1- the following substances are freely transferred across the placenta a-insulin. (false) b-thyroxine. (false) c-IgG.

(true) d-warfarin (true). e-glucose. (true) Comments: There are many drugs that freely cross the placenta including the oral hypoglycaemic agents hence insulin is preferred in pregnancy. Warfarin also ocross the placenta hence the preferred use of heparin. Glucose a nutrient obviously cross the placenta. IgG pass but not IgM pass placenta. Thyroxine does not cross the placenta hence the reason for not using a block and replace regimen for treating thyrotoxicosis as carbimazole and propyl thiouracil does cross the placenta. 2- in a consanguineous marriage a- the risk of a serious disease or defect is double that for an unrelated mating. (true) b-the risk of recurrence for autosomal recessive disorders is 50%.(false) c-there is an increased risk of producing mentally retarded child. (true) d-when it is between second cousins, does not carry an increased risk. (true) e-there is an increased risk of producing a deaf child. (true) Comments: Consanguinity (marriage to a blood relative) is associated with an increased risk of inherited disorders, birth defects as down syndrome and tends to be approximately double that of unrelated couples but not near 50%. This risk is attenuated as relationship between partners becomes more distant. 3-Autoimmune addison's disease is associated with a-premature ovarian failure. (true) b-hypokalemia.(false) c-hypothyroidism. (true) d-vitiligo. (true) e-Sjogren's syndrome. (true) Comments: b- hyperkalemia. e-in 47% of patients with autoimmune Addison's disease at least one other autoimmune disorder was present. Primary hypothyroidism has the highest prevalence (20%) followed by vitiligo(9%), non toxic goiter, premature menopause, grave's disease, pernicious anaemia, sjogren's disease, hypoparathyroidism,type 1 diabetes mellitus and celiac disease. 4- the following drugs cause hypokalemia a- commencement of digoxin for atrial fibrillation.(false) b-ACE inhibitors.(false) c-salbutamol for asthma. (true) d-vitamin B12 for the treatment of pernicious anaemia. (true)

e-cimetidine for duodenal ulcer.(false) Comments: a-only toxicity of digoxin cause toxicity. b-hyperkalaemia. c-especially high dose in nebulisers for acute asthma. d-paarticularly at the beginning of the treatment. 5-Regarding the climacteric menopause a-the average age of the menopause in the united kingdom is about 50 years. (true) b-demineralization of bones take place after the menopause. (true) c-the level of prolactin rises after the last period.(false) d-the severity of flushing has been shown to be related to the level of oestrogen in the blood.(false) e-clinical studies have shown that the later the menarche the earlier the menopause.(false) Comments: Average age for menopause is approximately 50 years and is associated with sharp reduction in bone mineral density and increase in cardiovascular risk c- it falls. d-there is no relationship with severity. The presence of sweating is more likely in women with low oestrogen level e-no relation between menarche and menopause. 12-hypoparathyroidism is associated with a-increased incidence of Addison's disease. (true) b-chronic mucocutaneous candidiasis. (true) c-basal ganglia calcification commonly causing parkinsonism. (false) d-short 4th and 5th metacarpals.(false) e-good response of hypocalcaemia to calcium and vitamin D treatment (true) Comments: a-Hypoparathyroidism is associated with Addison,s disease. c- short 4th and 5th metacarpals is associated with pseudohyperparathyroidism. d-basal ganglia calcification is common but usually cause chorea. e- the condition is treated buy vitamin D. 13-Gastrin a-Stimulates gastric acid secretion in response to meals (true) b-stimulates the growth of cells in the gastric mucosa. (true) c-is predominantly produced by G cells located in the pancreas (false) d-levels are decreased in atrophic gastritis(pernicious anaemia) (false) e-stimulates insulin secretion particularly after a carbohydrate meal. (false) Comments:

The main action of gastrin is stimulation of gastric acid and pepsin secretion and stimulation of growth of mucosa of the stomach and intestine.It is produced by G cells in the gastric antrum ,duodenum, fetal pancreas and in adults with pancreatic tumors as gastrinoma .Levels are increased in conditions of low acid production e.g:atrophic gastritis and proton pump inhibitor therapy due to loss of negative feed back. Gastrin levels only reach high enough levels following a protein meal to stimulate insulin secretion. 14-Galactorhoea may be caused by treatment with a-levodopa. (false) b-cimetidine. (true) c-aspirin. (false) d-spironolactone. (false) e-haloperidol. (true) Comments: Hyperprolactinaemia caused by dopamine antagonism (TCA, major tranquilizers, haloperidol, high dose SSRI may push up prolactin producing galactorrhoea a-levodopa does not cause hyperprolactinaemia but methyl dopa does. d-causes of gynaecomastia but not galactorrhoea (not cause hyperprolactinaemia) 15-Sulphonyl urea therapy: a-may increase weight.(true) b-is useful in all type 2 diabetics.(false) c-enhances glucose stimulated insulin release from the pancreas. (true) d-stimulates peripheral glucose utilization. (false) e-has hyponatraemia as a side effect (true) Comments: Sulphonylurea therapy stimulate insulin secretion from the beta cells of pancreas through potassium channel opening . metformin cause increased glucose utilization . These agents may cause SIADH. 16- drugs which can be given in near normal dosage in severe renal failure include a- benzyl penicillin. (false) b-digitoxin. (true) c-doxycycline. (flase) d-streptomycin. (false) e-rifampicin. (true) Comments: Drugs whose concentration may accumulate in renal failure include digoxin (digitoxin metabolized by liver),streptomycin,penicillin,statins,furosomide,doxycycline can worsen renal failure. 17-Hypercalcaemia is associated with: a-thyrotoxicosis. (true)

b-secondary hyperpaprathyroidism. (false) c-excessive absorbable alkali reserve. (true) d-sarcoidosis. (true) e-acute adrenal failure. (true) Comments: Hypercalcaemia may occur in association with hyperpaprathyroidism, vitaminosis D, sarcoidosis, Addison's disease, milk alkali syndrome,thyrotoxicosis. Secondary hyperparathyroidism is associated with hypocalcaemia with chronic renal failure and impairment of 1 alpha hydroxylation of vitamin D by the kidneys. 18-Testicular feminization syndrome a-is characterisedby XXY chromosomal pattern. (false) b-have a female phenotype. (true) c-is associated with low serum testosterone levels (false) d-have undetectable serum oestrogen concentrations (false) e-is an x-linked disorder. (true) Comments: a-it is XY. Testicular feminization syndrome or androgen insensitivity syndrome(AIS) is when a person has XY genotype but is resistant to androgens. As a result the individual has some or all of the physical characteristics of a woman, despite having genetic make up of a man. Its types complete and incomplete. Complete AIS results in someone who looks as a female. In incomplete AIS the degree of sexual ambiguity varies widely from individual to other. Testosterone concentrations are in normal male range but the receptor defect prevents the testosterone from exerting its effects. Oestradiol concentrations are measurable and produced from the peripheral conversion of testosterone as well as by the gonads. 19- which of the following predispose to microbial invasion a-urinary obstruction. (true) b-ciliary dyskinesia. (true) c-cystic fibrosis. (true) d-skin ulceration. (true) e-neutrophil deficiency. (true)

20-Autosomal dominant inheritance a-25% of offspring are affected with an affected parent. (false) b-is the mode of inheritance in multiple neurofibromatosis. (true) c-afects both sexes equally. (true) d-shows a pattern of vertical inheritance in a pedigree. (true) e-always manifests at birth. (false) Comments:

Autosomal dominant conditions include huntington's chorea, achondroplasia, MEN type 1. It affects both sexes equally and 50% of offspring are affected with an affected parent.

21- In the treatment of cushing's disease a-long term metyrapone may be used. (true) b-cabergoline is used in patients unfit for surgery. (false) c-after bilateral adrenalectomy, Nelson's syndrome is prevented by adequate glucocorticoid replacement . (false) d-recurrence of cd after transphenoidal surgery is virtually zero. (false) e-yttrium implantation is indicated in the treatment of pituitary tumors compressing the optic hiasma. (false) Comments: Cushing's disease equates the pituitary dependant disorder while cushing syndrome include all the other causes as ectopic and adrenal. Cabergoline is used in prolactinomas not CD. Metyrapone blocks cortisol production. Recurrence after pituitary surgery is of the order of 20-40%. Yttrium implantation is never used these days. 22-Polycystic ovary syndrome is characterized by a-hirsutism .(true) b-raised serum LH. (true) c-raised serum testosterone. (true) d-raised FSH. (false) e-menorrhagia. (false) Comments: PCOS is characterized by hirsutism, oligomenorhoea(usually with normal oestrogen concentration)and obesity. Insulin resistance is thought to play a major part in evolution of oligomenorrhoea and contribute to elevated LH with normal FSH and a slightly elevated testosterone. 23-Polymerase chain reaction(PCR) a-can amplify RNA but not DNA. (false) b-it is of no value in prenatal diagnosis. (false) c-depends on thermostable taq DNA polymerase. (true) d-requires primer bits either side. (true) e-use heat to separate 2 strands of DNA. (True) Comments: PCR allows amplification of small samples of DNA and through reverse transcriptase RNA. It can be used for prenatal diagnosis of disease as cystic fibrosis. d-this is a disadvantage because the primers have to be known. 24-Characteristic finding in anorexia nervosa are

a-a decrease in cortisol levels. (false) b-increase in LH levels. (false) c-impaired glucose tolerance. (true) d-raised androgen levels. (false) e-hyperkalemia. (false) Comments: a-cortisol and growth hormones are elevated. b-LH and FSH low and LH response to LHRH is impaired when weight loss is severe. e-hypokalemia, hypoalbuminaemia, anaemia, leukopenuia, raised serum carotene. 25- Acidosis may result in a-potassium retention. (true) b-a rise in plasma chloride (true) c-a low pCO2 . (true) d-peripheral vasodilatation. (true) e-tetany. (false) Comments: Acidosis is associated with potassium retention and rise in chloride with maintainance of the anion gap.Peripheral vasodilation occurs to improve oxygenation of metabolizing tissue. Alkalosis is associated with tetany and reduction of ionized calcium.in an effort to correct acidosis respiration increase with reduction of pCO2. 26-primary hyperparathyroidism a-is associated with hypocalcuria due to elevated PTH levels . (false) b-PTH is secreted in a pulsatile manner from the posterior pituitary and acts through PTH receptors on parathyroid cell membranes . (false) c-is usually caused by an adenoma of a single parathyroid gland. (true) d-progresses to tertiary hyperparathyroidism with time. (false) e-is associated with bone resorption by PTH to restore depressed serum calcium levels to normal. (false) Comment: Associated with hypercalcaemia, hypophosphataemia and there is usually hypercalcuria. It is usually a consequence of a single adenoma but may be associate with hyperplasia and rarely carcinoma where PTH concentrations may be particularly high d- secondary progress to tertiary. 27-Recognized features of acromegaly include: a-hypocalcuria. (false) b-intestinal polyposis. (true) c-splenomegaly. (true) d-Palpable peripheral nerves. (true) e-proximal myopathy. (true) Comment:

