3rd Year Final Exams Batch 2020 (175/200) PDF

3rd Year Final Batch 2020 (175 / 200) Explained by: Mohammed Alrashidi Khawla Almuhana Shahad...

3rd Year Final Batch 2020 (175 / 200) Explained by: Mohammed Alrashidi Khawla Almuhana Shahad Alhubaini Were those questions in the exam? Put ✅ next to it if yes 1. What causes the Ca+ slippage in non shivering thermogenesis? (the options may not be accurate)✅ a. UCP1 b. Perilipin c. Lipin d. Myosin e. Sarcolipin 2. What antibodies are found in hashimoto’s?✅ a. Thyroid receptor + thyroid peroxidase b. Thyroglobulin + thyroperoxidase c. Enolase + peroxidase d. Thyroid receptor 3. Which part of the suprarenal gland is responsible for Na+ secretion? a. Zona glomerulosa b. Zona fasciculata c. Zona reticularis d. Medulla 4. 35 y/o women low TSH high T4 palpitations shakiness. Low radioactivity but with tissue background, what is the diagnosis? a. iffuse toxic goiter b. subacute thyroiditis c. multinodular goiter d. single nodules goiter 5. A non smoker with progressive dyspnea, low FEV1/FVC ratio, the LOWER lobes were affected, his brother also has the same disease, cause? ✅ a. Because he’s a smoker(?)(???) b. Elastase secreted by neutrophils  Blood: ✔✔ 1. What is the major blood forming organ in the second trimester? a. liver b. spleen c. bone marrow d. yolk sac 2. HBSC disease is a hemoglobinopathy and a milder type of SCD, it develops from a point of mutation in which gene? a. alpha globin b. beta globin c. gamma globin d. delta globin 3. Which of the following indicates Pernicious anemia in a schilling test? a. Normal phase 1 abnormal phase 2 b. Abnormal phase 1 normal phase 2 c. Abnormal phase 1 and 2 d. Normal phase 1 and 2 4. In bone marrow, what cell has a short life span and high rate turnover? a. Myeloblast b. Promyelocyte c. mature neutrophils d. metamyelocyte (?) 5. What do lymphocytes express in CLL? a. CD20,CD19, CD5 b. CD3,CD5,TDT c. CD19,CD20,TDT d. CD15, CD30 6. A blood transfusion is completed w/ 4 hours to prevent (similar wording): a. fluid overload b. bacterial growth c. Hypotension d. hypothermia 7. What’s the role of vWF in secondary hemostasis? a. Platelet aggregation b. Binds to factor Vlll to stabilize it 8. What is the role of proximal histidine on each globin subunit of hemoglobin? a. Covalently binds an O2 molecule b. Non-covalently binds an O2 molecule c. Facilitates binding between globin subunits d. Covalently binds to the heme prosthetic group e. Required for allosteric regulation by 2,3 BPG 9. Question on TTP , which blood component is used in transfusion? a. Fresh frozen plasma b. Cryoprecipitate c. Platelet 10. Which antibody mediates hypersensitivity reaction in ABO blood transfusions? a. IgG b. IgE c. IgM d. IgA 11. What type of hypersensitivity occurs in drug induced hemolytic anemia? a. anaphylaxis b. cytotoxic c. delayed type hypersensitivity d. immune complex mediated e. Complement 12. What types of hemoglobin are present in a healthy adult? a. A, A2, F b. A, S, A2 c. A, D, A2 13. What causes erythema infectiosum? a. HIV b. RSV c. parvovirus b19 14. Morbidly obese patient underwent surgery for a femur fracture. 2 days later, he presented with dyspnea and chest pain. What could be the reason? a. pulmonary embolism b. myocardial infarction 15. What cell expresses CD34+ surface marker? a. pluripotent stem cells b. multipotent stem cells 16. What is given to reverse warfarin effects? 17. They gave a history of an old patient in ICU, he took multiple antibiotics in the last 3 weeks, has prolonged APTT and PT and D-dimers 200 (normal 5’AMP a. GHRH b. Ghrelin c. Leptin d. somatostatin 11. Patient with hyperthyroidism was given a medication to rapidly inhibits thyroid hormone release, and it can only be taken for 4 weeks. What is it? a. Iodide salts b. Methimazole c. Radioactive iodine d. Propylthiouracil e. Propranolol 12. Prevention of iodine deficiency reduces the risk of what? a. Mental retardation b. Thyroid cancer c. Hyperthyroidism 13. What could be affected if thyroid peroxidase is not functioning? a. Conversion on I- to I b. Conversion of T4 to T3 c. Release of T3 and T4 from thyroglobin d. Production of H2O2 e. Conversion of T4 to rT3 14. What is cosyntropin used for? A. Taken orally differentiate between primary and secondary adrenal insufficiency B. Causes increased cAMP by binding to M2CR 15. What is the auto antigen in lymphocytic hypophysitis? a. alpha- enolase b. beta- enolase 16. How to scan pheochromocytoma? 17. Patient with hypothyroidism ( low thyrotropin ), and when he is given thyrotropin releasing hormone, the thyrotropin increases. Where is the problem? a. thyroid tumor b. hypothalamus abnormality c. pituitary abnormality d. Pituitary adenoma 18. What causes high prolactin in someone with high TSH? (a table was provided) a. TSH activating lactotrophs b. TRH activating lactotrophs c. Dopamine inhibition by TSH 19. GH is secreted during exercises and sleep, which of the following indicates the circadian rhythm of GH? a. A b. B c. C d. D 20. What is the role of the kidney in calcium absorption from the gut? 21. A 57- year old female fell down while she was shopping and got a hip fracture. She has a history of thyroidectomy and she is on levothyroxine but she is not compliant with it. + they included high TSH levels i think (no they only mentioned it was high) What is the major contributing factor to her fracture? a. Perimenopause b. low bone mass density at peak age c. Elevated TSH level d. Slow bone marrow resorption 22. High ca high parathormone why do we tc-99 MIBI? a. Confirm diagnosis of hyperparathyroidism b. Check nearby structures(?) c. Localize active tissue d. Find any ectopic tumors 23. Young male (17?) with polyurea and polydipsia BMI 24, family history of diabetes, he has ketone bodies in urine. What’s mostly suggestive that he has type 1 diabetes? a. Ketone bodies b. His high BMI c. Family history d. Age e. High Glucose 24. A case with psammoma bodies, cytoplasmic inclusions and nuclear grooves. What’s the disease? a. Follicular carcinoma b. Papillary carcinoma c. Medullary carcinoma 25. What is the Function of 11-B HSD2 a. Inactivation of cortisol b. Aldosterone synthesis c. Progesterone synthesis d. metabolism of something something 26. Pathogenesis in addison’s? a. Destruction of adrenal cortex b. Destruction of steroid cells of medulla c. Hyperplasia of adrenal gland 27. A patient with adrenal tumor and blood pressure of 120/100, what is the most probable clinical feature? a. Orthostatic hypotension b. Hypertension  28. Patient with hypotension, low Na+, and high K+ (table with values from the patient and normal values). a. Cushing’s syndrome b. Cushing’s disease c. Addison’s disease d. Hyperaldosteronism 29. someone had palpitations with heart rate of 130/70 and brisk reflexes, hands were warm and moist, what causes this? a. Lymphocytic infiltration b. Giant cells c. C-cell hyperplasia d. Diffuse atrophy of thyroid 30. What is the consequence for GH binding to GH binding protein a. Increase affinity to receptor b. Shorten half life c. Inhibit binding 31. Hormone inhibits somatostatin to increase GH? a. Ghrelin b. Leptin 32. What is the course of chronic diseases? a. It affects middle to late aged people b. It doesn't matter when it starts, it matter when it peaks c. In utero environment affects chronic diseases in later life d. Genetic play more role than environmental factors e. E?? 33. Which of the following anti-inflammatory steroids can be used for a long period of time? (Not exact wording) A) dexamethasone B) Cortisone C) Hydrocortisone D) Fludrocortisone E) Prednisolone 34. Someone with prostate cancer, what will you see on TC-99? (not sure if it was prostate) a. Increased uptake in the pubis area b. Increased uptake in humerus c. Increase uptake in random areas in the bone 35. What could be injured when ligating the inferior thyroid artery? a. Recurrent laryngeal nerve b. External laryngeal nerve 37. What will happen if the pituitary tumor grows upward? a. Loss if vision in the nasal side of one eye b. Loss if vision in the temporal side of one eye c. Loss if vision in the nasal side of both eyes d. Loss if vision in the temporal side of both eyes  MSK: ✔✔ 1. At what position is the shoulder joint at a greater risk to dislocate when force is applied? a. Extended b. Fully adducted c. Fully abducted d. Medially rotated e. Laterally rotated 2. In which artery the direction of blood can be reversed in the pathological block of the second segment of the axillary artery? a. Thoracoacromial artery b. Subscapular artery c. Lateral thoracic artery d. Anterior circumflex humeral artery e. Superior thoracic artery 3. An orthopedic surgeon, examining a patient with a knee injury, found that his leg moved freely forward when he pulled it in a flexed leg position. What tendon could be torn? a. lateral collateral b. medial collateral c. anterior cruciate d. posterior cruciate e. patellar ligament 4. A 66 yrs old patient with acute lobar pneumonia of 6 weeks, he has increased WBC, pain in the joints with turbid yellow fluid (something like that) a. osteoarthritis b. rheumatoid arthritis c. septic arthritis d. gout arthritis e. pseudogout arthritis 5. What is the mechanism of action of ibuprofen? a. Reversible inhibition of COX2 b. Irreversible inhibition of COX1 6. What is the mechanism of action of tofacitinib? a. Inhibits IL2 b. Inhibits Ca channels c. Inhibits JAK kinase d. Inhibits TNF- alpha 7. Which of the following is a TNF alpha inhibitor? a. Infliximab b. Tofacitinib 8. How does copper deficiency result in defective collagen formation? a. decrease the cleavage of procollagen C and N terminals b. decreases tropocollagen cross linkage c. decreases collagen glycosylation 9. What would an injury to the femoral nerve cause? a. loss of sensation of medial side of leg b. loss of sensation of lateral side of thigh c. paralysis of psoas major d. paralysis of adductor longus e. loss of knee flexion 10. Mass in the popliteal fossa compressing tibial nerve, what's the action that’ll be affected?(not sure of wording or answers) a. Dorsiflexion b. Plantarflexion 11. What muscle has its main function as stabilizing the clavicle? A. Sternocleidomastoid B. Subclavius C. Pectoralis major D. Pectoralis minor 12. Injury to inferior gluteal nerve, which action of the hip is mostly affected? a. Extension b. Flexion c. Abduction d. Adduction e. Medial rotation 13. If the father has a mitochondrial disorder, what percentage of his sons will inherit it? (Wasnt it the mother that had the disorder? No it was the father 100%) a. 0% b. 25% c. 50% d. 100% 14. What explains the increased prevalence and decreased incidence of RA? a. more people dying b. increased disabled patients c. more surviving patients d. none of the above 15. Mutation in transcription factor that permits terminal differentiation of osteoblast causeing osteoporosis and osteogenesis imperfecta? a. Runx2 b. Osterix c. Lrp5 d. Wnt 16. An injury of the nerve to quadratus femoris causes a paralysis of which muscle ? a. Inferior gemellus muscle b. obturator externus c. Obturator internus d. superior gemellus 17. Why does the sudden contraction followed by relaxation not result in jerky body movement? 18. Case scenario of RA pain in wrist joints high TNF-alpha high Anti-CCP Mechanism / pathogenesis? a. Wear and tear cartilage degradation b. Synovitis and something about it being autoimmune? c. Mechanical injury of the joint 19. A mastectomy was done (in lymphs near the axilla), then after days the patient complained of numbness and pain when raising arm above head. Which nerve was injured? 