Anatomy Past Paper PDF

Anatomy 1. which of the following structure does not related to the parasympathetic innervation of the submandibular gland? A) lingual nerve B) submandibular ganglion C) chorda tympani D) superior salivatory nucleus E) lesser petrosal nerve 2: a man feels severe pain at lower right quadrant as he l...

Anatomy 1. which of the following structure does not related to the parasympathetic innervation of the submandibular gland? A) lingual nerve B) submandibular ganglion C) chorda tympani D) superior salivatory nucleus E) lesser petrosal nerve 2: a man feels severe pain at lower right quadrant as he lifts a heavy object. Surgery is indicated and during surgery surgeon finds a hernial sac just above inguinal ligament and lateral inferior epigastric vessels. What type hernia is this? A) femoral hernia B) indirect inguinal hernia C) direct inguinal hernia D)abdominal hernia E) incisional hernia 3: which of the following anatomic regions is used for harvesting eggs from ovaries or remove an ectopic pregnancy? A) ischiorectal fossae B) retrocecal recess, ischiorectal fossae C) vagina, rectouterine (dougles) pouch D) vesicouterine pouch E) lateral and medial paracolicgutters 4)lingual carcinoma in the posterior part of the tongue metastasizes ___ lymph nodes A) inferior deep cervical B)jugular C) sublingual D) submandibular E) superior deep cervical 5) which part of the gastrointestional system Is sensitive to pain, temperature, touch and pressure? C) lower half of anal canal 6) the root of the mesentery is approximately 15cm long. It passes inferiorly and to the right, from the duodenojejunal junction to the ileocecal junction crossing the all following which one is the exception? A) right ureter B) left testicular or ovarian vessels C) abdominal aorta D) ascending and horizonal parts of the duodenum E) inferior vena cava 7) splenic artery was ligated near to celiac trunk to stop bleeding of rupture spleen. Which of the organs following structures is least likely affected by ligation? A) greater omentum B) body of pancreas C) stomach D) duodenum E) tail pancreas 8) paralysis of ___ muscle produces the tongue has tendency to fall posteriorly. A) hyoglossus B) inferior longitudinal C) genioglossus D) superior longitudinal E) styloglossus 9) peyers patches is observed in which part of the intestines? A) 3rd part of the duodenum B) caecum C) ileum D) 2nd part of the duodenum E) root of mesentery 10) the vagus nerve supplies motor parasympathetic innervation to all of the following structures, except? A) appendix vermiform B) ascending colon C) pyloric part of stomach D) sigmoid colon E) jejunum 11) 60 year old woman arrived at the emergency room complaing acute abdominal pain. She was ___ branches of the inferior mesenteric artery. Which of the following is most likely not to be seriously affected? A) caecum B) sigmoid colon C) descending colon D) splenic flexure E) rectum 12) a surgical approach to the abdomen necessitate a midline incision between the 2 rectus sheath A) arcuate line B) semilunar line C) limes aspects D) ileopectneal line E) linea alta 13) which of the following structure pierces the sphenomandibular ligament? A) auriculotemporal nerve B) mylohyoid neurovascular bundle C) maxillary artery D) inferior alveolar neurovascular bundle E) lingual nerve 14) which of the following mastication muscle attaches to the articular disc of TMJ? A) anterior part of temporal B) posterior part of temporal C) masseter D) medial pterygoid E) lateral pterygoid 15) during laparoscopic cholecystectomy in a 47 year old female patient the doctor accidentally clamped the. Which of the following vessels would most likely be occluded in this iatrogenic injury? A) superior mesenteric artery B) common hepatic artery C) proper hepatic artery D) inferior vena cava E) splenic artery 16) inferior mesenteric vein usually joins with which vein? A) portal vein B) superior mesenteric C) inferior vena cava D) left renal E) splenic Physiology: 1: which of the following statement is wrong regarding lipid digestion and absorption? A) micelles formed in the intestinal lumen must interact with unstirred water layer B) chylomicrons released from secretory granules into interstitial space by exocytosis C) chylomicron remnants are cleared from the circulation by hepatic receptors that recognize apolipoprotein E D) triglyceride component of chylomicrons is removed by triglyceride hydrolase located on the vascular endothelium E) bile salts emulsify lipids, thereby increasing the surface area available to lipolytic enzymes 2: which of the following statement is not correct regarding the water and electrolyte fluxes in the large intestine? A) luminal bicarbonate neutralizes acid load generated by short chain fatty acids B) short chain fatty acids in the lumen of large intestine augment the absorption water C) net water flux in the large intestine favors absorption D) secretes 400-1000 ml of fluid each day E) secretion of HCO3- occurs in exchange for absorption of CI- 3) when a person is in the fasting state, A) Glucose is the only fuel used by the central nervous system B) gluconeogenesis is inhibited C) Basal metabolic rate BMR decrease D) liver glycogen levels are increased