BABS 221 Paper 1 PDF

**SCHOOL OF MEDICINE** **PROGRAMME: MBChB** **END OF YEAR EXAMINATION** +-----------+-----------+-----------+-----------+-----------+-----------+ | **Code of | **Name of | **Date of | **Time of | **Duratio | **Paper** | | the | the | Exam** | Exam** | n** | | | M...

**SCHOOL OF MEDICINE** **PROGRAMME: MBChB** **END OF YEAR EXAMINATION** +-----------+-----------+-----------+-----------+-----------+-----------+ | **Code of | **Name of | **Date of | **Time of | **Duratio | **Paper** | | the | the | Exam** | Exam** | n** | | | Module** | Module** | | | | **No.** | +===========+===========+===========+===========+===========+===========+ | BABS 221 | BASIC & | 9^th^ | 9:00-12:0 | 3 Hours | 1 | | | APPLIED | January | 0 | | | | | BIOMEDICA | 2019 | hrs | | | | | L | | | | | | | SCIENCES | | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ **[INSTRUCTIONS TO THE CANDIDATES]** 1. Indicate your **Student ID number** on every page of the question paper. 2. This exam consists of two parts. Part ONE is Pharmacology and Part TWO is Biochemistry. 3. Read each component specific instructions carefully before you attempt the questions 4. Do not start writing until you are told to do so 5. You will be disqualified for any form of examination malpractice PART ONE-PHARMACOLOGY [SECTION A -- 60 marks] 1. Compared to subcutaneous injection, the intramuscular injection of drugs: A. Is more painful B. Produces faster response C. Is unsuitable for depot preparations D. Carries greater risk of anaphylactic reaction 2. Which of these drugs is used both for acute gout attacks and for prophylaxis of gout? A. Aspirin B. Allopurinol C. Probenecid D. Colchicine 3. Majority of drugs cross biological membranes primarily by: A. Passive diffusion B. Facilitated diffusion C. Active transport D. Pinocytosis 4. Bioavailability of drug refers to: A. Percentage of administered dose that reaches systemic circulation in the unchanged form B. Ratio of oral to parenteral dose C. Ratio of orally administered drug to that excreted in the faeces D. Ratio of drug excreted unchanged in urine to that excreted as metabolites 5. Which of the following is **always true**: A. A more potent drug is more efficacious B. A more potent drug is safer C. A more potent drug is clinically superior D. A more potent drug can produce the same response at lower dose 6. Higher efficacy of a drug necessarily confers: A. Greater safety B. Therapeutic superiority C. Capacity to produce more intense response D. Cost saving 7. The cardiac muscarinic receptors: A. Are of the M~1~ subtype B. Are of the M~2~ subtype C. Are selectively blocked by pirenzepine D. Function through the PIP2 → IP3/DAG pathway 8. Cholinergic muscarinic receptor stimulation produces the following effects **except**: A. Sweating B. Rise in blood pressure C. Bradycardia D. Urination 9. Pilocarpine is used for: A. Glaucoma B. Paralytic ileus C. Urinary retention D. All of the above 10. Actions of pilocarpine include the following **except**: A. Sweating B. Salivation C. Miosis D. Cycloplegia 11. Edrophonium is more suitable for differentiating myasthenic crisis from cholinergic crisis because of its: A. Shorter duration of action B. Longer duration of action C. Direct action on muscle end-plate D. Selective inhibition of true cholinesterase 12. Which is the most important drug in the treatment of organophosphate poisoning: A. Atropine sulfate B. Pralidoxime C. Diazepam D. Adrenaline 13. Atropine produces the following actions **except**: A. Tachycardia B. Mydriasis C. Dryness of mouth D. Urinary incontinence 14. Angiotensin II causes rise in blood pressure by: A. Direct vasoconstriction B. Releasing adrenaline from adrenal medulla