20. Allopurinol inhibits which of these? a. 6 Mercaptopurine a. 5 UMP 21. Hepatitis c and muscle pain, joint pain, and proteinuria What explains the pathogenesis? a. Inflammatory cytokines b. Increased viral load c. Increased creatine kinase d. cryoglobulinemia 22. Which cytokine released by macrophages is responsible for damage in RA? a. TNF-alpha b. IFN-gamma c. IL-10 d. IL-7 23. What’s a characteristic of Colles fracture? a. Fracture of proximal end of radius b. Fracture of neck of radius c. Tear on interosseous membrane d. Midshaft transverse fracture of both ulna and radius e. Avulsion of ulnar styloid process 24. What muscle when contracted makes flexor digitorum tendons in alignment with the toes? a. Quadratics plantae b. Lumbricals 25. What is a characteristic of gout? a. Common in young people b. 1-7% in population (not sure) c. Prevalent in people who eat purine rich food 26. Case with pseudogout. What are the crystals seen? a. Calcium pyrophosphate b. Sodium pyrophosphate c. Monosodium urate d. Calcium pyrophosphate dihydrate e. Sodium pyrophosphate dihydrate 27. What is a power stroke (physiology) a. Highest energy when binding with myosin head(?) b. Myosin is generating movement after release of adp (something like that) 28. patient with spinal stenosis whats the best imaging? a. MRI b. CT 29. Patient with spinal damage and numbness that radiates to the forearm and hand? a. Normal SNAP amplitude and normal latency b. Low SNAP amplitude with normal latency 30. A patient suffers from gouty arthritis. He was treated with an anti-uric medication. Before the treatment the doctor took a urine 24 sample. For the following three weeks the measurement of the urine were the same but the gout levels decreased significantly. What was the medication that was prescribed for this patient? a. Probenecid b. Allopurinol c. Colchicine 31. What is the reason for the irregularity in synovium? a. Increase surface area and decrease tension b. Increase surface are and increase tension c. Increase absorption of fluid d. Provide area for synovial fluid 32. Patient with drooping eyes and weakness and pain(?) of muscles that get worse while walking, what’s the cause? a. Myasthenia gravis b. Central core myopathy c. Inclusion body myositis d. Mitochondrial dysfunction e. Pompe’s disease 33. Patient with hyperuricemia, what is correct about the enzyme causing that? a. Xanthine oxidase —> deficiency b. HGPRT 34. Which of the following exerts its effect by selectively inhibiting cox 2 enzyme? a. Paracetamol b. Aspirin c. Indomethacin d. Celecoxib 35. Cells involved in RA? a. Macrophages & Tc b. Th1 & immune complexes c. Macrophages & autoantibodies 36. A 35 year old male who’s an IV drug addict, complains of knee redness and pain. He has septic arthritis, a biopsy shows gram negative bacilli. What's the causative agent? 37. a. long duration (>1 hour ) , low intensity b. very short duration ( 2-3 minutes) , high intensity c. short duration ( 10 minutes ) , moderate intensity d. medium duration ( 30 minutes) , high intensity  Cardio: 1. Where is the AV bundle located? a. Triangle of Koch b. Muscular part of septum c. Membranous part of septum d. Upper part of crista terminalis 2. What is the effect of the accumulation of oxLDL in vasculature ? a. inhibit the smooth muscle proliferation b. Change the macrophages phenotype to M1 c. Change the T cell phenotype to T2 3. A 46 year old female started a medication for hypertension, 3 weeks later she presented with bradycardia and hyperkalemia. Which of the following causes hyperkalemia? a. B-Blocker b. CCB c. Furosemide d. ACEI 4. A 60 year old man was prescribed medication to treat his chest pain and HFrEF. He came back after 3 weeks with a cough. What could cause this ? 5. In what condition is Sydenham’s chorea seen in? a. infective endocarditis b. myocardial infarction c. rheumatic heart disease 6. In what condition is erythema marginatum seen in? a. infective endocarditis b. myocardial infarction c. rheumatic heart disease 7. What microscopic finding is seen in the kidneys in a typical malignant hypertension? a. fibrinoid necrosis b. hyaline arteriosclerosis 8. What is seen in hypertensive nephrosclerosis? a. fine granular nephrosclerosis b. coarse granular nephrosclerosis c. hyperplastic arteriosclerosis 9. What causes elevated cytoplasmic Ca in cardiac myocyte ? a. activated PMCA b. activated Na/Ca exchanger c. dephosphorylation of RyR2 d. dephosphorylation of L-type Ca channels e. dephosphorylation of phosholamban 10. A 27 year old female experienced palpitations. ECG shows supraventricular tachycardia. Blood pressure 120/80. What first line treatment? a. IV Beta blocker b. IV adenosine c. IV calcium channel blocker d. IV digoxin 11. What causes left ventricular hypertrophy? a. Mitral stenosis b. Mitral regurgitation c. Hypertension 12. Old male patient with uncontrolled diabetes, has hypertension for 20 years, has hepatosplenomegaly and pitting edema in his ankle. What caused his symptoms? a. increased left ventricle contractility b. decreased venous return c. increased afterload d. increased preload 13. Which of the following best describes total peripheral resistance? a. resistance of systemic and pulmonary circulations b. Its controlled by Arteries c. It changes only cardiac function curve d. Preload e. ?? 14. What's the main regulator of coronary blood flow? a. Sympathetic b. Parasympathetic c. Hormonal d. Autoregulation 15. What happens if the afterload increases but inotropy and preload remain constant? a. increase stroke work b. decrease venous return 16. 60 year old patient with normal blood pressure, what is his risk of developing hypertension? a. Less than 10% b. 25-35% c. > 80% 17. An increase in which of the following causes a decrease in cardiac efficiency? a. stroke work b. preload c. Heart rate d. Venous return 18. Patient had a myocardial infarction and passed away 14 days later, what will we see post mortem? a. fibrosis b. granulation tissue c. neutrophiles 19. What is the main fuel used by the heart in normal conditions? a. Fatty acids> glucose> ketone bodies b. Fatty acids > amino acids > ketones c. Glucose > amino acids > ketones 20. Which drug causes persistent cough ? 21. Amiodarone is metabolized by the liver into desethylamiodarone, but it retains some of its activity. What is true about amiodarone? a. it's a prodrug b. it remains active for a while after discontinued use 22. Drug that inhibits HMG-CoA-reductase? 23. Drug that inhibits Na+/K+ ATPase? 24. What’s the significance of screening for monogenic mutations in cardiomyopathy ? a. identify family members at risk b. choose proper treatment c. determine prognosis of patient d. Gene treatment? 25. What increases HDL and lowers LDL? a. Monounsaturated FA b. Saturated FA c. Omega 6 d. Omega 3 26. What causes high LDL and low HDL? a. Trans fat b. Monounsaturated FA c. Polyunsaturated fatty acids d. Omega 6 27. ECG: a. PVC (couplets) b. LBBB 28. Most common cause of death in kuwait? a. Pneumonia b. Car accidents c. CVD d. Cancer 29. Which is correct? a. Renin -> convert angiotensin 1 to angiotensin 2 b. ADH -> increase Na and water excretion c. Natriuretic peptide -> increase glomerular filtration rate 30. Where is the septomarginal trabeculae located? a. Right auricle b. Right atrium c. Left atrium d. Right ventricle e. Left ventricle 31. If there’s an embolism affecting LCA and blocking Circumflex artery, which part of the heart will be affected? a. Right and left ventricles b. Apex c. Left atrium and left ventricle 32. What do you tell people who claim that CVD is only important in males and not important for females? A. incorrect, CHD is the leading cause of death in females B. incorrect, female gender is a risk factor for CVD C. correct, females do not usually present with chest pain 33. Graph of left ventricle volume, where would QRS occur (not sure of the pic, it’s similar) 34. patient with spinal stenosis whats the best imaging? a. MRI b. CT 35. What’s the mechanism of atrial fibrillation? a. AVNRT b. Micro-reentry 36. Which of the following is not included in the CHA2DS2-VAS scoring system? a. Weight b. Age c. HTN d. Diabetes 37. What’s the cause of soft capsule in unstable angina? a. Increased lipid content b. Increased foam cells c. Increase inflammation d. Increased calcification 38. A patient comes with group A streptococcus which valves are most likely affected? a. Pulmonary and aortic b. Mitral and aortic c. Tricuspid and mitral 39. What is true about isovolumic relaxation? a. Ventricular filling b. Ejection c. S1 heart sounds d. All valves closed e. All valves open 41. A congenital anomaly where blood flows from the aorta to the pulmonary trunk? a. Patent ductus arteriosus b. Patent foramen ovale c. Pulmonary stenosis 42. What is the organism associated with infective endocarditis in IV drug user 43. Which of the following is a characteristic of turbulent blood flow? a. Increased viscosity (η) b. Reynold number less than 2000 44. What Artery supplies the SA node? a. Right coronary artery 45. Patient with heart failure and nephropathy, what drug will you give? a. ARB b. ? 46. A 45 year old lady has hypertension, and wants to know what’s required to do as a primary prevention of CVD? a. B blocker b. digoxin c. blood pressure control d. Aspirin 47. Which of the following causes increased coronary blood flow after parasympathetic stimulation? a. adrenaline b. nitric oxide c. angiotensin II d. endothelin  Resp 1. Which membrane with its lower free margin form the vestibular ligament? a. Quadrangular b. Cricothyroid c. Conus elasticus d. Thyrohyoid e. Cricotracheal 2. v/q scan, high perfusion, low ventilation a. COPD emphysema b. Pulmonary hemorrhage c. Pulmonary hypertension d. Pulmonary embolism e. Pulmonary edema - Low ventilation with normal perfusion = impaired lung function with normal blood flow. 3. Spirometry - full inspiration/expiration maneuver. Which point has the lowest pulmonary vascular resistance (PVR)? a. A b. B c. C d. D e. E 4. A 42 y/o man who was treated for pulmonary TB in the past, he presented with weight loss, cough, and hemoptysis. Image studies show avitary lesions, in the apical regions of both lungs, and sputum positive for acid fast bacilli. What will be the most likely result of a lympho-hematogenous dissemination of these lesions? a. tuberculous empyema b. tracheobronchial TB c. laryngeal TB d. miliary TB e. intestinal TB 5. Positive diagnosis for RSV in infants and young children: a. Viral culture b. PCR c. Serology 6. What’s a characteristic of dapsone? (drug used in M.leprae) a. causes discoloration of skin b. ocular(?) manifestations in 1% of users c. mimic the action of sulphonamide by blocking folic acid synthesis 7. In ultrasound for pregnant women, the fetal lung is filled with fluid, what is the cause? a. Tracheal diverticulum b. laryngotracheoesophageal cleft c. Increase type 1 pneumocytes d. Increase type 2 pneumocytes e. Congenital high airway obstruction 8. What test do we use to check for airway hyper responsiveness? 