E) the excretion of urea in the urine decreases 4) which of the following true for the pancreatic function and secretion? A) cholecytoskinin is considered to be major regulator of pancreatic growth B) all pancreatic enzymes are synthesized and secreted by the duct and myoepithelial cells C) cholecystokinin stimulates the pancreas to contract and release stored juice into the intestine D) increase in secretion rate results in decrease in K= concentration but E) portal circulation within the pancreas causes exocrine secretion to after 5) which of the following events take place when pH in the gastric lumen is reduced below A) O-cells are inhibited by a paracrine mechanism B) ECL cells release histamine to further stimulate the parietal cells C) somatostatin is given into blood circulation D) vagal fibers inhibit the D-cells E) G-cells release more gastrin into blood circulation 6) all of following is absorbed with Na+ through the intestine in the same way except: A) glucose B) dipeptides C) Ci- D) H+ E) amino acids 7) which of the following is correct regarding hepatic circulation? A) hepatic artery supplies majority of its blood supply B) stellate cells play important role in phagocytosis of microorganism C) capacitance function of the liver plays an important role during hemmorrahage D) the cells in zone 1 are situated near central vein E) accounts for approximately 10% of cardiac output 8) Gastrin releasing peptide (GRP) 1) is released during the cephalic phase by the 2) can be released during the gastric phase by 3) acts on G cells to release gastrin into blood circulation 4) is neurotransmitter released by preganglionion A) 2 and 4 correct B) all are correct C) 1,2,3 are correct D) 4 is correct E)Only 1 and 3 correct 9)which of the following statement is wrong regarding the functions of colonic microflora? A) immune modulation and regulation of T cell function by SCFA production B) conversion of bilirubin to urobilinogen C) regulation of intestinal barrier function by SCFA production D) lactate production and conversion to SCFA ( short chain fatty acids) E) production of certain vitamins like vitamin C and E 10) which of the following is not correct regarding hepatic circulation? A) kuppfer cells play important role in phagocytosis of microorganisms B) account for approximately 10% of cardia output C) capacitance function of the liver plays an important role during hemorrhage D) the cells in zone 3 are situated near central veins E) portal vein supplies majority of its blood supply 11) Which one of the following statements about small intestinal motility is correct? A) vagotomy abolishes contractile activity during the digestive period B) peristalsis is the major contractile pattern during feeding C) migrating motor complexes occur during the digestive period D) contractile frequency is constant drom duodenum to terminal ileum E) contractile activity is initiated in response to bowel wall distention 12) all of the following is related with thiamine deficiency except___ A) anemia B) peripheral vasodilation C) weakened cardiac muscle D) polyneuritis E) gastrointestinal disorders 13)which of the following is not associated with increased feeding behavior? A) release of a-melanocyte stimulating hormone in the brain B) inhibition of ventromedial nucleus of the hypothalamus C) stimulation of ventrolateral nucleus of the hypothalamus D) ghrelin release from the stomach E) release of neuropeptide Y in the brain 14) the principal paracrine secretion involved in the inhibitory feedback regulation of gastric acid secretion is __ A) enterogastrone B) somatostatin C) histamine D) gastrin E) acetylcholine 15)which of the following is correct for the regulation of salivary secretion? A) norepinephrine as a neurotransmitter stimulating the blood flow B) parasympathetic input to parotid gland from the facial nerve CN VII C) stimulation of salivary nuclei by chewing taste and smell D) parasympathetic input to submandibular gland from the glossopharyngeal nerve CN IX E) decreased salivation associated with manipulative activities and stimulation of pressoreceptors in the mouth 16) which of the following is not likely to be found within the pancreatic acinus? A) chymotripsinogen B) procolipase C) tyripsin inhibitor D) tyripsin E) ribonuclease Gastroenterology: 1: Which of the following is correct regarding abdominal pain? A) most patients with chronic abdominal pain have organic disorder B) ischemia, inflammation, or distention of hollow organs or capsular stretching of solid organs produces visceral type pain C) subdiaphragmatic irritation produces right infrascapular pain D) parietal pain is caused by irritation of fibers that innervate the visceral peritoneum E) a history of abdominal surgery is a risk factor for diverticulitis 2) which of the following statements is most accurate? A) the peak age for the diagnosis of AIH is 75-80 B) IgG level is more valuable marker for disease activity than alkaline phosphatase level in AIH C) Its difficult to distinguish between hepatitis B and AIH on liver biopsy D) autoimmune hepatitis is a rare condition which decreasing in incidence E)IgM elevation nis a characteristic feature of autoimmune hepatitis 3) which of the following