also support that decision because

they are supposed to go on vacation the following day.

What should a physician do in this situation?
Answer: The patient should be admitted and treated in
the hospital. If they refuse, legal action should be
taken.
28. A 2-year old girl is admitted with the diagnosis of
intestinal obstruction. Her mother has a psychiatric
problem. Her mother is not capable of giving the
consent. Her father died one year ago. What should a
surgeon do in this situation?
Answer:Legal steps may be taken to provide a surrogate
decision-maker.
29. A 67-year old widow has been using hypnotics for
the last 5 years. She is addicted. Her doctor wants to
withdraw her from her present medication by trial on
placebos. Is the physician making a right decision?
Answer: No. The physician cannot use placebos because
his decision is deceptive. The problem of addiction
should be discussed directly with the patient. The use
of deceptive placebo is indicated in the following
conditions:
(a) the patient insists on a prescription;
(b) the patient wishes to be treated;
(c) the alternative to placebo is either continue
illness or the use of a drug with know toxicity;
(d) high response rates to placebo (e.g., postoperative
pain, mild mental depression).
30. A 50-year old man is diagnosed to have multiple
sclerosis. In the morning, the surgeon asked the man
his opinion on the surgical procedure and he agreed. In
the evening, the man refused to give consent for the
same surgical procedure. He is also disoriented to
place and time. Is the patient capable of making the
decision?

Answer: No, the patient has impaired capacity.

31. A 55-year old woman with diabetes is diagnosed to
have gangrene on both feet. She was brought to the
hospital. She told the doctor the she is feeling fine
and she has no medical problems. Can she give consent
for the amputation of both legs?
Answer: No. The appointment of a surrogate should be
sought to get the consent for the surgery.
32. A 17-year old boy came to a surgeon for bilateral
vasectomy. He is the father of one child and does not
want to have any more children. He does not want to
tell his girlfriend and parents. He lives with his
parents. What should a surgeon do in this situation?
Answer: Surgeon should not perform bilateral vasectomy
and should offer him less radical alternatives. Please
remember, a mature minor may not comprehend the
implications of this procedure.
33. A 16-year old girl came to a doctor for bilateral
tubal ligations. She is a mother of one child and does
not want to have any more children. She does not want
to tell her boyfriend and parents. She lives with her
parents. What should a doctor do in this situation?
Answer: O & G doctor should not perform bilateral tubal
ligation and should offer her less radical
alternatives.
34. A 16-year old boy wants to donate one of his
kidneys to his friend who is suffering from ESRD (end
stage renal disease). The boys parents did not agree
with his decision. What should a physician do in this
situation?

Answer: The physician cannot accept his kidney.

However, he can donate one of his kidneys if his
parents agree.
35. A 15-year old boy wants to participate in a
research study. He told his parents who did
not agree. He lives with his parents. Can this boy
participate in the research study?
Answer: No the boy needs consent from his parents to
participate in a research study.
36. A 17-year old boy lives independently. He is
married and has one child. He wants to participate in a
research study. Does he need his parents permission?
Answer: No. He is an emancipated minor who lives
independently from his parents physically and
financially.
37. A 70-year old man is diagnosed with terminal
esophageal cancer and requires an insertion of a
gastrostomy tube. He has signed a DNR (Do Not
Resuscitate) order about a month ago. Should the
preexisting DNR order stand or be suspended during the
surgical procedure?
Answer: Attending physician, surgeons, and the patient
or surrogate should discuss the matter and either
affirm or suspend the order in anticipation of surgery.
If a patient is competent and wishes a preexisting DNR
order to stand, resuscitation should not be performed
in the event of an intrasurgical arrest.
38. An infant, born at 30 weeks gestation, appears to
be SGA (small for gestational age) with multiple
malformations. Amniocentesis study was not performed.
Infant needs resuscitation at birth. What should a
physician do in this situation?

