Q And A Chapter 1-11 PDF

CHAPTER 1: ANATOMY AND PHYSIOLOGY 1. Supination 2. Flexion 3. Abduction ----- ------------------------------------- ------- ------------------------------------ ----- -------------------- 4. Extension 5. Adduction 6. Parasagittal plane 7. Sagittal plane 8. Midsagittal plane 9. Kneecap 10. Biceps bronchi 11. Triceps bronchi 12. Dysphagia 13. Joints 14. Hormone glands 15. Blood vessels 16. Extensor muscles 17. Flexor muscles 18. Pubis 19. Ilium 20. Ischium 21. Transverse plane 22. Endocrine glands 23. Arteries 24. Skull bones 25. Moving away from body 26. Moving closer to body 27. Slicing vertically 28. Slicing vertically from middle line 29. Slicing vertically from side lines 30. Slicing horizontal 31. Dysuria 32. Dyspnea - Adduction → (26) - Abduction → (25) - Sagittal planes → (27) - Para sagittal plane → (29) - Mid sagittal plane → (28) - Transverse plane → (30) - Hip joints have → (18, 19, 20) - Flexor muscles are present in→ (10;pull joints toward middle line) - Extensor muscles are present in→ (11;push joints away from middle line) - Epithelial tissue is present in → (hormone glands 22) - Endothelial tissues are present in → (blood vessels, capillaries). - Write types of Skull bones →Cranial (8), facial, and ossicles. - Movement away from the midline of the body (3) - Act of turning the hand so that the palm is uppermost (1) - Bending part of the body (2) - Movement toward the midline of the body (5) - Lengthening or straightening of the flexed limb (4) - Muscles Found in arms and thighs (10) - Muscles Found in arms only (11) - Separates the body into unequal right and left portions (6) - Separates the body into equal right and left portions (8) - Separates the body into right and left portions (7) - What protects from injuries in the front of the knee joint (9) - Popliteal vein is present in? A deep vein behind the knee. - What muscles are found in limbs, foot, arms (flexor and extensor) - The shoulder joint are type of? Ball and socket joints - Popliteal nerve is present in knee (arc of knee) - Popliteal space? A lozenges shape space in knee joint also called popliteal fossa. - What is the other name of hip joint, shoulder joint? Ball and socket. - Example of sesamoid bone is?Patella bone. - Example of the carpals in the wrist? Scaphoid, lunate, triquetral, hamate, pisiform, capitate, trapezoid and trapezium. Additional Reference: www.visiblebody.com **1. What is the opposite of the anterior view?** 1. **A. Ventral view** 2. **B. Dorsal view** 3. **C. Lateral view** 4. **D. Medial view** 5. **E. Distal view** [**[Answer]**](about:blank) Ans: B Tips: Anterior: in front of (ventral)\ Posterior: In back of (dorsal)\ Medial: Toward the middle\ Lateral: Away from the middle\ Proximal: closer to the median plane (refer to the limbs only)\ Distal: Farther away from the median plane (refers to the limbs only)\ Caudal: Lower part (inferior)\ Superficial: Lower part (inferior)\ Ipsilateral: same side\ Contralateral: opposite side\ **2. Abduction is an anatomical movement of:** 1. **A. A muscle, which moves a body part away from the midline of the body.** 2. **B. A muscle, which moves a body part toward the midline of the body.** 3. **C. A muscle, which moves a body part downward the body.** 4. **D. A muscle, which moves a body part upward the body.** [**[Answer]**](about:blank) Ans: A Tips: Anterior: in front of (ventral)\ Posterior: In back of (dorsal)\ Medial: Toward the middle\ Lateral: Away from the middle\ Proximal: closer to the median plane (refer to the limbs only)\ Distal: Farther away from the median plane (refers to the limbs only)\ Caudal: Lower part (inferior)\ Superficial: Lower part (inferior)\ Ipsilateral: same side\ Contralateral: opposite side\ **3. Which of the following statements regarding bone shapes is correct?** 1. **A. Flat bones provide mechanical support and protect internal organs.** 2. **B. Irregular bones are typically found in the limbs and provide mobility.** 3. **C. Sesamoid bones are small, rounded bones embedded within tendons.** 4. **D. Short bones are elongated and play a role in weight-bearing.** 5. **E. Long bones are primarily found in the skull and provide protection.** [**[Answer]**](about:blank) Ans: C Tips: Sesamoid bones are unique bones that develop within tendons, typically in areas where there is high pressure, tension, or friction. Examples of sesamoid bones include the patella (kneecap) and the pisiform bone in the wrist. Flat bones (Option A) are thin and often have a protective function, such as the skull bones. Irregular bones (Option B) have complex shapes and are found in various locations, such as the vertebrae and facial bones. Short bones (Option D) are cube-shaped and are primarily found in the wrists and ankles. Long bones (Option E) are characterized by their elongated shape and are found in the limbs, such as the femur and humerus. **4. Which of the following locations does not contain epithelial tissue?** 1. **A. Skin** 2. **B. sweat gland** 3. **C. Heart** 4. **D. Oil glands** 5. **E. salivary gland in mouth** [**[Answer]**](about:blank) Ans: C Tips: Epithelial tissue is primarily found covering and lining various body surfaces and organs. The skin, sweat glands, oil glands, and salivary glands all have epithelial tissue present. However, the heart is primarily composed of cardiac muscle tissue and does not have a layer of epithelial tissue covering its surface. **5. Planes and sections of the body: Separates the body into equal right and left portions is referred to as:** 1. **A. Sagittal plane** 2. **B. Mid-sagittal plane** 3. **C. Coronal plane** 4. **D. Parasagittal plane** [**[Answer]**](about:blank) Ans: B ***Tips:*** *[Sagittal plane]* *àseparates the body into right and left portions*\ *[Midsagittal plane (Median plane]) àseparates the body/body part into equal right/left portions*\ *[Parasagittal plane]à separates the body into unequal right and left portions.*\ *[Coronal plane]à separates the body/body part into anterior and posterior portions.*\ *[Transverse plane]à divides the body/body part into superior and inferior portions.*\ *[Oblique plane]* *àpasses through the body/body part at an angle*\ **6. Which of the following is NOT a function of the skin?** 1. **A. Secretion** 2. **B. Stimuli with irritant** 3. **C. Locomotion** 4. **D. Regulate body temperature** [**[Answer]**](about:blank) Ans: C Tips: The skin has multiple functions, including protection, sensation, regulation of body temperature, and secretion. However, locomotion is not a function directly associated with the skin. Locomotion refers to the ability to move from one place to another, which is primarily controlled by the skeletal and muscular systems. The skin plays a role in providing a smooth surface for movement but does not directly contribute to locomotion. **7. Anterior excruciate ligament is found in?** 1. **A. Shoulder** 2. **B. Knee** 3. **C. Hip** 4. **D. Ankle** 5. **E. Arm** [**[Answer]**](about:blank) Ans: B Tips: Anterior excruciate ligament connects to the femur, tibia and patella. **8. What cavity has lumbar vertebrae?** 1. **A. Ventral cavity** 2. **B. Dorsal cavity** 3. **C. Thoracic cavity** 4. **D. Abdominal cavity** 5. **E. Pelvic cavity** [**[Answer]**](about:blank) Ans: B Tips: dorsal cavity consists of the cranial cavity and vertebral cavity. **9. Pelvic cavity consists of all, EXCEPT:** 1. **A. Rectum** 2. **B. Reproductive organs** 3. **C. Urinary bladder** 4. **D. Kidney** 5. **E. Uterus** [**[Answer]**](about:blank) Ans: D ***Tips:** Kidneys are present in the abdominal cavity.*\ ***Strategic thinking: **in answering this type of question:* 1. *Read the question. Be very mindful of the terms like EXCEPT, LEAST, MOST. These are clues that lead you to the best option.* 2. *Picture out the location of the body part being asked. From the choices, imagine where these organs are located.* 3. *The question asked for a body part that is NOT within the pelvic cavity. The kidneys are situated higher anatomically, found particularly in the abdomen.* **10. The pelvis bones or hip joints have?** 1. **A. Pubis, ilium, and ischium** 2. **B. Scapula, ilium and ischium** 3. **C. Humerus, ilium, and ischium** 4. **D. Ligament, humerus, scapula** [**[Answer]**](about:blank) Ans: A Tips: Hip consists of pubis, ilium and ischium bones. Humerus bone connects from shoulder to elbow. **11. Which of the following does NOT include the cranial bones?** 1. **A. Facial bones** 2. **B. Parietal** 3. **C. Temporal** 4. **D. Occipital** 5. **E. Ethmoid** [**[Answer]**](about:blank) Ans: A **Tips: mnemonic "PEST OF" **Parietal (2), Ethmoid, Sphenoid, Temporal (2), Occipital, AND Frontal.\ The eight cranial bones are:\ Frontal bone: forms the forehead and upper part of the eye sockets.\ Parietal bones: two bones on the upper sides of the skull.\ Occipital bone: forms the back of the skull and contains the foramen magnum, which allows the spinal cord to pass through.\ Temporal bones: two bones on the lower sides of the skull that contain the external auditory canal and the styloid process.\ Sphenoid bone: a single bone that forms part of the base of the skull and contains the sella turcica, which houses the pituitary gland.\ Ethmoid bone: a single bone that forms part of the anterior skull and contributes to the nasal septum and eye sockets.\ Vomer bone: a single bone that forms the nasal septum.\ Mandible: the lower jawbone that is the only movable bone in the skull.\ These cranial bones are tightly interlocked with each other to form a protective shell around the brain. They also provide attachment points for muscles and serve as landmarks for neuroanatomical and surgical reference.\ **12. Which of the following is the primary neurotransmitter involved in skeletal muscle contraction?** 1. **A. Dopamine** 2. **B. Serotonin** 3. **C. Acetylcholine** 4. **D. Norepinephrine** [**[Answer]**](about:blank) Ans: C Tips: The contraction of muscle fibers is regulated by the nervous system. When a motor neuron is stimulated, it releases acetylcholine at the neuromuscular junction. Acetylcholine binds to receptors on the muscle fiber, triggering an action potential that spreads down the muscle fiber and causes the release of calcium ions from the sarcoplasmic reticulum **13. Which of the following proteins binds calcium ions to initiate muscle contraction?** 1. **A. Actin** 2. **B. Myosin** 3. **C. Troponin** 4. **D. Tropomyosin** [**[Answer]**](about:blank) Ans: C **14. Which of the following opposites of anatomical views are incorrect?** 1. **A. Dorsal and frontal (ventral)** 2. **B. Lateral and medial** 3. **C. Prone and Supine** 4. **D. Sagittal and para sagittal** [**[Answer]**](about:blank) Ans: D **15. Which of the following is not part of the axial skeleton?** 1. **A. Femur** 2. **B. Sternum** 3. **C. Mandible** 4. **D. Sacrum** 5. **E. Vertebral column** [**[Answer]**](about:blank) Ans: A Tips: The axial skeleton consist of 80 bones from head, the sternum, ribs, vertebral column. The femur is thigh bone and not from axial skeleton. **16. Which of the following is the primary energy source for muscle contraction?** 1. **A. Glucose** 2. **B. Fatty acids** 3. **C. Adenosine triphosphate (ATP)** 4. **D. Lactic acid** [**[Answer]**](about:blank) Ans: C Tips: ATP is the primary energy source for muscle contraction. It is required for the cross-bridge cycling between the actin and myosin filaments, which generates the force that produces muscle contraction. While glucose and fatty acids can be used as sources of energy for ATP production, they must be converted to ATP through the process of cellular respiration. Lactic acid is produced as a byproduct of anaerobic metabolism when glucose is converted to ATP in the absence of oxygen, but it is not a primary energy source for muscle contraction. **17. Which of the following joint is \"multiaxial ball and socket \" type?