statement is not correct for inflammatory bowel disease? A) perianal disease is more frequently seen in Crohns disease than ulcerative colitis B) fistulas are more frequently seen in Crohns disease than ulcerative colitis C) ulcerative colitis is a disease limited to colon D) ulcerative colitis composes a superficial continuous inflammation in colon E)p-ANCA positivity is frequently observed in Crohns disease 4) von meyenburg complex is a benign liver malformation that includes biliary cystic lesions with __ A) liver cancer B) liver adenomas C) congenital hepatic fibrosis D) congenital portal hypertension E) congenital heart disease 5) 18 yr old male is presented for evaluation of painless jaundice. He initially presented to a campus health center for evaluation of a flu-like illness with high fevers, where mild scleral icterus was noted. Initial laboratory studies revealed a normal complete blood count, normal alkaline phosphatase level and normal alanine aminotransferase ALT and aspartate aminotransferase AST levels as well as total serum bilirubin of mg/dl and direct serum bilirubinof0.4mg/dl. Serologic testing for hepatitis was negative. At this visit, the flu-like illness has spontaneously resolved, and repeat laboratory testing reveals that total serum bilirubin has returned to normal. He has not taken any medication for his illness. What is the most likely cause of this patients elevated serum bilirubin level? A) primary sclerosing cholangitis B) transient biliary obstruction caused by gallstone C)gilberts syndrome D) acute viral hepatitis E) primary biliary cirrhosis PBC 6) 35 year old presents to the clinic with complaints of earlt sabiety, bloat, and swelling of lower extremeties __ pain. He reports no blood in stools or diarrhea. Labs showed normal hemoglobin, normal liver function and, (normal 6-8g/dl), serum albumin is 2.7g/dl(notmal 3.5 to 5/dl). There is no other apparent cause of__ ei liver dieeases. A diagnosis of proten-losing enteropathy is suspected. Which of the following is the next__? A) lactose tolerance test B) esophagogastroduodenoscopy C) technetium 99 labeled serum albumin scintigraphy D) fecal alpha-1 antitrypsin A1AT clearance test E) colonoscopy 7) 45 year old woman admits to emergency room with jaundice and whitish clay like stool for the last two days. Based on these signs which of the following diagnosis is most likely? A) portal vein thrombosis B) cirrhosis C) acute cholecystitis D) acute viral hepatitis E) head of pancreas tumor 8) which one of the following virus is the major cause of hepatocellular carcinoma in the world? A) hepatitis D B) hepatitis C C) hepatitis A D) hepatitis B E) hepatitis E 9) which of the following is not an acknowledge cause of erythema nodule? A) romatoid arthritis B) tuberculosis C) ulcerative colitis D) crohns disease E) sarcoidosis 10) in the pathogensis of acute fulminant liver failure__ is the other major component of the pathogensis togetherwith the liver failure. A) dehidratation B) brain swelling C) hypertension D) steril inflammation E) muscle contractions 11) which one of the following gene mutation is responsible for Wison__ A) p53 B) H63D C) C282 D) ATP7B E) AMP6 12) which of following are true for Hepatitis E virus? I RNA virus II cause chronic liver disease III cause fulminant hepatitis especially in pregnant women IV most common in East and south America A) I and II B) II and III C) II and IV D) I and III E) III and IV 13) 36 yearold male complains of intest mid abdominal pain that radiates to his back. The pain started 5 hour ago after he car__ states that he found him groaing of pain on his bed in the fetal position. He says that curling himself up in the fetal psotion_ reports nausea and he vomited 2 times since the pain started. He denies alcohol use. He has cholelithiasis as past medical history the vomitus, diarrhea or constipation. Vital signs BP:125/80mm Hg, HR:102bpm, T:36,4C and oxygen saturation:98% on abdomen is soft with tenderness in the mid-epigastrium and murphy’s sign is negative. Which of the following is the best next diagnosis in this patient? A) endoscopic retrograde cholaniopancreatography (ERCP) B) A blood test and CT of the abdomen C) stool culture D) Ct of the abdomen only E) a blood test only 14) which one of the following condition does not increase risk of gastric adenocarcinoma? A) postgastrectomy stumps B) gastric adenomatous polyps C) incomplete intestinal metaplasia D) atrophic gastritis E) duodenal ulcer 15) 30 year old female presents to the hospital with complaints of epigastric abdominal pain, nausea, and vomiting for one day. Her blood pressure is 110/70mmHg, heart rate is 84bpm, oxygen saturation of 99% on room air and she is afebrile. She does not drink alcohol, there is no evidence of gallstones on ultrasonography. Physical exam reveals tenderness in the epigastrium and the pateints prefers to sit while leaning forward. What laboratory tests should be ordered to diagnose the etiology in her current condition? A) serum TSH levels B) Serum LDH levels C)Serum total cholesterol levels D) HbA1C levels E) serum triglyceride levels 16) which of these listed is the medical term for vomiting of blood? A) melena B) hematochezia C) hematuria