Answer: Physician must resuscitate the patient in the

delivery room because the diagnosis is uncertain.
39. A 60-year old man is diagnosed with terminally ill
colon cancer and needs resuscitation. He did not sign a
DNR order. The physician has decided to perform a slow
code on his own. Is this the right decision?
Answer: No. Please remember, a performance of slow
code or show code is not acceptable to the patient.
This decision by the doctor represents the failure to
come to a timely and clear decision about the patients
resuscitation status. DNR (Do Not Rescuscitate)
40. A 20-year old man is diagnosed with suspected
bacteremia and meningitis. He refuses antibiotic
therapy. He collapses and requires resuscitation. What
should a physician do in this situation?
Answer: The physician should resuscitate the patient
despite the patients refusal to antibiotic therapy.
41. A 50-year old woman is diagnosed with severe aortic
stenosis. She collapsed in a doctors office and
required resuscitation. She is waiting for valve
replacement surgery. What should a physician so in this
situation?
Answer: This condition is called physiological
futility. In severe aortic stenosis, vigorous
resuscitation is highly unlikely to restore adequate
cardiac output. Therefore, the physician might
reasonably refrain from resuscitation.
42. A 14-year old boy is diagnosed with terminally ill
cancer. He is not responding to chemotherapy. His
parents want to continue the treatment. However, the
boy does not want to continue his suffering. The
physician told the parents that chemotherapy will not

be helpful. What is the appropriate decision at this

point?
Answer: The boys decision should be respected because
the treatment is futile.
43. A surrogate pregnant mother made a surrogacy
contract with a couple in which she will give the baby
to the couple. She developed complications in the first
trimester and wanted to abort. Is she allowed to do
that?
Answer: Yes. If her life or health becomes threatened
from continuing the pregnancy, she should retain her
right to abortion.
44. A physician became sexually involved with a current
patient who initiated or consented
to the contact. Is it ethical for a physician to become
sexually involved?
Answer: No. Sexual involvement between physicians and
former patients raises concern. The physician should
discuss with a colleague or other professional before
becoming sexually involved with a former patient. The
physician should terminate the physician-patient
relationship before initiating a romantic or sexual
relationship with a patient.
45. A physician decided to take care of his own family
members and relatives. He is a very smart physician. Is
this a right decision?
Answer: No. The physician should encourage all friends
and family members to have their own personal
physician.
46. A male patient wants to have a copy of his medical
records. What should a physician do in this situation?

Answer: The physician should retain the original of the

chart. Information should only be released with the
written permission of the patient or the patients
legally authorized representative (e.g., attorney).
47. A 30-year old female wants to have an abortion. Her
physician objects to abortion on moral, religious, or
ethical grounds. What should a physician do in this
situation?
Answer: Physician should not offer advice to the
patient.
48. A physician sees patients at a reduced fee. He
spends very little time with each patient. Is the
physician doing the right thing?
Answer: No. The physician is not providing optimal
care.
49. A surrogate pregnant mother signed a surrogacy
contract with a couple. Male partner gave sperms which
were artificially inseminated to the surrogate mother.
Surrogate mother has a genetic relation to the child.
She wants to void the contract after the baby is
born. Is she allowed to breach the contract?
Answer: Yes. Surrogate contracts, while permissible,
should grant the birth mother the right to void the
contract within a reasonable period of time after the
birth of the child.
50. A surrogate pregnant mother signed a surrogacy
contract with a couple. Both male and female parents
gave sperm and ovums respectively. The surrogate mother
wants to void the contract and she has no genetic
relation. Is she allowed to breach the contract?
Answer: No. Genetic parents have exclusive custody and
parental rights.

NEUROANATOMY (THURSDAY)
1.The optic nerve enters the orbit passing through the
optic canal is accompanied by the:
A.Ophthalmic artery
B.Suspensory ligaments of the eye
C.Ophthalmic vein
D.Trochlear nerve
A

2.What structure in the middle ear separates the

tympanic cavity from the meninges and temporal lobe
of the brain?

A.Floor of the middle ear

B.Anterior wall of the middle ear
C.Tegmen tympani
D.Mastoid antrum
C

3.Inadequate treatment of otitis media can result in

acute mastoiditis due to spread via what structure?