9. Which become mediastinal pleura anteriorly? a. Sternal line b. Costal line c. Diaphragmatic line d. Vertebral line 10. What epithelium lines the alveoli? a. simple squamous epithelium b. simple cuboidal c. stratified squamous d. simple columnar 11. What condition makes it more sensitive to PaCO2? a. Acute metabolic acidosis b. metabolic alkalosis c. Hypoxemia d. Sleep e. emphysema 12. A polysomnography? A: Central sleep apnea B: Obstructive sleep apnea C: Cheyenne stoke Dynamic small airway intrathoracic obstruction flow-volume loop? I’m 13. flow-volume loop, Which is correct, options described each one, all wrong exept one. 14. What is the role of RARs and SARs in coughing reflex? a. Sense solid dust particles in airways b. Sense harmful chemical particles in airway c. No role in cough reflex d. limit inspiration e. controls inspiratory volume and hence controls PEFV 15. What is the most important lipid mediator in inflammation? a. TBX b. PGI c. LTB2 16. A mutation to SR-B1 would lead to high number of which cell? (not exact wording) a. small HDL b. LDL c. VLDL d. Large HDL 17. Specimen for epiglottitis a. nasal swab b. Nasopharyngeal swab c. Throat swab d. Blood e. Sputum 18. A patient was infected with mycobacterium TB, his innate immune response was sufficient to get rid of the infection without adaptive immune response. What tests correlate? (not exact wording) a. IGRA -ve, Tuberculin -ve b. IGRA +ve, Tuberculin -ve c. IGRA +ve, Tuberculin +ve d. IGRA -ve, Tuberculin +ve 19. Sphenopalatine artery arises from which artery? a. Maxillary artery b. Facial artery c. Greater palatine artery 20. Qs about der P a. cleave junction of GI b. cleave junction of respiratory system expose to Th1 c. cleave junction of respiratory system expose to Th2 21. What’s the mechanism of action of mucolytics? 22. How do antihistamines treat acute urticaria? a. decrease peripheral vascular permeability b. decrease histamine release from skin mast cells c. Block H2 receptors 23. What's causing the pathogenesis in Class IV cystic fibrosis? A. Conductance defect B. quantitative defect C. qualitative defect D. gating defect 24. The cause of cilia not working properly in Cystic fire a) Cl- secretion in apical membrane b) Na absorption in apical membrane c) something basolateral d) Thick mucus ?? Something (answer) 25. What causes acute bronchitis? A. Streptococcus agalactiae B. Haemophilus influenzae C. klebsiella pneumoniae D. Escherichia coli 26. What cells are elevated in Sars-Cov-2? a. Neutrophils b. lymphocytes 27. Equation to calculate AaDO2 (PaO2 & PaCO2 were given, only calculate PAO2 then u get AaDO2) 28. someone with short inspiration, and he was gasping, what part is damaged? a. Lower pons b. Upper pons c. Medulla 29. How long does it take for cellular immunity (cytotoxic T cells) to appear in TB? a. 2-3 days b. 3-8 weeks c. 1-2 weeks d. 3-6 months 30. Peripheral lung tumor, EGFR positive, Which cancer? 31. 27. A patient with type 2 diabetes has been on immunosuppressants for the past 12 years following his kidney transplant. He recently presented with sinusitis that isn’t being relieved by antibiotics. A biopsy of the sinuses showed non-septate hyphae, what is the diagnosis? a. Candidiasis b. aspergillosis c. Mucormycosis d. Blastomycosis  Batch 19 Final Exam 1. What is the least related to Philadelphia gene mutation? a. CML b. Child ALL c. Adult ALL d. AML Ans: D Explanation: This is a direct question from the CML LT 2. What is true about a child with mutation in in this hemoglobin that replaces all beta chains with gamma chains? a. higher affinity to 2,3-BPG b. higher affinity to oxygen Ans: B So it’s basically talking about fetal hemoglobin HbF, which has 2 gamma chains, and we know that fetal Hb has higher affinity to O2 bcz of theses gamma chains this is why O2 can be transported from the mothers circulation to the fetus 3. Methylene blue is used in the treatment of a blood disorder. What is the disorder and what is the enzyme involved? a. Coptoprotoporphyrin, Uro III syntahse b. Methoglobinemia, NADPH dependent enzyme (correct) c. Sickle cell, HbS reductade d. Hemolytic anemia, G6PD Ans: B Straight forward,this explanation for thoses who want to know why NADPH and not NADH. NADPH is correct bcz those who have methoglobinemia have defective NADH this is why they developed methoglobinemia so if we want to treat it we should give a drug that targets another enzyme which is NADPH 4. What does the anticoagulant effect of heparin is dependent on? a. GpIIa/IIIb b. Factor Xa c. Fibrin d. Antithrombin III Ans: D Straight forward, heparin increases the activity of antithrombin III, which is responsible for inactivating clotting factors IX, X, XI, XII,XIII, as well as Thrombin lla 5. A patient with rheumatoid arthritis presents with fatigue. RBCs low WBCs low Platelets normal MCV normal Reticulocytes normal. What causes his low WBC count?  a. Aplastic anemia b. Felty’s syndrome c. Steroid use for RA Ans: B Felty's syndrome Is an autoimmune disease which can cause neutropenia = low WBCs from LT 6. what can you find in children leukemias? a. Myeloxidases in blast cells b. T cell more common than b cells c. trisomy 21 is a feature d. indulent course Ans:D Trisomy 21 is basically Down syndrome and it was mentioned in the lecture as one of the causes 7. A 60-year-old male had a road traffic accident and came to the hospital bleeding he needs blood transfusion. what test should be done? a. abo testing and antibodies b. C,E,e,c testing c. direct antiglobulin test d. igM, igA, igG levels Ans: A 8. Woman is pregnant and displays excessive bruising, a table was given showing low platelets count, high APTT, high PTT, and high D-dimers? a. consumptive coagulopathy Ans: BAll the givens are features of DIC which we know from the note that it’s a consumptive coagulopathy disease, meaning it consumes all the coagulation factors and also the platelets 9. what does thrombin time test? a. fibrinogen b. thrombin c. Lupus anticoagulant Ans: A Straight forward bcz we want to measure the time it takes for fibrinogen to be converted to fibrin  10. What suggests a fat embolism? a. difficult pregnancy b. fracture of a long bone c. rupture of a fatty plaque Ans: B We took it in 2nd year when bones are broken the bone marrow will be released causing a fat embolism 11. What is the first cell in erythropoiesis to undergo ribosome synthesis a. Basophilic erythroblast b. Orthochromatophilc erythroblast c. Normoblast d. Late erythroblast Ans: A You guys need to memorize them in order 12. What is the major blood forming organ in second trimester? a. liver b. yolk sac c. bone marrow d. Spleen Ans: A Memorization 13. What protects vitamin B12 from degradation in stomach? a. Haptocorrin b. IF c. Cubulin d. Transcobulamin Ans: A The answer is not IF bcz B12 bind to IF in the small intestine not stomach 14. A 2-year-old Mediterranean boy, which is not eating or growing well, ad looks pale, jaundiced, with splenomegaly, and severe microcytic hypochromic anemia, which hemoglobin is predominant? a. HbS b. HbA2 c. HbF  d. HbBart Ans: C All the symptoms are of B thalassemia major and we know in B thalassemia major HbF is elevated, while in B thalassemia trait, which is a mild symptoms and most of the time there is no symptoms, HbA2 will be elevated it’s really imp to know the difference B thalassemia major = HbF elevated B thalassemia trait = HbA2 elevated 15. 68 year old presented with symptomatic anemia CBC shows WBC low platelets low MCV high Hb low bone marrow: hypercellular with micromegakaryocytes what is true? a. can be treated with vitamin b12 supplements b. can progress to acute leukemia c. can present with lymphadenopathy d. gallstones can be seen Ans: B Old age, anemia, and more than one cytoopenia: low WBCs, Hb, and platelets. Also high MCV and micromegakaryoctes, which is basically blast cells = immature cells, suggest Myelodysplastic syndrome which is a Preleukemic disorder so it can progress to acute leukemia 16. 5 year old boy bone pain, bruising cbc was given i don’t remember a. acute leukemia Ans: A 17. patient with B- thalassemia major, what is most likely associated with the disease? a. Increased conjugated bilirubin b. low reticulocytes c. gallstones d. auto splenectomy Ans: C Gallstones is a very common complication of B thalassemia and sickle cell and any hemolytic anemia, while auto splenectomy is related to sickle cell disease only 18. A patient with dyspnea and swollen red lower limb CBC, APPT, PT were normal D- dimers were high (1000), what is the etiology of his presentation? a. DVT complicated with pulmonary embolism b. DIC Ans: A Dyspnea due to pulmonary embolism, swollen red lower limbs indicate DVT, not DIC bcz we have normal APPT and PT 19. A patient with itching after shower and panmyelosis in bone marrow, what is the most likely mutation? a. association with JAK2 mutation Ans: A Panmyelosis = everything is increased, and itching after shower are key words for Polycythemia Vera, which is associated with JAK2 mutation in more than 95% of the cases 20. A young boy with bleeding disorder with normal platelets APTT and PT, what is the cause of his bleeding? a. hemophilia A b. factor viii deficiency c. platelet dysfunction d. factor v deficiency Ans: C Bcz of the normal APPT and PT we can element a, b, and d so the answer is 21. What cells are CD34+? a. pluripotent stem cells b. Multipotents stem cells Ans: A 22. A 60-year-old patient with gastrointestinal bleeding. he had low hemoglobin (they gave us reference values) and came to the emergency department for blood transfusion. following the transfusion, his hb remained low and he felt pain at the site of injection, nausea and back pain. the plasma is pink. he is blood group A. What do you think happened or most appropriate? a. give antihistamines due to acute the allergic reaction that happened b. give broad spectrum antibiotics c. reassure him that its okay and continue the transfusion d. stop transfusion and send for DAT Ans: D DAT = coombs test used to investigate if there is a hemolytic transfusion reaction so it’s the appropriate thing to do if a patient starts experiencing symptoms immediately after blood transfusion 23. Which drug causes hepatic fibrosis and pneumonitis? a. methotrexate b. cyclosporin a Ans: A 24. A patient with antibodies against parietal cells and intrinsic factor and macrocytic anemia, what condition does he have? a. pernicious anemia  Ans: A 25. Which of the following is a type of autoimmune hemolysis? a. warm and cold Ans: A 26. What is a characteristic of complete AV block? a. dissociation between p waves and qrs complexes b. Prolonged p intervals Ans:A bcz a feature of a third degree AV block, which is a complete AV block is dissociation between p waves and qrs complexes bcz there is no communication between the Atria and ventricles so there will be different pace makers working at the same time SA in the atrium giving us the p wave and a ventricular pace maker generating the qrs complexes 27. If you were to press your index finger on the anterior structure of the oblique sinus, what would you press? a. Arch of aorta b. Superior vena cava c. Left atrium d. Right atrium Ans: C 28. what is true? a. CVD is uncommon in women b. Female gender is a risk factor of CVD c. women with CVD do not experience chest pain as often as men d. CVD is among the most common causes of death in women Ans:D a & c absolutely wrong by logic, b is wrong bcz male gender is the risk factor 29. Whats most likely causative agent of Pulmonary embolism in infective endocarditis?  