Features of acromegaly include large hands, feet, macroglossia, organomegaly and prognathism. a-hypercalcuria. b-compression of the optic chiasma may produce a bitemporal hemianopia.proximal myopathy can occur as well as diabetes mellitus, glucose intolerance and hypertension. Diagnosis on the basis o non suppression of GH concentrations with the oral glucose tolerance test. 28-the following are true: a-an elevated TSH level excludes the diagnosis of hyperthyroidism. (false) b-free thyroxine levels are elevated in normal pregnancy. (false) c-most circulating thyroxine s bound to thyroglobulin. (false) d-phenytoin may reduce total thyroxine levels.(true) e-amiodarone treatment may cause hyperthyroidism. (true) comments: Elevated normal TSH is expected in secondary hyperthyroidism.Total T4 concentrations are usually low or normal in normal pregnancy due to dilutional effects. Best to regard the TSH concentration. However. Early pregnancy may be associated with slight rise in T4 associated with elevated HCG which declines as pregnancy progresses.75% of T4 is bound to thyroid binding globulin not thyroglobulin.Phenytoin treatment of euthyroid patients results in a 30 to 40% decrease in serum T4 and free T4 levels and either normal or slightly decreased levels of T3 and free T3 .Amiodarone may cause hyper as well as hypothyroidism. 29-The following may be associated with hypocalcaemia: a-convulsions. (true) b-psychosis. (true) c-restless legs. (false) d-Peripheral neuropathy. (false) e-Papilloedaema. (true) Comments: And depression , raised ICP and prolonged QT interval. 30-the following cause multiple painful genital ulcers: a-circinate balanitis. (false) b-herpes simplex. (true) c-chancroid. (true) d-Primary syphilis. (false) e-granuloma inguinale. (false) Comments: A+d+e usually are painless . Painful ulceration includes herpes simplex/zoster and genital herpes. Behcet's disease,Reiter's,chancroid and gonocoocal disease. 31-raised aldosterone levels are found in: a-normal pregnancy. (true)

b-renal artery stenosis. (true) c-loop diuretics therapy. (true) d-polycystic ovariansyndrome.(false) e-Liddle syndrome (false) Comments: Aldosterone is elevated in association with reduced circulating volumes,pregnancy,conn's syndrome,and raised with diuretic therapy (hence good combination of diuretics and ACEI). Liddle's disease is a renal tubular defect due to Na/K channels and is associated with hyporenninaemic hypoaldosteronism with hypokalaemic hypertension. 32-Which of the following are found in multiple endocrine neoplasia type 1 syndrome: a-phaeochromocytoma. (false) b-medullary carcinoma of the thyroid. (false) c-hyperparathyroidism. (true) d-prolactinoma. (true) e-insulinoma. (true) Comments: MEN type 1 is associated with pituitary, parathyroid, and pancreatic tumours. MEN type 2 is associated with medullary thyroid carcinoma. 33-Turner syndrome: a-is seen only in females. (true) b-may have one chromosome as an isochromosome. (true) c-is usually associated with severe mental retardation. (false) d-pateints usually present with primary amenorrhoea. (true) e-cannot be detected at birth. (false) Comments: Turner syndrome XO is associated with a female phenotype with webbed neck,short stature, cardiac abnormalities and streak gonads. Intelligence is usually unaffected. 34-In diabetic ketoacidosis: a-leukocytosis is common and does not confirm infection. (true) b-Amylase levels may be raised in the absence of pancreatitis. (true) c-urinary stick testing for ketosis may be negative. (true) d-plasma glucose may be low. (false) e-a normal plasma potassium level excludes significant potassium defeicienc. (false) Comments: DKA is typically associated with increased plasma glucose,leukocytosis,reduced pH,bicarbonate, pCO2 and pO2. However it is well recognized that DKAmay still be associated with normal or not so high eg:15mmol/L .Usually ketones are found in urinebut occasionally are absent for reasons as impaired clearance during DKA. Due

to excess renal losses, total body potassium is typically low even if plasma potassium is high. 35-Causes of anovulation include: a-hyperprolactinaemia. (true) b-weight loss. (true) c-Obesity (true) d-polycystic ovary syndrome . (true) e-propranolol. (false) Comments: Anovulation may occur in association with poly cystic ovarian syndrome, anorexia/marked weight loss but is also associated with obesity.Hyperprolactnaemia through negative feedback on gonadotrophes in the pituitary produces hypogonadotrophic hypogonadism and amenorrhoea. Propranolol is not associated with anovulation. 36-Karyotypic abnormalities are found in the following: a-Huntington's disease. (true) b-Burkitts lymphoma. (true) c-Chronic granulocytic leukemia. (true) d-phenylketonuria. (false) e-Acute lymphocytic leukaemia. (true) Comments: a-if very large number of triplet repeats. d-autosomal recessive single gene defect. 37-Abnormal colouration of urine in absence of haematuria may be due to: a-consumption of beetroot. (true) b-treatment with codanthramer.( true) c-phenylketonuria. (false) d-porphyria cutanea tarda. (true) e-acute intravascular haemolysis. (true) Comments: b-may be pink if rifampicin or isoniazid c-alkaptonuria. d-the urine is darker in porphyria cutanea tarda.It has red fluorescence under wood's light. e-haemoglobinuria. 38-the following congenital abnormalities are associated with a characteristic karyotype: a-Klinefelter's syndrome. (true) b-cri-du-chat syndrome. (true) c-Ovarian dysgenesis. (true) d-Pierre-Robin syndrome. (false)

e-meningomyelocoele. (false) Comments: Klinefelter's syndrome-XXY,cri-du-chat deletion chromosome 5p. Turner /gonadal dysgenesis-XO. 39-Epstein-Barr virus is associated with: a-Burkitt's lymphoma. (true) b-Cervical neoplasia. (false) c-nasopharyngeal carcinoma. (true) d-pharyngitis. (true) e-autoimmune haemolytic anaemia. (true) Comments: b-No association with cervical neoplasia unlike human papilloma virus. c-Anaplastic nasopharyngeal carcinoma.common in SE china, virtually all cases have evidence of EBin the tumour tissue. d-infectious mononucleosis usually severe pharyngitis. e-usually resolves after 1-2 months. 40-The following drugs in pharmaceutical doses have been shown to cause a rise in: a-thiazide diuretics. (true) b-ethanol. (false) c-Aspirin. (false) d-gliclazide. (false) e-Atenolol. (false) Comments: Drugs that may cause hperglycaemia include: corticosteroids, thiazides, glucagon. Atenolol is associated with hypoglycaemia. Gliclazide is an oral hypoglycaemic b-it causes a fall. c-It causes a fall. 41-Causes of metabolic acidosis include: a-starvation. (true) b-thiazide diuretics. (false) c-uraemia. (true) d-pyloric stenosis. (false) e-Sulphonylurea. (false) Comments: a-starvation ketoacidosis. b-can cause metabolic alkalosis. c-may be caused by diversion of glutamate metabolism to the liver and the consequent bicarbonate consuming effect of hepatic ureagenesis.

d-an important cause of metabolic alkalosis. e-biguanides however are associated with lacticacidosis. Comments: The primary host response to bacterial infectionsis dependant on mononuclear phagocytes and neutrophils. T-lymphocytes are involved in cell mediated acquired immune responses where as B-lymphocytes are involved in humoral immunity and produce immunoglobulins. T-lymphocytes compose the majority of circulating lymphocytes in plasma. Epstein-Barr virus infects B-lymphocytes and squamous epithelial cells of the oropharynx. The virus can transform B cells and epithelial cells to produce Burkitt's lymphoma, a subset of hodgkin's lymphoma.Nasopharyngeal carcinoma and oral hairy leukaemia. T cell lymphoma makes up 10 to 20% of non Hodgkin lymphoma and has a worse prognosis than B cell lymphoma. 43-The action of noradrenaline released at sympathetic nerve endings is terminated by: a-enzymatic decarboxlation. (false) b-enzymatic inactivation by catechol O methyl transferase. (false) c-re-uptake of nordrenaline by the axonal terminals. (true) d-oxidative deamination by monoamine oxidase. (false) e-it is removed by the circulating blood. (false) Comments: Popular pathway to be asked . 44-which of the following conditions are a consequence of chromosomal aberrations: a-fragile X syndrome. (true) b-phenylketonuria. (false) c-Cri du chat syndrome. (true) d-Osteogenesis imperfect. (false) e-Down's syndrome. (true) Comments: Fragile X syndrome is due to micodeletions on the X chromosom giving the appearance of fragile notch in this chromosome. Cri du chat is due to a deletion in 5p. Down's syndrome may be due to trisomy of chromosome 21 or translocation of 14 to 21. OI is autosomal recessive as is phenylketonuria. 45-Side effects of alpha methyl dopa include: a-pyrexia. (true) b-visual disturbance. (false) c-Oedema. (true) d-nasal congestion. (true) e-depression. (true) Comments:

Also haemoytic anaemia, weight gain, GI disturbance,arthralgia,parkinsonism,nightmares,gyaecomastia,galactorhea, hepatitis.

46-In the normal neonate: a-the white cell count may be 25x10(9). (true) b-haemoglobin F is the predominant haemoglobin. (true) c-The platelet count is in the normal adult range. (true) d-nucleated red cells are rarely seen in the peripheral blood. (false) e-the mean cell volume is greater than 100 fl. (true)

47-In mitosis: a-the number of chromosomes is halved. (false) b-anaphase lag may produce turner syndrome. (true) c-the stage of metaphase shows separation of whole chromosome. (false) d-non disjunction increases with decreasing maternal age. (false) e-an abnormal plane of division of the chromatids produce isochromosomes. (true) Comments: Each time new cells are produced there is a mitotic cycle it must go through. They are interphase, prophase, metaphase, anaphase, telophase. 48-Which of the following organelles have their own self replicating DNA: a-lysosymes. (false) b-golgi bodies.(false) c-mitochondria.(true) d-nucleus. (false) e-rough ER. (false) Comments: Mitochondria have DNA and give rise to maternally inherited disease as mitochondrial myopathies, red ragged fibres, DIDMOAD syndrome, wolfram disease 49-Hypothyroidism: a-is more common than hyperthyroidism . (false) b-is associated with low serum carotene. (false) c-is a cause of pericardial effusion. (true) d-may present with cerebellar ataxia. (true) e-is associated with a reduced CSF protein. (false) Comments: Hyperthyroidism is 8 times commoner. b-increased. e-elevated.

50-Common features of cushing's syndrome due to adrenal carcinoma include: a-retarded growth in children. (true) b-Clitoromegaly. (true) c-subconjunctival oedema. (true) d-marked hyperpigmentation. (false) e-supraclavicular fat pads. (true) Comments: Adrenal carcinoma and cushing are rare.typically more than 4 cm. Growth retardation due to increased cortisol is typical in children. Co secretion of androgen may produce clitoromegaly.Typical features of Cushing include fat pad or buffalo hump,thin skin, easy bruising and subconjunctival oedema d-this may be seen in Cushing's syndrome due to ectopic ACTH. 51-In hypopituitarism: a-selective gonadotrohin deficiency may be present. (true) b-concomitant diabetes inspidus may be masked by anterior pituitary failure.(true) c-adrenal steroid replacement must be started before thyroid replacement. (true) d-mineralocorticoid replacement is usually necessary. (false) e-in men,androgen replacement will cause masculinisation and restore fertility. (false) Comments: Hypopituitarism is typically caused by a non functional pituitary tumour with a staged loss of hormones first GH then LH and FSH then ACTH and finally TSH.The secretion of aldosterone is unaffected as it depend on rennin secretion.Testosterone restores masculinatoin but not fertility. 52-Congenital hypothyroidism a-Cannot confidently be diagnosed before the age of 3 months. (false) b-is in some cases associated with a goiter. (true) c-affects approximately 1 in 10,000 infants. (false) d-may present with jaundice.(true) e-requires thyroxine treatment fro life. ( true) Comments: Diagnosis is possible within neonatal period, a goiter may be seen in the child and the disorder affects 1:3500 births.Jaundice, hypotonia, growth retardation and appearance may prompt diagnosis. Causes include embryological or congenital abnormalities plus maternal drugs thionamides. 53-Carbimazole: a-is contraindicated in breast feeding mothers. (false) b-may cause lymphadenopathy. (true) c-is a prodrug. (true) d-may cause reversible agranulocytosis. (true) e-is teratogenic. (false) Comments:

It may be used in breastfeeding although the dose needs to be the low as the drug is excreted in breast milk. It is converted to methimazole which can cause a serum sickness like adverse effect including lyphadennopathy. It is used in pregnancy and is not teratogenic.But the dose again needs to be minimized to avoid neonatal hypothyroidism. 54-The following enzymes are involved in the synthesis of the neurotransmitterswith which hey are paired: a-cholinesterase: acetylcholine. (false) b-dopa decarboxylase :noradrenaline. (true) c-catechol-o-methyl transferase:dopamine. (false) d-monoamine oxidase:serotonin. (false) e-glutamic acid decarboxylase:gamma amino butyric acid (GABA) .(true) Comments: a-breakdown. b-dopa to dopamine beta oxidase. c-metabolism of NA to VMA. d-breakdown to 5 HIAA. 55-pnemocystis carinii pneumonia: a-is the commeest presenting feature in European AIDS patients. (true) b-is the commonest presenting feature in Ugandan AIDS patients. (false) c-can be successfully prevented with nebulised inhaled pentamidine. (true) d-may be present despite a clear chest X-ray. (true) e-occurs in non-HIV infected individuals. (true) Comments: PCP is the commonest mode of presentation of HIV infection and represents an AIDS defining illness.It can occur in other immunocompromised patients as leukaemia. CXR may be clear but a tell tale feature is hypoxia with mild exertion. b-slim disease with cachexia. Its treatment depends on cotrimoxazole and pentamidine is also effective. 56-The long term treatment of acne with tetracycline: a-is unsuccessful in 75% of patients. (false) b-may predispose to scarring of the skin. (false) c-predispose to candida infection. (true) d-may damage the fetus in utero. (true) e-may predispose o gram negative folliculitits. (true) Comments: Tetracyclines are a frequent and successful treatment of acne but are associated with side effects as teeth staining in utero and should be used in caution in renal impairment.they may predispose to fungal infection.

57-The coomb's antiglobulin test is characteristically positive in haemolytic anaemia associated with : a-chronic lymphocytic leukaemia. (true) b-thalassaemia. (false) c-Systemic lupus erythematosus. (true) d-methyl dopa therapy. (true) e-administration of primaquine. (false) 58-The production rate of aldosterone: a-increases when sodium intake is reduced. (true) b-is increased when the serum sodium levels falls following administration of water and vasopressin. (false) c-falls to nil after hypophysectomy. (false) d-may be increased in the presence of oedema. (true) e-is increased by a dose of angiotensin which is insufficient to raise the arterial blood pressure. (true) Comments: Aldosterone secretion is increased by rennin secreted by juxtaglomerular apparatus.This is released through reduced circulating plasma volume. Hypovolaemia, hypotension. This causes hypervolaemia which will not stimulate rennin d- example CCF. 59-Opsonization: a-enhances phagocytosis. (true) b-is mediated by certain complement components. (true) c-does not involve immunoglobulins. (false) d-may utilize fibronectin. (true) e-is MHC restricted. (false) comments: a-phagocytosis though possible in saline medium is enhanced in the presence of fresh serum. This is due to opsonins. b-opsonins include C3b, for which phagocytic cells possess a receptor. c-immunoglobulins specially IgG 1 and 3, for the Fc portion of which phagocytic cells possess receptors, are potent opsinizing agents. d-fibronectin acts as a glue for neutrophil-target interaction.it is a glycoprotein. e-opsonization is not MHC restricted. 60-The X chromosome a-carries the gene for sickle cell anaemia.(false) b-of the male forms a Barr body in a buccal smear test. (false) c-is not found in the nuclei of all spermatozoa. (true) d-may show an increased fragility in some conditions. (true) e-carries the gene for the Xg blood group. (true) Comments:

The X chromosome/sex chromosome carries the gene responsible for sexual differentiation and may be foud as an inactive Barr body in females ina buccal smear.The gene for sickle cell disease is carried on chromosome 11,whereas X linked conditions as haemophilia A is carried on the X chromosome. Spermatozoa carry 22 autosomes and either X or Y chromosomes. Fragile X condition is associated with narrowing of the arm of the X chromosome. 61-Tricyclic antidepressants: a-relieve depression more quickly than electro-convulsant therapy. (false) b-are associated with an increased incidence of cerebrovascular accidents . (true) c-may cause acute dystonias. (false) d-may cause postural hypotension. (true) e-may cause paralytic ileus in the elderly. (true) Comments: TCA effects on depression are much slower than ECT. Like antipsychotics such as respiridine they are associated with an increased risk of CVAs. They have little effect on dopamine receptors ad so do not cause dystonias(metoclopromide typical for this). The postural hypotension, tachycardia, dry mouth, blurred vision, urinary retention, constipation may ensue from anticholinergic effects. 62-Elevated prolactin levels are associated with: a-acromegaly. (true) b-dopamine agonists. (false) c-pregnancy. (true) d-metoclopromide. (true) e-external beam radiotherapy treatment of pituitary tumours. (true) Comments: Acromegaly associated with hyperprolactinaemia either through stalk compression or co secretion of prolactin with growth hormone. b-bromocriptine suppress prolactin secretion unlike metoclopromide which is a dopamine antagonist e-acute though laterhypopituitarism ensues-believed to be related to hypothalamic involvement and reduced dopaminergic control. 63-The following drugs are unsafe in the last 4 weeks of pregnancy: a-warfarin. (true) b-cotrimoxazole. (true) c-Paracetamol. (false) d-methylpenicillin. (false) e-tetracycline. (true) Comments: a-crosses placena and cause haemorrhage. Warfarin is also teratogenic in first trimester. b-neonatal haemolysis and methaemoglobinaemia. Also teratogenic in 1st trimester. C+d are safe.

e-dental discolouration, maternal hepatotoxicity in large doses tetracycline best avoided but not unsafe in limited doses. 64-Drugs that reduce gastric acid secretion include: a-aluminum hydroxide. (false) b-omeprazol. (true) c-cimetidine. (true) d-misoprostol. (true) e-prednisolone. (false) Comments: a-simple antacid neutralizes acid but not reduce production. b-proton pump inhibitor, powerful acid suppressor. c-H2 antagonist. d-Prostaglandin E2 analogue,increase mucosal protection and has some antisecretory properties,reduce acid and gastrin secretion. 65-The following drugs have been shown to interact with alcohol: a-griseofulvin. (true) b-triazolam. (true) c-chlorpropamide. (true) d-Metronidazole. (true) e-Furosemide. (false) Comments: a-alcohol potentiates its effect. b-alcohol potentiates its effect. c- alcohol potentiates its effect. d-an antabuse reaction occurs due to interference with alcohol dehydrogenase making the side effects of alcohol worse. 66-1,25 dihydroxy cholecalciferol (vitminD):(calcitriol) a-stimulates the absorption of calcium and phosphate from the gut. (true) b-facilitates calcium and phosphate reabsorption from bone. (false) c-stimulates the execretion of calcium and phosphate into renal tubules. (false) d-levels are low during lactation.(false) e-is more active than 24.25(OH)2 vitamin D. (true) Comments: Calcitriol acts on intestines, kidney, and bone to increase calcium and phosphate levels in serum. 24,25 vitamin D is relatively inactive. The main site of action is the intestine,where calcitriol stimulates calcium and phosphate absorption. In the kidney calcitriol promotes renal phosphate resorption in PCT and calcium resorption in DCT. In bone calcitriol facilitates the action of PTH on osteoblasts to increase bone formation. 67-Myxaedaema ay present with: a-fits. (true)

b-ataxic gait. (true) c-dementia. (true) d-loss of vision. (false) e-dipolpia. (false) Comments: Other unusual ones include: normocytic/microcytic anaemia, dilutional hyponatraemia, menorrhagia. 68-which of the following are found in pseudohypoparathyroidis: a-brachydactly. (true) b-hypothyroidism. (true) c-low serum calcium, high serum phosphate, normal PTH. (false) d-low serum calcium, high serum phosphate, high PTH. (true) e-Digeorge's syndrome. (false) Comments: Pseudohypoparathyroidism is associated with low serum calcium, high serum phosphate(same abnormalities as hypoparathyroidism) but elevated PTH (hence pseudo).Brachydactly(short 4th metacarpal)is seen. DIGeorge's is absent parathyroid and thymus associated with chromosomal abnormality. 69-The following may cause hypothyroidism: a-amiodarone. (true) b-Allopurinol. (false) c-Doxycycline. (false) d-lthiuim. (true) e-Probenicid. (false) Comments: Also cobal, iodides, butazolidine, sulphonylurea, antithyroid drugs. Amiodarone is a typical drug associated with both hypothyroidism (interferes with conversion of T4 to T3 )and hyperthyroidism. 70-Within lymph nodes: a-B lymphocytes predominate in the paracortex. (false) b-primary follicles are aggregates of B cells. (true) c-secondary follicles develop following antigenic stimulation. (true) d-lymph flows from the hilum of the node outwards to the marginal sinus. (false) e-the medulla is rich in plasma cells. (true) Comments: a-B lymphocytes predominate in the follicles in the cortex. T lymphocyte in the paracortex. d-flow of lymph is from marginal sinus through node to afferent lymphatic. e-large numbers of plasma cells are found in the medullary cords.

71-Which of the following regarding Y chromosome is/are true: a-it carries a few loci concerned with metabolism. (true) b-it is the only acrocentric chromosome seen in humans. (false) c-it carries the testis determining factor on its short arm. (true) d-Klinefelter's syndrome has 2 Y chromosomes. (false) e-It may be detected in some phenotypic females. (true) Comments: The main Y gene is called the SRY gene, which specifies maleness and male features.it is the single gene that sets off the initial cascade of hormonal changes that make a person a male.it is not the entire chromosome but just this gene that is necessary for maleness.There is evidence for this in disease where SRY is missing. People who are genetically male with XY chromosomes but with mutation or deletion of this SRY gene on the Y chromosome will be female despite having most of the Y chromosome.and people who are genetically female with XX but have tiny pieces of Y chromosome with this gene will become male despite their XX chromosomes. 72-Natural killer cells: a-are a type of T lymphocyte. (true) b-are predominantly found in lymph nodes. (false) c-express cell surface CD3. (false) d-kill antibody coated cells. (true) e-release tumour necrosis factor. (true) Comments: a-Natural killer cells are type of B or T lymphocyte and are involved in defence against malignancy, virus, bacteria, and parasites. b-rarely found in thymus or lymph nodes unlike T cells. c- NK cells are CD3 negative and have CD16/56(opposite T cells) d-NK kill spontaneously and are stimulated by IL2 or antibody coated cells through binding to their CD16 receptors. e-and IFN gamma, granulocyte, macrophage colony stimulating factor and CSF 1. 73-Long term corticosteroid therapy may be associated wih: a-hypochloraemic alkalosis. (true) b-positive nitrogen balance. (false) c-thrombophlebitis. (false) d-increased gastric acidity. (true) e-sleeplessness. (true) Comments: Effects include hyperlycaemia,increased catabolism with increased urea, weight gain, salt and water retension and hypertension, increased osteoclastic activity(reduced bone density and osteoporosis) and CNS effects(depression, anxiety and poor sleep).increased incidence of peptic ulcer wih increased gastric acid secretion and reduces mucosal protection. 74-The thyroid gland: a-develops from the endoderm between the 2nd and 3rd pharyngeal pouches. (false)

b-has C cells that are derived from the ultimobranchial body. (true) c-usually weighs about 100g. (false) d-is at the level of the 5th to 7th cervical and 1st thoracic vertebrae. (true) e-may have accessory nodules in the tongue. (true) Comments: a-1st and 2nd pouches. The C cells are responsible for the secretion of calcitonin. c-25 g

75-Cryptospoidiosis in HIV positive patients: a-present with bloody diarrhea.(false) b-can produce up to 10 litres of liquid faeces per day. (true) c-is the commonest cause of diarrhea in these patients. (false) d-is effectively terminated by spiramycin (false) e-can produce sclerosing cholangitits with inflammation and ulceration of intra and extra hepatic bile ducts. (true) Comments: a-eatery c-everyday stool pathogens are commoner. 76-the following can give a biochemical picture indistinguishable from extra hepatic obstructive jaundice: a-chlorpromazine. (true) b-halothane. (false) c-methyltestosterone. (true) d-isoniazid. (false) e-erythromycin estolate. (true) Comments: Extra hepatic would suggest raised bilirubin with raised alkaline phosphatase and GGT B+d- hepatic picture (raised AST and ALT ) c- dose related. 77-mycoplasma pneumonia: a-infection is associated with the development of agglutinins to a non haemolytic streptococcus. (true) b-can be grown on a cell free medium. (true) c-predominantly causes infection n the elderly. (false) d-infection is associated with polymorph nuclear leucocytosis. (false) e-infection is associated with steven's Johnson syndrome. (true) Comments:

a+cold agglutinins to group O RBCs b-the medium is a complex mixture of heart infusion, peptone, yeast extract, salts, glucose or arginine and horse serum(5-25%) mycoplasma contaminate cell cultures. In the host they form extracellular branched mycellioid structures. 78-Prostaglandin PGI2(prostacyclin) a-reduces arterial smooth muscle tone. (true) b-is a product of arachidonic acid metabolism. (true) c-production is inhibited by NSAID. (true) d-increases platelets cyclic AMP concentration. (true) e-inhibits platelet aggregation to damaged vessel walls. Comments: Prostacyclins reduce arterial tone, is produced from arachidonic acid and is inhibited by NSAIDs. It is involved in platelet aggregation through increasing cAMP concentration. 79-Rubella a-typically has an incubation period of 7-10 days. (false) b-is more frequently associated with palpable splenomegaly than is infectious mononucleosis. (false) c-may be complicated by polyarthralgia. (true) d-is an indication for termination if it occurs in the first 2 months pregnancy. (true) e-can be prevented by vaccination in over 80% of individuals. (true) Comments: Rubella has an incubation period of 14-23 days,the rash lasts about 3 days and is rarely associated with splenomegaly unlike IM. Congenital rubella is a serious problem with gross developmental interference and cardiac abnormalities associated with infection of a non immune patient. Early infection is worse due to organogenesis at this stage. MMR vaccination is very effective with a claim of 90% protection . 80-In non-iatrogenic Cushing's syndrome the following are true. a-the commonest cause in adults is pituitary dependant disease. (true Cushing's disease). (true) b-in the majority of patients with cushing's disease the pituitary fossa on lateral skull x-ray appears normal. (true) c-hypokalaemia is more common in ectopic ACTH syndrome than Cushing disease. (true) d-in Cushing's syndrome associated with bronchial carcinoma the classical findings are usually florid. (false) e-the skin may peel after successful restoration of the eucorticoid state. (true) Comments: Non iatrogenic cushing's syndrome could be due to a pituitary ACTH adenoma(80% of subjects and usually micoadenoma), ectopic ACTH secretion (bronchial carcinoid

or bronchogenic carcinoma-signs are often absent as rapid development )or a cortisol secreting adrenal adenoma. (low ACTH) 81-Hirsutism in females: a-when idiopathic is associated with normal plasma testosterone levels. (true) b-can be caused by phenytoin. (true) c-when ovarian in oriin, is most commonly due to arrhenoblastoma. (false) d-is a presenting symptom of hyperprolactinaemia. (false) e-may be due to congenital adrenal hyperplasia. (true) Comments: Commonest cause of hirsutism is polycystic ovarian syndrome, can also be caused by medication such as phenytoin and has been associated with valproate. Hirsutism is not a presenting feature of hyperprolactinaemia but hyperprolactinaemia may be associated . i.e:PCOs. Usuallu testosterone concentrations are normal with idiopathic hirsutism but may also be slightly elevated. 82-Beta-thalassaemia major(homozygous) a-is characterized by persistence of Hb F. (true) b-is associated with a chronic marked reticulocytosis. (false) c-is always associated with a raised proportion of HbA2. (false) d-is very rarely associated with nucleated red cells. (false) e-is a cause of pathological fracture of long bones. (true) Comments: Nucleated red cells are always seen, retics low, HbA2 raised in B thalassaemia trait. 83-Actions of glucagon include a-glycogenolysis in the liver. (true) b-inhibition of insulin secretion. (false) c-gluconeogenesis in the liver. (true) d-inhibition of adenyl cyclase. (false) e-a positive inotropic effect on the heart. (true) Comments: Glucagon causes the recruitment of glucose from hepatic stores and has a positive inotropic effect on the heart. Paradoxically stimulates insulin release. 84-The normal metabolic response to a major surgical operation includes: a-antidiiuresis for 12-24 hours. (true) b-retention of sodium. (true) c-increased utilization of glucose. (false) d-increased renal excretion of nitrogen. (true) e-increased rernal excretion of potassium. (true)

Comments: Physiological effects of surgery include antidiuresis (increased ADH secretion in an effort to retain water and increase BP), increased catecholamine, cortisol and aldosterone release(increased sodium retention and increased potassium losses)and increased nitrogen excretion. There is decreased utilization of glucose as a consequence of the excess secretion of cortisol/catecholamines. 85-Insulin action: a-Increases liver glycogenolysis. (false) b-increases muscle glycogen synthesis. (true) c-increases liver gluconeogenesis. (true) d-increases liver fatty acid synthesis. (true) e-facilitates red blood cell glucose uptake. (false) Comments: Insulin acts to inhibit lipolysis and gluconeogenesis by promoting glycogenesis. Insulin promotes synthesis of fatty acids in the liver. e-does not increase uptake into brain or liver either. 86-The following statements concerning syphilis are correct: a-in the primary stage all serological tests for the disease may be negative. (true) b-repeatedly significant treponemal antibody titres are diagnostic of latent syphilis. (false) c-a patient with syphilitic aortitis is at special risk of death following the administration of penicillin. (true) d-in the secondary stage serological tests for the disease are positive in over 90% of cases. (true) e-a baby born to an adequately treated syphilitic woman should be treated if serological tests for the disease are positive in cord blood. (false) Comments: Unlike secondary syphilis where the serology is usually always positive, the serology may well be negative in primary syphilis and the diagnosis depends on the demonstration of T.pallidum in the exudates taken from the chancre. False positive treponemal antibody tests are recognized with Yaws. Due to Jarisch-Herxheimer reaction where there is an acute exacerbation of features following the introduction of therapy patients with syphilitic aortitis or neurosphilis are most at risk. 87-Thiazide dieuretics: a-act on the loop of henle distal to the major site of sodium reabsorption. (true) b-cause hypokalaemia by blocking the sodium potassium exchange site in the distal tubule. (false) c-increase the renal excretion of calcium. (false) d-increase the renal excretion of magnesium, (true) e-elevate LDL cholesterol in long term use. (true) Comments: a-proximal tubule. b-potassium sparing act here.

c-decrease,thiazides reduce ion excretion and may lead to hypercalcuria. Other metabolic effects include hyperglycaemia, hyperuricaemia and dyslipidaemia. 88-The human X chromosome: a-has the gene for Duchene muscular dystrophy on its short arm. (true) b-is associated with the Y chromosome side by side during synapse formation in spermatogenesis. (false) c-in the female somatic cell is never completely inactivated. (true) d-is a metacentric chromosome. (false) e-in normal females may be seen as a chromatin body in a buccal smear analysis. (true) Comments: Normally the female complement is 2 X sex chromosomes. One is derived from each parent and one of the pair is also randomly inactivated by a process called lionization at an early developmental stage. A chromatin body may be seen in buccal smears in normal females. It is cleaved from the Y chromosomes during spermatogenesis. 89-Which of the following statements regarding multifactorial inheritance are true or false? a-most isolated neural tube defects belong to this category. (true) b-the recurrence risk in this type does not depend on the previous incidence of the same condition in the family. (false) c-Blood groups are inherited in this manner. (false) d-It is due to the effects of a large number of genes and the environment. (true) e-can be diagnosed by chromosome culture. (false) Comments: Polygenic or multifactorial inheritance occurs in conditions as diabetes mellitus, rheumatoid arthritis, NTDs,cardiac defects. Blood groups have a specifeic pattern of mendelian inheritance. 90-Genetic deficiency of thyroid hormaone production. (dyshormonogenesis) a-leads to the formation of a goiter. (true) b-is associated with a diminished ptake of radioactive iodine. (false) c-may be associated with congenital nerve deafness. (true) d-is best treated with iodine in mild cases. (false) e-may produce no signs or symptoms of thyroid deficiency. (true) Comments: Dyshormonogenesis results from a deficiency or absence of one or more of the enzymes involved in thyroid hormone synthesis or secretion. The most common enzyme abnormality is absent or insufficient thyroid peroxidase activity which results in failure of oxidation.(organification. )of iodide to iodine.The iodine will be trapped but not organified. These patients may have enlarged or may be normal gland, an elevated TSH due to decreased levels of thyroid hormones, and a high uptake of I-123 at 4 hours,and Tc pertechnetate. T4 and FTI are usually decreased . The perchlorate washout test will be positive in these patients. Deficient peroxidase activity associated

with a familial goiter and deafness or hearing loss is referred to as Pendred's syndrome. 91-Hyperthyroidism: a-diagnosis is untenable if patients gains weight. (false) b-may cause short stature in childhood. (false) c-may be caused by subacute thyroiditis. (true) d-is usually associated with raised serum T3 and reverse T3. (true) e-may be associated with periodic paralysis. (true) Comments: c-in the early stages thyroid hormone may be released from the gland causing transient hyperthyroidism. Typically there is a high ESR and depressed R AIU. 92-X-linked recessive inheritance is recognized in a-Tay-Sach's disease. (false) b-hypophophataemic vitamin D resistant rickets. (false) c-Wisckott-Aldrich syndrome. (true) d-icthyosis. (true) e-Hunter's syndrome. (true) Comments: X-linked recessive inheritance is typified by haemophilia A.can be associated with congenital adrenal hyperplasia although this is usually autosomal recessive a-AR. b-X-linked dominant d-although icthyosis is typically autosomal dominant it can be inherited as X-linked recessive. 93-Campylobacter jejuni: a-attack rates are higher in the elderly. (false) b-infections are treated with ciprofloxacin. (true) c-is a recognized pathogen in domestic animals. (true) d-is readily isolated in stool culture. (false) e-cause colitits. (true) Comments: a-young adults and children. b-cipro and erythromycin but most are self limiting. c-transmitted to humans by milk or water infected by wild and domestic animals and poultry. d-requires special conditions:42c ,microaerobic atmosphere on blood agar with antimicrobials added. e-proctocolitits and enterocolitits may be due to sexually transmitted agents such as campylobacter entamaeba,lymphogranulomma venereum and may be clinically indistinguishable from non infective causes.

94-Tumour necrosis factor: a-is a cytokine released by activated monocytes. (true) b-is formed in the necrotic centres of tumours. (false) c-is involved in cachexia syndrome. (true) d-is the cause of gram negative endotoxin induced toxic shock syndrome. (true) e-causes increased capillary wall permeability. (true) Comments: TNF alpha is a cytokine and induces acute phase proteins from the liver.The main sources in vivo are stimulated monocytes, fibroblasts, and endothelial cells. Physiological stimuli for the synthesis of TNF alpha are IL1, bacterial endotoxins, TNF, PDGF, and oncostatin M. c-also, fever,osteoclastic bone resorption. 95-Bromocriptine: a-will suppress lacation in the puerperium. (true) b-may be a useful adjunct in acromegaly. (true) c-may cause enlargement of the pituitary in a patient with a prolactinoma. (true) d-inhibits dopamine receptors. (false) e-is an ergot derivative. (true) Comments: b-reduces growth hormone in most patients, improve visual fields, diabetes and may even shrink tumour. High doses needed, 10-20 mg/day.Usually produces marked reduction in size of prolactinoma but tumour enlargement and apoplexy has rarely been associated with bromocriptine use. d-Dopamine(DA2) receptor agonist. 96-Hypothyroidism: a-carpal tunnel syndrome is caused by amyloid deposits with the flexor ratinaculum. (false) b-may be associated with a microcytic or macrocytic anaemia. (true) c-may be caused by hashimoto's thyroiditis . (true) d-is the end result of subacute thyroiditis. (false) e-is often associated with pretibial myxoedema. (false) Comments: a-Myxoedematous change. d-most end up euthyroid. e-is associated with Graves disease and therefore usually thyrotoxicosis. 97-A female taking an oral contraceptive regularly may complain of breakthrough bleeding or pregnancy if she also took the following drugs: a-cimetidine. (false)

b-carbamazepine. (true) c-phenytoin. (true) d-indomethacin. (false) e-rifampicin. (true) Comments: Liver enzyme inducers as carbamazepine, phenytoin, alcohol, smoking, omeprazole and rifampicin would cause increased metabolism of the OCP and result in reduced efficacy. Cimetidine inhibits cyto P450. 98-In an adolescent with insulin dependant diabetes mellitus the following support a diagnosis of diabetic ketoacidosis: a-abdominal pain at onset. (false) b-serum bicarbonate. (true) c-serum glucose 14 mmol/L. (false) d-increased appetite in the past few days. e-shallow respiration. (false) Comments: a-An unusual but recognized feature particularly in children. However does not support diagnosis of DKA. b-suggests metabolic acidosis. c-normoglycaemic DKA can occur and a glucose of 14 does not rule out the diagnosis but it does not support the diagnosis. d-ususally patients are unwell with infections and anorexia. e-respiratory compensation leads to rapid deep (Kussmaul's)breathing 99-Metronidazole: a-is a dihydrofolate reductase inhibitor. (false) b-80% of a per rectal dose is absorbed. (true) c-the dose needs to be adjusted in renal failure. (true) d-is associated with disulfiram like reaction. (true) e-causes peripheral neuropathy. (true) Comments: a-its action is not fully undersood but causes cytotoxic effects in anaerobes by a reduction reaction probably via the hydroxylamine derivative. b-59-94% c-accumulation of metabolites can occur. d- in some patients. e-primariy with high doses of long duration in children. Most commonly ild sensory and reversible. 100-Etidronate: a-decreases the incidence of vertebral frctures in postmenopausal females when used cyclically with calcium. (true)

b-binds to hydroxyapatite in bone. (true) c-inhibits osteoclastic resorption of bone. (true) d-if used as monotherapy is associated with inhibited bone mineralization. (true) e-exacerbate paget's diseasaae of bone.. (false) Comments: Etidronate a so called bisphosphonates increases bone mineralization and is a treatment for osteoporosis through the inhibition of bone resorption by osteocalsts. d-and can cause fractures. e-is used in the treatment of paget's. 101-Polymerase chain reaction: a-takes several days to complete.(false) b-DNA or RNA can be used as the template. (true) c-helps in diagnosis of infection. (true) d-in diagnostic PCR the exact sequence at both ends of the target region must be known. (true) e-Polymorphisms in the viral genome my result in amplification failure. (true) Comments: PCR is a rapid technique which produces a result in a ew hours.So used for rapid diagnosis of TB where culture mwthods take several weeks.DNA is the standard template but viral RNA can be amplified if enzyme reverse transcriptase is used. Primers used in the reaction must be complementary to the nucleic acid sequence surrounding the region to be amplified therefore these sequences must be known. In HIV and other viruses sequence polymorphism may prevent binding of primers and result in failure of amplification. Primers which were developed for amplification of the predominant clade B strain found in Europeans and Americans have proved unreliable for amplification of other HIV clades from Africa and Asia. 102-causes of thrombocytopenia include: a-low molecular weight heparin. (true) b-aspirin. (true) c-isoniazid. (false) d-D-penicillamine. (true) e-bendroflumethiazide. (true) Comments: a-although it is more typical with unfractionated heparin. b-causes a qualitative reduction in platelet activity and numbers. c-but can cause agranulocytosis. e-and more rarelt pancytopenia. 103-Insulin: a-is secreted mainly as proinsulin. (false) b-has equal biological activity to C-peptide. (false) c-release from he pancreatic beta cell is stimulated by biguanides. (false)

d-has a half life of less than 8 minutes when given intravenously. (true) e- 80% is degraded by the liver and kidney. (true) Comments: Insulin (and C-peptide which is inactive)is secreted by the beta cells within the langerhan as the active molecule following cleavage from preproinsulin, then proinsulin.it is metabolized in the liver and undergoes renal excretion. 104-The Wasserman reaction may be positive in: a-Yaws. (true) b-Cat scratch fever. (false) c-systemic lupus eryhtematosus. (true) d-Hashimoto's throiditis. (true) e-Sarcoidosis. (false) Comments: The wasserman reaction is a complement fixation test for syphilis but other spirochetes and phospholipidic disorders as malaria ,SLE,Leprosy give false positive resuls. 105-Bromocriptine therapy may cause: a-dyskinesias. (true) b-retroperitoneal fibrosis. (true) c-gynaecomastia. (false) d-hypertension. (true) e-Raynaud's phenomenon. (true) Comments: d-more often causes hypotension, hypertension, MI, seizures, and mental disorders have been reported in postpartum women given bromocriptine for lactation suppression. 106-Human breast milk: a-can be safely used in babies with galactosaemia. (false) b-contains more protein per milliliter than cow's milk. (false) c-contains less fat per milliliter than cow's milk. (false) d-has a relatively high sodium content. (false) e-contains more carbohydrate per milliliter than cow's milk. (true) Comments: Human breast milk is produced under the influence of prolactin, has less calorific value than cow's milk(less protein, more fat and carbohydrate) and low sodium content. Breast milk is not recommended in galactosaemia due to precipitation of hypoglycaemia. 107-Concerning hepatitis E infection: a-it can be transmitted with hepatitis B. (false) b-it is a recognized cause of chronic liver disease. (false)

c-Ct scan of the liver with contrast showsdiagnostic appearances. (false) d-the incidence of chronic liver disease is reduced by administration of alpha interferon. (false) e-it does not result in a carrier state. (true) Comments: e-five hepatitis viruses form a heterogenous group causing similar clinical illness. Hepatitis A,C,D,E are all RNA viruses coming from 4 different families and hepatitis B is a DNA virus. Hepatitis A and E cause acute illness with the formercausing most hepatitis in childhood and hepatitis E being very rare. Hepatitis B,C,D cause chronic morbidity and mortality with B causing a third of cases,hepatitis C a fifth of cases, and D is very rare. Hepatitis D can't occur without B as a helper.Hepatitis B can be treated with interferon alpha, which improves liver disease. 108-A dominant R wave in lead V1 is characteristic in: a-pulmonary embolus. (false) b-WPW. (true) c-LBBB. (false) d-hyperkalaemia. (false) e-true posterior myocardial infarction. (true) Comments: a- A ightward shift of axis acutely can produce this in a massive PE bu characteristic implies commonly seen, which isn't b- Type A. C+d leftward shift. 109-which of the following statements are true or false: a-familial hypercholesterolaemia is autosomal dominant. (true) b-alpha thalassaemia is autosomal recessive. (true) c-adult polycystic kidney disease is autosomal dominant. (true) d-Hurler syndrome is autosomal recessive. (true) e-sickle cell anaemia is inherited as an autosomal dominant condition. (false) Comments: Alpha thalassaemia, Hurler's syndrome, and SCD are autosomal recessive, AD conditions include achondroplasia,huntington's, FH and APCKD. 110-The following are autosomal dominant: a-neurofibromatosis type 1. (true) b-cystic fibrosis. (false) c-familial polyposis coli. (true) d-Huntington's chorea. (true) e-adult polycystic kidney. (true) Comments: Autosomal dominant disorders include Huntington's, achondroplasia,neurofibromatosis,adult polycystic kidney, polyposis coli.

111-Genetic aniciaption occurs in: a-cystic fibrosis. (false) b-dystrophia myotonica. (true) c-fragile X syndrome. (true) d-Huntington's disease. (true) e-Marfan syndrome. (false) Comments: b-extreme amplifications are not transmitted through the male line. This explains the occurrence of the severe congenital form almost exclusively in the offspring of affected women. 112-Thype 1 insulin dependant diabetes mellitus is associated with a-about a 1:3 positive family history. (false) b-decreased islet cells antibodies with increasing time from diagnosis. (true) c-an 80% concordance among identical twins. (false) d-high plasma glucagon. (true) e-insulin resistance. (false) Comments: a-about 1:10 c-this is the figure for type 2 diabetes, type 1 about 40% d-but suppressible with insulin. e-type 2. In type 1 insulin is low or absent rather than high. 113-Common features of pheochromocytoma include: a-panic attacks. (true) b-bradycardia. (false) c-diarrhoea. (true) d-hypoglycaemia. (false) e-hypokalaemia. (false) Comments: Typical features include:paroxysmal panic attacks, sweats, anxiety, tremor,palpitations, hypertension or postural hypotension.Diabetes is a biochemical feature as is hypokalaemia.It is detected by elevated urine free meta adrenaline or normetadrenaline with high sensitivity and specificity. b-reflex bradycardia. d-hyperglycaemia. e-rarely. 114-Low molecular weight heparin: a-exerts its anticoagulant effect by biding with antithrombin. (true) b-inactivates thrombin more readily than unfractionated heparin. (false) c-has fewer chains containing the unique pentasaccharide sequence(the binding site)than unfcationated heparin. (false) d-has a more potent effect on platelets than does unfractionated heparin. (false) e-is excreted in urine. (true)

115-Vancomycin resistant enterococci: a-cause resistant infective diarrhea. (false) b-produce an enzyme that inactivates vancomycin. (false) c-may be found in healthy community not recently hospitalized. (true) d-high dose ampicillin is the treatment of choice. (false) e-are commonly vancomycin dependant. (false) Comments: a-When they cause clinical problems they are usually UTI, bacteraemia, wound infection, neonatal infection, endocarditis. b-they alter peptidoglycan precursors used to build cell walls.vancomycin binds to Dala-D-ala but the resistant enterococci have D-ala-D-lac or D-ala terminating precursors. They acquire genes that produce enzymes to change the precursors. c-2% in UK general practice.,28% in belguim.Community reservoir in meat,poultry and cheese. d-only if the MIC of ampicillin is not too high.Evidence exists for its use in E.faecalis endocarditis 20 g/day. e-some strains only explained by that there is an inability to produce cell walls because vancomycin sensitive precursor genes have been turned off and resistant ones only appear in the presence of vancomycin.

116-There is an increased tendency to thrombosis in a-Behcet's disease (true) b-Kawasaki's disease. (true) c-Paroxysmal nocturnal haemoglobinuria. (true) d-homocystinuria. (true) e-metastatic malignancy.(true) Comments: Other acquired causes include:CCF,trauma, surgery, myeloproliferative disease, OCP. Other inherited causes:antithrombin 3, protein C & S deficiency or FVL mutation, dysplasminogenaemia,dysfibrinogenaemia and heparin cofactor 2 deficiency. 117- Circulating anticoagulants have been described in: a-SLE. (true) b-Post-partum. (true) c-homocystinuria. (false) d-haemophilia. (true) e-the elderly. (true) Comments: Circulating anticoagulant usually IgG interfere with coagulation reactions. .the main lab feature are prolonged PT and PTT which persists if normal plasma is added a-these are non specific inhibitors which prolong haemostsis by binding to phospholipids,anti factor 8 antibodies may be seen. B+D+E antifactor 8 antibodies. c-thrombotic tendency.

d-haemophilics who had plasma transfusions. 118-A raised iron levels is seen in: a-thalassaemia major. (true) b-polycythaemia rubra vera. (false) c-myelodysplasia. (true) d-haemochromatosis. (true) e-rheumatoid disease. (false) Comments: a,c-iron overload may be seen in repeated transfusions and reduced wih subcutaneous desferioxamine. (iron chelation) and oral vitamin C d-increased iron absorbtion and deposition in various tissues. 119- X-linked inheritance is seen in : a-achondroplasia. (false) b-Huntington's disease. (false) c-G6PD deficiency. (true) d-haemophilia. (true) e-vitamin D resistant rickets. (true) Comments: X linked inherited conditions include; Haemophilia A, colour blindness, G6PD and vitamin D resistant rickets. In X linked dominant where both sexes are equally affected. A,b-autosomal dominant. e- X linked dominant. 120-Increased sweating is seen in: a-acromegaly. (true) b-phaeochromocytoma. (true) c-diabetic ketoacidosis. (false) d-hypoadrenalism. (false) e-insulinoma. (true) Comments: Sweats are seen in association with the menopause, acromegaly,phaeochromocytoma, thyrotoxicosis and hypoglycaemia (insulinoma), old TB, lymphoma, brucella. 122-Tetany may occur in: a-osteoporosis. (false) b-thyroid surgery. (true) c-respiratory acidosis. (false) d-hyperventilation. (true) e-untreated hyperparathyroidism. (false) Comments:

Tetany occurs in association with low calcium or magnesium, a-osteomalacia. b-by producing iatrogenic hypoparathyroidism. c-respiratory alkalosis would cause low ionized calcium. d-cause respiratory alkalosis. e-this gives hypercalcaemia. 123-When considering drug therapy during pregnancy: a-Methyl dopa is contra indicated in all stages. (false) b-isotretinoin is indication for termination. (true) c-folic acid supplements should be given to patients taking phenytoin. (true) d-heparin cause CNS damage in the fetus if given in 2nd or 3rd trimester. (false) e-thiazide diuretics have been shown to decrease placental perfusion. (true) Comments: a-it is only hypotensive safe in all stages. b-pregnancy is not advised for 2 years after cessation of treatment. d-but warfarin does. 124-A 21 year old nurse who has been nursing a 6 week old child wih congenital rubella for the last week discovers she is pregnant.She does not remember being vaccinated against rubella: a-congenital rubella is not infectious beyond the 1st few days.she can be reassured. (false) b-she should be given attenuated rubella vaccine immediately. (false) c-blood should be taken for serology. (true) d-gammaglobulin injection upsets later serological diagnosis. (false) e-a rising IgM antibody titre is indicative of recent infection. (true) Comments: a-infectious for weeks.This nurse runs the risk of developing rubella infection herself and the process of investigation is 1st to discover if she has IgG antibodies to rubella signifying immunity. IgM suggests recent infection and if she is not immune then she requires treatment with immunoglobulin. 125-Thrombocytopenia is a recognized adverse effect of the following drugs: a-aspirin. (true) b-oxymethalone. (false) c-thiazide diuretics. (true) d-gold. (true) e-dapsone. (false) Comments: a-aspirin causes reduced placental function, thrombocytopenia and increased bleeding time. 126-In the T cell response to antigen:

a-a process of affinity maturation of the T cell receptor occurs.(false) b-intact antigen is presented in association with self MHC molecules. (false) c-co-operation with other cell types is required for T cell recognition of antigen. (true) d-gamma/delta + T cells respond to antigen presented in association with MHC class 2 molecules. (false) e-interactions of the TcR with an appropriate Ag/MHC complex activates a resting T cell. (false) Comments: a-affinity maturation in an ongoing immune response is a feature of the antibody response. There is no evidence that a similar process occurs in the T cell response. b-MHC molecules present short antigen derived peptides, not the intact antigen. c-T cells recognize antigen only when presented by self MHC molecules on an antigen presenting cell. d-MHC class 2 molecules present antigen to CD4, alpha , beta, + T cells. Most gamma,delta + T cells do not appear to be restricted by self MHC molecules. e-additional costimulatory signals are required to activate resting T cell. Interaction of the TcR of a resting T cell with an appropriate Ag/MHC complex in the absence of costimulatory signals may lead to the induction of anergy. 127-In acute allergic reactions: a-there is an increase in bradykinins. (true) b-T helper cells are involved. (true) c-there is an increase in the products of 5-lipoxygenase pathway. (true) d-gene for allergy located on chromosome 12. (false) e-may be triggered by acute complement activation. (true) Comments: c-leukotrienes. d-chromosome 6. e-anaphylatoxins. 128-Attacks of hypoglycaemia are a recognized complication of: a-Von giereke's disease. (true) b-galactosaemia. (true) c-G6PD deficiency. (false) d-fructosaemia. (true) e-Gaucher's disease. (false) Comments: Hypolycaemia is a feature of glycogen storage disease as Von giereke's disease and Pompe's disease.and also a feature of galactosaemia, fructosaemia. G6PD deficiency causes anaemia, spherocytosis and haemolysis but not hypoglycaemia. Gaucher's diasease is an inherited metabolic disorder in which glucocerebroside accumulate in spleen, liver, lungs, bone marrow and rarely brain. 129-The following are true: a-phaeochromocytoma occurs as part of MEN syndrome type 1. (false)

b-elevated alkaline phosphatase is a feature of osteoporosis. (false) c-patients with Down's syndrome have an increased incidence of thyrotoxicosis. (false) d-fertility in Kallaman's syndrome is restored by therapy with GnRH. (false) e-elevated urinary VMA can occur in insulin dependant diabetic patients with hypoglycaemia (true) Comments: a-MEN type 2. Osteoporosis typically associated with no abnormalities of bone except fractures where alkaline phophatase may rise. Down have an increased risk of hypothyroidism. Fertility may be restored in Kallaman's partially by LH and FSH therapy. e-also in association with foods as vanilla, beta blockers and ganglion blockers. 130-a single nuclear sex chromatin body will be found in: a-males with Down syndrome.(false) b-most females with Turner's syndrome. (false) c-males with kleinefelter syndrome. (true) d-females wih adrenogenotal syndrome. (true) e-females wih XXX sex chromosome. (false) Comments: Barr body b-only some the mosaics e-2 131-A karyotype: a-may be prepared from chorionic villi of the fetus. (true) b-helps in the diagnosis of chromosome disorders. (true) c-is made from cells arrested at telophase of mitosis. (false) d-from a patau syndrome a patient shows an extra chromosome number 18. (false) e-helps in the identification of the Philadelphia chromosome in chronic myeloid leukaemia. (true) Comments; Karyotype is the chromosomal composition of cells-normal karyotype is 46XX or XY. Patau syndrome is associated with trisomy of chromosome 13. 132-Trinucleotide repeat sequence are seen in: a-cystic fibrosis. (false) b-Duchenne muscular dystrophy. (false) c-myotonic dystrophy. (true) d-fragile X syndrome. (true) e-Leber's optic atrophy. (false) Comments: Also Huntington's chorea

133-Regarding primary genital herpes: a-has an incubation period of 2 months. (false) b-tender inguinal lymphadenopathy frequently occurs. (true) c-oral acyclovir given within 48 hours reduces duration of symptoms. (true) d-first attack is milder than subsequent attacks. (false) e-urinary retention is a recognized feature. (true) Comments: The incubation period of genital herpes is about 2 to 12 days. Temder inguinal lymphadenopathy frequently accompanies the primary attack. Oral acyclovir has been shown to be effective treatment for primary genital herpes infection, reducing the duration of local symptoms and virus shedding. The primary infection is generally much more severe than subsequent attacks. Urinary retension, neuralgia and constipation may all occur due to sacroradiculomyelitits. 134-presenting features of hypothyroidism include: a-deafness. (true) b-menorhagia. (true) c-hirsutism. (true) d-enlarged thyroid gland. (true) e-osteoporosis. (false) Comments: Hirsutism is rarely reported in association with hypothyroidism although hair loss also features. Goitre is a frequent feaure in both Hashimoto's thyroiditis and also iodine deficiency. Other presenting features include ataxia/neuronopathies especially compression neuropathiesand the peaches and cream appearance due to hyper beta carotenaemia. Cognitive impairment, macrocytic anaemia and pleural effusion also feature. 135-In a double blind placebo control clinical trial: a-some of the patients are not treated nor given placebo. (false) b-some of the patients receive a placebo. (true) c-the patients do not know which treatment they receive. (true) d-everybody receives both treatments. (false) e-the clinical assessing in the effects of the treatment does not show which treatment the patient has been given. (true) Comments: a-all are treated identically although some are treated with placebo. c-the patients are blind to the treatment choice. d-that would be a double blind crossover study. e-the clinician is blind to the treatment choice. 136-Recognised features of untreated panhypopituitarism include: a-growth of lanugo hair. (false) b-increased insulin sensitivity. (true) c-pigmentation of mucous membrane. (false)

d-extreme emaciation. (false) e-low total serum thyroxine concentration. (true) Comments: A and D-anorexia nervosa. Panhypopituitary patients look pale, have fine wrinkled skin and loss of body hair. c-Addison's. There is low T4 and TSH, low sex hormones and LH/FSH with hypocortisolaemia and low ACTH. GH and IGF-1 are also low. 137-The following factors will lower the ESR: a-polycythaemia. (true) b-macrocytosis. (false) c-sickle cell disease. (true) d-DIC. (true) e-female gender. (false) Comments: Large cells, less cells and more proteins increase ESR. d-other protein factors that may reduce ESR include hypofibrinogenaemia, dysfibrinogenaemia, hypogammaglobulinaemia, low molecular weight dextran. 138-Physiologically elevated body temperature is found: a-in the tropics. (true) b-following a large meal. (true) c-with emotional disturbance. (true) d-during part of the menstrual cycle. (true) e-during REM sleep. (false) Comments: Elevation of body temperature is a feature of topical climates ,drugs as ecstasy, ovulation and following a large meal. Falls in temperature are typical of sleep. 139-ADH secretion is inhibited by: a-cold. (true) b-increase blood pressure. (true) c-alcohol. (true) d-decrease body fluid tonicity. (true) e-barbiturates. (false) Comments: ADH secretion is inhibited by dilution, cold, increased blood pressure, alcohol, and tetracyclines. Barbiturates and SSRIs as well as sulphonylureas increase secretion. 140-Polyxystic ovary syndrome is associated with: a-primary amenorrhoea. (true) b-hirsutism. (true) c-increased FSH, decreased LH. (false) d-decreased sex hormone binding globulin. (true)

e-increased androgens. (true) Comments: a-usually secondary amenorrhoea occurs but rarely it may be primary. b-a particular problem. c-increase LH and decrease FSH. d-because of decreased synthesis in the liver from the effect of androgens. e-increased production from ovaries and adrenals. 141-adverse effects of carbimazole include: a-cholestatic jaundice. (true) b-agranulocytosis. (true) c-impaired renal function. (false) d-alopecia. (true) e-gynaecomastia. (false) Comments: Rarely agranulocytosis and neutropenia is associated but the most worrying side effect, others are pruritits, rash and alopecia, vasculitis rarely. 142-Acyclovir: a-is effective against CMV. (false) b-acts ia viral thymidine cycle. (true) c-treats herpes simplx encephalitits. (true) d-decreases recurrence of genital herpes. (true) e-stops herpetic neuralgia. (false) Comments: a-ganciclovir. Is effective against cmv. b-aciclovir is phosphorylated by this pathway and then competes with deoxyguanosine triphosphate for a position in the viral DNA. c-given IV for 10 days. e-prevents herpetic neuralgia if given at the onset of infection but is ineffective later. 143-Diamorphine elixir for the relief of pain in terminal patients: a-initial sedation typically continuewhile drug is administered. (false) b-analgesia is enhanced if cocaine is added. (false) c-constipation is characteristic sequel of treatment. (true) d-dependance occurs rapidly. (false) e-the same amount of pain relief is produced as when the same dose is given via intramuscular injection. (false) Comments: a-sedation occurring in the first few days typically wears off. b-halucinations also occur. c-an aperients should always be added to the treatment regimen. d-adiction is not a problem. e-an intramuscular injection is 3 times more effective than the same oral dose.

144-The following side effects of drugs are describes in the fetus: a-alcoholism producing microcephaly. (true) b-sulphonylureas produce neural tube defect. (false) c-chloroquine producing corneal opacities. (true) d-hydrocortisone producing cleft palates. (false) e-tetacycline producing phocomelai. (false) Comments: Alcohol excess cause fetal alcohol syndrome with micrognatiha,microcephaly,and small fetus. Sulphonyl ureas may produce marked hyperinsulinism in the fetus with fetal hypoglycaemia.Chloroquine like in adults may cause cataracts and opacification.High dose steroids are safe due to ability of placenta to metabolise cortisol to the inactive cortisone.tetracycline causes dental pigmentation. 145-With regard to calcium metabolism and its control: a-the major stimulant to parathyroid hormone secretion is a fall in the plasma unionized calcium concentration. (false) b-in plasma calcium binding to protein is pH dependant. (true) c-calcitonin secretion may be stimulated by alcohol.(true) d-cholecalciferol is 25-hydroxylated in the liver. (true) e-the average daily absorption of calcium from the diet is 10mmol. (true) Comments: Calcium metabolism is mostly under control of PTH and vitamin D. Calcitonin released from the c cells of the thyroid act to reduce calcium. 146-Antimicrobial agents effective against pseudomonas aeroginosa infections include: a-gentamicin. (true) b-flucloxacillin. (false) c-cephalexin. (false) d-carbenicillin. (true) e-metronidazole. (false) Comments: others are ceftazidime, ciprofloxacillin. 147-hyperprolactinaemia may be associated with: a-myxaedaema. (true) b-galactorrhoea. (true) c-brommocriptine therapy. (false) d-chlorpromazine therapy. (true) e-non functioning pituitary tumour. (true) Comments: Hyperprolactinaemia is associated with non functional pituitary tumours due to stalk compression.also found in acromegaly and hypothyroidism. c-dopamine agonist used to treat hyperprolactinaemia.

Cholorpromazine like haloperidol,domperidone is a dopamine antagonist and causes hyperprolactinaemia. 148-Side effects of thiazide diuretics include: a-hypercalcaemia.(true) b-acute pancreatitis. (true) c-hperglycaemia. (true) d-cholestatic jaundice. (true) e-necrotizing vasculitis. (true) Comments: Side effects of thiazide include,hyperglycaemia,hyperuricaemia,postural hypotension,impotence,hyponatraemia and hypokalaemia,mild calcium elevation,lipid abnormalities. Skin reactions including pemphigoid and rarely necrotizing vasculitis are recognized. 149-The following are true: A-carbimazole is teratogenic and must be avoided in pregnancy. (false) b-skin rashes due to carbimazole are unlikely to recur if therapy is changed to propylthiouracil.(true) c-relapse in thyrotoxicosis is very rare when carbimazole treatment is continued for 2 years. (false) d-carbimazol is secreted in milk. (true) e-symptomatic hypocalcaemia following subtotal thyroidectomy is generally transient. (true) Comments: Carbimazole is used in treatment of thyrotoxicosis with pregnancy. It is associated with aplasia cutis but this may be more associated with thyrotoxicosis per se than the drugs.thionamides are used in thyrotoxicosis for variable periods form 6 months to 2 years,but irrespective recurrence of thyrotoxicosis following withdrawal is of the order of 70% 150-Hyponatraemia is a recognized complication of: a-carbenoxalone therapy. (false) b-major surgery. (true) c-hepato-cellular failure. (true) d-congestive heart failure. (true) e-cerebral contusion. (true) Comments: Hyponatraemia can be classified to hypovolaemic,euvolaemic and hypervolaemic states.the former is due to marked dehydration with excessive salt losses, vomiting, Addison's . The middle typically reflects SIADH. The latter due to conditions as CCF, cirrhosis, nephritic syndrome, myxaeddaema.carbenoxalone causes pseudohyperaldosteronism with hypertension,hypernatrraemia and hypokalaemia.Major surgery,pneumonia,subarachnoid,meningitis and injury as well as drugs can induce SIADH.

151-Hyperprolactinaemia may be found in: a-chronic renal failure. (true) b-testosterone therapy. (false) c-pregnancy. (true) d-chlorpropamide therapy. (false) e-LHRH analogue therapy. (false) Comments: Hyperprolactinaemia is caused by dopamine antagonists as chlorpromazine,haloperidol,metoclopramide,sulpiride.concentrations rise dramatically in pregnancy and are elevated in hypothyroidism, acromegaly, renal failure. 152-Concerning secondary lymphoid follicles: a-the cells of the follicle centre are exclusively B-cells. (false) b-immunoblasts are numerous. (false) c-A mantle zone surrounds the follicle centre. (true) d-centrocytes result from mitotic division of centroblasts. (false) e-antigen presenting cells are present. Comments: a-within lymphoid follicles there are tangible macrophages, follicular dendritic cells and T-lymphocytes.however B-cells predominate. b-the majority of immunoblasts are found outside the follicles. c-the mantle zone consists mainly of small B-lymphocytes surrounding the germinal centre. d-centrocytes develop from stimulated B-cells and are thought to give rise to centroblasts. e-antigen presenting dendritic cells are present within the follicles. 153-Which of these statements regarding carriers is/are correct: a-in classical aemophilia A carriers may show clinical features. (true) b-in duchenne muscular dystrophy carriers never produce affected males, if the husband is normal. (false) c-In cystic fibrosis 2 carriers have a 25% risk of having a child affected with the condition. (true) d-carrier states are seen in achondroplasia. (false) e-certain carrier states can be detected using DNA studies. (true) Comments: The carriers of haemophilia A (females) have 40-50% activity of FVIIIc and so are prone at times of stress to potential increased bleeding-menorrhagia. Duchenne muscular dystrophy is an X-linked recessive condition-carriers always are the ones to produce the affected males. Cystic fibrosis is recessive and there would be a 50% chance of having an affected child with 2 parents who are carriers. Achondroplasia is dominant, penetrance may be an issue here rather than carrier status. 154-Turner's syndrome(karyotype 45XO)s associated with :

a-abnormal breast development. (true) b-infantile lymphaedaema. (true) c-increased incidence of bone fractures. (true) d-coarctation of the aorta. (true) e-primary aamenorrhoea. (true) Comments: Turner's syndrome is associated with delayed pubertal development, a characteristic phenotype, (short, wide carrying angle, shield chest. )due to primary hypogonadism. C-osteoporosis due to oestrogen deficiency. Hypertension is commoner in this condition an coarctation may be found in up to 10% of cases. 155-The following conditions can cause hyperprolactinaemia: a-oral contraceptives. (false) b-metoclopramide. (true) c-hyperthyroidism. (false) d-craniopharyngioma. (true) e-chronic renal failure. (true) Comments: a-oral contraceptives do not cause hyperprolactinaemia. Dopamine antagonists as metoclopramide and haloperidol and new antipsychotics as otanzapine, produce hyperprolactinaemia. Other drugs as MAOI, methyl dopa, reserpine, phenothiazines, butyrophenones, morphine. Craniopharyngioma (as well as any pituitary tumour.)may produce pituitary stalk compression and hyperprolactinaemia. CRF causes hyperprolactinaemia as the consequences of impaired prolactin excretion. Hypothyroidism not hyperthyroidism produce increased prolactin. 156-Hyperosmolar non-ketotic diabetic coma: a-is unusual in the elderly. (false) b-is rarely associated with a blood sugar 30 mmol/L. (false) c-may cause focal neurologicall signs. (true) d-causes hyperventilation. (false) e-predispose to thrombosis. (true) Comments: a-commonest in the elderly. b-typically d-not associated with acidosis. e-full anticoagulation is part of the treatment. 157-Insulin: a-interacts with nuclear membrane. (false) b-causes an increased glucose protein transport on the endoplasmic reticulum. (false) c-acts via a similar mechanism as steroid receptors. (false) d-can be detected in the lymph. (true)

e-is synthesized in the alpha cells of islets of Langerhans. (false) Comments: a-cell surface receptors. Insulin binding to its receptor result in receptor autophosphorylation on tyrosine residues and tyrosine phosphorylation of insulin receptor substrates, (IRS-1,2,3)by the insulin receptor tyrosine kinase e-beta. 158-Recognised causes of body hair loss: A-hypothyroidism. (true) b-anorexia nervosa. (true) c-haemochromatosis. (true) d-Cushing's syndrome. (false) e-sheehan syndrome, (postpartum pituitary nerosis). (true) Comments: a-dry and progressively sparse hair. b-loss of axillary and pubic hair although there is also growth of lanugo hair. c-hpogonadism. d-increased hair/hirsuism. e-any cause of hypopituitarism as iron deficiency, cytotoxic drugs, child birth, (telogen effluvium), OCP, antithyroid drugs, anticoagulants, retinoids. 159-Hypoparathyroidism: a-causes short stature, candidiasis, and impaired nail and dental development in children. (true) b-may be a feature of Crohn's disease. (false) c-when due to an abnormality of PTH receptor is termed pseudo-pseudo hypoparathyroidism. (false) d-biochemically is characterized by increased calcium, increased phosphate and normal alkaline phosphatase. (false) e-positive Chvostek's sign can be treated with intravenous calcium. (true) Comments: a-as part of autoimmune polyendocrine syndrome type 1. b-no association. Reduced calcium and high phosphate typify the condition. c-just pseudo hypoPTH. Pseudo-pseudo hypoPTH is where there are typical physical features as short 4th metacarpal but no biochemical abnormality. Tetany can be treated with IV calcium gluconate.