A.Semicircular ducts

B.Mastoid antrum
C.Petrous bone
D.Tegmen tympani
B

4.The spinal cord is anchored vertically to the

coccyx by the:

A.Denticulate ligament
B.Ligamentum flavum
C.Lilum terminale
D.Cauda equina
C

5.The fasciculus cuneatus is found at this spinal

cord segment:

A.Lumbar
B.Sacral
C.Thoracic
D.Cervical
D

6.The lateral corticospinal tract carry these

impulses to the effector organs:

A.Motor
B.Sympathetic
C.Sensory
D.Parasympathetic
A

7.Pain and temperature impulses on the left sole

ascends to the thalamic area via:

A.Ipsilateral lateral spinothalamic tract

B.Ipsilateral posterior column
C.Contralateral lateral spinothalamic tract
D.Contralateral posterior column
C

8.Loss of pain ad temperature sensation at the level

of the umbilicus points to a lesion at this cord
level:

A.T10
B.T8

C.L2
D.T12
B

9.The fiber tract that coordinates the functions of

cranial nerves II, IV and VI:

A.Medial lemniscus
B.Medial longitudinal fasciculus
C.Fasciculus gracilis
D.Lateral meniscus
B

10.The efferent nucleus of the pupillary light reflex

is:

A.Lateral geniculate body

B.Edinger-Westpal
C.Oculomotor nucleus
D.Trouchlear nucleus
B

11.CSF flows from the 3rd ventricle to the 4th

ventricle via:

A.Formina of Monro
B.Cerebral aqueduct
C.Foramina of Magendie
D.Foramina of Luschka
C

12.Pain and temperature sensation from the head is

received in the brainstrem by the:

A.Mesencphalic nucleus of V
B.Motor nucleus of V
C.Trigeminal spinal nucleus
D.Nucleus ambigous
C

13.Which is an INCORRECT statement about an

intervertebral disc?

A. During aging, fluid within the nucleus pulposus is

replaced by fibrocartilage
B. Atlanto-axial joint possesses no disc
C. Nucleus pulposus is most likely to herniate in an
anterolateral direction

D. Disc are thickest in the lumbar region

C

14. After extensive surgical dissection in the

posterior cervical triangle, drooping of the skin in
the neck was noted postoperatively. This is due to
injury of what nerve?

A.Trigeminal
B.Spinal accessory
C.Hypoglossal
D.Facial
D

15.Not found in the CNS:

A. Astrocytes
B. Bipolar cells
C. Schwann cell
D. Brainstem
C

16.Space between the cornea and the iris and lens:

A.Anterior chamber
B.Posterior chamber
C.Vitreous cavity
D. Aqueos humor
A

17.A severe infection that obstructs the middle meatus

would affect drainage from each of the following
sinuses EXCEPT the;

A.Maxillary sinus
B.Frontal sinus
C.Nasolacrimal duct
D.Anterior ethmoid air cells
C

18.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 nerve
B.Vagus nerve
C.Glossopharyngeal nerve
D.Facial

19.When a patient attempts protrusion of the tongue,the

tongue deviates to the right. This would indicate
damage to which of the following nerves?

A.Right glossopharyngeal
B.Left accessory
C.Right hypoglossal
D.Left hypoglossal
C

20.If a patient presented with a permanently dilated

pupil, which one of the following nerves could be
assumed to be involved?

A.Optic
B.Sympathetic trunk
C.Ophthalmic
D.Occulomotor
D

21.Following a tonsillectomy, a patient noted loss of

general sensation and taste from the posterior 1/3 of

the tongue. It could be assumed that the

was a branch of the;

injured nerve

A.Glossopharyngeal nerve
B.Facial nerve
C.Lingual nerve
D.Vagus nerve
A

22. A stab wound on the neck which injures the spinal

root of CN XI results in the following signs and
symptoms EXCEPT:

A loss of pain sensation on the shoulder and upper

chest
B. drooping of the shoulder
C. inability to elevate the shoulder
D. weakness and atrophy of the trapezius
A

23. The cerebral aqueduct is located in the:

A. cerebrum
B. midbrain

C. diencephalons
D. pons
B

24. Damage to the anterior division of the middle

meningeal artery may results in what type of
intracranial hemorrhage:

A. extradural hemorrhage
B. subdural hemorrhage
C. subarachnoid hemorrhage
D. weakness and atrophy of the trapezius
A

25. In which bone is the inner ear located?

A. Sphenoid
B. Temporal
C. Parietal
D. Occipital
B

26. Regarding the tympanic cavity, which of the

following statements is/are true?