D) hematemesis E) hemoptysis 17) 50 year old female patient referred to ur outpatient__ mellitus and adiposity with a BMI of 42kg/m 2. HbA1c__ examination liver was palpable below right costal margin__ following: HBsAg negative, HBsAb: positive, HBcAg: negative A) treatment with ursodeoxycholic acid B) treatment with prednisolone C) immediate start with antiviral therapy D) immediate start of insulin to control diabetes mellitus E) lifestyle changes and loss of weight 18) which of the statement is not one of the common characteristic? A) each can have disease course with remissions and relapses B) they both increase colon cancer risk C) each can cause chronic inflammation in colon D) each can present with extraintestinal symptoms E) the cure for both diseases includes total colectomy Pathology: 1. 47 year old female patient had fever and flu-like symptoms. On physical examination she had severe right quadrant abdominal pain with palpitation. Microscopically, spotty-focal necrotic areas of the parenchyma is present in her liver biopsy. Immunohistochemically, inclusions are positive in some of the hepatocytes of her liver biopsy. Which of the following microorganism could her disease related to be? A) plasmodium falciparum B) streptococcus pneumoniae C) herpes simplex virus D) brucella melitensis E) aspergillus fumigatus 2) 43 years old male patient has complained right quadrant discomfort. He had history of blood transfusion because of abundant hemorrhage after a car accident. His transaminase levels were found elevated. Please look below for the microscopic images of this case and answer the questions. Question 1: which histomorphology findings are representatives for this case Question 2: what is the most probable diagnosis for this case? A) 1. Pericentral inflammation and cirrhosis. 2 chronic viral hepatitis B) 1. Portal inflammation and interface hepatitis. 2. Hepatosteatosis C) 1. Ballooning degeneration and macrosteatosis 2. Chronic viral hepatitis D) 1. Macrosteatosis and fibrosis. 2. Steatohepatitis E) 1. ground glass hepatocytes and portal inflammation 2. Chronic viral hepatitis 3) 27 years old female patient with sever epigastric pain and anemia underwent subtotoal gastrectomy because of her gastric hemorrage. She has complained mild epigastric pain for two years before this operation. She has perforated area 2 cm in diameter and also lesions other than perforated area as stated below microscopic image. Which of the following is correct for her non-perforated stomach? A) chronic active gastritis with helicobacter pylori B) neuroendocrine cell tumor, grade 1 C) gastric adenocarcinoma intestinal type D) chronic atrophic gastritis with intestinal metaplasia E) chronic atrophic gastritis with neuroendocrine cell hyperplasia 4) which of the following morphological features seen in the liver biopsy, make us think that there is an acute cholestatic injury? A) feathery degeneration B) cholate stasis C) piecemeal necrosis D) ballooning degeneration E) Mallory-Denk bodies 5) which of the following is an example for unpredictable drug reactions of liver? A) the cause of liver injury due to isoniazid is believed to be accumulation of a toxic intermediate of its metal B) exposure to amanita phallloides toxin causes hepatic injury in patients C) after exposure to high levels of carbon tetrachloride induced liver toxicity D) usage of over doses of amiodarone results hepatosteatosis and fibrosis E) acetaminophen causes cholestasis in patients 6) which of the following is the cell responsible of chronic pancreatitis? A) ductal cell B) islet cell C) pancreatic stellate cell D) acinar cell E) vascular endothelium 7) select the electrolyte couple that gastric acid increases the absorption through intestine. A) sodium- chloride B) iron- calcium C) sodium- iron D) calcium-chloride E) potassium- iron 8) which of the following salivary flan tumor is typically composed cystic spaces line by oncocytic cells and prominent A) acinic cell carcinoma B) adenoid cystic carcinoma C)warthin tumor D) mucoepidermoid carcinoma E) pleomorphic adenoma 9) which of the following is not a risk factor for gallstone formation? A) male gender B) latin ethnicity C) supersaturation of bile D)pregnancy E) mucin hypersecretion 10) primary biliary cirrhosis, which of the following cell has main role in fibrogenesis? C) portal fibroblasts 11) which of the following pathogens do have chronic carrier state in gallbladder? A) giardia lamblia B) salmonella typhi C) clostridum difficile D) shigella dysenteria E) entamoeba histolytica 12) all of the following are true for hepatocellular adenoma except? A) its associated with oral contraceptive and anabolic steroid usage B) in the setting of glycogen storage disease, its seen during childhood period C) its not accepted as preneoplastic lesion but the risk of hepatocellular carcinoma is higher than the normal population, especially in patients using anabolic steroids D) hepatocellular adenoma is yellow tan solitary nodule with. Central satellite scar E) its seen only in non cirrhotic liver 13) which of the following part of stomach biopsy should be preferred for helicobacter pylori gastritis? A) fundus B) cardia C) antrum D) corpus E) ulcer 14) in Celiac Syndrome, inflammatory reaction is mediated with which of the following cells?