C. Increasing central sympathetic tone D. All of the above 15. The following factors enhance renin release from the kidney **except**: A. Fall in blood pressure B. Reduction in blood volume C. Enhanced sympathetic activity D. Volume overload 16. The following drug has been demonstrated to retard progression of left ventricular dysfunction and prolong survival of congestive heart failure patients: A. Digoxin B. Furosemide C. Enalapril D. Amrinone 17. Losartan is a: A. Selective AT1 receptor antagonist B. Selective AT2 receptor antagonist C. Nonselective AT1 + AT2 receptor antagonist D. AT1 receptor partial agonist 18. Beneficial effect/effects of diuretics in CHF patients include the following: A. Symptomatic relief B. Regression of pathological changes C. Prolongation of life expectancy D. Both 'A' and 'C' 19. Persistent dry cough may occur as a side effect of the following antihypertensive drug: A. Enalapril B. Atenolol C. Diltiazem D. Methyldopa 20. The following antihypertensive drug has a favourable effect on plasma lipid profile: A. Prazosin B. Propranolol C. Hydrochlorothiazide D. Furosemide 21. The following antihypertensive combination is irrational, and therefore should not be used: A. Nifedipine + hydralazine B. Amlodipine + atenolol C. Enalapril + clonidine D. Enalapril + hydrochlorothiazide 22. The following analgesic lacks anti-inflammatory action: A. Paracetamol B. Ibuprofen C. Diclofenac sodium D. Piroxicam 23. Aspirin reduces fever by: A. Decreasing heat production in the body B. Enhancing cutaneous blood flow C. Inducing sweating D. Both 'B' and 'C' are correct 24. The drug of choice for trigeminal neuralgia is: A. Aspirin B. Imipramine C. Carbamazepine D. Valproic acid 25. The antidote of choice for morphine poisoning is: A. Nalorphine B. Nalbuphine C. Naltrexone D. Naloxone 26. Selective cyclo-oxygenase-2 inhibitors have been associated with A. Increased incidence of peptic ulceration B. Increased incidence of myocardial infarction C. Greater benefit in ischaemic heart disease compared to non-selective cyclo-oxygenase inhibitors D. Increased nephrotoxicity compared to non-selective cyclo-oxygenase inhibitors 27. Paracetamol A. Has negligible anti-inflammatory effects B. Has negligible anti-pyretic effects C. Is a selective cyclo-oxygenase-2 inhibitor D. has uricosuric effects 28. Which of these NSAIDs has restricted clinical use due to causing aplastic anemia? A. Indomethacin B. Aspirin C. Phenylbutazone D. Nabumetone 29. Concerning infliximab A. Acts by inhibiting dihydrofolate reductase B. Should not be used concurrently with methotrexate C. Can lead to acute exacerbations of rheumatoid arthritis D. Acts by inhibiting tumour necrosis factor 30. Which of these drugs is used both for acute gout attacks and for prophylaxis of gout? A. Aspirin B. Allopurinol C. Probenecid D. Colchicine 31. Which of the following effects is related to direct beta-1 adrenoceptor activation? A. Bronchodilatation B. Vasodilatation C. Tachycardia D. Bradycardia 32. In which of the following tissues does alpha-1 and beta-2 adrenergic stimulation produce the same effect? A. Blood vessels B. Intestine C. Uterus D. Bronchial smooth muscle 33. Which of the following statements is not correct? A. Alpha adrenoceptor agonists cause myosis B. Alpha adrenoceptor agonists cause vasoconstriction C. Beta adrenoceptor antagonists decrease the production of aqueous humour D. Beta-2 adrenoceptor agonists produce vasodilatation 34. Which of the following statements is not correct? A. Epinephrine acts on both alpha and beta adrenoceptors B. Norepinephrine has predominantly beta adrenoceptor action C. Phenylephrine has predominantly alpha adrenoceptor action D. Isoprenaline has a