A. an airfilled space in the petrous portion of the

temporal bone
B. communicates with the pharynx via the eustachian
tube
C. houses the incus, malleus and stapes
D. All of the above
D

27. All are supplied by the oculomotor nerve, EXCEPT;

A. Superior rectus
B. Medial rectus
C. Inferior oblique
D. Lateral rectus
D

28. The inability to focus horizontally or vertically

is a problem inherent to the;

A. Cornea
B. Lens
C. Vitreous humor
D. Retina

29. Neurologic examination of a 37-year old alcoholic

man with clumsiness of his right hand revealed poor
dorsiflexion of the hand at the wrist. He most likely
injured his:

A. Median nerve
B. Brachioradialis nerve
C. Musculocutaneous nerve
D. Radial nerve
D

30. Which of the following statement is true regarding

transection of the optic nerve?

A. Direct pupillary light reflex would be unaffected

B. The affected eye will be blind
C. There would be bitemporal hemianopsia
D. Consensual light reflex would be lost on the
affected eye
B

31. Which of the following reflexes is a monosynaptic

reflex?

A. Achilles reflex
B. Pupillary light reflex
C. Corneal reflex
D. Extensor plantar reflex
A

32. Which of the following blood vessels would be most

likely involved in patient showing homonymous
hemianopia with macular sparing?

A. Internal carotid artery

B. Posterior cerebral artery
C. Middle cerebral artery
D. Anterior cerebral artery
B

33. Which of the following statements are/is true of

the middle cerebral artery?

A. It supplies the occipital and posterior portion of

the temporal lobe
B. It is the continuation of the internal carotid
artery

C. It supplies the portion of the motor cortex

corresponding to the legs
D. It gives rise to the medial striate artery
B

34. Which of the following centers is located in the

frontal lobe?

A. Brocas speech area

B. Wernikes speech area
C. Primary visual area
D. Primary auditory area
A

35. Which tendon of the following muscles is tapped to

illicit the knee-jerk reflex?

A. Quadriceps femoris
B. Sartorius
C. Tibialis anterior
D. Popliteus
A

36. A laboratory technician not aware of the gluteal

anatomy gave his friend a flu shot at the lower aspect
of the right gluteus. Afterwards, his friend noted
decreased sensation over the anterolateral aspect of
the right leg and foot. Also his right foot was noted
to drop and drag to the floor. Which of the nerves was
probably injured?

A. Common peroneal nerve

B. Sciatic nerve
C. Tibial nerve
D. Obturator nerve
A

37. A 20 year old patient sustains a deep cut on the

volar surface of right wrist. Median nerve injury would
affect which of the following muscles?

A. Medial lumbricals
B. Thenar
C. Dorsal interossei
D. Palmar interossei
B

38. Which of the following ligaments is traversed by

the needle in performing a lumbar tap?

A. Posterior longitudinal
B. Cruciate
C. Anterior longitudinal
D. Ligamentum flavum
D

39. When a persons neck and trunk are flexed, as in

preparation for a spinal tap, the spinous process of C7
becomes visible and it is for this reason that it is
called:

A. Spina bifida
B. Vertebra prominen
C. Atlas
D. Intervertebral disc herniation
B

40. In patient with fracture of the middle humerus ;

the following muscles will be denervated EXCEPT:

A. Triceps brachii
B. Extensior digitorum communis
C. Abductor pollicis

brevis

D. Supinator
C

41. Which branch of the brachial plexus DOES NOT give

off branch(es) to the upper arm and shoulder?

A. Musculocutaneous nerve
B. Radial nerve
C. Ulnar nerve
D. Circumflex nerve
C

42. Which of the following muscles of mastication

protracts the jaw?

A. masseter
B. lateral pterygoid
C. temporalis
D. medial pterygoid
B

43. Optic nerves are formed by axons of neurons found

in the ___ layer of the retina.

A. Ganglion
B. Inner nuclear
C. Outer nuclear
D. Photoreceptor
A

44. Which of the following structures forms part of the

vascular coat of the eyeball?

A. Choroid
B. Retina
C. Conjunctiva
D. Sclera
A

45. Which of the following nerves subserve/s taste

sensation from the posterior third of the tongue?

A. Vagus
B. Glossopharyngeal
C. Facial
D. All of the above
B

46. An intern is trying to elicit the presence of

corneal blink reflex on a patient. Which of the
following cranial nerves is the afferent arm of this
reflex?