** 1. **A. Hip joints** 2. **B. Knee joints** 3. **C. Elbow joint** 4. **D. Shoulder and hip joint** [**[Answer]**](about:blank) Ans: D **18. What are the following muscle fibers that help in muscle contraction?** 1. **A. Actin and myosin** 2. **B. Myosin and inhibin** 3. **C. Inhibin and actin** 4. **D. Actin, myosin and inhibin** [**[Answer]**](about:blank) Ans: A Tips: Actin and myosin fibers cause contractions. Inhibin is a hormone released from maturing follicles and corpus luteum. **19. A muscle which can both flex the hip and extend to the knee is?** 1. **A. Sartorius** 2. **B. Rectos femoris** 3. **C. Semimembranosus** 4. **D. Biceps femoris** [**[Answer]**](about:blank) Ans: B Tips: Rectus femoris is a muscle in the quadriceps, the rectus femoris is attached to the hip and helps extend or raise the knee. This muscle also used to flex the thigh. The rectus femoris is the only muscle that can flex the hip. **20. What are the examples of sesamoid bones are?** 1. **A. Vertebrae** 2. **B. Scaphoid** 3. **C. femur** 4. **D. Patella** 5. **E. Radius** [**[Answer]**](about:blank) Ans: D Tips: Sesamoid bones are embedded in tendons, round bones commonly found in tendons of knee, feet and hand. CHAPTER 2: GI TRACT 1. Diarrhea 2. Constipation 3 . Bloating ----- ------------------------- ----- ---------------------------- ----- --------------------------------- 4. Cramps 5. Proteases 6. Nuclease 7. 2 glucose molecules 8. Colon 9. Gluten present in cerea 10. Alpha glucosidase 11. 95-100% anaerobic bacteria 12. Fructose + glucose 13. Peptidase 14. Enterokinase 15. Chymotrypsin 16. Trypsin 17. Vitamin D~3~ 18. Deficiency of intrinsic factors 19. Parenteral vitaminB~12~ 20. Alcohol dehydrogenase 21. Achlorhydric 22. Decreases 23. Inguinal hernia 24. Low pH - The most basic pH part of the GI tract (colon) - Irritable bowel syndrome symptoms (1,2,3,4) - The proteins are digested by (Proteases, 15, 16) - What converts nucleic acid into nucleotides (nuclease) - The pernicious anemia is caused by (18 ) - What enzymes digest peptides into amino acids (13) - Pernicious anemia is treated by (19) - What converts inactive trypsinogen into trypsin (Enterokinase in small intestine (14) - What enzyme oxidizes alcohol to aldehyde and acids (20) - What are the major bacteria present in colon (99% anaerobic bacteria) - Breakdown sucrose & starch to glucose (glucosidase) - Pernicious anemia is treated by → (Vitamin B~12~ IM, sc injection) - Maltase breakdowns maltose to → 2 glucoses - Sucrase breakdowns sucrose to → glucose and fructose - Irritable bowel symptoms include→ Diarrhea, constipation, bloating, Nausea & vomiting(except GI bleeding) - Bacteria in colon makes \--\> vitamin K~2~, as well as methane, and hydrogen sulfide. - What GIT conditions are associated with GI bleeding symptoms? Cancer, Ulcers, Crohn's disease, ulcerative colitis's, and gastritis. (Except, IBS, pancreatitis) - The decreased state of acid in stomach is described as? Achlorhydric - Generally elderly are achlorhydric, pH increases and GI motility? Decrease. - Infants are chlorhydria, thus the pH is? Acidic - What is the most common type of hernia in old age? Inguinal hernia - Active transport of calcium depends on the action of? calcitriol and intestinal vitamin D receptors. **1. What are the parts of small intestines in sequence from stomach to rectum?** 1. **A. Duodenum, Jejunum and Ileum** 2. **B. Jejunum, Duodenum and Ileum** 3. **C. Ileum, Duodenum and Jejunum** 4. **D. Duodenum, Ileum and Jejunum** [**[Answer]**](about:blank) Ans: A Tips: mnemonic: DJI = Duodenum, jejunum and ileum **2. The lower part of gut contains the following microorganisms.** 1. **A. 10 to 50% anaerobic** 2. **B. 90 to 99% anaerobic** 3. **C. 10 to 50% aerobic** 4. **D. 90 to 99% aerobic** [**[Answer]**](about:blank) Ans: B Tips: The colon has the highest anaerobic bacteria, and it can range from 90 to 99%. **3. Which part of the GI tract has the least pH?** 1. **A. Esophagus** 2. **B. Stomach** 3. **C. Small intestine** 4. **D. Colon** [**[Answer]**](about:blank) Ans: B Tips: The stomach has the least pH, which makes it the most acidic ranging from pH 1.5 to 3.5. **4. What is the most basic (alkaline) section of the gastrointestinal tract?** 1. **A. Esophagus** 2. **B. Stomach** 3. **C. Small intestine** 4. **D. Colon** [**[Answer]**](about:blank) Ans: D Tips: Colon is the most basic part of the GI tract. **5. Intrinsic factor is released from?** 1. **A. G cell** 2. **B. Stomach** 3. **C. Parietal cell** 4. **D. Mucus cell** 5. **E. Pancreas** [**[Answer]**](about:blank) Ans: C Tips: Parietal cells (also known as oxyntic or delomorphous cells), are the epithelial cells that secrete hydrochloric acid (HCl) and intrinsic factor. They are located in the gastric glands found in the lining of the fundus and in the body of the stomach. They contain an extensive secretory network (called canaliculi) from which the HCl is secreted by active transport into the stomach. **6. Deficiency of parietal cell can cause?** 1. **A. Deficiency of vitamin D** 2. **B. Deficiency of vitamin K** 3. **C. Achlorhydric** 4. **D. Chlorhydric** [**[Answer]**](about:blank) Ans: C Tips: Parietal cell produces HCL and intrinsic factors. Achlorhydria or hypochlorhydria refers to states where the production of hydrochloric acid in gastric secretions of the stomach and other digestive organs is absent or low, respectively.\ ***Strategic thinking: **in answering this type of question:* 1. *Read the question.* 2. *Make an association of the function of the cells, in this case parietal, with what is expected to happen if the body has less of these. As discussed from the **TIPS, **parietal cells play a major role in the stomach's acidity.* 3. *Choose the option that describes a condition of low acidity, as this is the consequence of decreased parietal cells.* *(Refer from your Misbah's Evaluating review book the cells that play an important function in the normal physiology of the body system they belong. Knowing these would help you determine the consequences in cases where there is either deficiency or excess of these. In addition, note the surgical alteration/removal of the organs that secrete these cells as this will largely aid you analyze problems expected to arise when a patient is under medication. Example: Gastrectromy: partial or complete removal of the stomach. Patient is taking an antifungal, (i.e. Ketoconazole) which requires acidic environment for optimal absorption. )*\ **7. A patient with intrinsic factor deficiency developed megaloblastic anemia (pernicious anemia). What is the correct recommendation?** 1. **A. Oral vitamin B12 supplements** 2. **B. Antacids with vitamin B12** 3. **C. Vitamin B12 injections** 4. **D. Vitamin B12 with acidic drugs** [**[Answer]**](about:blank) Ans: C **8. Maltase breaks down maltose to?\*** 1. **A. Glucose +fructose** 2. **B. Glucose + glucose** 3. **C. Glucose + Starch** 4. **D. Glucose + lactose** 5. **E. Starch + sucrose** [**[Answer]**](about:blank) Ans: B Tips:\ Glucose +fructose → sucrase\ Glucose + glucose → maltase\ Glucose + Starch → amylase\ Glucose + galactose → lactase\ E. Starch + sucrose → alpha glucosidase\ *Maltase is the enzyme that breaks down maltose to two glucose units.* --------- --------------------- --------------------- ENZYME CARBOHYDRATE PRODUCT Amylase Starch and glycogen Maltose Maltase Maltose Glucose + glucose Sucrase Sucrose Glucose + Fructose Lactase Lactose Glucose + galactose --------- --------------------- --------------------- \ \ \ \ \ \ \ \ \ \ \ \ \ \ ***Strategic thinking: **in answering this type of question:* 1. *Read the question.* 2. *Look for keyword. In this case, **BREAKS. **So, we are looking for products that are simpler in form than the one mentioned in the question. In this case, we know that **Maltose **is a **DISACCHARIDE. **We are looking for (a) monosaccaride/s which is/are the basic unit of carbohydrates. Options C, D and E are wrong because the combination of the carbohydrates mentioned include disaccharide (lactose) and complex carbohydrates (starch) in them.* 3. *Correct answer is B. this type of questions requires both memorization and analysis. Memorize the basic units of a product.* **9. Celiac disease is caused by?** 1. **A. Deficiency of gluten** 2. **B. H. pylori infection** 3. **C. It is type of inflammatory bowel disease** 4. **D. None of the above** [**[Answer]**](about:blank) Ans: D Tips: Celiac disease is due to sensitivity to gliadin fraction of ingested gluten, resulting in immunologically mediated inflammatory damage to the lining of the small intestine in genetically predisposed individuals. The inflammation may lead to malabsorption by reducing the amount of surface area available for absorption of nutrients, fluids and electrolytes. **10. Steathorrhea can result to?** 1. **A. Fat absorption impaired** 2. **B. Indigestion of carbohydrate** 3. **C. Secretion of vitamin A, D, E and K** 4. **D. Excessive absorption of lipids** [**[Answer]**](about:blank) Ans: C Tips: Steatorrhea can result into excessive secretion of fat soluble vitamins A, D, E and K. Drugs like Orlistat (Xenical) can cause steatorrhea. **11. Ulcerative colitis occurs at?** 1. **A. Colon** 2. **B. Stomach** 3. **C. All GI tract** 4. **D. Small intestine** 5. **E. Esophagus** [**[Answer]**](about:blank) Ans: A **12. Excessive acid secretion causes?** 1. **A. Crohn's disease** 2. **B. Peptic ulcers** 3. **C. Ulcerative colitis (inflammatory)** 4. **D. H. pylori ulcers** 5. **E. Irritable bowel disease** [**[Answer]**](about:blank) Ans: B **13. Irritable bowel syndrome (IBS) symptoms include all, EXCEPT:** 1. **A. Diarrhea** 2. **B. Constipation** 3. **C. GI bleeding** 4. **D. Bloating** 5. **E. GI upset** [**[Answer]**](about:blank) Ans: C Tips: Irritable bowel syndrome (IBS) is a chronic disorder with symptoms of bloating, cramps, constipation/ diarrhea, N&V symptoms. On the other hand, Inflammatory Bowel Disease (IBD) and (Crohn\'s disease and UC) may cause bleeding and diarrhea. **14. All of the following conditions are associated with upper gastrointestinal bleeding, EXCEPT:** 1. **A. Liver cirrhosis** 2. **B. Peptic ulcers** 3. **C. Gastric ulcer** 4. **D. Acute Pancreatitis** 5. **E. Variceal bleeding** [**[Answer]**](about:blank) Ans: D Tips: Acute Pancreatitis is sudden inflammation of pancreas. It can be mild or life threatening. It may involve regional tissue or other organs. Sever constant abdominal pain is main symptoms. Pain is mainly below sternum and can radiate to back. Three main causes of pancreatitis is gallstones, heavy alcohol use, and medications side effects. All above conditions peptic ulcers, liver cirrhosis, variceal bleeding are associated with gastrointestinal bleeding. **15. Why are most drugs absorbed from the small intestine?** 1. **A. Because drug first enters the small intestine.** 2. **B. Because small intestine has large surface area.** 3. **C. Because small intestine is not acidic.** 4. **D. Because small intestine is small.** [**[Answer]**](about:blank) Ans: B Tips:\ *The large surface area of the small intestine is due to the unique structural features of its inner wall or mucosa that is covered in wrinkles or folds called plicae circulares, from which microscopic finger-like pieces of tissue called villi project, and each villus also has finger-like projections called microvilli. The small intestine also has rugae that allow distention and contraction. These features are designed to increase the amount of surface area available for the absorption of nutrients, and to limit the loss of said nutrients to intestinal fauna.*\ **16. Crohn's disease commonly occurs at the?