/18 E) T lymphocytes 15) which one of the following statement is not criteria of the metabolic syndrome for world health organization? A) diabetes mellitus B) elevated transaminase levels C) impaired fasting glucose D) blood pressure > 140/90mmHg E) central obesity 16) compared to others, in which of the following causes of chronic hepatitis, cirrhosis risk is lower? A) hepatitis B B) autoimmune hepatitis C) hepatitis D coinfection D) hemosiderosis E) hepatitis C 17) which of the following complications is more common in ulcerative colitis than in Crohns disease? A) abcess formation B) bowel obstruction C) colorectal carcinoma D) perforation sinus tract formation E) sinus tract formation 18) which of the following statement regarding Lynch Syndrome is/are true? I. in lynch syndrome, colorectal carcinomas can be either chromosomal unstable or microsatellite unstable II. due to defective mismatch repair genes there is an increased risk for both colorectal and endometrial adenocarcinomas III the most common tumor suppressor gene mutation seen in Lynch syndrome is p53 mutation IV. it is on the of the polyposis syndrome in which we can see more than 100 polyps in large bowel. A) I,II, IV B) II C) I and III D) I E) I, II, III, IV 19) which of the following do not effect esophagus? A) ulcerative colitis B) crohn disease C) sarcoidosis D) deskuamtive skin lesions E) tuberculosis 20) more than half of the gastrointestinal stromal tumors occur in the __ A) appendix B) stomach C) rectum D) jejunum E) colon 21) in a liver biopsy if u see perisentral fibrosis with central to central bridging without any portal and periportal fibrosis which of the following may the cause? A) chronic viral hepatitis B) primary biliary cholangitis C) wilsons disease D) autoimmune hepatitis E) steatohepatitis Medical Biochem: 1) 49 year old female had the following test results: ALT 281, IU/L, AST 184 IU/L, GGT 14 IU/L, total protein 6.1g/dL. Alb 3.4g/dL totally bilirubin 1.6mg/dL. Based on the information u have at the point. what is most likely diagnosis for her abnormal LFTs? A) acute hepatitis B) ischemic hepatitis C) primary biliary cirrhosis D) chronic hepatitis E) primary sclerosing cholangitis 2) In which one of the following situations does the body excrete less nitrogen than __ A) tissue degradation B) surgical operation C) injury D) pregnancy E) Illness 3) select the incorrect items about the regulation of carbohydrate metabolism in liver tissue 1. hexokinase is inhibited by G-6-P while chronic insulin induces glucokinase 2. glucagon phosphorylates and activates pyruvate kinase to assure that brain gets glucose III. PFK-1 is allosterically inhibited by citrate and activated by fructose-2,6-bisphosphate IV. pyruvate carboxylase and phosphoenolpyruvate carboxykinase allosterically activates V. glucose, ATP, and G-6-P inactivate glycogen phosphorylate A) I and III B) II,III, IV C) I, II D) Only II and IV E)III, IV 4) which one of the following is correct? E) pe_osinogen is the common activator of pancreatic proteolytic enzymes. 5) select the incorrect items about the glucose tra_ I. glucose is transported to intestinal epithelia II. fetal tissues take glucose and galactose with III. brain takes glucose and galactose with GLUT- IV Uptake of glucose in liver is proportional to V. increased number of GLUT-4 receptors in A) I,III B) II,III,IV C) I, II D) II,IV E) Only III and IV 6) the enzyme that synthesizes and enables the acid production in the stomach is: A) Carbonic dehydrogenase B) carbonic anhydrase C) carbonic oxidase D) amino oxidase E) carbonic dehydratase 7) which of the following vitamins is not synthesized to some extent by humans? A) Vitamin K B) Niacin C) Vitamin D D) Biotin E) Vitamin C 8) gout is characterized by elevated uric acid concentrations in blood and urine due to a variety of metabolic abnormalities that lead to the overproduction of purine. Allopurinol is used in the treatment of gout because this drug and its metabolic product, alloxanthine, act as inhibitors of: A) Hypoxanthine guanine phosphoribosyl transferase B) PRPP synthetase C) Xanthine oxidase D) Nucleotides E) Adenyl succinate synthase 9) which of the following favors reduction of ferric iron to ferrous iron for the absorption of iron from enterocytes? A) vitamin C B) copper C) heme D) biotin E) nicotinamide adenine dinucleotide 10) which one of the following is correct? A) L-amino acids are actively transported through the intestinal epithelium with transporter protein B) pepsinogen is the common activator of pancreatic proteolytic enzymes C) lipase hydrolyze triacylglycerol molecule starting from the ester bond at the carbon 2 of glycerol D) intrinsic factor is required for the digestion of vitamin B2 E) because bile acids synthesized from cholesterol, they are extremely hydrophobic and solubilize dietary lipids 11)which of the following molecular groups is on the substituent groups on porphyrin ring structures? A) aldehyde B) butyric acid C) amino D) methyl E) carboxyl 12) which one of the following statements regarding the synthesis of urea is correct? A) 3 ATP’s are hydrolyzed and 2 NADH are generated B) 4 ATP’s