A. II
B. V
C. III
D. VII
B

47. A patient with tertiary syphilis has impairment of

his sense of orientation and position in space. This is
indicative of a damage to the:

A. Pyramidal tract
B. Antero-lateral spinothalamic tract
C. Dorsal column pathway
D. Corticospinal tract
B

48. Special somatic afferent fibers are found in which

of the following cranial nerves?

A. II

B. VIII
C. VI
D. IX
A

49. A blind-folded woman was made to guess the letter

written on her palm. The second-order neuron of the
involved sensory pathway is located at the:
A. Dorsal horn
B. Nucleus cuneatus
C. Fasciculus cuneatus
D. Nucleus gracilis
B

50.In cases of nerve fiber injury, what structure in the

perikaryon will be decreased in number?
A.Mitochondria
B.Nissl body
C.Golgi apparatus
D.Ribosome
B

PHYSIOLOGY(FRIDAY)
1. A 62 old man with COPD presents to the ER in
respiratory distress. The physician uses
succniylecholine to produce muscle relaxation prior to
tracheal intubation. Soon after infusion he developed
severe bradycardia. Which drug would counteract the
bradycardia without affecting muscle relaxation:

A.Curare
B.Atropine
C.Epinephrine
D.Acetylcholine
B

2.When a pheochromocytoma suddenly discharges a large

amount of epinephrine into the circulation the
patients heart rate would be expected to:

A.Increase because epinephrine has a direct

chronotropic effect on the heart
B.Increase because of increased parasympathetic
discharge to the heart
C.Decrease because the increase in blood pressure
stimulates the carotid and aortic baroreceptor
D.Decrease because of increased tonic parasympathetic
discharge to heart
A

3.Loss of fear and emotion is often observed in the

lesion at:

A.Subthalmic

nucleus

B.Thalamus
C.Amygdaloidal nucleus
D.Substantia nigra
C

4.Which of the following will require the smallest

increase in oxygen consumption by the heart:
A.Generating an increase in left ventricular
pressure.
B.Severe hypertension.
C.Generating an increase in stroke volume.
D.Aortic stenosis
C
5.A 53 year old man complains of mild chronic
cough and heart burn. Esophageal manometric and
endoscopic evaluation reveals a lower esophageal
sphincter [LES] pressure and mild gastro
esophageal reflux. Which of the following is the
primary genesis of LES pressure in adult?
A.Tonic excitatory sympathetic nerve input to
the smooth muscles
B.Tonic excitatory parasympathetic nerve input
to the smooth muscle
C.Circulating gastrin
D.Myogenic properties of LES smooth muscle

D
6.A 16 years old girl complains of being tired
more than usual, she also complains Of muscle
cramps in her legs and generalized weakness
after exercise. Her BP 160/100 mmHg. Her ECG
showed prolong QT interval and U wave. Blood
analysis showed hypokalemia and metabolic
acidosis. Plasma rennin activity and
aldosterone level are lower than normal. Her
clinical condition reversed after she is placed
on diuretic amiloride, which blocks tubular
epithelial channels. Based on this finding,
which of the following renal transport processes
is major defect causing her metabolic disorder?
A.Greater than normal
proximal tubules
B.Greater than normal
distal tubules
C.Inability of distal
potassium ions
D.Inability of distal
ions
B

sodium reabsoption by the

sodium reabsoption by the
nephron to secret
nephron to secret hydrogen

7.In starvation which of the following is

reduced:
A.Plasma T4
B.PlasmaT3
C.Tri-iodothyroxine
D.Thyroxin
B
8. What effect does urine pH have on salicylate
clearance?

A. Stomach: Low pH, acidic. Salicylate will be

unionized, therefore absorbed across stomach. Stomach
has small surface area, so not much will be absorbed
B. Intestines:pH 7-8:Salicylate will be more ionized,
therefore harder to cross membrane o Intestines have
large surface area and some salicylate will be
unionized still, so significant amount will be absorbed
C. Kidney:Ultrafiltrate of plasma passes through
kidneys from circulation. Blood is well buffered, and
hence cant change pH.The glomerulus filters the
plasma. Drug is filtered out, and some cross membrane
D. All of the above
D
9. Salicylate clearance;
A. In an overdose, give patient something alkali to
drink to make urine more alkali, and increase rate of
clearance
B. Increased clearance rate, a problem when you want to
maintain drug in a therapeutic range (i.e. plasma
concentrations where drugs work). E.g. cardiac
glycoside has narrow range
C. A & B
D. None of the above
C
10-Enterogastric nervous reflexes from the duodenum:
A.Promotes antral contraction
B.Are activated by isotonic antral fluid

C.Are activated by increase PH of antral mucosa

D.Produce inhibitory effect on gastric contraction
D
11.A young woman is found comatose, having taken
unknown number of sleeping pills an unknown time
before. An arterial blood sample yields the following
values: pH 7.0 2HCO314 meq/L PaCO2 68 mmHg. This
patient's acid-base status is most accurately described
as:

A.Uncompensated metabolic acidosis

B.Uncompensated respiratory acidosis
C.Simultaneous respiratory and metabolic acidosis
D.Respiratory acidosis with partial renal compensation
C
12.A 20-monthes old baby presented to the pediatrician
for check up. On examination Babinski sign was
elicited, this may indicate damage to which of the
following:
A.Spinal cord
B.Cerebellum
C.Brainstem
D.Pyramids
D
13.The upstroke of ventricular action potential is
primarily due to which one of the following actions:
A.An inward flux of Ca2
B.An inward flux of K+ current

C.An inward flux of Na+

D.An outward flux of K+ current
C
14.You are asked to assess a patient in ICU who is
ventilated at frequency of 12/min and a Tidal volume of
0.6L. His arterial PH> 7.6, to correct his condition
you should:
A.Decrease
B.Decrease
C.Increase
D.Increase
B

Dead space
Tidal volume
oxygen fraction
mint ventilation

15. If the FSH producing cells were selectively

destroyed this would lead to:
A.Decrease
B.Decrease
C.Decrease
D.Increase
C

level
level
sperm
level

of testosterone
of LH
count
of testosterone

16. If natural Killer cells are selectively destroyed

by irradiation then:
A.Adaptive immunity will be affected
B.Lyses of tumor cells will be accelerated
C.Host rejection of bacteria infected cells will be
impaired
D.Host rejection of tumor cells will be impaired
D
17.If electron transport chain is inhibited, which of
the following cells will be least or not affected:

A.Cardiac muscle cells

B.Parietal cells of the stoma

C.Proximal convoluted tubule cells
D.Red blood cells
D
18. A 23 years old female presents with fatigue and
found to have higher than normal COP, most likely she
has:

A.Hypertension
B.Aortic regurgitation
C.Anemia
D.Hyperthyroidism
C
19. If the patient is unable to hear high frequency
sounds, the damage to the basilar membrane is closest
to which of the following:

A.Oval window
B.Cochlea
C.External meatus
D.Schala Media
A

20. The following values are measured for potassium ion

in a human subject.Plasma K+ 5 meq/liter, Urine K+ 50
meq/liter,Renal creatinine clearance 80 ml/min,Urine
formation rate 1.5 ml/minute.This patient's potassium
clearance is closest to which of the following?

A.5 ml/minute
B.7.5 ml/minute
C.15 ml/minute
D.50 ml/minute
C

Question 21- 25; Match the following lesion in the

pyramidal tract of one side with their respective
effects:
A

B
21. In crus of the
midbrain
C
22.In the cerebral
cortex in the left
side
A

A.Monoplegia and
aphasia
B.Hemiplegia and
sensory disturbances
in the opposite side

23.In the internal

capsule
B

C.Contralateral
hemplegia and
ipsilatral eye is
fixed downward and
outward

24.In the medulla

above motor
decussation

D.Contralateral
hemplegia and
ipsilatral facial

pulsy

25.In the pons

D

E.Contralateral
hemplegia and
ipsilatral lingual
muscle paralysis

Question 26- 30;For each of the intravenous

fluids, select the most appropriate option:
A

B
26. 50 glucose
C
27. 1.8% saline
D
28. 5 % glucose
B
29. Normal saline
A
30. 8.4% sodium
bicarbonate
E

A.Isotonic solution
mainly expands the
ECV
B.Isotonic solution
mainly expands ICV
& ECV
C.Major nutrient
used in IV
nutrition
D.Hypertonic fluid
with about twice
the osmolarity of
plasma
E.Occasionally used
in severe acidosis

31. A patient with a traumatic aortic rupture undergoes

aortic repair. The patient presents with hoarseness
after surgery. The most likely cause of hoarseness is?
A.
B.
C.
D.
C