a. eikenella corrodens b. Staphylococcus aures Ans:B 30. what is the rash associated with rheumatic heart disease called? a. erythema multiforme b. erythema migrans c. Erythema marginatum Ans:C 31. What is the source of energy in ischemic heart? a. glucose by glycolysis b. glucose by TCA c. fatty acid by TCA d. Glucose by gluconeogenesis Ans:A In ischemic heart we have less O2 supply so using glucose is more efficient it gives more energy per molecule of O2 32. What best describes the bowditch effect? a. main positive ionotrpic effect during exercise b. increase in SR Ca store c. after load dependent d. it happens with reduced HR Ans:B d is wrong bcz it happens when the heart rate increases. c is wrong bcz anrep effect is the afterload dependent. It’s clear in the note why B is the answer bcz more stored Ca —> stronger contraction 33. An acute decrease in mean arterial pressure detected by stretch receptors in the aortic arch is followed by a decrease in: a. sympathetic activity b. parasympathetic activity c. cardiac contractility d. peripheral vasodilation Ans:B Here we have low BP so the body will try to compensate by increasing the BP by two ways:1- increase the activity of the sympathetic system and by 2- decrease the activity of the parasympathetic 34.ECG a. Atrial fibrillation b. Atrial flutter Ans:A In the exam the waves were similar to this as u can see the main way to differentiate between a fibrillation and flutter is by looking at the R-R waves interval it’s irregular in fibrillation like the one we had in the exam 35. ecg (it had high qrs in v3-v5 , inverted p waves in lead2, tachycardia ) a. Sinus tachycardia b. Atrial tachycardia c. Left ventricular hypertrophy d. Accelerated junctional rhythm  Ans:C 36. a women taking a medication got bradycardia, and hyperkalemia. What caused her hyperkalemia? a. angiotensin converting enzyme inhibitor b. Calcium channel blockers c. Beta blockers Ans:A All RAAS system drugs cause hyperkalemia bcz they will inhibit the release of aldosterone therefore causing potassium retention = hyperkalemia 37. Which of the following causes secondary hypertension? a. Corticosteroids b. Aortic stenosis c. Anemia d. Hepatic failure Ans:A Don’t get confused aortic coarctation is the one causing HTN not stenosis 38. Drug that induces cough? a. ACE inhibitor b. Nitrates Ans:A Bcz they inhibit bradykinin degradation resulting in bradykinin accumulation causing bronchoconstriction (cough) and vasodilation (lowering BP) 39. Which of the following will decrease death and morbidity in those with HFpEF? a. Digoxin b. CCB c. Nitrate d. None of the above Ans:D They only work on HFrEF Drugs that reduce mortality: 1-ACE inhibitors and Angiotensin II Receptor Blockers (ARBs) 2- beta blockers 3-Mineralocorticoid Receptor Antagonist (MRA): Spironolactone Drugs that only reduce symptoms: 1- digoxin 2-diuretics 40. A 45 year old lady has hypertension, and want to know what’s required to do as a primary prevention of cvd a. B blocker b. digoxin c. blood pressure control d. Aspirin Ans:C d is wrong bcz aspirin is never recommended for primary prevention bcz it increases the risk of bleeding. Keep it in your mind that the only drug that can be used for primary prevention of cardiovascular events is statin the rest are used for secondary prevention 41. what is likely to cause a plaque rupture? a. increase in foam cells b. increase in calcification c. increase in collagen d. increase in inflammation Ans:A Increase foam cells —> inflammation—> rupture of the plaque 42. endocardial biopsy of 20 year old male with heart failure + common cold +lymphocytic infiltration.what is the most common pathogen ? a. adenovirus b. parainfluenza c. coxasckie Ans:C lymphocytic infiltration and heart failure is basically meaning myocarditis here and coxackie is a common cause of myocarditis 43. Which structure contributes to the division of the atrioventrecular canal? a. Septum primum b. Endocardial cushions c. Bulbus Cordis Ans:B 44. Where is the AV node located? a. triangle of Koch b. Crista terminalis Ans:A 45. What do you tell people who claim that CVD is only important in males and not important for females? a. incorrect , CHD is the leading cause of death in females b. incorrect, female gender is a risk factor for CVD c. correct, females do not usually present with chest pain Ans:A 46. a person would have an Increased CHD risk if a first-degree relative ( from family) developed CHD before which age a. 75 b. 65 c. 55 d. 45 Ans:C 47. Which of the following is not included in CHA2DS2-Vas scoring system: a. HTN  b. diabetes c. Age d. weight Ans:D 48. A patient with long standing hypertension for 10 years (he was asymptomatic) what do u see postmortem? a. LVH b. AS c. MA d. Left ventricular dilation e. Right ventricular hypertrophy Ans:A HTN (also stenosis) cause pressure overload resulting in hypertrophic. In regurgitation it’s volume overload causing dilatation 49. Which of the following causes increased coronary blood flow after parasympathetic stimulation? a. adrenaline b. nitric oxide c. angiotensin II d. endothelin Ans:B Bcz b is the only vasodilator the rest of the choices cause vasoconstriction 50. partial depolarization of ap making membrane potential -50. what is true? a. may lead to slow action potential b. partial deactivation of fast Na channel Ans:A Partial depolarization changes the resting membrane potential=RMP for example from-90 to -50 so it made the RMP more positive by doing that we will have slow action potential why? Bcz we know that at -60 Na channels get inactivated and Ca channels will take over (Ca channels are slow and this is why SA and AV node AP is slow bcz they have Ca channels not Na channels(which are fast) 51. young patient football player, died postmortem showed thick septum and heart weight was high microscopy showed myocyte dissarray what is the most likely cause? a. genetic mutation b. hemochromatosis Ans:A Young football player +Thick septum+ myocyte disarray all indicate hypertrophic cardiomyopathy and we know from the lecture that it’s a result from a genetic mutation 52. Patient with dilated cardiomyopathy what is true? a. systolic dysfunction b. diastolic dysfunction Ans:A Dilated so the ventricles can’t contract so they can’t eject blood so it’s a systolic dysfunction 53. woman had an acute MI then developed a stroke in the left hemisphere 6 months after, what is the cause? a. aneurysm b. infarction of lateral wall c. Rupture of papillary muscle d. healed infarcts Ans:A After MI the ventricles can become dilated aka aneurysm —> result in blood stasis—> develop a thrombus—> lead to embolism—> goes to the brain —> develop a stroke 54. In cardiac tamponde what is the source of blood ? a. Rupture of coronary arteries b. Myocardial perfusion c. rupture of pericardial arteries Ans:B Myocardial perfusion due to the rupture of the cardiac wall so the blood that was in the ventricles will leak out and accumulate in the pericardium 55. Descripe the apperance of kidneys in benign HTN a. Fine granular nephrosclerosis b. Coarsly granular nephrosclerosis Ans:A 56. What is true about histology of IVC ? a. Thick adventetia with SMCs b. Fenestrated endothelium c. Tunica media with smc Ans:A 57.cardiac anamolies causes cyanosis ? a. VSD b. atrial septal defect c. Patent ductus arteriosus d. Truncus arteriosus e. transposition of vessels Ans:E E is the only sever one where the whole blood that goes through the aorta from the heart to the body is not oxygenated 58. Which condition will hear murmur during diastole only ? a. Aortic stenosis b. Tricuspid stenosis c. Mitral regurgitation d. patent ductus arterious Ans:B Bcz tricuspid valve opens during diastole so when it become stenoses it won’t open probably during diastole resulting in a diastolic murmur 59. A patient comes with group A streptococcus which valves are most likely affected? a. mitral and aortic b. tricuspid and pulmonary c. mitral and tricuspid Ans:A Bcz group A streptococcus cause rheumatic fever which mostly affect the mitral valve then most commonly the aortic valve 60. What is the most common organism that causes infective endocarditis? a. S. aures 61. Surgeon was ligating LAD punctured the vein accompanying the artery which vein? a. great cardiac vein b. middle cardiac vein c. small cardiac vein d. diagonal artery Ans:A 62. A study was done to follow SA node artery until it ends.Where does this artery end in the surface of the epicardium? a. the superior end of the sulcus terminals b. The inferior end of the sulcus terminals c. Right to left atrium Ans:A The superior end of the sulcus terminals is where the SA node located 63. which drug inhibits Na/ATPase? a. ACE-I b. ARBs c. digoxin Ans:C 64. 35 y/o female has had no menstrual period for 7 months. The hormonal tests show high LH high FSH and low Estradiol what is the cause / diagnosis for her condition? pregnancy a. Primary ovarian failure b. Hypogonadotropic hypogonadism c. Sheehan’s syndrome Ans:A – High LH and FSH show that the hypothalamus and pituatry gland are functioning, but the ovaries aren’t producing estradiol, which is primary ovarian failure 65. From which layer does an aldosterone secreting tumor originates from? a. zona glomerulosa b. Zona fasiculata c. Zona reticularis d. Medulla Ans:A – Aldosterone is produced in the Zona glomerulosa. A good way to remember it is G-salt(aldosterone), F-sweet (cortisol), R-sex (androgens) 66. a 98-Lady with Hypothyroidism had treatment with levothyroxine and then Turned back euthyroid, 6 month later she came with dry skin and constipation and then checked her level she has high TSH then it was revealed that she takes supplements with her medication for the past 2 months What it the supplement ? a. Vit C b. Vit E c. Iron d. Zinc Ans:C – Iron supplements may decrease absorption of thyroid hormone medications 67. 35 y/o women low TSH high T4 palpitations shakiness. Low radioactivity but with tissue back ground, what is the diagnosis? a. diffuse toxic goiter b. subacute thyroiditis c. multinodular goiter d. single nodules goiter Ans:B – in subacute thyroiditis you will see low nuclear uptake in the thyroid gland itself since its being destroyed, but a high background nuclear uptake since the stored T4 is being released 68. what hetrodimerise with insulin ? a. insulin like growth factor 1 b. insulin like growth factor 2 c. growth hormone d. somatostain Ans:A - 69. The absence of which enzyme prevents the ovary from synthesizing corticosterone from cholesterol? a. 17 alpha hydroxylaae b. 3 B-HSD c. 17 B-HSD d. 21 hydroxlase Ans:D – the ovaries produce estrogen, so answers, a, b, and c are needed, but 21 hydroxylase is not needed (Endo biochemistry seminar 3) 70. What causes the Ca+ slippage in non shivering thermogensis ? a. Sarcolipin b. Perilipin c. Lipin d. Myosin Ans:A – sarcolipin inhibits SERCA, so calcium can’t go back into the SR 71. What is defected in vit d dependent rickets? a. 1 alpha hydroxylase b. 25 hydroxylase c. 21 hydroxylase d. vitamin d receptor Ans:A – 1a-hydroxylase is missing so the active product of Vit D cannot be produced 72. which of these drugs destroys thyroid gland tissue in patients with hyperthyroidism? a. Radioactive iodine b. Levothyroxine c. Iodide salts Ans:A – Radiation ablation of the thyroid gland 73. what is the function of active metabolite vitamin D? a. Absorption of Ca from GI b. Inhibition of phosphate reabsorption Ans:A – Vit D affects the GI mainly and increases the absorption of both Ca and phosphate 74. 65 female with type 2 diabetes has heart failure. Which of the following will not be a good medication choice? a. rosiglitazone b. sitgaliptin c. exenatide d. metformin Ans:A – rosiglitazone is contraindicated in patients with CHF, as it can cause fluid retention 75. Post portum hemorrhage , the mother reported failure of lactation , and sexual dysfunction , what it the etiology ( this is the content ) a. Hemorrhagic necrosis of adrenals b. Hemorrhagic necrosis of the PLH producing pituitary c. Ischemic infarction of pituitary d. Cranioparyngioma Ans:C – This is Sheehan’s syndrome, which is hemorrhage of the pituitary gland after delivery, which causes ischemia  76. A patient complains about her shoes not being able to fit her feet anymore because they’re growing. You suspect excess growth hormone and do an oral glucose tolerance test. What can you conclude after the following results from the test. m a. the results are normal and you dismiss the patient b. the patient is a diabetic but growth hormone is normal c. the patient is a diabetic and growth hormone is not responding to the glucose level d. the patient is a diabetic and the growth hormone is responding to the glucose level Ans:C – This is a scenario of acromegaly, so we expect GH to be high, and not decrease 77. What hormone follows an ultradian and infradian rhythm? a. LH b. GH c. cortisol d. testosterone Ans:A – both LH and FSH follow an ultradian (pulsatile, every 1-2 hrs) and infradian (periodicity in days/month) 78. what stimulates growth hormone? a. hypoglycemia Ans: A – Growth hormone is released during hunger by ghrelin and hypoglycemia since it breaks down carbs and is used to bring the glucose levels back to normal 79. What positively correlates with BMI? a. Resistin b. insulin c. adiponectin d. growth hormone e. Cortisol Ans:A – resistin is produced by adipocytes and immune cells, and in obese patients you would find an increased number of both 80. Why does copper deficiency result in defective collagen formation? a. Cleavage of procollagen C and N terminals b. Reduced activity of lysyl oxidase c. Reduced activity of prolyl hydroxylase  d. Reduced glycosylation of lysine Ans:B – copper is a cofactor of lysyl oxidase 81. what antibodies are found in hashimoto’s? a. Thyroid receptor + thyroid peroxidase b. Thyroglobulin +thyroperoxidase c. Enolase +peroxidase d. thyroid receptor Ans:B – antibodies against thyroglobulin and thyroperoxidase which prevents the synthesis of thyroid hormones, causing the symptoms of hypothyroidism seen in hashimotos 82. A patient came with the findings of hyperthyroidism, she took medication, then presented with respiratory infection what is the medication she was treated with? a. levothyroxine b. propranolol c. cabergoline Ans: not sure but I think B, since that’s the only drug given to patients with hyperthyroidism 83. Which part of suprarenal gland responsible for regulating Na+? a. Zona glomerulosa b. Zona fasciculata c. Zona reticularis d. Medulla Ans:A – zona glomerulosa secretes aldosterone, which regulates Na+ and K+ levels 84. What is true about insulin glucagon ration after high protein meal? a. insulin: increased glucagon: decreased b. insulin: decreased glucagon: increased c. insulin: decreased glucagon: decreased d. insulin: increased glucagon: increased Ans:D – After a high protein meal insulin is increased to help with the uptake of the protein, and glucagon is also increased to prevent hypoglycemia from the increased insulin 85. what enzyme activates this pathway? cAMP ———-> 5’AMP a. growth hormone releasing hormone b. ghrelin c. leptin d. somatostatin Ans:D – somatostatin activates G inhibitory a-subunit to inactivate adenyl cyclase, so cAMP is broken down to 5’AMP by phophodiesterase 86. A patient with hypercortisolism and there was lack of suppression of acth in both low and high dose dexamathasone test. what is the cause? a. Cushing’s disease b. adrenal adenoma c. ectopic ACTH secretion Ans:C – in ectoptic ACTH secretion both low and high dose suppression of ACTH won’t have any affect on ACTH levels 87. What triggers the release of vasopressin a. high serum osmolality Ans:A – vasopressin (ADH) is secreted when the serum osmolality is high, resulting in an increase of water reabsorption in an effort to regulate the serum osmolality 88. patient with hyperthyroidism and atrophied thyroid gland, what is the cause? his thyroxine was increased. a. exogenous thyroid intake b. the patient is in propylthiouracil Ans:A – exogenous thyroid uptake will cause a decrease in TSH so the thyroid wont be stimulated anymore and it will atrophy 89. Ultrastructural features of pancreatic endocrine tumors that seen by electomicroscopy ? a. cytoplasmic electron dense neurosecretory granules Ans:A (Dr Maamoun al Aynatis LT) 90. Long scenario with keyword : oval small cells with intranuclear cytoplasmic inclusion? a. Papillary carcinoma b. Medullary carcinoma c. follicular carcinoma Ans:A – describing orphan annie eye nuclei seen in PTC 91. PAS-1 ( Polyglandular Autoimmune Syndrome ) caused by which mutation ? a. AIRE Ans:A - memorise 92. The Superior parathyroid gland is formed from which of the following? a. 4th pharyngeal pouch b. 3rd pharyngeal pouch c. 2nd pharyngeal pouch d. 1st pharyngeal cleft e. 1st pharyngeal pouch Ans:A – 4th pharyngeal pouch: superior parathyroid, 3 rd pharyngeal pouch: inferior parathyroid and thymus 93.What could be injured when ligating the inferior parathyroid artery?  a. Recurrent laryngeal nerve b. External laryngeal nerve Ans:A- they are close together, the external laryngeal nerve is close to the superior parathyroid artery 94. What will be affected if thyroperoxidase is not functioning? a. Conversion of I- to I b. Conversion of T3 to T4 c. Relase of T3 and T4 from thryoglobin d. Production of H2O2 Ans:A – it catalyses the oxidation of I- to I and coupling of monoiodotyrosines and diiodotyrosines to form either T3 or T4 95. Where is 1,25 dihydroxyvitamin D produced? a. Kidney b. Liver c. Intestine Ans:A – kidney has 1a-hyroxylase with makes vit D active 96. 10 year old boy with viriluizing features, high serum DHEA, what is the most likely cause of his symptoms? a. adrenocortical carcinoma b. adrenocortical adenoma c. pheochromocytoma d. waterhouse friderichsen syndrome Ans:A – since there is virilizing features and high DHEA this indicates that it is most likely an adremal tumor of the zona reticularis, and its most likely a carcinoma due to the high DHEA 97. A patient presents with hypertension, headache, palpitations, sweating what is the cause of his complaints? a. pheochromocytoma b. Cushing’s disease c. pituitary tumor d. hyperthyroidism Ans:A- hall marks of pheochromocytoma from the cues, since there will be a large amount of epinephrine and nor-epinephrine produced in the adrenal medulla 98. What drug is associated with CYP2C19 a. warfarin b. clopidogrel c. aspirin Ans:B- memorise; CYP2C19 – clopidogrel CYP2C9 – warfarin CYP1A2 - caffeine 99. A question case describing type 2 diabetes with increased sugar and osmolarity , he had low sodium a. he is in severe hyperosmolar state b. he has ketones in his urine Ans: A – type 2 diabetes is associated with hyperosmolar hyperglycemic state, while type 1 with DKA 100. Fracture to clavicle and injury to lower trunk, affects which nerves? a. Ulnar and median cutaneous b. Supraclavicular c. Radial d. Dorsal scapular Ans:A- lower trunk injury affects the median nerve and ulnar nerve 101. Diabetic patient had pain in the medial ankle of the leg 1 year ago, now present with a flat foot, what happened a. lax fibularis longus b. tibialis posterior injury c. Hyperlaxity of spring ligament d. Congenital deformity Ans:B – a problem in the medial arch, and tibialis posterior is one of the muscular supports of the medial arch and is medial to the ankle 102. what is implicated in the induction of SLE a. Apoptosis of b cell b. Defective neutrophil c. HLA-DR2 Ans:C – one of the risk factors for SLE is HLA-DR2/DR3 103. A 23 year old man had a deep stab to the pelvis. MRI showed lesion in right L4 ventral ramus. What abnormality will be found? a. Reduced sensation of medial aspect of leg b. Cant laterally rotate the thigh Ans:A – injury to the obturator nerve 104. MRI showed puncture or stab above the heal, a chord like structure is affected while the others are intact. plantarflexion is lost. what is affected? a. flexor digitorum b. achilles tendon Ans:B – plantarflexion is from the calf muscles (posterior leg compartment), which insert into the achilles tendon at the heel 105. A man got a posterior acetabular fracture and Lost sensory cutaneous innervation on lower buttocks, posterior and superior lateral area of the leg which nerve was most probably involved? a. Posterior femoral cutaneous b. Femoral c. Obturator d. Lateral femoral cutaneous e. Sciatic Ans:A – memorise areas of sensory innervation of the lower limb 106. What characterises mechanical arthritis? a. bilateral joint involvement b. pain less that 30 mins c. inflammation d. locking Ans:B non-inflammatory pain is usually shorter in duration 107. Soccer player injury heard a loud pop sound & effusion. + anterior drawer test, + mcmurry, -vagus/varus. What to confirm the dignosis? a. Xray of knee b. MRI c. CT Ans:B – MRI is the best in assessing damaged to ACL and other ligaments 108. What does highTc99 MDP high indicate? a. Bone destruction b. New formed bone c. Osteoporosis Ans:B – new formed bone will have an increased uptake of the Tc99 due to being more vascular 109. Fracture in skull, how it’s healed? a. indirect healing b. Intramembranous healing c. Primary healing d. Secondary healing Ans:B – intramembranous (direct) healing is seen when the gap is very small, like in the skull 110. what is the pathophysiology of the disease? a. chronic bronchitis b. emphysema c. asthma d. restrictive Ans:B Explanation: for our level if this diagram is present then we have 3 cases, either normal, chronic bronchitis or emphysema. In this case we have ventilation that is not matched to perfusion which is emphysema. 111. Child that was hypersensitive (allergic) to penicillin presented with strep throat caused by gram +ve cocci in chains.What drug would you use? a. Erythromycin b. Cefotaxime c. Amoxicillin d. Clavulanic acid Ans: A Explanation: Strep throat infection —> use penicillin, if allergic use a macrolide such as Erythromycin 112. a non smoker with progressive dyspnea, low FEV1/FVC ratio, the LOWER lobes were affected, his brother also has the same disease, what is the mechanism behind the disease? a. cystic fibrosis b. antielastase deficiency Ans:B Explanation:non-smoker (rule out chronic bronchitis), progressive dyspnea (chronic), low ratio (obstructive disease), brother has the same condition (hereditary) + LOWER LOBES —> all of these point towards a1 anti trypsin deficiency 113. In maxillary air sinus carcinoma if the invasion is upward which of these is least likely to occur? a. displacement of the globe of the eye b. double vision c. facial pain and anaesthesia of the skin over the maxilla d. swelling on the face and a palpable mass in the labiogingival groove Ans:D, Straight from the note 114. What is the pathogenesis of cystic fibrosis? a. defect in cl secretion at apical membrane b. Defect in cl absorption in basolateral membrane c. Defect in na secretion at apical membrane d. Defect in na absorption at basolateral membrane Ans:A Explanation: Cystic fibrosis is a mutation in the chloride transporter on the apical membrane. so B, C, and D are wrong, 115. Which one is Part of nasal septum (medial wall of nasal cavity) a. Perpendicular plate of ethmoid bone b. Perpendicular plate of palatine bone c. Cribriform plate of ethmoid bone Ans:A, direct question 116. What is the of this finding in a V/Q scan? a. Pulmonary embolism b. Pneumothorax c. Pulmonary Edema Ans:A Explanation: We can see that the perfusion in the right lung is affected, and what can affect the perfusion? Pulmonary embolism 117. What is true about the function of proteoglycans that is important for cartilage ? a. Water retention b. Cross links collagen Ans:A, direct question; water retention is one of the main properties of proteoglycans 118. Which of following associated with lung cancer ? a. benzopyrene 119. Which mutation causes a benign tumor of nerve sheath? a. NF1 b. Braf Ans:A Explanation: Direct question, since a schwannoma (benign tumor of nerve sheath) is caused by NF1 and has a chance of developing into malignant peripheral nerve sheath tumor. 120. person living in high altitude, barometric pressure is 548 mmhg, the Paco2 is 37 what is the PAo2 ? ( oxygen 21% R 0.8) a. 150 mmhg b. 69 mmhg c. 61 mmhg d. 59 mmhg Ans:D Explanation: We just substitute now: (548-47)*0.21-37/0.8 = 58.96. 121. Which cells form TB granuloma? a. cd4t, macrophages and giant cells b. Antibodies and e cells c. CD4, CD8, b cells Ans:A Explanation: Direct question, macrophages are an essential component of the TB granuloma 122. How can that the intrapleural pressure becomes more positive? a. Forced expiration 3 Liters b. Forced inspiration 3 liters c. Normal expiration d. Normal inspiration Ans:A Explanation:Max expiration will make the pleural pressure positive 123. Airway resistance is highest at a. Activation of ach agonist b. Activation of SNS c. Nitric Oxide Ans:A Explanation: Because it causes bronchoconstriction 124. How do dust particles elicit cough? a. Extrapulmonary mechanoreceptors b. RAR c. A gamma fibers d. C fibers Ans:A Explanation: C & D are chemosensors so the only detect chemicals. Extrapulmonary mechanosesors are cough receptors they induce cough when there is a particular in the airway. RAR and SAR they don’t cause cough they only regulate the amount of air in the lungs. Also RAR can a adjust the compliance of the airways therefore affecting the speed of air flow 125. What is the most important in lipid mediator in inflammation? a. TBX b. PGI c. Leukotrin d. Lipoxin Ans: C 126. Which has the highest/ more sensitive response to Increasing CO2? a. Chronic hypercapnia b. Obesity c. Metabolic acidosis d. hypoxemia e. Sleep Ans:C Explanation: As you can see in the diagram the steepest curve is the metabolic acidosis one; meaning, it’s more sensitive. 127. Which become mediastinal pleura anteriorly a. Sternal line b. Costal line c. Diaphragmatic line d. Vertebral line Ans:A Explanation: Direct from the note. 128. What is the origin of parietal pleura? a. Somatopelura b. Pleuroperitoneal canal Ans:A 129. Which of the following binds to Sr-b1 receptor? a. Large hdl b. Small hdl c. Ldl d. Ox-ldl Ans:A Explanation: Direct from the note 130. Which of the following undergoes Antigenic shift? a. Parainfluenza virus b. Influenza A virus c. coxsackievirus b Ans:B Explanation: Antigenic shift is one of the properties of influenza virus. 131. Which of the following is ABCA1 ligand? a. Small HDL b. ApoA Ans:B Explanation: 132. How does dobutamine work? a. Alpha agonist b. Beta agonist c. Beta antagonist Ans:B, Memorization 133. What is the mechanism of action of ephedrine? a. 1 adrenoreceptor agonist 134. Which one of the following is an invasive ventilator?  a. Pressure assist control b. Synchronized intermittent mandatory ventilation c. Volume assist control d. Bilevel positive airway pressure 135. What is true about viral infections? a. Arthalgia only in the only in the onset of infection b. Adult and children both experience myalgia c. Myalgia is caused by relase of anti inflammatory cytokines Ans:B Explanation: Influenza A causes myalgia in Adults, while Influenza B causes myalgia in children 136. Where is the highest pulmonary vascular resistance? Ans:A Explanation: “PVR is highest at total lung capacity (TLC), high at residual volume (RV), and lowest at functional residual capacity (FRC)” 137. What is the significance of av shunt on skin? a. Contributes in temperature regulation 138. Which of the following statements is true? a. Adenohypophysis receives direct blood supply from the inferior hypophyseal artery b. Neurohypophysis receives direct blood supply from the superior hypophyseal artery  c. Capillary plexus from hypothalmus to median imminence d. The long portal vessels arise from the capillary plexus in the lower infundibulu, and adenohypophysis Ans:C, memorization 139. A patient with celiac disease and rheumatoid arthritis presented with leukocytosis, what is the cause of the leukocytosis? a. Chronic steroid use b. bone marrow suppression c. Infection Ans:A Explanation: He has both celiac disease and RA, so he is most likely using steroids, which can cause leukocytosis (since it causes WBC to demarginate from the blood vessel wall)  3rd year Final Exam (115/200) Batch 18 exam tafreegh committee Done by: Fatema Al Kandari, Laila Kazem, and Fatema Al Mansour Thanks to all batch 18 1- 2- 3- what is the most accurate statement regarding renal impairment in plasmas cell dyscrasias? A) it can be caused by NSAIDS usage B) occur in cases of underlying kidney disease C) a feature of MGUS D) unlikely in AL amyloid 4- 5- 6- 7- A biochemical analysis was performed for a patient with hemolytic anemia, what would show during an acute hemolytic attack? A) High LDH Normal Total Bilirubin High Conjugated Bilirubin Decreased Haptoglobin B) High LDH High Total Bilirubin Normal Conjugated Bilirubin Decreased Haptoglobin 8- 9- 10- 11- 12- deficiency in which of the following predisposes to venous thrombosis? A) Thrombin B) fibrin C) Protein C D) Factor 8 E) Vit k 13-HbSC disease is a hemoglobinopathy & a milder type of SCD developed of two point mutation in which gene? A) Alpha globin B) Beta globin C) Gamma globin D) delta globin 14- A 55-year-old patient with a well known history of kidney failure presented to the hospital complaining of fatigue and weakness. A complete blood count was ordered. He had a normal serum ferritin but low TIBC and serum iron. What would his diagnosis be? A) iron deficiency anemia B) Anemia of chronic disease C) pernicious anemia D) megaloblastic anemia 15- What is the main role of vWF in secondary hemostasis? A) Stabilize factor V B) Stabilize factor VII C) Stabilize factor VIII D) Stabilize factor X 16- 17- A 50-year-old male complaining of dizziness and fatigue. Physical examination revealed pallor, fever and hepatosplenomegaly. CBC showed anemia and neutropenia. PBS showed large cells, some with intracytoplasmic rod like structure. What is expected in bone marrow examination? A) Infiltration by myeloblast B) Fibrosis C) Necrosis D) Lymphocytic infiltration E) Hypocellular 18- A 50-year-old presents with burning sensation in the toes. CBC shows thrombocytosis (700x10^9). What is the most likely diagnosis? A) Essential thrombocytosis B) Polycythemia vera C) Chronic myeloid leukemia 19- Patient's tests indicate presence of CD 19, CD 10, and TdT: A) Acute myeloid leukemia B) Acute lymphoblastic leukemia C) Plasma cell myeloma 20- As a consequence of AGE binding to AGE receptors, which enzyme increases reactive oxygen species? A- Xanthine dehydrogenase B- NADPH oxidase C- Isocitrate dehydrogenase 21- 22- 23- what would be the consequence if lactate was not exported out of erythrocytes? - Glycolysis stops 24- 25- Pathogenesis of hereditary spherocytosis? A) defective cytoskeleton B) defective membrane phospholipid C) protein interaction 26- what is the fully differentiated antibody secreting stage of B lymphocytes? A) Mature B cell B) Plasma cell C) pro B cell D) Resting B cell 27- 28- 29- 30- Patient with microcytic anemia and chronic kidney disease, which hormone will be increased? -Hepcidin 31- Where is the AV node located? A) Triangle of kotch B) upper crista terminalis C) lower crista terminalis 32- A surgeon was conducting a study on a patient’s left anterior descending artery to evaluate him for a bypass surgery. However, as he was doing that, he accidentally punctured a nearby vein. What vein has been likely injured? A) Small cardiac vein B) Middle cardiac vein C) Great cardiac vein D) The oblique vein of Marshall E) Thebesian veins 33- Which of the following organs has continuous endothelium? A) Liver B) Lung C) Kidney D) Spleen E) Adrenal glands 34- in which of the following congenital anomalies blood flows from the aorta to the pulmonary trunk? A) patent ductus arteriosus B) ostium secundum defects C) patent foramen ovale D) dextrocardia E) pulmonary stenosis 35- Patient with a complete heart block later presented with a junctional pacemaker and a HR of 45 bpm. What’s the most likely finding on an ECG? A) Inverted T wave B) 1:1 ratio of p to QRS complexes C) normal QRS D) prolonged PR intervals (we are not 100% sure because we weren’t taught about the ecg pattern of secondary pacemakers in complete heart block, ask a dr if you want to be sure) 36- 37- 38- 39- A 17 y/o female with HTN, what’s the most likely cause? A) Coarctation of aorta B) Aortic stenosis C) Aneurysm D) Hepatic failure 40- 41- 42- A 27 y/o woman presenting with palpitations. Her ECG showed supraventricular arrhythmia and her BP was 120/80. What should the first line of treatment be? A) IV adenosine B) IV BB C) IV digoxin D) IV CCB 43- Which anti-anginal drug is contraindicated in patients taking sildenafil (viagra)? A- atenolol B- calcium channel blockers C- nitroglycerin 44- 45- MAO of Amiodarone -blocks K+ channels 46- 47- 48- Which drug works by inhibiting Na/K ATPase? A) diuretics B) Class 1 antiarrhythmics C) CCB D) digoxin 49- 50- 51- 52- Which of the following inhibits HMG CoA reductase? A) statins B) ezetimibe C) BCSK9 inhibitors D) Colestipol 53- How does clofibrate work? (not exact wording) - I think the answer was indirect, something like “increase LPL activity” 54- What is the most common type of arrhythmia found in thyrotoxicosis? Answer: atrial fibrillation 55- Which of the following occurs during ventricular diastole? A) Atrial contraction B) AV valve closure C) Rapid atrial filling D) Blood ejection 56- which of the following structures of streptococcus pyogenes mimics the cardiac myosin and leads to the development of autoantibodies? A) M protein B) Flagella 57- bearing in mind Frank Starling mechanism, which sarcomere stretch produces the strongest contraction? A) 2.4 B) 3.6 C) 1.2 D) 6.2 58- An increase of which will increase SV and EDP? A) Afterload B) Inotropy C) Preload D) Heart rate 59- CO=6L/min MAP=112mmHg ESV=50ml EDV=150ml What is the heart rate bpm? Answer: 60 60- Graph A represents AP impulse. Graph B represents conductance (ion channel permeability). What ion channel is represented in graph B? A) Potassium (graph B only had the black line) B) Calcium A the point of this question is to know which ion channels are activated and which are closed throughout the AP of a cardiac myocyte. B 61- 62- 63- 64- A man was found dead in his apartment. Which muscle undergoes rigor mortis first? A) cardiac muscle B) intercostal muscle C) arm muscle D) thigh muscle E) jaw muscle (rigor mortis starts from head to toe, and the smallest muscles become rigid first) 65- a man brought to the ER with abrasions and bruises on the dominant parts of his face, what is the most likely mechanism of injury? A) Fabricated B) RTA C) Criminal assault 66- someone died by hanging and had hemorrhage from sternocleidomastoid muscle + fracture of (c2-c3?) vertebrae. A) suicide hanging B) accidental hanging C) homicidal hanging D) judicial hanging E) autoerotic hanging 67- Main ligand for (SR-B1)? A) Large HDL B) Large LDL C) small HDL D) small LDL Two answers are possible because in Dr. Aisha’s note it would be large HDL, while in Dr. Farouq’s note it would be would be LDL (didn’t specify large or small). Check with Drs. 68- 69- How does fatty acid oxidation Directly regulate glucose oxidation? Acetyl coA activates pyruvate dehydrogenase kinase (to help you understand: pyruvate dehydrogenase kinase INACTIVATES PDH, which is the enzyme at the end of glycolysis that converts pyruvate to acetyl coA in order to enter TCA cycle.) 70- About fetal heart metabolic profile: Answer: high glycolytic rate but low level of mitochondrial oxidation 71- Increased cardiac AMP will increase the uptake and oxidation of what? A) glucose B) amino acid C) ketone bodies D) fatty acid 72- 73- Which of the following correctly describes the blood supply of the pituitary gland? Answer: capillary plexus at the median eminence receives connections from the hypothalamus. 74- 75- 76- Patient with hypernatremia, fluid retention, and hypokalemia, which cell is affected? A) Curved columns of cells B) Straight cords C) Irregular clusters of cells (you need to infer that the patient has hyperaldosteronism first, then you chose the description that fits histology of zona glomerulosa). 77- 78- karyotype of a newborn baby showed deletion of long arm of chromosome 22, what structures absent in the baby? Answer: Thymus and all parathyroid glands (this is Digeorge syndrome) 79- 80- 81- 82- What is the effect of growth hormone on protein in skeletal muscles and lipids in adipose tissue? 83- How does somatostatin inhibit GH? A) Increase camp B) decrease camp C) increase ca2+ D) decrease ca2+ 84- 85- 86- 5 kg weight reduction leads to this decrease in the risk of diabetes type 2? A) 10-20% B) 35-55% C) 50-60% 87- what’s the function of 11β-hydroxysteroid dehydrogenase type 2? A) reduces Na reabsorption by the kidney B) stimulated as a response to increased plasma Na C) catalyzes the activation of cortisol due to stress D) protects mineralocorticoid receptor due to stress 88- what is a very strong risk factor of post-partum thyroiditis? A) smoking during pregnancy B) anti-thyroid AB C) young age D) low fetal weight 89- Case w/ Features of graves: A) Thyroid peroxidase antibody B) Thyroglobulin antibody C) Thyroid stimulating hormone receptor antibody D) Thyroid inhibiting hormone receptor antibody 90- Autoantigen for Lymphocytic hypophysitis? (frequently repeated, make sure u know!) Answer: Alpha-enolase 91- Which of the following features are relevant to Addison’s disease? A) immunological destruction of adrenal medullar cells B) increased production of cortisol C) increased production of aldosterone D) immunological destruction of steroid cells in the adrenal cortex E) increased growth of adrenal cortex cells 92- 93- Which gene is associated with monogenic obesity? A) FTO B) LEP 94- 95- 96- which of the following symptoms of a patient with pancreatic tail tumor may suggest that the patient has somatostatinoma? A) cholelithiasis and steatorrhea B) high volume watery diarrhea C) hypoglycemia D) nausea, vomiting and peptic ulcer disease E) necrolytic migratory erythema 97- Which of the following is a characteristic of metabolic syndrome? 98- 99- 100- 101- A 48 yr. old woman who underwent surgery was given metformin. What statement characterizes this medication? A) hypoglycemia is an adverse effect B) decreases gluconeogenesis C) controls prandial activity 102- 103- Which of the following if given orally can cause hypoglycemia? A) Acarbose B) Glimepiride C) Metformin (glimepiride is the most potent potent sulfonylurea drug, and sulfonyurea side effects include hypoglycemia) 104- 60 years old was diagnosed with hyponatremia that’s “probably” result from excess water retention and not of lack of sodium intake, dr prescribed an aquaretic drug that competitively blocked vasopressin-V2- receptors which one of the following it is? A) leuprolide B) desmopressin C) demeclocycline D) conivaptan 105- a question about ganirelix characteristics can’t remember the choices (‫)من امتحانات قديمة‬ A) direct GnRH antagonist B) treats ovarian overstimulation C) alleviates acromegaly symptoms 106- Which mutation should present to treat adenocarcinoma with tyrosine kinase inhibitor? A) KRAS B) EGFR 107- went something like this: how can you tell the difference between a malignant follicular carcinoma and a follicular adenoma? Answer: Invasion of vessel (malignancy in FTC is determined by histology; if vessel or capsule is invaded then it’s malignant) 108- Patient has hypertension and is using medication for hypertension. Blood pressure is 150/95. They gave us values and normal ranges the K was low and HCO3 high. Adrenal adenoma 1.5cm seen on CT. What is true? A) Increase plasma renin B) Origin of tumor in zona reticularis C) Low K excretion D) High urine aldosterone 109- 53 years old female with fatigue and generalized bone pain, on long-term hemodialysis, Ca low Phosphate high Creatinine high Alkaline phosphatase high (Given normal range) What is the cause of her bone pain? A) Parathyroid hormone deficiency B) 25hydroxycholecalciferol increase C) 25hydroxycholecalciferol decrease D) parathyroid hormone increase (we aren’t sure which one is correct, ask Dr’s) 110- 111- A 35-year-old female presented with amenorrhea and galactorrhea and pregnancy test is negative? Serum prolactin level increased? A) primary hypothyroidism should be ruled out B) hypogonadotropic hypergonadism is expected C) if prolactinoma is detected, dopamine antagonist is administered 112- 113- 114- 115- 116- What is the correct order? A) anaerobic, aerobic then pc B) aerobic, anaerobic then pc C) pc, anaerobic then aerobic D) pc, aerobic then anaerobic 117- Someone tried to protect his head with his arms in a fight and he got stabbed, medical student noticed that he couldn't adduct his thumb anymore. Which nerve injured? -Ulnar nerve 118- Muscle that attaches to iliotibial tract? A) Gluteus maximus B) Gluteus Medius C) Sartorius D) Iliopsoas 119- 120- 121- which curve represents hemoglobin stripped of 2,3BPG? A) A B) B C) C D) D 122- Anteromedial supply to the leg? Answer: Saphenous nerve 123- Which of the following artery supply lateral compartment of leg? A) Fibular B) Medial circumflex of femoral C) Lateral circumflex of femoral 124- Patient with everted foot which nerve was injured? A. Tibial nerve B. Common fibular C. Femoral 125- Worker fell and caused injury to the sustentaculum tali which of the following nerves is most likely torn? A) Flexor digitorm brevis B) Flexor digitorm longus C) Flexor hallicus longus D) Flexor hallicus brevis E) Tibialis posterior Not sure 126- 127- MRI of spine shows disc herniation of nucleus polposus what could be the reason? A. Annulus fibrosis is thin posterolaterally (not the exact wording) 128- What is the following structure that is a remanent of the axial skeleton of the embryo? A) Nucleus Pulposus B) Apical ectodermal ridge C) Somite D) Sclerotome E) Myotome 129- 130- 131- 132- 133- 134- 135- what is the effect of smoking on bone healing? A) vasoconstriction which diminishes blood flow to the fractured area B) increase the efficiency of bone healing by producing some cytokines 136- A young child recently diagnosed with osteopetrosis. The disease process is attributed to a defect in gene responsible for production of proton required for dissolving bone by osteoclast. A) OPG B) CA2 137- Question about a child have periosteal lifting and histology shows cells in background of pink osteoid, where does it happen? A) Epiphysis B) Diaphysis C) Metaphysis This is osteosarcoma 138- AT1 receptor, Salt and water retention ? 139- 140- Which of the following drugs is associated with Reye’s syndrome in children with viral infections? A) aspirin B) indomethacin C) celecoxib D) ibuprofen 141- 29-year-old Physical trainer Arthritis - both knees Brown discoloration: sclera, nasal bridge, and …. History: passed dark urine more than on occasion X-ray: marked damage to both knees Q: What is the primary mechanism that leads to this disease? A) Defects in collagen synthesis B) Deposition of crystals in joints C) Trauma to joints D) Degeneration of articular cartilage (this is a case of ochronosis) 142- Which drug increases excretion of uric acid? A) Probenecid B) colchicine C) Allopurinol 143- Patient had pain in his left shoulder area. When the dr checked, it was found he had spleen rupture. Which nerve transmits the the referred pain this patient feels? A) phrenic B) vagus??? C) thoracic splanchnic nerves 144- 145- 146- Can be the cause of type 1 respiratory failure but never type 2? A) interstitial fibrosis B) COPD/emphysema C) low inspired PO2 D) pneumonia 147- which age range has the highest rheumatoid arthritis incidence? A) 10-30 B) 30-55 C) 60-85 D) >90 148- 149- 150- 151- What characterizes temporal dispersion in demyelinated neuropathy? A) Longer compound AP duration, shorter amplitude B) Longer compound AP duration, normal amplitude C) Shorter compound AP latency, shorter amplitude D) Shorter compound AP latency, normal amplitude 152- 153- 154- 155- 156- 157- 158- 159- Which cytokine is upregulated upon immunotherapy with Treg? Answer: IL-10 160- 161- 162- what stimulate mast degranulation? "‫" مو متأكده من صيغة االجوبه‬ A) binding allergen w/ lgE molecule B) lgE on mast or eosinophils... C) production of specific lgE and on re-exposure for allergen D) lgE through its Fc receptor - bind for receptor on mast cells (the answer COULD be A or C, we’re not sure because we dont have the exact wording, but on the exam it was clear by elimination!) 163- Which test is used to identify airway hyper-responsiveness A) methacholine challenge test B) pulmonary function test C) Inspiratory peak flow D) Bronchial provocation test 164- Which infectious disease is prevented with a live attenuated vaccine? A) Rubella B) hepatitis A C) rabies D) Polio (salk) 165- Delayed type hypersensitivity disease: A) Anaphylaxis B) Autoimmune hemolytic anemia C) Serum sickness D) Contact dermatitis 166- 167- A 3 yo child with fever, earache........ gram positive diplococci. What is the organism? A) P.aeruginosa? B) N. Meningitis C) S.Pneumonia D) H.influenza 167- 168- 169- what is the immunological status of a person after M.TB infection and activated adaptive immunity? A) + IGRA, - TST B) + IGRA, + TST C) – IGRA, - TST D) – IGRA, + TST 170- what is the most common upper respiratory tract Infections in Kuwait? A) Enterovirus B) Rhinovirus C) Adenovirus B) Coronavirus 171- 172- 173- What is the most important in limiting flow during forced expiration from total lung capacity? A) contractility of expiratory muscles B) action of the diaphragm C) elasticity of the chest wall D) compression of the airways 174- Which if the following lung volumes and capacities can be measured by spirometry? A) total lung capacity B) Inspiratory reserve volume C) functional residual capacity D) residual volume 175- Which of the following is consistent with asthma attack? A) Constriction of airway smooth muscle B) a1 antitrypsin deficiency C) Collapse of airway due to alveolar septa destruction D) Reduced total lung capacity and residual volume 176- 177- 178- 179- What is the main reason that a diffusing capacity of lungs for O2 is not a good predictor of the function of the respiratory membrane? A) Transfer air -> blood limited by perfusion B) Poor soluble in plasma C) Bind Hb tightly D) Metabolized by cells of the respiratory membrane 180- What must be done before VQ scan for pulmonary embolism assessment? A) Chest CT within 72hrs B) PA and lateral chest x-ray within 24hrs C) PA and lateral chest x-ray within 72hrs D) Chest MRI within 24hrs 181- The diffusing capacity DLCO for carbon monoxide is reduced in: A) Anemia B) Asthma C) Chronic bronchitis 182- where is the origin of the signal that limits inspiration when the tidal volume increases (i.e. 2-3 L)? A) Central chemoreceptors B) Peripheral chemoreceptors C) Slowly adapting mechanoreceptors in the lungs D) A delta (Aδ) fibers 183- hypercapnia trigger hyperventilation in normal people, which cells responsible for detecting changes in partial pressure of CO2? A) type 1 glomus cells in carotid body B) H+ sensitive neurons in medulla near brain ventricle C) Dorsal root ganglion D) pump cells 184- An incision was made between pons and the medulla in an experimental animal, vagus was blocked. What is the pattern of breathing? A) apneustic breathing B) Cheyenne strokes breathing 185- can’t remember the exact question but it was about a condition or disease that cause error in helium dilution technique A) COPD B) Asthma C) weak respiratory muscles D) abdominal gas 186- what is the reason of increased N2 concentration in phase IV? A) increased dead space B) air from apical alveoli 187- what causes type 1 but never type 2 respiratory failure? A) High amplitude B) Pulmonary fibrosis C) COPD/ emphysema D) Pneumonia 188- what is mainly used to assess hypoventilation? A) PaCO2 B) PaO2 C) PvCO2 D) PvO2 189- What is the most likely reason for the patient’s findings on the right? A) Intrathoracic obstruction B) Extra thoracic obstruction C) Restrictive D) Poor cooperation 190- 191- which of the following carcinogens is associated with lung cancer? A) mercury B) benzyl cyanide C) benzopyrene D) benzaldehyde 192- 193- 194- 195- 196- 197- a 50-year-old woman with a 20 pack year history of smoking with symptoms of cough and dyspnea presenting with the following values in her PFT: fvc decreased - fev1 decreased – fev1/fvc ratio decreased - tlc increase - rv increased - bronchodilator effect on fvc 10% improvement and on fev1 17% improvement. What is she suffering from? A. Asthma B. Emphysema C. Interstitial lung disease 198- ECG showing increased PR intervals. What is the condition? A) accessory AV conducting pathway B) CCB overdose C) fever D) hyperthyroidism (this is first degree heart block. Overdose of rate-controlling drugs such as CCB and BB can lead to heart block) 199- ECG showing +ve QRS waves with depression in leads v1-3 & lead 1 was -ve (=right axis deviation) & HR=96. What is the diagnosis? A) Subendocardial ischemia B) Rv hypertrophy C) Old MI 200- Physio pft table low tlc low rv low frc low fev 1 low ratio A) ILD B) Emphysema C. pneumonia ANSWERS 3- A 69- / 137- C 7- B 70-/ 138- / 12- C 71- D 140- A 13-B 73-/ 141- D 14- B 76- A 142- A 15- C 78-/ 143- A 17- A 82-/ 146- C 18- A 83- B 147- B 19- B 86- C 151- A 20- B 87- D 159- / 23- / 88- B 162- A 25- A 89- C 163- A 26- B 90- / 164- A 30-/ 91- D 165- D 31- A 93- B 167- C 32- C 96- A 169- B 33- B 97- / 170- B 34- A 101- B 173- D 35- C 103- B 174- B 39- A 104- D 175- A 42- A 105- A&B are correct 179- A 43- C 106- B 180- B 45-/ 107- / 181- A 48- D 108- D 182- C 52- A 109- C&D 183- B 53-/ 111- A 184- A 54-/ 116- C 185- A 55- A 117- / 186- B 56-A 118- A 187- A 57-A 121- A 188- A 58- C 123- A 189- A 59-/ 124- A 191- C 60- A 125- ? 197- B 64- E 127- / 198- B 65- B 128- A 199- B 66- D 135- A 200- A 67- A? 136- B  3rd year Final Exam (115/200) Batch 18 exam tafreegh committee Done by: Fatema Al Kandari, Laila Kazem, and Fatema Al Mansour Thanks to all batch 18 1- 2- 3- what is the most accurate statement regarding renal impairment in plasmas cell dyscrasias? A) it can be caused by NSAIDS usage B) occur in cases of underlying kidney disease C) a feature of MGUS D) unlikely in AL amyloid 4- 5- 6- 7- A biochemical analysis was performed for a patient with hemolytic anemia, what would show during an acute hemolytic attack? A) High LDH Normal Total Bilirubin High Conjugated Bilirubin Decreased Haptoglobin B) High LDH High Total Bilirubin Normal Conjugated Bilirubin Decreased Haptoglobin 8- 9- 10- 11- 12- deficiency in which of the following predisposes to venous thrombosis? A) Thrombin B) fibrin C) Protein C D) Factor 8 E) Vit k 13-HbSC disease is a hemoglobinopathy & a milder type of SCD developed of two point mutation in which gene? A) Alpha globin B) Beta globin C) Gamma globin D) delta globin 14- A 55-year-old patient with a well known history of kidney failure presented to the hospital complaining of fatigue and weakness. A complete blood count was ordered. He had a normal serum ferritin but low TIBC and serum iron. What would his diagnosis be? A) iron deficiency anemia B) Anemia of chronic disease C) pernicious anemia D) megaloblastic anemia 15- What is the main role of vWF in secondary hemostasis? A) Stabilize factor V B) Stabilize factor VII C) Stabilize factor VIII D) Stabilize factor X 16- 17- A 50-year-old male complaining of dizziness and fatigue. Physical examination revealed pallor, fever and hepatosplenomegaly. CBC showed anemia and neutropenia. PBS showed large cells, some with intracytoplasmic rod like structure. What is expected in bone marrow examination? A) Infiltration by myeloblast B) Fibrosis C) Necrosis D) Lymphocytic infiltration E) Hypocellular 18- A 50-year-old presents with burning sensation in the toes. CBC shows thrombocytosis (700x10^9). What is the most likely diagnosis? A) Essential thrombocytosis B) Polycythemia vera C) Chronic myeloid leukemia 19- Patient's tests indicate presence of CD 19, CD 10, and TdT: A) Acute myeloid leukemia B) Acute lymphoblastic leukemia C) Plasma cell myeloma 20- As a consequence of AGE binding to AGE receptors, which enzyme increases reactive oxygen species? A- Xanthine dehydrogenase B- NADPH oxidase C- Isocitrate dehydrogenase 21- 22- 23- what would be the consequence if lactate was not exported out of erythrocytes? - Glycolysis stops 24- 25- Pathogenesis of hereditary spherocytosis? A) defective cytoskeleton B) defective membrane phospholipid C) protein interaction 26- what is the fully differentiated antibody secreting stage of B lymphocytes? A) Mature B cell B) Plasma cell C) pro B cell D) Resting B cell 27- 28- 29- 30- Patient with microcytic anemia and chronic kidney disease, which hormone will be increased? -Hepcidin 31- Where is the AV node located? A) Triangle of kotch B) upper crista terminalis C) lower crista terminalis 32- A surgeon was conducting a study on a patient’s left anterior descending artery to evaluate him for a bypass surgery. However, as he was doing that, he accidentally punctured a nearby vein. What vein has been likely injured? A) Small cardiac vein B) Middle cardiac vein C) Great cardiac vein D) The oblique vein of Marshall E) Thebesian veins 33- Which of the following organs has continuous endothelium? A) Liver B) Lung C) Kidney D) Spleen E) Adrenal glands 34- in which of the following congenital anomalies blood flows from the aorta to the pulmonary trunk? A) patent ductus arteriosus B) ostium secundum defects C) patent foramen ovale D) dextrocardia E) pulmonary stenosis 35- Patient with a complete heart block later presented with a junctional pacemaker and a HR of 45 bpm. What’s the most likely finding on an ECG? A) Inverted T wave B) 1:1 ratio of p to QRS complexes C) normal QRS D) prolonged PR intervals (we are not 100% sure because we weren’t taught about the ecg pattern of secondary pacemakers in complete heart block, ask a dr if you want to be sure) 36- 37- 38- 39- A 17 y/o female with HTN, what’s the most likely cause? A) Coarctation of aorta B) Aortic stenosis C) Aneurysm D) Hepatic failure 40- 41- 42- A 27 y/o woman presenting with palpitations. Her ECG showed supraventricular arrhythmia and her BP was 120/80. What should the first line of treatment be? A) IV adenosine B) IV BB C) IV digoxin D) IV CCB 43- Which anti-anginal drug is contraindicated in patients taking sildenafil (viagra)? A- atenolol B- calcium channel blockers C- nitroglycerin 44- 45- MAO of Amiodarone -blocks K+ channels 46- 47- 48- Which drug works by inhibiting Na/K ATPase? A) diuretics B) Class 1 antiarrhythmics C) CCB D) digoxin 49- 50- 51- 52- Which of the following inhibits HMG CoA reductase? A) statins B) ezetimibe C) BCSK9 inhibitors D) Colestipol 53- How does clofibrate work? (not exact wording) - I think the answer was indirect, something like “increase LPL activity” 54- What is the most common type of arrhythmia found in thyrotoxicosis? Answer: atrial fibrillation 55- Which of the following occurs during ventricular diastole? A) Atrial contraction B) AV valve closure C) Rapid atrial filling D) Blood ejection 56- which of the following structures of streptococcus pyogenes mimics the cardiac myosin and leads to the development of autoantibodies? A) M protein B) Flagella 57- bearing in mind Frank Starling mechanism, which sarcomere stretch produces the strongest contraction? A) 2.4 B) 3.6 C) 1.2 D) 6.2 58- An increase of which will increase SV and EDP? A) Afterload B) Inotropy C) Preload D) Heart rate 59- CO=6L/min MAP=112mmHg ESV=50ml EDV=150ml What is the heart rate bpm? Answer: 60 60- Graph A represents AP impulse. Graph B represents conductance (ion channel permeability). What ion channel is represented in graph B? A) Potassium (graph B only had the black line) B) Calcium A the point of this question is to know which ion channels are activated and which are closed throughout the AP of a cardiac myocyte. B 61- 62- 63- 64- A man was found dead in his apartment. Which muscle undergoes rigor mortis first? A) cardiac muscle B) intercostal muscle C) arm muscle D) thigh muscle E) jaw muscle (rigor mortis starts from head to toe, and the smallest muscles become rigid first) 65- a man brought to the ER with abrasions and bruises on the dominant parts of his face, what is the most likely mechanism of injury? A) Fabricated B) RTA C) Criminal assault 66- someone died by hanging and had hemorrhage from sternocleidomastoid muscle + fracture of (c2-c3?) vertebrae. A) suicide hanging B) accidental hanging C) homicidal hanging D) judicial hanging E) autoerotic hanging 67- Main ligand for (SR-B1)? A) Large HDL B) Large LDL C) small HDL D) small LDL Two answers are possible because in Dr. Aisha’s note it would be large HDL, while in Dr. Farouq’s note it would be would be LDL (didn’t specify large or small). Check with Drs. 68- 69- How does fatty acid oxidation Directly regulate glucose oxidation? Acetyl coA activates pyruvate dehydrogenase kinase (to help you understand: pyruvate dehydrogenase kinase INACTIVATES PDH, which is the enzyme at the end of glycolysis that converts pyruvate to acetyl coA in order to enter TCA cycle.) 70- About fetal heart metabolic profile: Answer: high glycolytic rate but low level of mitochondrial oxidation 71- Increased cardiac AMP will increase the uptake and oxidation of what? A) glucose B) amino acid C) ketone bodies D) fatty acid 72- 73- Which of the following correctly describes the blood supply of the pituitary gland? Answer: capillary plexus at the median eminence receives connections from the hypothalamus. 74- 75- 76- Patient with hypernatremia, fluid retention, and hypokalemia, which cell is affected? A) Curved columns of cells B) Straight cords C) Irregular clusters of cells (you need to infer that the patient has hyperaldosteronism first, then you chose the description that fits histology of zona glomerulosa). 77