are hydrolyzed and one NADH is generated C) 3 high energy phosphate bonds are hydrolyzed and one NADH is generated D) 4 high energy phosphate bonds are hydrolyzed and one NADH is generated E) 2 ATP’s are hydrolyzed and one NADH generated 13) which of the following statements about serum gastrin level is incorrect? A) its not increased in simple peptic ulcer B) its decreased in Zollinger-Ellison syndrome C) its increased in pernicious anemia D) its increased in fundal gastritis E) its low to normal in antral gastritis 14) which of the following structures binds to lipoic acid and can inhibit the pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase enzymes? A) butanol B) na arsenide C) ethanol D) ammonia E) propanol 15) phase 1 reactions include, I reduction II glucuronidation III sulphation IV deamination A) I, IV B) I, II, III C) I, II D) II, III E) I, II,III, IV 16) select incorrect item about carbohydrate metabolism. A) trauma increase glucose uptake from circulation as result of release cytokines B) catabolic hormones insulin and catecholamines increase precursors for gluconeogenesis C) glucose comes from glycogenolysis and gluconeogenesis in the postabsorptive phase, while liver will not use it D) in early pregnancy glucose and insulin concentrations increase in postprandial state E) after fasting for more than 18 hours ketone bodies bHB, acetoactate and acetone are used as the energy source 17) select the incorrect items about the diseases of carbohydrate metabolism I aldose B is the deficient enzyme in essential fructosuria which should be rapidly detected to remove fructose and sucrose II von gierkes disease glucose-6-phosphatase defect is manifested by hyperglycemia and lactic acidemia III antimalarial drugs may lead to hemolytic anemia in G-6 phosphate dehydrogenase deficient patients IV Gal-1 phosphate uridyl transferase is the deficient enzyme in galactosemia which should be rapidly detected to end breast feeding V in McArdle disease skeletal muscle glycogen phosphorylase defect there is no rise in blood lactate during strenuous exercise A) II, IV B) III, IV C) I, II D) II, III, IV E) I,III 18) which one of the following aminoacids carbon skeleton is not metabolized to gluconeogenesis? A)lysine B) phenylalanine C) valine D) isoleucine E) serine Medical genetics: 1: Alagille syndrome is a complex multisystem disorder defined clinically by hepatic bile duct paucity and cholestasis in association with cardiac, skeletal, and ophthalmologic manifestation. Which gene is involved in 1%-2% of this disease? A)JAK1 B) JAG1 ? C) Jag2 D)Jak2 E) NOTCH2 ? Biophysics: 1) which of the following is a false statement about heat transfer? A) thermal conductivity of air is quite small B) blood acts as a convective fluid to transfer heat C) the efficiency of heat conduction depends on the number of collisions and amount D) gravity convection is an important factor in most fluid heating E)all heat transfer types require material to transport the energy 2) in ___ diathermy, energy released from __ is mainly absorbed by ___ A) microwave, magnetron, lipid B) microwave, magneton, water C) shortwave, coils, lipid D) shortwave, magnetron, water E) microwave coils,lipid 3) territorial analysis of the surface temperature of the body is done by__ it is a ___ A) thermography, non-invasive, infrared B) thermography invasive infrared C) ultrasonography invasive infrared D) ultrasonography noninvasice infrared E) thermography, invasive ulvraviolet Public health: 1: Which of the following vaccine use for prevention from Rabies? A) inactivated vaccine B) mRNA vaccine C) Nasal live vaccine D) Live vaccine E) Human diploid cell vaccine 2) which of the following diseases can observed in anthrax? I gastrointestinal disease II pneumonia III dermatologic disease IV hepatitis V encephalitis A) II, III, IV B) II, V C) I,II,III D) IV, V E) V 3) which of the following statements is not true for food additives? A) potassium bromate is genotoxic, carcinogen and mutagenic B) butylated hydroxytoluene is not genotoxic C) nitrites can cause methemoglobinemia D) nitrates can inhibit the function of the thyroid gland E) aflatoxin is not a carcinogen General surgery: 1: Which one of the followings is the most reliable diagnostic imaging method in the diagnosis of acute pancreatitis? A) abdominal computed tomography (CT) B) erect plain abdominal film C) abdominal ultrasonography D) endoscopic retrograde cholangiography E) abdominal magnetic resonance imaging MRI Pediatric surgery: Which of the following is not diagnostic method for differential diagnosis of acute appendicitis? A) computerized tomography B) urinary analysis C) voiding cystourethrography VCUG D) chest radiography E) pelvic ultrasonography Child health and Disease: 1) which of the following statements below is not correct? A) in acute gastroenteritis, children with poor baseline nutritional status are at increase risk B) infants and preschool children with profuse diarrhea and frequent episodes of vomiting C) clinical signs symptoms of dehydration usually become evident when the loss of body weight D) a recent history of travel use of antibiotics presence of similar symptoms in family members E) treatment of severe dehydration should be started immediately with oral dehydration solutions Nuclear medicine: 1: which of the following is true for mechanism of uptake for the Tc-99m labeled iminodiacetic acid (IDA) in the liver? A) kupffer cell uptake and conjugated similar to bilirubin B) blood pool visualization C)blood flow visualization D)Kupffer cell uptake and riot conjugated similar to bilirubin E) hepatocyte uptake and not conjugated similar to bilirubin Pharmacology: 1: which of the following drugs can cause tardive dyskinesia? A) mecitizine B) cicapride C) domperidone D) metoclopramide E)bethanechol 2) which factors may lead to increased serum free and/or total drug concentrations in patients with chronic liver disease? 