Postoperative viral infection

Damage to phrenic nerve
Trauma to recurrent laryngeal nerve
injury to sympathetic chain

32. A 35 year old male is involved in a head on motor

vehicle accident. On arrival to the emergency room, he
has severe bruises to his chest but is otherwise
stable. The chest X ray reveals a widen mediastinum. An
angiogram is ordered which reveals a traumatic aortic
rupture. The most common site of aortic rupture after
severe blunt trauma to the chest is ?
A.
B.
C.
D.
D

Ascending aorta
Abdominal aorta
Aortic arch
Descending aorta distal to left subclavian artery

33. Failure to develop the 3 and 4th pharyngeal pouches

are linked to what immune disorder?
A.
B.
C.
D.
C

AIDs
SCIDs
DiGeorge
CGD

34. Which of the following is false about bombesin?

A.
B.
C.
D.
D

It is an autocrine growth factor

It is found in the gi tract
Contracts gall bladder
Functions as an endocrine hormone

35. Which lung cancer is commonly associated with

hypercalcemia?
A.
B.
C.
D.
B

Small cell
Squamous cell
Adenocarcinoma
Carcinoid

36. Which lung cancer is most commonly associated with

the SIADH SYNDROME?
A.
B.
C.
D.

Squamous cell
Carcinoid
Small cell
Adenocarcinoma

C
37. In ethanol drinking, the typical enzymatic pattern
of liver enzymes is?
A.
B.
C.
D.

AST> ALT
ALT> AST
elevated alkaline phosphatase
elevated bilirubin

A
38. Aspirin allergy is related to?
A.Arachidonic acid
B.Bradykinin
C.Leukotrienes
D.Histamine
C
39. The slow releasing substance of anaphylaxis is?

A.
B.
C.
D.
D

Histamine
Bradykinin
Serotonin
Leukotrienes

40. Parafollicular cells of the thyroid secrete:

A.
B.
C.
D.
A

Calcitonin
Amyloid
Thryoglobulin
Parathyroid hormone

41. A 55 year old previously healthy male has been

complaining of palpitations for the past 3 months. He
was seen in the cardiology clinic. After a quick
physical exam, the ECG reveals that he has atrial
fibrillation. Five minutes later, you noticed that the

patient is not responsive and has a Blood Pressure of

60/20. The next step in his management is?
A.
B.
C.
D.
D

Amiodarone
Quinidine
Lidocaine
Cardioversion

42. Which of the following is false about Amiodarone?

A.
B.
C.
D.
D

is used for both atrial and ventricular arrhythmias

blocks sodium, calcium and potassium channels
can cause corneal deposits
Has a very short half life

43. Which of the following is false about beta

blockers?
A. Metoprolol is useful in the treatment of patients
after an MI
B. Metoprolol can depress the cardiac output
C. Beta blockers reduce arrhythmias
D. Oral Esmolol is effective for outpatient treatment
of hypertension
D
44. Which of the following is false about Adenosine?
A. Adenosine is a normal component of body tissues
B. The drug is effective is treating atrial arrhythmias
C. It has a very short duration of action

D. It depolarizes the AV node to decrease the nodal

arrhythmias
D

45. Which of the following is false about calcium

channel blockers?
A.
B.
C.
D.
D

can be used to treat hypertension and arrhythmias

block L calcium type channels
PR interval is typically shortened by these agents
Effective in patients with congestive heart failure

46. Digoxin induced arrhythmias can be decreased by?

A.Calcium
B.Sodium
C.Magnesium
D.Uranium
C
47. The beta blocker which is classified as a class 3
anti-arrhythmic agent is?
A.Metoprolol
B.Atenolol
C.Esmolol
D.Sotalol
D
48. The major mechanism of class 3 anti arrhythmic
agents is?
A.Inhibition of Sodium influx

B.Inhibition of l type Calcium channels

C.Reducing outward phase of Potassium current
D.Inhibiting Na K ATPase
C
49. The agent which can sometimes be used to treat
digoxin induced arrhythmias is?
A.Quinidine
B.Amiodarone
C.Phenytoin
D.Sotalol
C
50. The diuretic used in the treatment of mountain
sickness is?

A.Acetozolamide
B.Furosemide
C.Thiazide
D.Spironolactone
A

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