predominantly beta adrenoceptor action 35. Alpha~1~ adrenoceptor stimulation causes contraction of A. Vascular smooth muscle B. Intestinal smooth muscle C. Myocardium D. All the above 36. Which of these drugs has no direct action on alpha adrenoceptors? A. Noradrenaline B. Adrenaline C. Dopamine D. Isoprenaline 37. Which of the following agents would block the direct cardiac effects of dobutamine? A. Prazosin B. Metoprolol C. Clonidine D. Isoprenaline 38. Which of the following is an irreversible alpha adrenoceptor antagonist? A. Labetalol B. Phentolamine C. Phenoxybenzamine D. Prazosin 39. Intravenous administration of epinephrine to a patient results in a severe decrease in diastolic pressure and an increase in cardiac output. Suggest a drug that the patient might have previously taken that could account for this unexpected effect. A. Propranolol B. Prazosin C. Dopamine D. Salbutamol 40. Which of these drugs are non-selective alpha-adrenoceptor blockers 1. Phentolamine 2. Yohimbine 3. Phenoxybenzamine A. 1 and 2 B. 1 and 3 C. 2 and 3 D. 1, 2 and 3 41. Effects of muscarinic receptor antagonists include 1. Mydriasis 2. Cycloplegia 3. Bradycardia A. 1 and 2 B. 1 and 3 C. 2 and 3 D. 1, 2 and 3 42. Which of these selective α~1~ blockers do not have a role in the management of hypertension? 1. Terazosin 2. Tamsulosin 3. Doxazocin A. 1 and 2 B. 1 and 3 C. 2 D. 1, 2 and 3 43. Which of the following is true concerning actions/effects of direct acting muscarinic receptor agonists? A. Bethanecol : is used in urinary retention B. Carbachol : is used to reduce urinary urgency C. Methacholine : is not suitable for use in gastric atony D. Pilocapine : is a choline ester 44. Which of the following muscarinic antagonists are correctly matched to the given clinical indications? 1. Hyoscine: motion sickness 2. Atropine: glaucoma 3. Oxybutynin : urinary retention 4. Tropicamide : fundoscope (eye examination) 5. Tolterodine : bradycardia **A** **1 and 4** ------- ------------- **B** **2 and 5** **C** **3 and 5** **D** **4 and 5** 45. Which of the following anticholinesterases are correctly matched to the given clinical use? 1. Ecothiophate : glaucoma 2. Physostigmine : fundoscope (eye examination) 3. Pyridostigmine : treatment of myasthenia gravis 4. Ecothiophate : diagnosis of myasthenia gravis 5. Edrophonium : To reverse effects of non-depolarizing neuromuscular junction blockers **A** **1, 3 and 5** ------- ----------------------- **B** **1 and 3** **C** **1, 2, 3, 4 and 5** **D** **None of the above** 46. **Which of these drugs is most appropriate for use in the treatment of Raynald's phenomenon?** A. **Terazosin** B. **Phenoxybenzamine** C. **Neostigmine** D. **Phentolamine** 47. **The rapid heart rate sometimes seen after α~1~ blockers administration is best explained by:** A. **A direct positive chronotropic effect on the myocardium** B. **Reflex sympathetic discharge due to a fall in systemic blood pressure** C. **The ability of alpha1 blockers to release norepinephrine from sympathetic nerve endings** D. **A decrease in intracranial pressure** 48. **Orthostatic hypotension is a potential adverse effect associated with:** A. **Atropine** B. **Scopolamine** C. **Doxazocin** D. **Tiotropium** 49. Which of the following drugs is associated with cycloplegia? A. Carbachol B. Pilocarpine C. Tropicamide D. Muscarine 50. **Which of these drugs is most likely to cause bradycardia?** A. **Atropine** B. **Dobutamine** C. **Clonidine** D. **Isoprenaline** 51. **Which of the following medications is contraindicated in a patient with organophosphate poisoning?** A. **Atropine** B. **Bethanecol** C. **Obidoxime** D. **Pralidoxime** 52. **Which of the following is a FALSE statement concerning the clinical use of direct-acting muscarinic agonists?