1.decreased protein binding of the drug due to decreased albumin concentrations 2. decreased drug bonding capacity of the albumin due to increased bilirubin binding 3. increased serum drug concentration due to decreased hepatic metabolism A) 1, 2 B) 1,2,3 C)2,3 D) 3 E) 1,3 3) hepatitis A is mostly transmitted by A) consumption of contaminated water and food B) blood transfusion C) sharing or reusing needle D) saliva E) sexual intercourse 4) which parameters are evaluated to determine whether a patient with viral hepatitis should be hospitalized or not? I INR II HBsAg III metal status IV significant electrolyte disturbance V ALT A) I, II, V B) III C) I D) I, III, IV E) II, V 5) 33year old man has never been vaccinated for hepatitis B. serologic tests reveal negative HlbsAg and positive antibody __ following conditions does this serologic pattern best fit with? A) acute hepatitis B infection B) need for vaccine to hepatitis C) previous hepatitis B infection D) poor prognosis E) chronic hepatitis 6) Which of the following is the most useful blood test to differentiate between acute and chronic hepatitis B? A) anti HB_IgM B)serum AST, ALT C) total anti HBc D) anti-HBe E) HBsAg 7) acetylcholine is the major neurotransmitter in all of the dollowing synaptic sits except than: A) sympathetic neuroeffector junction B) parasympathetic neuroeffector junction C) sympathetic ganglia D) parasympathetic ganglia E) neuromuscular junction 8) 10 weeks pregnant woman hepatitis marker test results revealed positive HbsAg and HbeAg. Which statement is true for this case? A) breastfeeding is forbidden for this mother after birth B) prophylactic antiviral therapy can never be used during pregnancy C) perinatal chronic hepatits B virus infection risk is low in this case so the newborn from this mother can be followed with routine newborn follow up D) the mother should be advised to terminate the pregnancy E)administration of hepatitis immune globulin and hepatitis B virus vaccination within early hours of birth are required 9) which of the following drugs used for the triple therapy of helicobacter pylori associated ulcer disease? A) clarithromycin amoxicillin and iansorprazole B) calcium carbonate amoxicillin and metronidazole C)ranitdine, clarithromycin and metronidazole D) sucralfate, lansoprazole and tinidazole E) omeprazole cimetidine and tinidazole 10) bethanechol stimulates which one of the receptor on muscle cells and at myenteric plexus synapses? A) 5HT3 receptors B) M3 receptors C) Beta 1 receptors D) Alta 2 receptors E) D2 receptors (E) Family Medicine: 1: 52 years old female patient complaints of a discomfort in the upper abdomen, nausea, early satiety and bloat following meals since nearly three months. She has anemia and reveals that has unintentionally loosed nearly ten percent of her body weight in the last 3 month. What should be the first step for the management of this patient? A) urea breath test for helicobacter pylori B) empiric use of proton pump inhibitors C) empiric use of antiacids D) upper gastrointestinal endoscopy E) direct antibiotic use for helicobacter pylori 2) 42 year old female patient has been complaining of epigastric pain and nausea in the morning for the last month. She has no alarming symptoms and no previously documented ulcer. The family physician tested the patient for H.pylori. the result was positive. What is the following step in the management plan? A) eradication of helicobacter pylori infection B) empiric use of a proton pomp inhibitor C) empiric use of an antiacid D) upper gastrointestinal endoscopy E) serological assessment for helicobacter pylori infection Medical Microbiology: 1) which of the following is not true regarding hepatitis B virus and its infection? A) the presence of HBsAg in the serum after the sixth month of HBV infection is an indicator of chronic B) HBV vaccine induces the production of specific antibodies against HBsAg. C) hepatitis B infection is found to be moderately 2-7%endemic in turkey D) hepatitis B virus core antigen is only found in hepatocytes E) the risk of developing chronic infections during HBV infection in children under 5 years of age ranges from 2% to 10%. 