** 1. **A. Colon** 2. **B. Stomach** 3. **C. Terminal small intestine and colon** 4. **D. Small intestine** [**[Answer]**](about:blank) Ans: C Tips: Crohn's commonly occurs at terminal small intestine and colon. **17. Which of the following protein digestive enzyme is released from pancreas into the small intestine?** 1. **A. Pepsin** 2. **B. Trypsinogen** 3. **C. Maltase** 4. **D. Sucrase** [**[Answer]**](about:blank) Ans: B Tips: Pancreas produces 3 enzymes amylase, trypsin and lipase and released as pancreatic juice into the small intestine. The other enzymes produced in cells converting villi in small intestine's ileum are maltase, sucrase, lactase, peptidase, and lipase. **18. What food/diet induces HCl secretion?** 1. **A. Carbohydrate** 2. **B. Fat** 3. **C. Proteins** 4. **D. Vitamins** [**[Answer]**](about:blank) Ans: C Tips: Proteins stimulate gastrin production and gastrin secretes HCl from parietal cells. **19. About calcium, all are correct, EXCEPT:** 1. **A. Calcium is absorbed in all parts of small intestine.** 2. **B. Two mechanisms of absorption are active transport and passive absorption.** 3. **C. Lactose and vitamin D enhance calcium absorption.** 4. **D. The efficacy of absorption increases as calcium intake increases.** [**[Answer]**](about:blank) Ans: D Tips: The efficacy of absorption decreases as calcium intake increases. High doses of calcium supplements like 1500 mg have to be divided 500 mg tid. **20. What is not true about the gastrointestinal system in elderly populations?** 1. **A. Increased pH** 2. **B. Deficiency of intrinsic factors** 3. **C. Increase GI motility** 4. **D. Deficiency of Vitamin B12** 5. **E. Vitamin B12 injection is recommended** [**[Answer]**](about:blank) Ans: C **21. A customer of your pharmacy presents with a prescription of loperamide and lactulose. He is experiencing abdominal pain and bloating. He has hard-bullet like stools followed by diarrhea. He may be experiencing?** 1. **A. Ulcerative colitis** 2. **B. Crohn's disease** 3. **C. Inflammatory bowel disease** 4. **D. Irritable Bowel Syndrome** [**[Answer]**](about:blank) Ans: D Tips: Ref: CTC e-therapeutics\ *Symptoms of IBS include abnormal stool frequency (a) \3 bowel movements per day; abnormal stool form (c) lumpy/hard stool or (d) loose/watery stool; (e) defecation straining; (f) urgency or also feeling of incomplete bowel movement, passing mucus and bloating.*\ **22. What is NOT a symptom of Irritable Bowel Syndrome (IBS)?** 1. **A. Constipation** 2. **B. Bleeding from gut** 3. **C. Nausea and vomiting** 4. **D. abdominal cramps, and pain** [**[Answer]**](about:blank) Ans: B **23. Which of the following GI conditions is NOT associated with GI bleeding?** 1. **A. Gastritis** 2. **B. Gastroenteritis** 3. **C. Pancreatitis** 4. **D. GI cancer** 5. **E. Inflammatory bowel disease** [**[Answer]**](about:blank) Ans: C Tips: Pancreatitis has no GI bleeding and pancreatitis symptoms are upper abdominal pain that radiates into the back. It may be aggravated by eating, especially foods high in fat. It is characterized by tender abdomen, nausea and vomiting and increased heart rate. **24. Chronic alcoholism may cause?** 1. **A. Gastritis** 2. **B. Crohn\'s disease** 3. **C. Peptic ulcer** 4. **D. GI cancer** [**[Answer]**](about:blank) Ans: A Tips: NSAIDs, smoking and chronic alcoholism cause gastritis. Gastritis causes inflammation of the GI lining. The most common cause of gastritis in Canada is due to chronic alcoholism. **25. A patient is experiencing chronic diarrhea and her symptoms changed that she now has hard bullet like stools. Patient may be experiencing:** 1. **A. Diarrhea** 2. **B. Inflammatory Bowel Disease** 3. **C. Crohn's disease** 4. **D. Irritable bowel Syndrome** 5. **E. Constipation** [**[Answer]**](about:blank) Ans: D Tips: Symptoms include abdominal cramps, chronic diarrhea and chronic constipation.\ \ IBS-predominant diarrhea: Bristol-Stool Chart 7: Loperamide,\ *IBS-predominant constipation: Bristol Stool Chart 1: Laxatives*\ *IBS-mixed diarrhea and constipation: Bristol Stool Chart 3-4: Abdominal cramps Amitriptyline, muscle relaxant**.***\ **26. Fistula or granulomas occur in?** 1. **A. Irritable bowel disease** 2. **B. Ulcerative colitis** 3. **C. Crohn\'s disease** 4. **D. Gastritis** [**[Answer]**](about:blank) Ans: C **27. Polypeptides and caffeine stimulate secretion of?** 1. **A. Parietal cells** 2. **B. Vitamin B12** 3. **C. Gastrin** 4. **D. Chyme** [**[Answer]**](about:blank) Ans: C Tips: Gastrin is stimulated by polypeptides and caffeine. Gastrin is a hormone that is secreted by the G cells of the stomach and stimulates the secretion of gastric acid by the parietal cells. When polypeptides and caffeine are present in the stomach, they stimulate the release of gastrin, which in turn increases the production of gastric acid. This acid helps to break down food and also plays a role in the absorption of certain nutrients like vitamin B12. **28. When parietal cells are stimulated, they secrete?** 1. **A. Intrinsic factor and gastrin** 2. **B. Intrinsic factor and HCl** 3. **C. Intrinsic factor and HCO3** 4. **D. Intrinsic factor and mucus** [**[Answer]**](about:blank) Ans: B **29. A patient of your pharmacy recently had gastrectomy and ileum was removed. Which of the following will be deficient?** 1. **A. Iron leading to Iron deficiency anemia.** 2. **B. Calcium due to deficiency of vitamin D.** 3. **C. Vitamin B12 due to deficiency of intrinsic factor.** 4. **D. Vitamin K due to deficiency if GI bacteria.** [**[Answer]**](about:blank) Ans: C **30. Innervation of vagal nerve causes?** 1. **A. Constipation** 2. **B. Diarrhea** 3. **C. Urinary retention** 4. **D. Urinary incontinence** [**[Answer]**](about:blank) Ans: B Tips: vagal nerve act as parasympathetic (cholinergic) nerve cause diarrhea. Anticholinergic drugs cause constipation. **31. Achlorhydric patient decreases absorption of?** 1. **A. Cyanocobalamin** 2. **B. Calcium carbonate** 3. **C. Iron supplements** 4. **D. Nutrient** 5. **E. Food** [**[Answer]**](about:blank) Ans: B Tips: achlorhydric is a state of less acidic; calcium carbonate has higher absorption in chlorhydric. Calcium citrate does not require acidic environment for absorption. **32. What prostaglandin is mainly present in gastrointestinal tract (GIT)?** 1. **A. PGE1** 2. **B. PGE2** 3. **C. PGF2 alpha** 4. **D. A and B** [**[Answer]**](about:blank) Ans: D Tips: PGE1 protect gastric mucosa from acidic pH. PGE1 analogs misoprostol is for gastric mucosal protection.\ Prostaglandin E2 (PGE2) is mainly present in the gastrointestinal tract (GIT). PGE2 is a type of prostaglandin that is produced by cells in the stomach and intestines, as well as by immune cells that are present in the GIT.\ PGE2 plays an important role in regulating various physiological processes in the GIT, including the secretion of mucus, bicarbonate, and digestive enzymes, as well as the contraction and relaxation of smooth muscle cells in the intestinal wall. PGE2 also helps to maintain the integrity of the gastric mucosa by promoting blood flow to the stomach and protecting it from damage caused by stomach acid.\ In addition to its role in the GIT, PGE2 is involved in a wide range of physiological and pathophysiological processes throughout the body, including inflammation, pain, fever, and blood clotting. As a result, drugs that target PGE2, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen, can have both beneficial and harmful effects on the body.\ **33. What is incorrect about digestive enzymes?** 1. **A. Protease breaks down proteins.** 2. **B. Amylase breaks down carbohydrates.** 3. **C. Lipase breaks down fats.** 4. **D. Pepsin is a pancreatic enzyme** [**[Answer]**](about:blank) Ans: D Tips: Nucleic acid digestion is catalyzed by Nuclease and Nucleosidase.\ *Proteins digestion is catalyzed by Pepsin, Trypsin, and Peptidases.*\ *Carbohydrate digestion is catalyzed by salivary amylase, pancreatic amylase, altase*\ *Fat digestion is catalyzed by Lipase.*\ \ **34. All of the following digestive enzymes are produced from the pancreas, EXCEPT:** 1. **A. Pancreatic amylase** 2. **B. Trypsin** 3. **C. Lipase** 4. **D. Gastrin** 5. **E. Pepsin** [**[Answer]**](about:blank) Ans: D Tips: Pepsin is produced by stomach also helps protein breakdown\ *Gastrin is produced from stomach's G-cell. Pancreatic enzymes include pancreatic amylase, Trypsin, Lipase, Nuclease, and Nucleosidase.*\ **35. Enzymes that play a major role in digestion of food?** 1. **A. Stomach secretion** 2. **B. Liver** 3. **C. Pancreatic enzymes** 4. **D. Saliva** 5. **E. Colon** [**[Answer]**](about:blank) Ans: C Tips: Pancreatic enzymes help in food digestion. Examples of pancreatic enzymes include trypsin, chymotrypsin, amylase, and lipase.\ The main pancreatic enzymes involved in food digestion are:\ Amylase: This enzyme breaks down carbohydrates, such as starch and glycogen, into simple sugars like glucose.\ Proteases: Proteases are a group of enzymes that break down proteins into smaller peptides and amino acids. The three main types of proteases produced by the pancreas are trypsin, chymotrypsin, and carboxypeptidase.\ Lipase: This enzyme breaks down fats, or lipids, into fatty acids and glycerol.\ **36. Which of the following influences the release of pancreatic juice and bile?** 1. **A. Cholecystokinin and secretin** 2. **B. Secretin and gastrin** 3. **C. Cholecystokinin and gastrin** 4. **D. Renin and cholecystokinin** [**[Answer]**](about:blank) Ans: A Tips: Cholecystokinin stimulates pancreas and bile from the gallbladder.\ *Secretin is released into the blood stream and acts on the acinar cells of the pancreas to secrete water and bicarbonate into the pancreatic ducts that drain into the duodenum.*\ **37. Gastric emptying slowed by all the following, EXCEPT:** 1. **A. Fatty food** 2. **B. Vigorous exercise** 3. **C. Hot meal** 4. **D. Hunger** 5. **E. Emotional stress** [**[Answer]**](about:blank) Ans: C Tips: ---------------------------------------------------------------------------- --------------------------------------------------------------------- **Factors promote stomach emptying** **Factors Inhibit gastric emptying** Gastric volume (increase food volume in stomach promotes gastric emptying. Duodenal distention,\ **High intensity,** intermittent exercise can slow gastric emptying Clear liquids empty rapidly than solid food Fats and proteins breakdown in small intestine Protein empty fastest than carbohydrate and then fats Temperature cold liquids (4c) empty slowly ---------------------------------------------------------------------------- --------------------------------------------------------------------- **38. Correct statement regarding pernicious anemia may include:** 1. **A. Due to dietary deficiency of vitamin B12.** 2. **B. Prevented by oral administration of vitamin B12.** 3. **C. Treated by parenteral administration of folic acid.** 4. **D. Treated by parenteral administration of vitamin B12.** 5. **E. Caused by deficiency of iron** [**[Answer]**](about:blank) Ans: D Tips: Pernicious anemia is characterized by deficiency of vitamin B12-cyanocobalamine and therefore should be treated with intramuscular injection of vitamin B12 because this vitamin is poorly absorbed orally.\ ***Strategic thinking:*** 1. *Read the question.* 2. *Choose elimination method in answering this type of question to increase your chance of arriving at the correct answer. In light of this item, 3 options are relevant, options A, B and D. But you can easily eliminate A and B on the basis that Pernicious anemia is not a deficiency of Vitamin 12 but of the intrinsic factor that facilitates the absorption of Vitamin B12. If questions asks for the result of pernicious anemia, the correct answer is A. But in this case it is D as explained in the TIPS.* 3. *D is the option that makes the most sense. * \ **39. Fecal occult blood test (FOBT) is recommended for screening of?** 1. **A. Peptic ulcer** 2. **B. Crohn's disease** 3. **C. Ulcerative colitis** 4. **D. Colon cancer** 5. **E. Benign prostatic hyperplasia** [**[Answer]**](about:blank) Ans: D Tips: Fecal occult blood is traces of invisible blood. Colon cancer is the best answer. Fecal occult blood test (FOBT) is a noninvasive screening test that detects the presence of hidden blood in the stool. FOBT is recommended as a screening test for colon cancer, which is also known as colorectal cancer. Peptic ulcer, Crohn\'s disease, ulcerative colitis, and benign prostatic hyperplasia are not typically screened for using a fecal occult blood test. **40. C. difficile is an anaerobic bacterium present in colon. It is?** 1. **A. Obligate anaerobic** 2. **B. Obligate aerobic** 3. **C. Facultative anaerobic** 4. **D. Facultative aerobic** [**[Answer]**](about:blank) Ans: A Tips: C. difficile is a gram positive, spore forming bacterium that is an obligate anaerobe and potentially fatal GI pathogen. C. difficile is very sensitive to even low levels of oxygen. **41. A patient was diagnosed with endocarditis due to S. viridans. The most powerful source of infection is?** 1. **A. Mouth** 2. **B. Lung** 3. **C. GI tract** 4. **D. Urinary tract** 5. **E. Liver** [**[Answer]**](about:blank) Ans: A **42. The small intestine is divided into three parts. The anatomical order of division of the small intestine starting from the end of the stomach is:** 1. **A. Jejunum, duodenum and ileum** 2. **B. Ileum, jejunum and duodenum** 3. **C. Duodenun, jejunun and ileum** 4. **D. Duodenun, ileum and jejunun** 5. **E. Jejunun, ileum and duodenun** [**[Answer]**](about:blank) Ans: C Tips: The small intestine is anatomically divided in Duodenum, Jejunum and ileum. **43. All of the following are examples of gastric acid stimulators, EXCEPT:** 1. **A. Gastrin** 2. **B. Acetylcholine** 3. **C. Somatotropin** 4. **D. G-Cell** 5. **E. None of the above** [**[Answer]**](about:blank) Ans: C Tips: Somatotropin is a growth hormone with no effect on gastric acid secretion. **44. One of the most common conditions associated with acute hemorrhagic gastritis may include:** 1. **A. Chronic alcoholism** 2. **B. H. pyloric bacterial infection** 3. **C. Carcinoma of stomach** 4. **D. Carcinoma of colon** 5. **E. Traveler's diarrhea** [**[Answer]**](about:blank) Ans: A Tips: Acute hemorrhagic gastritis is an erosive inflammation of the stomach with bleeding normally seen with chronic alcoholism. **45. Elongated proliferations in the small intestine are called:\ \ I. Villi\ II. Fontanelle\ III. Hernias** 1. **A. I only** 2. **B. III only** 3. **C. I and II only** 4. **D. II and III only** 5. **E. All are correct** [**[Answer]**](about:blank) Ans: A Tips: Villi and microvilli are found in the small intestine and are formed of capillaries that work in the absorption of digestive food to rich the venous and capillaries drainage of the gut. **46. All of the following enzymes are found in saliva, EXCEPT:** 1. **A. Amylase** 2. **B. Ptyalin** 3. **C. Gastrin** 4. **D. Lysozyme** 5. **E. All of the above** [**[Answer]**](about:blank) Ans: C Tips: Gastrin, also known as G-cell is present in the stomach and stimulates acid secretion. Saliva contains enzyme amylase also called (ptyalin) which breakdown starch into simpler sugars such as maltose and dextrin. Lysozyme is special enzyme found in saliva, tears,sweat and other body fluids, and mucosal lining such as nasal cavity. Lysozyme destroys bacteria that attempt to enter our body through these passages. **47. Which of the following is/are examples of salivary glands?\ \ I. Parotid\ II. Submandibular\ III. Sublingual** 1. **A. I only** 2. **B. III only** 3. **C. I and II only** 4. **D. II and III only** 5. **E. All are correct** [**[Answer]**](about:blank) Ans: E Tips: Salivary glands are composed of 3 pairs of glands: Parotid, submandibular and sublingual gland. **48. The digestive process is done in many different steps. The first step of digestion may be taken in:** 1. **A. Mouth** 2. **B. Esophagus** 3. **C. Stomach** 4. **D. Small intestine** 5. **E. Large intestine** [**[Answer]**](about:blank) Ans: A Tips: The first step of digestion is done in the mouth by the salivary enzymes, amylase, ptyalin and lysozyme. **49. Wrong statement regarding stomach secretions may include:** 1. **A. Mucus layer is present in stomach as lubricant and protects surface from acid.** 2. **B. Acids breakdown food, kill bacteria and convert pepsin to pepsinogen.** 3. **C. The gastric "chief cell" releases pepsinogen and chymosin in stomach.** 4. **D. Gastrin is the one that inhibits acid secretion.** 5. **E. The intrinsic factor in stomach is secreted from parietal cell.** [**[Answer]**](about:blank) Ans: D Tips: Gastrin is responsible for the stimulation of gastric acid secretion. The gastric "chief cell" releases pepsinogen and chymosin in stomach. Pepsinogen is activated into the digestive enzyme pepsin when it comes in contact with acid produced by gastric parietal cell. **50. Conditions that may be the main cause of duodenal ulcers include:** 1. **A. High motility of stomach** 2. **B. Bacterial migration** 3. **C. Squirting of acid stomach contents into the duodenal wall** 4. **D. Reflux of stomach contents into the esophagus** 5. **E. Hyperacidity of stomach** [**[Answer]**](about:blank) Ans: C Tips: Duodenal ulcers also known as peptic ulcers are mainly characterized by squirting of acid stomach into the duodenal wall. **51. Gastrointestinal Process that is not directly regulated by?** 1. **A. Pancreatic Enzymes** 2. **B. Gastrointestinal Enzymes** 3. **C. Absorption Of Lipid** 4. **D. HCl Secretion** [**[Answer]**](about:blank) Ans: C Tips: Absorption Of Lipid is the gastrointestinal process that is not directly regulated by any specific enzyme. While lipases are involved in the breakdown of lipids during digestion, absorption of lipids occurs mainly through passive diffusion and is not directly regulated by a specific enzyme. HCl secretion, pancreatic enzymes, and gastrointestinal enzymes all play important roles in regulating various aspects of the gastrointestinal process. **52. Colon is the last part of the digestive system and may be anatomically divided in:** 1. **A. Ascending colon** 2. **B. Transverse colon** 3. **C. Descending colon** 4. **D. Sigmoid colon and rectum** 5. **E. All are correct** [**[Answer]**](about:blank) Ans: E Tips: The colon is anatomically divided into: Ascending colon, transverse colon, descending colon, sigmoid colon and rectum. **53. A patient presents with acute onset abdominal pain that is persistent accompanied by severe epigastric pain often radiating to the back. Based on symptoms presentation, the doctor suspects pancreatitis. Which of the following is the most common cause of acute pancreatitis?** 1. **A. Gallstones** 2. **B. Diabetes** 3. **C. Peptic ulcer** 4. **D. Hyperlipidemia** 5. **E. Hypertension** [**[Answer]**](about:blank) Ans: A Tips: There are 3 main causes of acute pancreatitis namely heavy alcohol use, gallstones, and medication. The condition develops when gallstones travel out of the gallbladder into bile ducts where they block the opening that drains the common bile duct and pancreatic duct. **54. A patient presents with difficulty in swallowing. The pharmacist referred patient to physician for investigation. What is termed?** 1. **A. Odynophagia** 2. **B. Dyspepsia** 3. **C. Dysphagia** 4. **D. Dyspnea** 5. **E. Dysmenorrhea** [**[Answer]**](about:blank) Ans: C *Dysphagia = difficulty in swallowing*\ *Odynophagia = pain after swallowing*\ *Dyspepsia = upper GI problems (peptic ulcer, GERD, gastritis).*\ *Dyspnea = shortness of breath*\ **55. The lower part of the bile duct opens into?** 1. **A. Stomach** 2. **B. Duodenum** 3. **C. Jejunum** 4. **D. Ilium** 5. **E. Colon** [**[Answer]**](about:blank) Ans: B **56. A long-term care facility reported an outbreak of C. diff diarrhea. Which of the following is correct?** 1. **A. Treat all long-term care patients with vancomycin IV** 2. **B. C. difficile diarrhea is contagious, follow hygiene guidelines to prevent transmission to all residents** 3. **C. C. difficile is not contagious, residents can share common items.** 4. **D. C. difficile is only caused by antibiotic use.** 5. **E. Administer metronidazole as prophylaxis to non-infected residents.** [**[Answer]**](about:blank) Ans: B **57. If the patient of old age is hospitalized, which of the following is the preferred treatment for C. difficile infection?** 1. **A. IV metronidazole** 2. **B. IV vancomycin** 3. **C. Oral metronidazole** 4. **D. PO vancomycin** [**[Answer]**](about:blank) Ans: D Tips: Vancomycin oral is the first-line therapy of all stages of C. difficile infections. **58. A 40-year-old male patient presents with complaints of heartburn, regurgitation, and difficulty swallowing for the past few months. He reports a burning sensation in his chest after eating, especially after consuming spicy or acidic foods. He also complains of a sour taste in his mouth, bad breath, and occasional chest pain. What is not a symptoms of GERD?** 1. **A. dysphagia** 2. **B. nausea,** 3. **C. chest pain** 4. **D. bad breath** [**[Answer]**](about:blank) Ans: C CHAPTER 3: NERVOUS SYSTEM 1. Sciatic nerve 2. Blood brain barrier 3. Adrenal medulla ----- ------------------------------------------------------------------------- ----- ----------------------------------------------------------- ---- ----------------- 4 . 5. Protects brain from endogenous &exogenous toxins 6. Bradykinesia 7. Nissl substance 8 . Multiple sclerosis 9. Cerebrum 10. It prevents escape of neurotransmitter from CNS into blood circulations 11. Lipid soluble drugs cross faster than H~2~O soluble drugs - What is the barrier between cerebral capillary blood and cerebrospinal fluid. The CSF fills the ventricles & the subarachnoid space (blood brain barrier). - A CNS disease where the myelin sheath of motor neurons is degenerating or being destroyed, which interferes with neuronal impulses (Multiple sclerosis). - The nerve that pass-through buttocks, posterior thighs down to foot (Sciatic nerve). - What part of brain controls voluntary and involuntary movements (9). - Inappropriate posture of neck, face and limbs is referred as (Dystonia). - Functions of blood brain barrier (5, 10, 11). - The dark granular inside neuronal cell bodies (Nissl substance). - Sciatica is → pain passing through buttocks and thighs . - The longest and largest nerve is \--\> Sciatic nerve . - What section of brain control involuntary and voluntary movement (9) - What section of brain control balance and coordination (Cerebellum). - Angina pain from shoulder to arm is called \--\>Referred pain. - Radial nerve damage? Inability to move wrist and finger. - Axillary nerve damage? Loss of sensation in should deltoid muscles (shoulder). - Chronic spasticity is brain disorder is associated with?(Stroke, MS, Cerebral palsy, spinal cord injuries). - What neurological disorder is autoimmune? Multiple Sclerosis. - What are the symptoms of Meniere's disease? Vertigo, tinnitus. - Bell\'s palsy is caused by? Viral (HSV-1). - Dysphasia means dysfunction of? Speech. - Nystagmus? Rapid eye movement. - Medulla oblongata relates to? - Corpus collasum relates to? - Febrile seizure caused by?Rise in body temperature usually occurs within 1 to 24 hours fever onset. **1. Which part of the brain controls important cognitive skills in humans, such as emotional expression, problem solving, memory, language (mesolimbic pathways)?** 1. **A. Frontal lobe** 2. **B. Occipital lobe** 3. **C. Temporal lobe** 4. **D. Parietal lobe** [**[Answer]**](about:blank) Ans: A **2. The blood brain barrier is present at?** 1. **A. Endothelial cells lining capillaries in cerebrospinal tissues.** 2. **B. Epithelial cells lining cerebrospinal tissues or capillaries.** 3. **C. Epithelial cell lining cerebral artery capillaries.** 4. **D. In blood circulations capillaries.** [**[Answer]**](about:blank) Ans: A **3. Cerebrospinal fluid is clear liquid envelops the brain and spinal cord, acting as?** 1. **A. A cushion and stabilizer to the brain** 2. **B. Prevent infection into brain and spine** 3. **C. Prevent drug distribution into brain** 4. **D. A blood brain barrier** 5. **E. Enhancer to drug distribution in brain** [**[Answer]**](about:blank) Ans: A Tips: Cerebrospinal fluid is clear liquid envelops the brain and spinal cord, acting as a cushion and stabilizer to the brain. **4. Which cranial nerve is responsible for regulating defecation?** 1. **A. Corpus callosum** 2. **B. Medulla oblongata** 3. **C. Trigeminal nerve** 4. **D. Vagus nerve** 5. **E. Optic nerve** [**[Answer]**](about:blank) Ans: D Tips: The vagus nerve (cranial nerve X) is responsible for regulating various bodily functions, including gastrointestinal motility and secretion. It is the longest of the cranial nerves, extending from the brainstem to the abdomen. In terms of defecation, the vagus nerve plays a role in coordinating the relaxation of the internal anal sphincter, allowing for the expulsion of feces. The nerve also helps to coordinate the movements of the colon and rectum, which are important for the process of defecation. Dysfunction of the vagus nerve can lead to constipation or fecal incontinence. **5. A man is unable to hold a typing paper between his index and middle finger. Which of the following nerves was likely injured?\*** 1. **A. Radial nerve** 2. **B. Median nerve** 3. **C. Ulnar nerve** 4. **D. Axillary nerve** 5. **E. Sciatic nerve** [**[Answer]**](about:blank) Ans: B Tips: Median nerve compressed at the wrist in numbness or pain between the index and middle finger.\ *Strategic thinking: in answering this type of question:* 1. *Read the question. Identify and organize information.* 2. *Look for keyword/s or key phrases. In this case, unable to hold a typing paper between his index and middle finger. All of the nerves from the choices are present in the arm. The question specifies the INDEX and MIDDLE FINGERS. The only nerve that passes through the carpal tunnel is median nerve. All the other nerves, although they supply the length of the arm, they are not specific.* 3. *The correct answer is B.* **6. What part of brain control the defecation?** 1. **A. Mid-brain** 2. **B. Pons** 3. **C. Medulla oblongata** 4. **D. Thalamus** 5. **E. Corpus callosum** [**[Answer]**](about:blank) Ans: C **7. Which part of the brain controls respiration?** 1. **A. Corpus callosum** 2. **B. Cerebellum** 3. **C. Medulla oblongata** 4. **D. Thalamus** [**[Answer]**](about:blank) Ans: C Tips: Medulla oblongata is the part of the brainstem that helps regulate autonomic function (involuntary organ function) breathing, heart and blood vessel function, and digestion, sneezing, and swallowing. **8. A patient has difficulty in chewing and is also experiencing problems during mastication. What cranial nerve is responsible for mastication?** 1. **A. Vagus** 2. **B. Olfactory** 3. **C. Glossopharyngeal** 4. **D. Optic** 5. **E. Trigeminal** [**[Answer]**](about:blank) Ans: E Tips: Trigeminal nerve is cranial nerve or fifth cranial nerve is responsible for sensation in the face and motor functions such as biting and chewing and it is largest of cranial nerve. **9. Medulla oblongata contains centers of all autonomic functions, except** 1. **A. Breathing, sneezing** 2. **B. Blood pressure** 3. **C. Heart rate** 4. **D. Defecation** 5. **E. Sleeping** [**[Answer]**](about:blank) Ans: E **10. Optic nerve is?** 1. **A. Peripheral** 2. **B. Central Nervous System (CNS)** 3. **C. Cranial** 4. **D. Auxiliary** 5. **E. Sensory and motor** [**[Answer]**](about:blank) Ans: C Tips: The optic nerve is the cranial and type of composition is sensory only. The function is only for vision. The other example trigeminal is motor and sensory. This means sensory from face and mouth. Motor to muscle of mastication (chewing). **11. Vagus nerve innervates?** 1. **A. Vision** 2. **B. Auditory function** 3. **C. Laryngeal** 4. **D. Defecation** [**[Answer]**](about:blank) Ans: D **12. Which of the following is NOT a sensory (somatic) nerve?** 1. **A. Ulnar** 2. **B. Radial** 3. **C. Esophageal nerve** 4. **D. Sciatic** [**[Answer]**](about:blank) Ans: C **13. Which of the following statement is correct about sciatic nerve?** 1. **A. It passes through the neck down to the buttocks.** 2. **B. It passes through the posterior thigh and all of the leg and foot.** 3. **C. It passes through the elbow to wrist.** 4. **D. It passes through knee down to foot.** [**[Answer]**](about:blank) Ans: B Tips: Sciatic nerve is the branch of sacral plexus. It divides into tibial and common fibular nerves, which supplies the muscles of the posterior thigh and all of the leg and foot. **14. Damage of the axillary nerve is thought to cause?** 1. **A. Paralysis of the fifth finger** 2. **B. Impaired sensation in deltoid muscle of shoulder** 3. **C. Numbness of extremities** 4. **D. Inability to bend elbow** 5. **E. Loss of sensations in thumb** [**[Answer]**](about:blank) Ans: B Tips: Axillary nerve supplies deltoid and teres minor muscles, shoulder joint, and skin on back of the arm. Injury to axillary nerve can cause loss of sensation in lower part of deltoid muscles. **15. Damage to radial nerve can cause?** 1. **A. Inability to move neck** 2. **B. Inability to move shoulders** 3. **C. Inability to move wrist and fingers** 4. **D. Inability to move toes** 5. **E. Impaired sensation in deltoid muscle of shoulder** [**[Answer]**](about:blank) Ans: C Tips: Radial nerve is a branch of brachial plexus. It supplies the triceps brachii, brachioradialis, and muscle of the extensors compartment of forearm. Radial nerve palsy (wrist drop) is caused by prolong compression of radial nerve, which runs along the underside of bone in the upper arm. It is also called Saturday night palsy. It usually improves once the pressure is relieved. **16. A CNS disease where the myelin sheath of motor neurons is degenerating or being destroyed, which interferes with neuronal impulses?** 1. **A. Parkinson\'s Disease** 2. **B. Multiple sclerosis** 3. **C. Alzheimer\'s dementia** 4. **D. Fibromyalgia** [**[Answer]**](about:blank) Ans: B **17. Lesions of substantia nigra are caused by destruction of dopaminergic neurons that occur in patient with?** 1. **A. Alzheimer\'s disease** 2. **B. Migraine** 3. **C. Meniere\'s disease** 4. **D. Parkinson\'s Disease** [**[Answer]**](about:blank) Ans: D **18. Involuntary functions are controlled by?** 1. **A. Cerebellum** 2. **B. Cerebrum** 3. **C. Cortex** 4. **D. Hypothalamus** [**[Answer]**](about:blank) Ans: B **19. Dopaminergic pathways are associated with?** 1. **A. Occipital lobe** 2. **B. Middle lobe** 3. **C. Frontal lobe** 4. **D. Temporal lobe** [**[Answer]**](about:blank) Ans: C Tips: Dopaminergic pathways are associated with frontal lobes **20. Compression of the ulnar nerve at the elbow will cause?** 1. **A. Numbness of small fingers** 2. **B. Wrist drops** 3. **C. Inability to move the elbow** 4. **D. Inability to move the shoulder** [**[Answer]**](about:blank) Ans: A Tips: Cubital tunnel syndrome (ulnar nerve compression in elbow). Ulnar nerve innervates small fingers. **21. All of the following drugs have CNS side effects, EXCEPT:** 1. **A. Rifampin** 2. **B. Cefuroxime sodium** 3. **C. Diphenhydramine** 4. **D. Ipratropium** [**[Answer]**](about:blank) Ans: D **22. Which of the following medical condition is associated with behavioral problem?** 1. **A. Restless leg syndrome** 2. **B. Dementia** 3. **C. Schizophrenia** 4. **D. Alzheimer's disease** [**[Answer]**](about:blank) Ans: C Tips: Behavioral problems include major depression, mania, and schizophrenia. **23. What is the dark granular substance found inside the cell body?** 1. **A. Golgi apparatus** 2. **B. Mitochondria** 3. **C. Nissl substance** 4. **D. Lysosome** [**[Answer]**](about:blank) Ans: C Tips: Nissl substance refers to the dark granular material found inside the cell body of a neuron. It consists of clusters of rough endoplasmic reticulum, which is involved in protein synthesis. Option A refers to the Golgi apparatus, which is responsible for packaging and modifying proteins. Option B refers to mitochondria, which are responsible for generating energy in the cell. Option D refers to lysosomes, which are involved in the degradation of cellular waste. Among the options provided, only option C accurately describes the dark granular substance found inside the cell body, making it the correct answer. **24. What is nystagmus?** 1. **A. Eye adjustment problem** 2. **B. Rapid eye movement** 3. **C. Eye imbalance** 4. **D. Eye visual fixation problem** 5. **E. Vestibular problem** [**[Answer]**](about:blank) Ans: B **25. Which of the following drug has nystagmus as side effect due to CNS toxicity?** 1. **A. Carbamazepine** 2. **B. Valproic acid** 3. **C. Lamotrigine** 4. **D. Phenytoin** [**[Answer]**](about:blank) Ans: D Tips: Phenytoin toxicity side effect is nystagmus. **26. Which of the following antibiotics can be used to treat meningitis?** 1. **A. Tetracycline** 2. **B. Rifampin** 3. **C. Vancomycin** 4. **D. Metronidazole** [**[Answer]**](about:blank) Ans: B **27. Radial nerve passes through what region?** 1. **A. Arm** 2. **B. Shoulder** 3. **C. Wrist** 4. **D. Forearm** 5. **E. Chest** [**[Answer]**](about:blank) Ans: D Tips: The radial nerve passes through and innervates several important structures arm muscles (triceps), elbow joints, forearm muscles and hand & fingers. **28. Injury to axillary nerve results in loss of sensation over?** 1. **A. Arm** 2. **B. Shoulder** 3. **C. Wrist** 4. **D. Elbow** [**[Answer]**](about:blank) Ans: B **29. How do sensory receptors differ from pain receptors?** 1. **A. Nociceptors receptors are less affected by morphine analgesic dose.** 2. **B. Sensory receptors are unmyelinated.** 3. **C. Nociceptor response have lower threshold for activation** 4. **D. Nociceptors are only present in the skin** [**[Answer]**](about:blank) Ans: C Tips: Sensory receptors and pain receptors, also known as nociceptors, play crucial roles in the perception and transmission of sensory information, particularly related to touch, temperature, and pain. Here is an expanded explanation of sensory and pain receptors:\ Sensory Receptors:\ Sensory receptors are specialized nerve endings or cells that detect specific types of sensory stimuli.\ They are responsible for converting various external or internal stimuli into electrical signals that can be interpreted by the nervous system.Different types of sensory receptors are designed to respond to specific stimuli, such as mechanoreceptors for touch and pressure, thermoreceptors for temperature, photoreceptors for light, and chemoreceptors for chemical stimuli.Sensory receptors are typically located in the skin, muscles, organs, and sensory organs like the eyes, ears, and nose. They transmit information to the central nervous system (brain and spinal cord) for further processing and interpretation.\ Pain Receptors (Nociceptors):\ Pain receptors, also known as nociceptors, are specialized sensory receptors that detect and transmit signals related to pain.Nociceptors are found throughout the body, including the skin, internal organs, and tissues.They respond to various noxious stimuli, such as mechanical damage (pressure, cuts, or abrasions), thermal extremes (extreme heat or cold), and chemical irritants (toxic substances or inflammatory mediators).When activated, nociceptors generate electrical impulses that signal the presence of tissue damage or potential harm.The transmission of pain signals occurs through specific pain pathways in the nervous system, ultimately reaching the brain, where the perception of pain occurs.\ Unlike other sensory receptors, nociceptors have a lower threshold for activation, meaning they can be stimulated by even relatively mild or moderate stimuli that are perceived as painful.\ **30. MP is a 30-year-old patient who presented at your pharmacy for refill of Risperidone. Pharmacist counselled him in the counseling room. The pharmacist noticed that the patient got up several times and sat, and at one point, he went out of the counseling room but returned a few moments later. Patient may be experiencing, which of the following condition?** 1. **A. Parkinson's symptoms** 2. **B. Alzheimer symptoms** 3. **C. Tardive dyskinesia** 4. **D. Akathisia** [**[Answer]**](about:blank) Ans: D Tips: Akathisia = restlessness or cannot sit still. **31. All are involved in the knee jerk reflex, EXCEPT:** 1. **A. Sensory nerves** 2. **B. Motor neurons** 3. **C. Quadriceps** 4. **D. Calcaneus bone** 5. **E. Patella bone** [**[Answer]**](about:blank) Ans: D Tips: foot of the tarsus is a bone of the heel bone.\ *The calcaneus, also called the heel bone, is a large bone that forms the foundation of the rear part of the foot. The calcaneus connects with the talus and cuboid bones. The connection between the talus and calcaneus forms the subtalar joint.*\ **32. Cerebrospinal fluid (CSF) circulates through all of the following, EXCEPT:** 1. **A. Corpus callosum** 2. **B. Lateral ventricles in the brain** 3. **C. 4th ventricles** 4. **D. Cerebral aqueduct** 5. **E. Central Canal** [**[Answer]**](about:blank) Ans: A Tips: Cerebrospinal fluid (CSF) circulates through the ventricular system in the brain and the subarachnoid space surrounding the brain and spinal cord. The ventricular system includes the lateral ventricles, the third ventricle, the fourth ventricle, and the cerebral aqueduct. The CSF flows from the lateral ventricles to the third ventricle through the interventricular foramen, and then to the fourth ventricle through the cerebral aqueduct. From the fourth ventricle, the CSF flows out into the subarachnoid space surrounding the brain and spinal cord. The central canal is part of the spinal cord, and it is also filled with CSF. The corpus callosum is a structure in the brain that connects the left and right hemispheres, but it does not contain CSF. **33. Which of the nerve plexuses serve the shoulder and arm?** 1. **A. Sacral** 2. **B. Cervical** 3. **C. Phrenic** 4. **D. Brachial** [**[Answer]**](about:blank) Ans: D Tips: The brachial plexus is a network of nerves that arises from the cervical and upper thoracic spinal nerves and innervates the shoulder, arm, forearm, and hand. It is formed by the anterior rami of spinal nerves C5-T1 and is located in the neck and axilla. The brachial plexus gives rise to various nerves that provide sensory and motor innervation to the upper limb, including the musculocutaneous, axillary, radial, median, and ulnar nerves. These nerves supply the muscles, skin, and joints of the upper limb, allowing for movement and sensation. Injury or compression of the brachial plexus can result in a range of symptoms, including weakness or paralysis of the upper limb, pain, and sensory loss. **34. Sciatic nerve innervates?** 1. **A. Innervates the whole foot** 2. **B. Innervates hips** 3. **C. Innervates large muscle of buttock** 4. **D. Innervate quadricep** [**[Answer]**](about:blank) Ans: A **35. Destruction of radial nerve causes:** 1. **A. Difficulty straightening elbow** 2. **B. Difficulty moving shoulders** 3. **C. Effecting knee function** 4. **D. Effecting index fingers** 5. **E. Effect on wrist function** [**[Answer]**](about:blank) Ans: E **36. Cell for regeneration of myelin sheath?** 1. **A. Schwan cell** 2. **B. Myalgia** 3. **C. Dendritic cells** 4. **D. Neurons** 5. **E. Nephrons** [**[Answer]**](about:blank) Ans: A Tips: Demyelination is observed in multiple sclerosis. Schwan cells (oligodendrocytes) are main glial cells of the peripheral nervous system which wrap around axons of motor or sensory neurons to form myelin sheath.\ *Dendritic cells (accessory cells) are antigen presenting cells of immune system. Their main function is to process antigen material and present it on the cell surface to the T-cell.*\ **37. In blood brain barrier, the monoamine oxidase enzyme carries out:** 1. **A. Oxidative deamination metabolic reactions** 2. **B. Cytochrome oxidation** 3. **C. Catalysis of proteins** 4. **D. Oxidation of lipids** 5. **E. Oxidation of carbohydrates** [**[Answer]**](about:blank) Ans: A Tips: MAO enzyme catalyzes oxidative deamination metabolic reaction. **38. Lewy bodies are proteins in nerve present in?** 1. **A. Parkinsonism** 2. **B. Psychosis** 3. **C. Depression** 4. **D. Epilepsy** 5. **E. Multiple sclerosis** [**[Answer]**](about:blank) Ans: A **39. Nystagmus involves all, EXCEPT:** 1. **A. Involuntary movement** 2. **B. Oscillation** 3. **C. Rapid eye movement** 4. **D. Repeating** 5. **E. Eye burger** [**[Answer]**](about:blank) Ans: E **40. Which nerve plexus that serves the shoulder and arm?** 1. **A. Cervical** 2. **B. Lumbar** 3. **C. Brachial** 4. **D. Sacral** 5. **E. Cranial** [**[Answer]**](about:blank) Ans: C Tips: The nerve plexus that serves the shoulder and arm is called the brachial plexus. The brachial plexus is a complex network of nerves formed by the ventral rami (branches) of the lower cervical spinal nerves (C5-C8) and the first thoracic spinal nerve (T1). It innervates the muscles and provides sensory input to the shoulder, arm, forearm, and hand. **41. Which nerve plexus serves the thigh?** 1. **A. Cervical** 2. **B. Lumbar** 3. **C. Brachial** 4. **D. Sacral** 5. **E. Femoral** [**[Answer]**](about:blank) Ans: B Tips: The main nerve plexus that serves the thigh is called the lumbar plexus. The lumbar plexus is formed by the ventral rami (branches) of the first four lumbar spinal nerves (L1-L4) and provides innervation to the lower abdominal wall, anterior and medial thigh, and part of the leg. ------------------ ------------------------------------------ Nerve plexus Peripheral nerve Cervical plexus: Phrenic nerve Brachial plexus: Axillary, median, radial and ulnar nerve Lumbar plexus: Obturator, femoral, saphenous nerve Sacral Plexus: sciatic nerve, gluteal region ------------------ ------------------------------------------ **42. A mother is suspecting febrile seizures of her 2-year-old child having 100°F & above temp. What should you recommend?** 1. **A. 9 months to 2 year usually have febrile seizure** 2. **B. Give acetaminophen** 3. **C. Give ibuprofen** 4. **D. Give phenytoin** [**[Answer]**](about:blank) Ans: B Tips: Up to 30% of patient experience reoccurrence, mostly during the year after first episode. Antiepileptic drugs usually not recommended for simple febrile seizures because increase incidence of side effects. Antiepileptic drugs have shown benefit in preventing seizure reoccurrence. Febrile seizure are classified as simple or complex. Simple febrile seizure are more common and characterized by generalized tonic-clonic convulsions lasting \ Q-T prolongation (long QT intervals} - Torsade's de pointes cause \--\> Ventricular fibrillation - P wave indicator of \--\> Activation of the atria or atrial depolarisation. - QRS wave indicator of \--\> Activation of the ventricle or ventricular depolarization. (Ventricular tachycardia) - T wave indicator of \--\> recovery wave - ST segment indicates \--\> absolute refractory period. (phase 1-3) - Echocardiograph is used for? Septal defect, heart valves defects, blood clot. - Electrocardiograph is used for? Dysrhythmias - Increase in force of contraction (+ve inotropic) - Decrease in force of contraction (-ve inotropic) - Drugs that cause +ve inotropic effect. (10,11,12) - Pre-load: volume of blood in ventricles at end of diastolic pressure. - After load: resistance left ventricles must overcome to circulate blood. - Atrial fibrillation (invisible p wave) and flutter (visible p wave) is very fast electrical discharge pattern that make the atria contract extremely rapidly, thus causing the ventricular to contract faster and less effective than normal. Thus this can produce the risk of? (17) ### ** Select True/False Statements** - A brain attack that occurs when a wandering clot (embolus) or some other particle forms in a blood vessel away from the brain-usually in the heart. (Cerebral embolism) True/False - Drugs that cause --ve chronotropic effect (digoxin, beta blockers). True/False - Stroke or brain attack happens when brain cells die because of inadequate blood flow to the brain. (True/False) **1. What is the histological difference between artery and vein?** 1. **A. Arteries will typically have a thicker tunica media and smaller lumen.** 2. **B. Arteries will typically have larger lumen and thickest layer is the tunica** 3. **C. Veins will have a larger lumen and the thicker layer is the tunica ~~media (~~should be tunica adventitia)** 4. **D. Arteries will typically have larger lumen and thicker tunica media** [**[Answer]**](about:blank) Ans: A Tips: Arteries will typically have a thicker tunica media and smaller lumen; whereas veins will have a larger lumen and the thickest layer is the tunica adventitia.\ \ Diagram of a diagram of the structure of the human body Description automatically generated **2. Pathway of [blood flow from systemic circulation to liver]?** 1. **A. Mesenteric vein and portal vein** 2. **B. Portal artery and hepatic vein** 3. **C. Portal vein and hepatic artery** 4. **D. Hepatic vein and portal artery** [**[Answer]**](about:blank) Ans: C **3. What is incorrect about lymphatic system? \* Platelets, RBC, plasma protein = ABSENT** 1. **A. Has no duct vessels or lymphatic valves** 2. **B. Connect between arteries and veins** 3. **C. Plasma proteins are absent** 4. **D. Consist of White blood cells** 5. **E. Platelets and red blood cells are absent** [**[Answer]**](about:blank) Ans: A Tips: **Lymphatic structures** **are lymphatic duct, lymphatic vessels, thymus, spleen, lymph nodes, and lymphatic capillaries.** **4. Change in cardiac automaticity (spontaneous activity initiated by cardiac cells generating periodic oscillations) is most directly associated with change in which slope of myocardial action potential?** 1. **A. Phase 0** 2. **B. Phase I** 3. **C. Phase 2** 4. **D. Phase 3** 5. **E. Phase 4 - SA and AV node and purkinje fibers** display automaticity [**[Answer]**](about:blank) Ans: A Tips: Cardiac automaticity is defined as the **ability of heart cells to spontaneously depolarize and generate action potential**. Many healthy ventricular and majority atrial muscle cells do not display automaticity. The **SA and AV node and purkinje fibers** display automaticity at phase 4 depolarization. **5. Absolute refractory period (ARP) reflects the time during which no action potential can be initiated regardless of how much inward current are supplies. The ARP begins and ends at.** 1. **A. Phase I to Phase 4** 2. **B. Phase 0 to phase 1** 3. **C. Phase 1 to phase 2** 4. **D. Phase 1 to phase 3** 5. **E. Phase 2 and 3 only** [**[Answer]**](about:blank) Ans: D **6. Myocardial contractility is best correlated with the intracellular concentration of** 1. **A. Free Ca2+** 2. **B. Free Na+** 3. **C. Free K+** 4. **D. Free Cl-** 5. **E. Free Mg2+** [**[Answer]**](about:blank) Ans: A Tips: Sympathetic stimulations increase calcium intake thus increase concentration of calcium around myofibrils. ↑ Ca will increase contractility by activating Actin and Myocin muscle fibres. **7. Aldosterone is secreted by adrenal cortex. What is incorrect about aldosterone?** 1. **A. Increases sodium chloride (NaCl) reabsorption by the renal distal tubules thereby increase blood volume and arterial pressure** 2. **B. It causes vasoconstriction of the arterioles, thus increase TPR and mean arterial pressure.** 3. **C. Angiotensin II stimulates the synthesis and secretion of aldosterone by the adrenal cortex** 4. **D. K+ excretion from renal distal tubule and water retention along with Na+** 5. **E. Acts as long-term regulator or blood pressure** [**[Answer]**](about:blank) Ans: B **8. Repolarization process produces?** 1. **A. Negative charge in cell** 2. **B. Sodium ion influx** 3. **C. Chloride efflux** 4. **D. Excessive positive charge inside cell** 5. **E. Excessive negative and positive charge inside cells** [**[Answer]**](about:blank) Ans: A Tips: in repolarization state cell goes negative charge.\ \ ![A graph of a function Description automatically generated](media/image2.png) **9. What disease is NOT associated with *thrombus in circulatory system*?** 1. **A. Acute coronary syndrome** 2. **B. Acute stroke** 3. **C. Stable angina** 4. **D. Ischemic heart diseases** 5. **E. Raynaud phenomenon** [**[Answer]**](about:blank) Ans: E **10. Which of the following best defines an embolus?** 1. **A. A floating blood clot** 2. **B. A blood clot at the site of plaque** 3. **C. A fibrin clot** 4. **D. Bulging of arteries** 5. **E. Hemorrhage** [**[Answer]**](about:blank) Ans: A **11. The electrical activity occurred during depolarization and repolarization transmitted through electrodes attached to the body and transformed by an electrocardiograph (ECG) in to series of waveforms. The \"QRS\" wave indicates?** 1. **A. Atrial depolarization -- P wave** 2. **B. Ventricular depolarization** 3. **C. Atrial repolarization** 4. **D. Ventricular repolarization** 5. **E. Plateau** [**[Answer]**](about:blank) Ans: B Tips: QRS is activation ventricles, P wave indicate activation atrium and T wave is recover wave. **12. What can be caused by QT prolongation (prolonged interval)?** 1. **A. Atrial fibrillation** 2. **B. Supraventricular fibrillation** 3. **C. Ventricular tachycardia** 4. **D. Supraventricular tachycardia** 5. **E. Ventricular fibrillation** [**[Answer]**](about:blank) Ans: C Reasoning: QT prolongation refers to an abnormal prolongation of the QT interval on an electrocardiogram (ECG), which indicates a delay in ventricular repolarization. This delay can disrupt the normal electrical activity of the heart and lead to various arrhythmias. While options A, B, D, and E represent different types of arrhythmias, ventricular tachycardia (option C) is specifically associated with QT prolongation. Therefore, the correct answer is C, Ventricular tachycardia. **13. Which of the following conditions risk factor is NOT related to first degree relative (family history)?** 1. **A. Premature cardiovascular disease** 2. **B. Type 2 Diabetes** 3. **C. Coronary artery diseases** 4. **D. Dyslipidemia** 5. **E. Hepatitis** [**[Answer]**](about:blank) Ans: E **14. Which of the following is the indicator of ventricular activation?** 1. **A. P wave** 2. **B. Q wave** 3. **C. Q-T wave** 4. **D. QRS wave** 5. **E. T wave** [**[Answer]**](about:blank) Ans: D **15. What structure follows the bundles of His in the cardiac conduction system?** 1. **A. Purkinje fibers** 2. **B. Atrioventricular (AV) node** 3. **C. Bundle branches** 4. **D. Bachmann bundle** 5. **E. Bundle of Kent** [**[Answer]**](about:blank) Ans: A Tips: After the bundles of His, the electrical impulse is transmitted to the Purkinje fibers. These specialized cardiac muscle fibers rapidly conduct the electrical signal throughout the ventricles, causing coordinated ventricular contraction. The Purkinje fibers play a crucial role in ensuring efficient and synchronized ventricular depolarization, leading to effective pumping of blood out of the heart. Option A accurately represents the continuation of the cardiac conduction system after the bundles of His. **16. Atrial fibrillations ECG or changes in electrode potential curve show the absence or change of?** 1. **A. P wave** 2. **B. QRS wave** 3. **C. T wave** 4. **D. QT wave** 5. **E. U wave** [**[Answer]**](about:blank) Ans: A Tips: Atrial fibrillation is the regularly irregular atrial rate that can change the P wave. Atrial fibrillation is the major risk factor for stroke. Frequent P waves appear in atrial fibrillation. Atrial fibrillation is the major risk factor for stroke. (blood clot or thrombus in brain or cerebral artery. **17. Which one of the following ECG waves is associated with ventricular depolarization?** 1. **A. P wave** 2. **B. QRS wave** 3. **C. T wave** 4. **D. QT interval prolongation** 5. **E. U wave** [**[Answer]**](about:blank) Ans: B Tips: There are three waves. QRS is activation ventricle depolarization. P wave indicate activation atrium or atrial depolarization. T wave is recovering wave. **18. Which of the following cardiovascular disease is least commonly associated with atherosclerotic plaques?** 1. **A. Angina** 2. **B. Myocardial infarction** 3. **C. Congestive heart failure** 4. **D. Ischemic stroke** 5. **E. Raynaud\'s phenomenon** [**[Answer]**](about:blank) Ans: E Tips: Raynaud's phenomenon is due to **vascular constriction in limbs.**\ Atherosclerosis leads to formation of plaques and facilitate blood clot formation. The most common conditions associated with atherosclerosis are angina, myocardial infarction, deep vein thrombosis and stroke. However, Raynaud's phenomenon is a peripheral vascular disease occurs due to vascular constriction in limbs.\ If stable plaque than commonly cause angina, if plaque is ruptured than cause inflammation can lead to MI. **19. What is the most common cause of arteriosclerosis?** 1. **A. High LDL** 2. **B. Smoking** 3. **C. Hypertension** 4. **D. Emotional stress** 5. **E. All of the above** [**[Answer]**](about:blank) Ans: A **20. A patient is diagnosed with atrial fibrillation. What is correct?** 1. **A. P wave is absent** 2. **B. P and QRS wave is absent** 3. **C. QRS wave is affected** 4. **D. T wave is affected** 5. **E. QT prolongation** [**[Answer]**](about:blank) Ans: A Tips: The absence of a distinct P wave on an ECG is a hallmark feature of atrial fibrillation and is used to diagnose the condition. Instead of a P wave, the ECG will show an irregular baseline, often referred to as \"irregularly irregular.\" **21. What is the primary use of an echocardiogram in clinical practice?** 1. **A. To measure blood pressure in the heart** 2. **B. To detect abnormalities in heart rhythm** 3. **C. To assess the structure and function of the heart such as valve, heart chamber abnormalities** 4. **D. To monitor oxygen saturation levels in the blood** [**[Answer]**](about:blank) Ans: C Tips: Primary function is to assess the structure and function of the heart.An echocardiogram is a non-invasive imaging test that uses sound waves to create images of the heart. It is primarily used to assess the structure and function of the heart, including the size, shape, and movement of the heart chambers and valves. It can also be used to detect abnormalities in heart rhythm and blood flow, but these are secondary uses. Blood pressure measurements and oxygen saturation monitoring are typically performed using separate devices and tests, and are not part of an echocardiogram. Therefore, options A, B, and D are not correct. **22. Arrange the following structures in the correct sequence of blood flow:** 1. **A. Vena cava ? right atrium ? right ventricle ? left pulmonary artery ? lungs ? left pulmonary vein ? left atrium ? left ventricle ? aorta ? systemic circulation** 2. **B. Right atrium ? right ventricle ? left pulmonary artery ? lungs ? left pulmonary vein ? left atrium ? left ventricle ? aorta ? vena cava** 3. **C. Left atrium ? left ventricle ? right atrium ? right ventricle ? left pulmonary artery ? lungs ? left pulmonary vein ? aorta ? vena cava** 4. **D. Vena cava ? left atrium ? left ventricle ? right atrium ? right ventricle ? lungs ? left pulmonary artery ? left pulmonary vein ? aorta** 5. **E. Right ventricle ? right atrium ? left atrium ? left ventricle ? left pulmonary artery ? lungs ? left pulmonary vein ? aorta ? vena cava** [**[Answer]**](about:blank) Ans: A Tips: The correct sequence of blood flow is essential to understand the circulation through the heart and the body. The blood flow begins with the vena cava, which brings deoxygenated blood from the systemic circulation into the right atrium. From the right atrium, blood flows into the right ventricle and is then pumped into the pulmonary artery, specifically the left pulmonary artery in this case. The blood then travels to the lungs for oxygenation. Oxygenated blood returns to the heart via the left pulmonary vein, entering the left atrium. From the left atrium, blood moves into the left ventricle, which then pumps it into the aorta. The aorta distributes oxygenated blood to the systemic circulation, supplying the body\'s organs and tissues. Option A correctly represents this sequential blood flow through the various structures. **23. Which acute coronary syndrome affects only subendocardial part of the myocardium and causes ST segment depression?** 1. **A. ST segment Elevated Myocardial Infarction (STEMI)** 2. **B. Non-ST segment Elevated Myocardial Infarction (NSTEMI)** 3. **C. Prinz mental angina** 4. **D. All of the above** [**[Answer]**](about:blank) Ans: B Tips: Acute coronary syndrome\ \ A diagram of ecg findings Description automatically generated **24. Which of the following statements describes a histological difference between arteries and veins?** 1. **A. Arteries have a larger lumen and a thicker tunica interna.** 2. **B. Arteries have a smaller lumen and a thicker tunica media.** 3. **C. Veins have a smaller lumen and a thicker tunica interna.** 4. **D. Veins have a larger lumen and a thicker tunica media.** [**[Answer]**](about:blank) Ans: B Tips: When comparing the histological structure of arteries and veins, there are several distinguishing features. The tunica media, which is the middle layer of the blood vessel wall, plays a significant role in these differences.\ Arteries generally have a smaller lumen (the central opening of the blood vessel) compared to veins. This smaller lumen contributes to the higher pressure and faster blood flow characteristic of arterial circulation.\ Furthermore, arteries have a thicker tunica media compared to veins. The tunica media of arteries contains smooth muscle cells and elastic fibers, allowing them to withstand the high pressure generated by the heart\'s pumping action. The thicker tunica media helps maintain arterial tone and regulate blood pressure.\ On the other hand, veins have a larger lumen and a thinner tunica media compared to arteries. The larger lumen allows veins to accommodate a larger volume of blood and facilitate its return to the heart. The tunica interna, also known as the intima, is the innermost layer of blood vessels and is typically the thickest layer in veins. It consists of endothelial cells and connective tissue.\ **25. After depolarization, the cell responds in the following manners? EXCEPT** 1. **A. Calcium channel opens** 2. **B. Sodium Channel closure** 3. **C. Chloride channel opens** 4. **D. Potassium channel opens** [**[Answer]**](about:blank) Ans: C Tips: After depolarization, the voltage-gated sodium channels responsible for the rapid influx of sodium ions into the cell close, while voltage-gated potassium channels responsible for the efflux of potassium ions open, leading to the restoration of the cell\'s negative membrane potential. Additionally, calcium channels can also open, leading to the release of calcium ions from the sarcoplasmic reticulum in muscle cells, which plays a crucial role in muscle contraction. However, chloride channels typically do not play a significant role in the repolarization process after depolarization. **26. Abnormal persistent dilatation of blood vessels is known as:** 1. **A. Embolism -** obstruction of airway by a mass transported in the circulation. 2. **B. Aneurism** 3. **C. Emphysema -** reversible form of airway obstruction. 4. **D. Starvation** 5. **E. Atherosclerosis** [**[Answer]**](about:blank) Ans: B Tips: Aneurysm is an abnormal dilatation of a blood vessel while embolism is an obstruction of airway by a mass transported in the circulation. Emphesema is a reversible form of airway obstruction. **27. What is an embolism?** 1. **A. A blockage of a blood vessel caused by a blood clot or other material that travels from one part of the body to another** 2. **B. A rupture of a blood vessel that causes bleeding into the surrounding tissue** 3. **C. A weakening and bulging of a blood vessel wall that can lead to rupture and bleeding** 4. **D. A narrowing of a blood vessel that reduces blood flow to the affected tissue** [**[Answer]**](about:blank) Ans: A Tips: An embolism is a blockage of a blood vessel caused by a blood clot or other material that travels from one part of the body to another. This can occur when a blood clot or other material, such as fat or air, breaks free from its site of origin and travels through the bloodstream until it becomes lodged in a narrow blood vessel, blocking blood flow to the affected tissue. Embolisms can cause serious damage to organs and tissues if not treated promptly. Options B, C, and D describe different types of blood vessel disorders, but they do not describe an embolism. Therefore, they are not correct. **28. Which blood vessel experiences the lowest blood pressure during inspiration in the supine position?** 1. **A. Vena cava** 2. **B. Internal carotid artery** 3. **C. Aorta artery** 4. **D. Sciatic artery** 5. **E. Pulmonary artery** [**[Answer]**](about:blank) Ans: A Tips: During inspiration, the process of taking in air, certain changes occur in the body, including alterations in blood pressure. The lowest blood pressure in the supine (lying down) position is typically observed in the vena cava.\ The vena cava is a large vein that carries deoxygenated blood from the body back to the heart. During inspiration, the diaphragm contracts and descends, leading to an increase in thoracic volume and a decrease in intrathoracic pressure. This decrease in pressure facilitates the flow of blood into the thoracic cavity, resulting in increased venous return to the heart.\ As a result of increased venous return during inspiration, blood pressure in the vena cava drops temporarily. This decrease in blood pressure is more pronounced in the vena cava compared to other blood vessels listed in the options.\ While the other options may represent important blood vessels in the body, they do not experience the same characteristic decrease in blood pressure during inspiration in the supine position. Therefore, option A, vena cava, is the correct answer.\ **29. Which of the following theories relates to the tension, radius of vessel and intraluminal pressure achieved in a blood vessel wall?** 1. **A. Fick's law** 2. **B. Arrhenius** 3. **C. LaPlace's law** 4. **D. Newtonian law** 5. **E. Henderson law** [**[Answer]**](about:blank) Ans: C Tips: LaPlace's Law explains the tension achieved in a blood vessel wall to the radius of vessel and intraluminal pressure. **30. The first location where blood is present in case of left ventricular heart failure:** 1. **A. Liver** 2. **B. Lung** 3. **C. Heart** 4. **D. Kidney** 5. **E. Brain** [**[Answer]**](about:blank) Ans: B Tips: Blood leaves the lung and reaches the left ventricle of the heart through pulmonary vein. In case of left ventricular failure, the tendency is accumulation of blood in the lung due to blockage of blood circulation from lung through the heart.\ Left ventricular failure = pulmonary edema (lung). Right ventricular failure = peripheral edema\ **31. Stenosis:** 1. **A. Dilatations of blood vessels** 2. **B. Increase in cardiac output** 3. **C. Accumulation of cholesterol in blood vessels** 4. **D. Narrowing of blood vessels** 5. **E. High pressure in blood vessels** [**[Answer]**](about:blank) Ans: D Tips: Stenosis is the narrowing of blood vessels **32. The first tissue that receive the greatest cardiac output at rest?** 1. **A. Lung -- 3rd** 2. **B. Liver -- 1st** 3. **C. Kidney -- 2nd** 4. **D. Muscle** 5. **E. Fat** [**[Answer]**](about:blank) Ans: B Tips: The first tissue that receives the greatest cardiac output at rest is liver, followed by kidney and lung. **33. Correct statements regarding blood pressure may include:\ \ I. Systolic pressure is the highest arterial pressure during a cardiac cycle.\ II. Diastolic pressure is the lowest arterial pressure during a cardiac cycle\ III. Diastolic pressure is crucial in verifying if a person suffers of high blood pressure** 1. **A. I only** 2. **B. III only** 3. **C. I and II only** 4. **D. II and III only** 5. **E. All are correct** [**[Answer]**](about:blank) Ans: E Tips: The normal blood pressure in a health adult is 120/80, where 80 is the diastolic and 120 is the systolic pressure. Systolic pressure is the highest arterial pressure during a cardiac cycle and is measured when the heart contracts while diastolic pressure is the lowest arterial pressure during a cardiac cycle and is measured when the heart is relaxed. **34. Phase 0 is?** 1. **A. Repolarization** 2. **B. Depolarization** 3. **C. Prolong repolarization** 4. **D. Plateau** 5. **E. None of the above** [**[Answer]**](about:blank) Ans: B **35. What is the primary function of the lymphatic system?** 1. **A. Production of red blood cells** 2. **B. Transporting lipid-soluble substances and waste** 3. **C. Regulation of body temperature** 4. **D. Secretion of digestive enzymes** [**[Answer]**](about:blank) Ans: B Tips: The lymphatic system is a vital part of the body\'s immune system and has several key functions. While it does contribute to the overall circulation of fluids, its primary function is the transportation of lipid-soluble substances and waste.\ the lymphatic system plays a crucial role in the absorption and transportation of dietary fats, fat-soluble vitamins (such as vitamins A, D, E, and K), and other lipid-soluble substances from the digestive system into the bloodstream. These substances are packaged into specialized vessels called lacteals, which are part of the lymphatic system.\ Additionally, the lymphatic system is responsible for the removal of waste materials, cellular debris, and pathogens from tissues. Lymph, the fluid within the lymphatic system, carries these waste products and other unwanted materials away from the tissues to be filtered and eliminated by lymph nodes and other lymphatic organs.\ **36. Difference between plasma and interstitial fluid:** 1. **A. Albumin** 2. **B. Sodium ion** 3. **C. Bicarbonate** 4. **D. Potassium** 5. **E. All of the above** [**[Answer]**](about:blank) Ans: A **37. Which of the following is NOT a complication of hypertension?** 1. **A. mitral valve prolapses** 2. **B. tricupsid valve prolapse** 3. **C. metabolic syndrome** 4. **D. atherosclerosis** 5. **E. aneurysm** [**[Answer]**](about:blank) Ans: B Tips: Tricuspid valve prolapse is a less common condition compared to mitral valve prolapse, and it is not typically associated with hypertension. Tricuspid valve prolapse occurs when the valve between the right atrium and right ventricle does not close properly, allowing blood to flow back into the atrium. It is often asymptomatic and does not require treatment. **38. Which of the vasoactive hormone causes arterial constriction?** 1. **A. Antihistamines** 2. **B. Bradykinin** 3. **C. Prostaglandin** 4. **D. Thromboxane A2** 5. **E. Prostacyclin** [**[Answer]**](about:blank) Ans: D **39. Which of the following is the rate-limiting step in atherosclerosis formation?** 1. **A. HMG-COA to mevalonate formation** 2. **B. Mevalonate to cholesterol formation** 3. **C. Low-density lipoprotein formation** 4. **D. Lipid synthesis** [**[Answer]**](about:blank) Ans: B Tips: Atherosclerosis is a complex process involving the accumulation of cholesterol in the arterial walls. The rate-limiting step in cholesterol synthesis is the conversion of mevalonate to cholesterol. This step is catalyzed by the enzyme HMG-COA reductase. Inhibition of this enzyme, often achieved by statin medications, can effectively reduce cholesterol levels and slow down the progression of atherosclerosis. Therefore, the correct answer is B, Mevalonate to cholesterol formation CHAPTER 5: ENDOCRINE SYSTEM 1. Adrenal medulla 2. Pituitary gland 3. Posterior pituitary gland ------- --------------------- ----- ---------------------- ----- --------------------------- 4. Diabetes insipidus 5. Glucose 6. Hypo corticosteroids 7. Excessive urination 8. Outer adrenal cortex 9. Sensitivity to cold 10. Bradycardia 11. Weight gain 12. Glycogen 13. Constipation 14. Dry skin 15. Weight loss 16. Tachycardia 17. Diarrhea 18. Sensitivity to heat 19. Sweating 20. Palpitation 21. Fatigue 22. Polyphagia 23. Polyuria 24. Blurred vision 25. Polydipsia - Epinephrine is released from? (adrenal medulla) - Aldosterone is released from? (outer layer of adrenal cortex) - ACTH (Adrenocorticotropic hormone) is secreted by? (anterior pituitary hormone) - Oxytocin is secreted from? (posterior pituitary gland) - ADH Antidiuretic hormone is secreted from? (posterior pituitary gland) - Deficiency of ADH gives\... (diabetes insipidus) - Symptom of diabetes insipidus (22, 23, 25) - Symptoms of diabetes mellitus (22, 23, 25) - Symptoms of hypoglycemia (19, 20, 21, 24) - What hormones are released from posterior pituitary gland? ADH and oxytocin. - Hypothyroidism laboratory investigation include (Increase serum TSH & decrease in T~3~ and T~4~) - Testosterone to 5-hydroxy testosterone is catalyzed by? 5-alpha reductase - Diabetes mellitus symptoms? 3 Poly (poly urea, polydipsia, polyphagia). - Hypoglycemia symptoms? (sweating, palpitation, confusion, fatigue) - Symptoms of hyperthyroidism? Weight loss, sensitivity to heat, tachycardia, and diarrhea. - Symptoms of hypothyroidism? Weight gain, edema, and sensitivity to cold, constipation, hypertension, and bradycardia. - Symptoms of Cushing syndrome? Hypercorticosteroidism, edema, weight gain, moon face, puffy face, and buffalo hump. - Addison disease is → hypocorticosteroids - Ovulation (day 14), occurs 14 days before menses (day of 1 of menses) regardless of cycle length. - Menses (days 1-4). The endometrium is sloughed because of the abrupt withdrawal of estrogen and progestin. - Pregnancy: is characterized by steadily increased levels of estrogen and progestin which maintain the endometrium for fetus, suppress ovarian follicular function by inhibiting FSH and LH. - What gland shrinks after age of puberty? Pineal gland undergoes a process of calcification with aging and melatonin levels decrease in 60 year old and over. **1. Which hormone keeps corpus luteum after fertilization and pregnancy?** 1. **A. Human chorionic gonadotropin hormone (HCG)** 2. **B. Progestin** 3. **C. Estrogen** 4. **D. Luteinizing hormone (LH)** 5. **E. FSH** [**[Answer]**](about:blank) Ans: A Tips: If fertilization occurs, the corpus luteum is rescued by regression of hCG, which is produced by the placenta. On the first trimester of pregnancy, the corpus luteum is stimulated by hCG for the production of estrogen & progestin.\ HCG = 1^st^ three months of pregnancy\ ↑ LH = day 14 of menstrual cycle (ovulation)\ ↑ Estrogen = follicular phase\ ↑ Progestin = luteal phase\ **2. Which statement accurately describes the proinsulin levels in patients with Type 1 and Type 2 diabetes?\ \ In both Type 1 and Type 2 diabetes, there is a dis

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