** A. **Suitable in urinary retention** B. **They are cholinergic receptor agonists** C. **Hypotension may be a limiting side effect** D. **They cause mydriasis on the eye** 53. Which of these drugs act at pre-synaptic alpha~2~ adrenoceptors and are used to treat hypertension? 1. Clonidine 2. Methyldopa 3. Prazosin A. 1 and 2 B. 1 and 3 C. 2 and 3 D. 1, 2 and 3 54. Which of these beta-adrenergic receptor blockers also block alpha-1 receptors? 1. Caverdilol 2. Pindolol 3. Labetalol A. 1 and 2 B. 1 and 3 C. 2 and 3 D. 1, 2 and 3 55. Which of these beta-adrenergic receptor blockers are relatively selective for beta-1 receptors (i.e. block beta-1 receptors more than beta-2 receptors)? 1. Atenolol 2. Bisoprolol 3. Nebivolol A. 1 and 2 B. 1 and 3 C. 2 and 3 D. 1, 2 and 3 56. A 23-year old woman presents with hypertension, anxiety and palpitations. A CT scan shows a unilateral phaeochromocytoma. The surgeon should start therapy with which drug prior to removal of the tumour? A. Bisoprolol B. Carteolol C. Pindolol D. Phentolamine 57. Which of these drugs would you recommend as first choice for the treatment of tachycardia associated with atropine overdose? A. Pyridosgimine B. Tropicamide C. Oxybutynin D. Pilocarpine 58. A 30 year old pregnant lady was diagnosed with haemolytic anaemia. No exact cause could be found. She gives a history of taking a drug for hypertension. Which is the most likely drug she has been taking? A. Clonidine B. Methyldopa C. Atenolol D. Bisoprolol 59. Which of the following beta blockers is most likely to exhibit intrinsic sympathomimetic activity? A. Propranolol B. Metoprolol C. Atenolol D. Pindolol 60. What significant adverse effect of prazosin should the doctor warn a 69-year old patient about? A. Bronchospasm B. Postural hypotension C. Heart failure D. Sedation PART TWO BIOCHEMISTRY 1. The citric acid cycle starts when acetyl-CoA reacts with which molecule? a. Citrate b. Pyruvate c. Malate d. Oxaloacetate e. Succinate 2. How many enzymatic reactions are in the citric acid cycle? f. 7 g. 12 h. 8 i. 9 j. 10 3. How many NADH molecules are formed after each citric acid cycle? k. 4 l. 3 m. 1 n. 6 o. 5 4. Which intermediate of the citric acid cycle is a substrate for purine biosynthesis? p. Malate succinate q. Succinyl-CoA r. Isocitrate s. Succinate t. None of the above is correct 5. Oxidative decarboxylation is catalyzed by....... u. Aconitase v. Pyruvate dehydrogenase complex w. Succinate dehydrogenase x. Citrate synthase y. None of the above is correct 6. Which vitamin is a structural component of coenzyme A? z. Riboflavin a. Folate b. Pantothenic acid c. Biotin d. Niacin 7. Glycolysis and the citric acid cycle are connected by a reaction catalyzed by which enzyme? e. Malate dehydrogenase f. Succinate dehydrogenase g. Pyruvate kinase h. Pyruvate dehydrogenase complex i. Isocitrate dehydrogenase 8. The enzyme in question 7 above requires................... j. Folate k. Thiamine l. Cobalamin m. Vitamin C n. Biotin 9. How many mobile electron carriers are in the electron transport chain? o. 3 p. 2 q. 1 r. 4 s. 5 10. Which enzyme complex is inhibited by rotenone? t. Complex I u. Complex II v. Complex III w. Complex IV x. None of the above is correct 11. Which enzyme complex is inhibited by cyanide y. Complex II z. Complex IV a. Complex III b. Complex I c. None of the above is correct 12. Where are enzyme complexes of the electron transport chain found? d. Cytosol e. Inner mitochondrial membrane f. Nucleus g. Ribosomes h. None of the above is correct 13. The final electron acceptor in the electron transport chain is...... i. Oxygen j. Carbon dioxide k. Carbon monoxide l. Hydrogen m. Nitrogen 14. Which organ below forms significant amounts of glycogen? n. Brain o. Red blood cells p. The bone marrow q. The liver r. The skin 15. Which enzyme is present in the liver but not in the muscle? s. Phosphoglucose isomerase t. Glycogen synthase u. Glucose 6-phosphatase v. Lactate dehydrogenase w. Glycogen phosphorylase 16. Which organ below carries out gluconeogenesis? x. Liver y. Muscles z. Brain a. Spleen b. Skin 17. Alcohol causes hypoglycaemia because.............. c. It breaks down glycogen d. It is metabolized in the liver e. It inhibits gluconeogenesis f. It speeds up reactions of the citric acid cycle g. It increases appetite 18. Which one below is a gluconeogenic precursor? h. Glutamine i. Chondroitin sulfate j. Glycogen k. Sucrose l. Maltose 19. Which organ forms ketone bodies? m. Muscles n. Kidneys o. Liver p. Red blood cells q. Brain 20. Which enzyme below is common to both glycogenolysis and gluconeogenesis in the liver? r. Glycogen phosphorylase s. Glycogen synthase t. Phosphoglucose isomerase u. Enolase v. Glucose 6-phosphatase 21. The α1,4 glycosidic bonds in glycogen are broken by which enzyme? w. Glycogen synthase x. Glycogen phosphorylase y. Glucose 6-phosphatase z. Citrate synthase a. None of the above is correct 22. What is the main role of liver glycogen? b. For metabolism within liver c. For glucose release in circulation to maintain blood glucose levels d. For speeding up gluconeogenesis e. For synthesis of heme in liver f. None of the above is correct 23. Which one below is a ketone body? g. Propionate h. Acetoacetate i. Pyruvate j. Isocitrate k. None of the above is correct 24. Where does fatty acid oxidation take place? l. Cytosol m. Cell membrane n. Nucleus o. Mitochondria p. Golgi complex 25. How many cycles of fatty acid oxidation will an 18-carbon saturated fatty acid go through after complete oxidation? q. 9 r. 7 s. 8 t. 12 u. 18 26. How many molecules of FADH~2~ will be formed after complete oxidation of a 14-carbon saturated fatty acid? v. 8 w. 5 x. 6 y. 10 z. None of the above is correct 27. How many molecules of NADH will be formed after complete oxidation of a 14-carbon saturated fatty acid? a. 6 b. 5 c. 12 d. 8 e. None of the above is correct 28. The initial product of fatty acid synthesis in humans is...... f. Linoleic acid g. Linolenic acid h. Palmitate i. Arachidonic acid j. Propionic acid a. 4 29. Lactic acid is produced by human muscles during strenuous exercise because of lack of a. Oxygen b. NAD^+^ c. Glucose d. ADP and *P~i~* 30. The enzymes of glycolysis in a eukaryotic cell are located in the a. intermembrane space b. plasma membrane c. cytosol d. mitochondrial matrix 31. Which of the following is not true of glycolysis a. ADP is phosphorylated to ATP via substrate level phosphorylation b. The pathway does not require oxygen c. The pathway oxidizes two moles of NADH to NAD+ for each mole of glucose that enters d. The pathway requires two moles of ATP to get started catabo-lizing each mole of glucose 32. The product of an isomerase catalyzed reaction in glycolysis is... k. Fructose 6-phosphate l. Dihydroxyacetone phosphate m. Phosphenolpyruvate n. Glyceraldehyde 3-phosphate o. Glucose 6-phosphate 33. Which of the following is correct sequence of processes in the oxidation of glucose a. Krebs cycle - glycolysis - electron transport b. Glycolysis - Krebs cycle - eletron transport c. Electron transport - Krebs cycle -- glycolysis d. Krebs cycle - electron transport -- glycolysis 34. The splitting of fructose 1,6-bisphosphate into two 3 carbon phosphorylated intermediates is catalyzed by........... p. Aldolase q. Hexokinase r. Glucokinase s. Pyruvate kinase t. None of the above is correct END OF EXAM!