2) which of the following hepatitis virus has high risk A) hepatitis E virus HEV B) hepatitis A virus HAV C) hepatitis B virus HBV D) hepatitis C virus HCV E) Hepatitis D virus HDV 3) which of the intestinal helminths could be related ___ deaths in some cases A)ancylostoma duodenale B) wuchereria bancrofti C) enterobius vermicularis D) trichirus trichura E) echinococcus granulosus 4) which of the following is not true regarding gastroenteritis A) norovirus genogroup II is the most prevalent norovirus B) antigen detection tests are not reliable in the diagnosis of C) rectum is the site of infection in viral gastroenteritis D) incubation period of adenoviral gastroenteritis is long E) serogroup A rotavirus is responsible for gastroenteritis 5) which of the following situation does not require immediate hospitalization or treatment? A) watery diarrhea in a child B) diarrhea in individuals 70 yrs of age or older or in those with known immunosuppression (eg chemotherapy) C) dehydration secondar to profuse watery diarrhea or inability to tolerate oral fluids D) diarrhea with severe abdominal pain in patients 50yrs of age or older E) diarrhea containing blood and mucus 6) which of the following statment about pathogenic E.coli is not correct? A) adults traveling from temperate climates to more tropical areas B) EIEC most notably O157:H7 is the serotype associated with hemorrhagic C) they become virulent when acquiring bacteriophage or plasmid dna encode D) loss of microvilli which is the result of rearrangement of the host cell cytosk E) electrolyte fluid therapy( oral or IV) is mainstay for treatment and antibiotics 7) in which of the following parasitic infection laboratory diagnosis is generally performed? A) enterobius vermicularis B) ascaris lumbricoides C) entamoeba histolytica D) cryptosporidium spp. E) taenia spp. 8) which of the following is not true about cholera? A) symptoms begin with sudden onset of blood diarrhea and vomiting B) after 24-48hrs incubation period symtoms begin with suddent onset C) it is caused by an gram negative, comma shaped motile bacteria D) crowding gathering of people during religious rituals enhance the spread E) it has 2 main reservoirs, man and water 9) 10 year old child developed diarrhea six to eight times a day. He reported presence of__ intermittent vomiting, and low grade fever. After four days dysentery, he went to see__ stained preparation. Which one of the following is likely agent of diarrhea. A) giardia intestinalis B) trichirus trichiura C) balantidium coli D) isospora belli E) entamoeba histolytica 10) ur patient is a 5yr old boy with diarrhea for past 2 dyas accompanied by fever to __ reveal the same organism. The cultures grew a gram negative rod that formed colorless __ hectoen-enteric agar. Which one of the following bacteria is most likely cause of this A) salmonella typhi B) vibrio cholerae C) helicobacter pylori D) shigella dysenteriae E) proteus mirabilis 11) which of the following causes intoxication due to toxins performed in the food? I bacillus cereus II clostridium botulinum III clostridium perifringens IV rotavirus V staphylococcus aureus A) III B) I,II,V C) I D) I, III, IV E) II Histology: 1)which of the following papillae type are the largest papillae in tongue? A) foliate papillae B) taste bud C) filiform papillae D) circumvallate papillae E) fungiform papillae 2) which of the following words should be written in the below sentences “during the tooth development enamel is produced by __ and dentin is produce by ___ A) ameloblasts, odontoblasts B) neural crest cells, odontoblasts C) cemetoblasts, odontoblasts D) odontoblasts, ameloblasts E) cemetoblasts, ameloblasts 3) find the incorrect statement about midgut. A) the cephalic limb will form the lower duodenum the jejunum B) the cephalic limb will form the ascending colon and 2/3 of the transverse colon C) the cephalic limb of the midgut extends from the duodenum to the yolk stalk D) the caudal limb will form the lower ileum the appendix, cecum E) the point of attachment of the yolk stalk is located in the adult about 2-4 feet from the ileum 4) which one of the following sentence is not true for the lower digestive tract? A) in each part of the lower digestive tract, epithelial and glandular cells are renewed B) in each part of the lower digestive tract, external muscular layer consists inner circular C) in each part of the lower digestive tract, submucosal layer of consists of blood vessels, lymph D) in each part of the lower digestive tract mucosal layer consists of epithelium lamina propria E) in each part of the lower digestive tract, adventitia layer is covered by mesothelium 5) concerning the development of gastrointestinal system which of the sentences below is false? A) the midgut forms half of the duodenum, the jejunum and ileum the ascending colon, and about two thirds of the transverse colon B) the hindgut forms one third of the transvers colon, the descending colon and sigmoid colon and the upper two thirds of the C) if the pancreatic lobes migrate around the duodenum in opposite directions to fuse with the dorsal pancreatic bud, an annular D) the stomach makes no turn during development E)the liver bud grows and expands in the ventral mesentery 6) which of the choices written below is/are the characteristic of all the diffuse neuroendocrine cells? I staining with silver salts II containing microvilli III lying on the basal lamina IV secreting their products into ground substance of connective tissue A) I, II, III B) I,II,III,IV C) I, II D) I, III, IV E) I, III NOT SURE: