MODULE 4

2011
QMU 2011

MCQ MANIA + ESSAYS SWAYS

MOD 4 : COHD mcq mania 1. The following are true about cell injury EXCEPT a. The type of stimulus determine the cells response to injurious agents. b. Glucose in hypertonic solution can cause cell injury. c. A cell undergoing caseous necrosis shows amorphous granular structureless basophilic debris. d. Autolysis is seen in liquifactive necrosis is spinal cord cell 2. What is the main cause of cloudy swelling? a. b. c. d. Cell loss its integrity Disturbance in the active transport of water outside the cell Mitochondria which has been damaged and become swollen Cell that are incapable of maintaining ionic and fluid homeostasis

3. What can you observe grossly on enzymatic fat necrosis? a. b. c. d. Chalky white areas Yellow-gray and rubbery White yellowish and cheesy-like Semiliquid

4. The following are true about cell injury except a. b. c. d. Type of stimulus determine cell response to injurious agents Glucose in hypetonic solution can cause cell injury A cell undergoing caseous show amorphous granular structureless basophilic debris Autolysis is seen in liquifactive necrosis in spinal cord cell

5. Why is the brain undergo liquifactive necrosis? a. b. c. d. Easily exposed to mechanical injury Contains many neurons Many blood supply Contain many lysosomal enzyme

6. Common cause of cell injury and death is a. b. c. d. Immunologic reaction Extreme temperature Mechanical trauma Hypoxia

7. Determine whether the statement is true or false a. b. c. d. Prolonged cell ischiemia can lead to reversible cell changes Free radicals are highly stable particles with odd number of electron s in their outer shells Mild fatty change does not effect the gross appearance of liver Nucleus of liver cells in case of fatty change appears microscopically centered

MOD 4 : COHD 8. All of the following are effects of ATP depletion except a. b. c. d. Cloudy swelling Accumulation of lactic acid and inorganic phosphate Increase protein synthesis Increase cytosolic ca 2+

9. Increased cytosolic ca2+ can stimulate all of the following except a. b. c. d. ATPase Protease Endonuclease Lipase

10. All of these are false except a. b. c. d. Inflammation has no setbacks Immune reaction causes inflammation Inflammation can cope with strong injurious agent Radiation do not cause inflammation reaction

11. Function of fibrin is .... a. b. c. d. Attract leucocytes to ground zero Provide food for leucocyte Prevent spread of inflammation Dilute toxin

12. All of the above are special types of abscess except a. b. c. d. Carbuncle Style Cellulitis Furuncle

13. The organelle that mainly effected by albuminous degeneration a. b. c. d. Golgi apparatus ER Nucleus Mitochondria

14. Purulent inflammation does not clot on standing because a. b. c. d. Excessive tissue destruction by toxins Fibrinogen content is destroyed by proteolytic enzymes Chemotactic agent affect neutrophils Neutrophils are killed by bacteria form pus

MOD 4 : COHD 15. Which is the following is true regarding sources of septic emboli in systemic pyemia a. b. c. d. Septic ulceration of the colon Phlegmonous appendicitis Suppurative otitis media Infected piles

16. Below are the possible gross appearance of papilloma except a. b. c. d. May be sessile or pedunculated Compound with thick and short branches Villous with thin long slender filament Projects above the surface of the mucus membrane and attains a pedicle due to contraction of viscus

17. All of the following are non functioning adenoma except a. b. c. d. Suprarenal gland Breast Lacrimal glands Intestine

18. The following are true except a. b. c. d. Rate of growth tumour is influenced by hormones for hormonally responsive tissue Neoplasm has completely or partial loss of regulation of mitosis and cell regulation Benign tumour are dangerous someone if the produce excess hormones Pleomorphic, hyperchromatic cell with well formed blood vessel are characteristic of malignant cells

19. Which is true about neuroma and schwanoma ? a. b. c. d. Sixth cranial nerve is the commonest site They are malignant tumours They may present single They arise from sheath of nerve

20. The following are true regarding malignant cell except a. b. c. d. Retain their function of their counterpart for well differentiated tumours Grow by infiltrative manner by destroying, invading and encapsulated May contain tripolar spindle fibre during mitosis Show wide variations of shape of nuclei and sizes

21. Why does calcification occurs in death tissue? I. II. III. IV. Presence of growth factor Organic phosphates Acidity Presence of bacteria

MOD 4 : COHD a. b. c. d. II only II and III I and II III and IV

22. Which is false regarding dystropic calcification? a. b. c. d. Presence of abnormalities in calcium metabolism Normal Ca2+ serum Due to local changes in tissues Can be seen at degenerative tumours

23. What is false regarding effects of metastatic calcification? a. b. c. d. May result in ischemia in small vessels i.e skin Nephrocalcinosis Impair parenchymal cell function Rarely disturb gasseous exchange in alveoli

24. Below are commonest site for malignant melanoma except a. b. c. d. Retina Head Extremities Sole of foot and hands

25. These are true aboust basal cell carcinoma except a. b. c. d. Floor covered by necrotic fluid Tumour start as a firm nodule or papule Edges are everted Base is fixed and indurated

26. Which is the correct order of the process of tissue repair? A. B. C. D. Angiogenesis Scar Remodeling Fibrosis Scar Remodeling Fibrosis Angiogenesis Fibrosis Angiogenesis Scar Remodeling Angiogenesis Fibrosis Scar Remodeling

27. Below are the systemic factors which causes the delay of wound healing, EXCEPT A. B. C. D. Protein malfunction Vitamin C deficiency Infection Diabetes mellitus

MOD 4 : COHD 28. Which of the following complications of wound healing rarely occur? A. B. C. D. Keloid Neoplasia Wound dehiscence Proud flesh

Wide gap of scar Presence of sepsis Marked tissue loss and necrosis 29. The above characteristics of wound healing are of which intention? A. First intention B. Second intention 30.Increase in the size of individual cells without increase in the number of cells The statement above refers to A. B. C. D. Aplasia Hypertrophy Metaplasia Agenesis

31. Agenesis is the complete absence of an organ or a part of an organ A. True B. False

32. This process of adaptation only occurs in organs which proliferation and mitosis are restricted. What is the name of the adaptation process? A. B. C. D. Hyperplasia Hypoplasia Dysplasia Hypertrophy

33. Below are terms used to describe the growth abnormalities, EXCEPT A. B. C. D. Hypoplasia Aplasia Atrophy Agenesis

34. Which of the following is the drug produced from micro-organisms? A. B. C. D. Insulin Penicillin Morphine Atropine

MOD 4 : COHD 35. All the following are the local routes of administration of drugs, EXCEPT A. B. C. D. Topical Injection Inhalation Sublingual

36. Below are parenteral routes of drug administrations, EXCEPT A. B. C. D. Transdermal Intradermal Subcutaneous Intravenous

37. Which of the following does not use inhalational route as the route of administration? A. B. C. D. Anesthetic gases Volatile liquids Therapeutic gases Aqueous solutions

38. Below are the absorption principles of pharmacokinetics, EXCEPT A. B. C. D. Lipid diffusion Facilitated diffusion Endocytosis and exocytosis Biotransformation

39. Elimination half-life is useful for all below, EXCEPT A. B. C. D. Estimating time to steady state Determining the frequency of drug administration Estimating the time required for drug removal Estimating time for drug absorption

40. During the phase II of drug metabolism, the metabolite forms covalent linkage between one of the functional group, EXCEPT A. B. C. D. Sulfate Glutathione Carbonate Acetate

41. Drugs transformed by during phase I does not lose pharmacological activity and become active A. True B. False

MOD 4 : COHD 42. Which below is the classification of the chemical mediators? A. B. C. D. Nitric oxide Neuropeptides Eicosanoids All of the above

43. Below are the actions of H1 receptors of histamine, EXCEPT A. B. C. D. Stimulation of adrenal medulla Vasodilation Stimulation of nerve endings Stimulation of gastric acid secretion

44. The kinetic mechanism of second generation of histamine receptor H1 blockers are as below, EXCEPT A. B. C. D. Absorbed orally Metabolized in the liver Crosses the blood brain barrier Short acting

45. The isoenzyme COX I is constitutively expressed A. True B. False 46. All of these are true about neoplasm EXCEPT a. It is an abnormal new growth of cell independent of physiologic growth stimuli b. It is characterized by partial or complete loss of cell regulation only c. It has no useful purpose d. The surrounding tissue is not coordinated with its growth 47. What is the biological behavior of benign tumor? I. Grows slowly II. Do not interfere with the persons well being to certain extend III. If the tumors produce harmful substances, it can cause death a. I and II b. I and III c. II and III d. All of the above 48. All of these true about malignant tumors a. More rapidly growing b. It is form by parenchymal neoplastic cells c. Can cause death although effectively treated d. Can destroy and infiltrate the normal structure

MOD 4 : COHD 49. All of these are NOT the characteristics of benign tumor EXCEPT a. Grow by expansion b. The cells are wide range of parenchymal differentiation c. The cells loss their polarity d. Tumors implants continuous with primary tumors possibly in remote tissue 50. The most accurate example of benign tumors is I. Squamous cell papilloma II. Squamous cell carcinoma III. Rhadmyoma IV. Lymphoma a. I and II b. III and IV c. I and III d. II and III 51. The FALSE statement about malignant tumors a. It grows destroy and penetrates the surrounding tissue b. Formed of undifferentiated cells c. It contain large polypoid nucleus or multiple nuclei d. Develop a fibrous capsule 52. All of these are malignant tumor EXCEPT a. Adenocarcinoma b. Neurofibroma c. Lymphoma d. Leukaemia 53. In the mechanism of metastasis, all of these are true about EXCEPT a. In lymphatics spread , it can occur by lymphatics permeation b. Metastasis can occur along the nerves which is called inoculation c. The most favorite method of spreading by sarcoma is blood spread d. Choriocarcinoma metastasis by blood spread 54. The _________ the differentiation, the ____________ number of mitosis, the ________ the grades a. Higher, lower, lower b. Lower, lower, higher c. Higher, higher, lower d. Lower, lower , higher 55. The most ACCURATE statement about special forms of neoplasia a. Papillary serous cystadenoma is one of its form b. There are malignant change in the epithelial cells but without invasion of the basement membrane c. One of these type are malignant tumors which are locally invasive and destructive d. They can also arising from totiptental germ cells

MOD 4 : COHD 56. The FALSE statement about squamous cell carcinoma a. It can arises from mucous membrane that are lined with stratified squamous epithelium b. It has an intermediate zone of polygonal cells resembling the prickle cell layer c. It has geographic appearance d. In between their cell nests, there is fibrous stroma, containing blood vessels and lymphocytes 57. In comparison carcinoma, sarcoma a. Being separated by a variable amount of connective tissue b. More vascular with hemorrhage and necrosis c. Usually forms a bulky mass d. Arises from mesenchymal tissue 58. All of these are true about etiology of cancer EXCEPT a. It can be direct acting carcinogen which include anticancer agents b. Human T-cell leukemia is the example of chemical carcinogens c. Ultraviolet rays can cause squamous cell carcinoma and malignant melanoma d. Aniline dye is one of the procarcinogens 59. Which is FALSE about principal target of gene damage? a. Growth promoting oncogenes b. Growth inhibitory cancer suppressor genes c. Gene that regulate apoptosis d. Genes promoting proto-oncogenes 60. All of these is true about cancer suppressor genes EXCEPT a. Increasing of the genes can cause cancer b. Alteration of PT53 can cause cancer c. When PT53 fails to arrest cell proliferation, it can cause cancer d. Inactivation of PT53 can cause cancer 61. The acquired pre-neoplastic disorders are I. Hepatocellular carcinoma II. Leukoplakia of oral III. Chronic atrophic gastritis IV. Squamous cell carcinoma a. I and II b. II and III c. I,II,III d. All of the above 62. All of these are problems associated with malignancies EXCEPT a. Anemia b. Loss of nutrition c. Leukemia d. Paraneoplastic syndromes

MOD 4 : COHD 63. The most accurate statement about intramuscular route is a. Drug absorption is slower in subcutaneous injection than intramuscular injection b. Drug given may available as depot preparation only c. IM injection is suitable for injecting highly irritant drug d. Example of IM injection is insulin for treatment of diabetes insipidus 64. The FALSE statement about transdermal is a. Drug is applied to skin b. Producing an effect as intravenous injection c. It is often used for sustained delivery d. Applied as transdermal patch 65. All of these true about absorption of drug EXCEPT a. The most important type of diffusion is lipid diffusion b. It is the passages of drug from site of action to systemic circulation c. Very hydrophilic drug are not well absorbed d. Oral drug administration does not give complete absorption 66. If the volume of distribution (Vd) of a drug is 200L and the amount of drug given is 4mg, what is the concentration of the drug in blood plasma? a. 0.2 mg/L b. 2 mg/L c. 0.002 mg/L d. 0.02 mg/L 67. When all drug-receptors complexes have been all used, it give the maximum response which is known as efficacy. a. True b. False 68. In pharmacokinetic antagonism a. Two drug combine in solution, thus the effect of the active drug is lost b. It is one type of reversible competitive antagonism c. A situation which the antagonist effectively reduce the concentration of the active drug at the site of action d. Interaction of two antagonists that act independently of each other 69. Drug that should be avoid by females is a. Phenobenzamine b. Salicylates c. Strong purgatives d. Cholaamphenicol 70. The false mechanism of tolerance is a. Alteration in concentration of the drug that reaches receptors b. Alteration in the number function of receptors c. Changes in components of response distal to receptor d. Exaggerated response to the drug

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MOD 4 : COHD Essays sways

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Enumerate causes of accumulation of triglyceride in liver Describe cell changes in necrosis Enumerate causes of chronic inflammation Role of lymphatics in inflammation Discuss methods of tumour spread Enumerate the causes, types and pathogenesis of cell injury Give differences between fatty change and stromal fatty infiltration (page 34, 35, 50) Give account on the differences between necrosis and apoptosis (page 43) Define gangrene and discuss the differences between dry and wet gangrene (page 44, 46) Elaborate the effects of depletion of ATP in pathogenesis of cell injury (page 30) Give explanation about the local signs of acute inflammation What is the different between exudates and transudates Explain the fate of acute inflammation for non suppurative inflammation Tabulate and differentiate between acute and chronic inflammation Give explanation the beneficial and harmful effects of inflammation

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MOD 4 : COHD

Answers 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. C B C C D D F,F,T,F C D B C C D 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. B C D A D D B B A C C C D (page 100) 27. C (page 105) 28. B (page 106) 29. B (page 104) 30. B (page 119) 31. A (page 121) 32. D (page 119) 33. C (page 120) 34. B (page 53) 35. D (page 54) 36. A (page 57) 37. D (page 57) 38. D (page 59) 39. D (page 59) 40. C (page 59) 41. B (page 59) 42. D (page 66) 43. D (page 66) 44. C (page 66) 45. A (page 69) 46. B 47. D 48. C 49. A 50. C 51. D 52. B

53. B 54. A 55. A 56. C 57. A 58. B 59. D 60. A 61. B 62. C 63. A 64. B 65. B

66. D 67. A 68. C 69. A 70. C

Essays 1) -excessive entry of fats to liver i.e starvation & corticosteroids & hypelipemia -interference of conversion of fatty acids to phosphorous and cholestrol i.e lead to increase conversion of triglyceride -increase esterification of fatty acids to triglycerides due to increase of alcohol -decrease apoprotein synthesis i.e which is necessary release of triglyceride eeg hypoxia -inhibition of fatty acids oxidation i.e hypoxia 2) -cytoplasm -increase eosinophillia because loss of RNA -cell boundaries are obliterated and indistinguishable -vacuolization because of lysosomal enzyme -calcification may occur -nucleus-karyorrhexis,pyknosis or karyolysis

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MOD 4 : COHD

3)

-it may follow acute inflammation - persistence of stimuli, interference of healing process -De Novo chronic inflammation persistence infection by microbes (low toxicity but evoke immune response) -prolonged exposure to non-degradable but toxic substances eg. Asbestos, silica -autoimmune eg. Rheumatoid athritis -filter ECF -lymphatic system + reticulo-endothelial system (spleen&lymph nodes) = secondary line of defence -lymph flow in inflammation is increased and helps to drain the oedema from EC spaces -if severe, lymph nodes will be inflamed to compensate severity. -direct spread(invade surrounding) -lymphatic spread along lymphatic vessels to nodes by permeation(side-by-side in a column) or embolization(small mass carried by lymph fluid) -lymph spread preferred by carcinomas -blood spread preferred by sarcoma from lymphatics, thoracic duct and nodes around veins -certain carcinomas have tendency invasion of veins hepatocellular, choriocarcinoma and renal cell carcinoma -natural passages i.e tubes eg. Ureter,fallopian,bronchi -transcoelomic spread through serous cavity i.e pleura, peritoneum e.g carcinoma of stomach to ovaries -inoculation defect in surgery eg. Scapel of surgeon transfered malignant cell to other organs -perineural along the nerves Causes of cell injury: Hypoxia Physical agents Chemical agents and drugs Biologic agents Immunologic reaction Genetic derangement Nutritional imbalance Aging

4)

5)

6) 1. 2. 3. 4. 5. 6. 7. 8.

Types of cell injury: 1. Irreversible 2. Reversible

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MOD 4 : COHD

Pathogenesis: Results from functional and biochemical abnormalities in essential cellular components. The most important targets of injurious stimuli are: 1. Aerobic respiration 2. Cell membrane integrity 3. Enzymatic and protein synthesis 4. Cytoskeleton 5. Integrity of genetic apparatus

7) FATTY CHANGE Occurs in cells involved in or dependent on fat metabolism 1. Excessive entry of FA acids into the liver, 2. Interference of conversion of FA to phospholipids, 3. increased esterification of FA to TGA, 1. Hepatocytes, 2. myocardial cells and 3. skeletal muscles STROMAL FATTY INFILTRATION Occurs in stromal connective tissue cells 1. Excessive intake especially of fat and CHO exceeding energy requirement, 2. Endocrinal cause

Causes

Site

1. Abdominal wall, 2. buttocks, 3. retroperitoneal tissue

8) NECROSIS Affects a group cells, so it can be detected grossly The cells in necrotic areas swell with disintegration of the cell organelles Plasma membrane is disrupted Inflammation surrounding the necrotic areas Always has a pathologic role APOPTOSIS Affected single cells. Cannot be detected grossly Cells are reduced in size. Chromatin condensed, intact organelles and formation of apoptotic bodies Plasma membrane is intact No inflammation Considered as physiologic means of eliminating of unwanted cells. It may be pathologic after some forms of injury specially DNA damage

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MOD 4 : COHD

9) Gangrene: Necrosis of tissues with superadded putrification DRY GANGRENE Arterial occlusion Exposed parts Slow putrification Occurs leading to tissue mummification Lines of demarcation and separation are present Slow spread Mild toxemia WET GANGRENE Sudden arterial and venous occlusion Internal organs and extremities Rapid putrification Does not occur leading to tissue edema No limiting defensive lines Rapid spread Severe toxemia

Cause Sites Progress Evaporation Defensive lines Spread Associated toxemia

10) 1. Intracellular accumulation of water and electrolytes, due to dysfunction of energy dependent sodium pump in the plasma membrane 2. Increased intracellular calcium due to disturbance of the energy dependant activity of cell membrane 3. Switch to anaerobic metabolism through glycolysis

11) Explanation of local signs of acute inflammation (pg78) a. Redness (rubor) is caused by vascular dilatation and opening of all closed capillaries b. Hotness (calor) is caused by arteriolar dilatation and increased blood flow to affected part c. Swelling (tumor) is caused by vascular dilatation and accumulation of inflammatory exudates d. Pain (dolor) is caused by irritation of the nerve endings by the products of inflammation e. Loss of function is due to pain and tissue damage

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MOD 4 : COHD

12) Differences between exudate and transudate (pg77) EXUDATE PROTEIN CONTENT High: >1gm% TRANSUDATE Low: <1gm%

TYPES OF PROTEIN

Plasma protein including fibrinogen

Small molecules mostly albumin

TENDENCY TO COAGULATION

Positive

Negative

SPECIFIC GRAVITY

>1020

<102G

NUMBER OF CELLS

Many

Few Caused by increase hydrostatic pressure or decreased osmotic pressure in presence of normal vascular permeability Hypoproteinemia

MECHANISM

Increased vascular permeability

CAUSE

Inflammation

Heart failure Lymphatic congestion

13) Fate of acute inflammation which is non-supperative inflammation (pg 90-91) Healing by complete resolution a. Means returning back to normal b. This can occur when There is a minimal tissue damage There is rapid elimination of causative agent The tissue is capable of regeneration

c. Complete resolution occurs through digestion of the fibrin, resorption of inflammatory exudates by blood vessels and lymphatics and removal of the cell debris by phagocytes

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MOD 4 : COHD

Healing by scarring or fibrosis (organization) This occur when Acute inflammation occurs in tissues which do not regenerate Acute inflammation is associated with excessive tissue destruction There is a excessive exudation associated with delay in its absorption

Progression to chronic inflammation This occur when the acute inflammatory response does not resolve owing either to Persistence of the injurious agent Interference in the normal process of healing

Superadded suppuration It occurs due to supperadded infection with pyogenic microorganisms

Spread 14) Different between acute and chronic inflammation (pg 74, 75, 78, 95, 96) Both of them can be differentiate by: Definition Nature and origin of cells in acute and chronic inflammation Fate of the inflammation

15) Beneficial and harmful effect of inflammation (pg74) Beneficial Elimination of the causative agent and resultant dead tissue Dilution of toxins Prepare tissue for repair

Harmful Cause edema If inflammation occur at vital organ such as brain and larynx, this can lead to fatal condition

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MOD 4 : COHD more The study of effects of drugs on the body , its mode of action ,indications, unwanted effects is called a) Pharmacotherapeutics b) Pharmacodynamics * c) Pharmacokinetics d) Pharmacopeias Clinical use of the drug and the drug of choice in different medical problems is called a) pharmacotherapeutics * b) pharmacodynamics c) Pharmacokinetics d) Pharmacopeias The study of the effect of the body on the drug ,its metabolism .distribution, elimination is called a) pharmacotherapeutics b) pharmacodynamics c) Pharmacokinetics * d) Pharmacopeias Dictionary or official list containing names of drugs ,their degree of purity ,dosage, effects, mode of action, methods of administration, side effects is called a) pharmacotherapeutics b) pharmacodynamics c) Pharmacokinetics d) Pharmacopeias * We use genetic engineering as a source of drugs as in : a) Heparin b) Aspirin c) Human insulin * d) Morphine Pencilium is a........... that use as a source of penicillin a) Plant b) Animal c) Mineral d) Microorganism *

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MOD 4 : COHD In all Routes of drug may avoid 1st pass metabolism except : a) Oral * b) Rectal c) I.V d) Sublingual Agonist is n agent that can bind to a receptor to elicit a response : a) True * b) False The maximal response produced by the drug is called a) Potency b) Therapeutic index c) Efficacy * d) Antagonism ........... is often expressed as the dose that gives 50% of the maximal response , ED50 a) Efficacy b) Agonist c) Antagonism d) Potency * Therapeutic index is a measure of drug safety ,thus the lower the index the safer is the drug a) True b) False * Heparin and protamine sulphate are examples of : a) Functional antagonism b) Chemical antagonism * c) Receptor blockage d) No receptor antagonism The reduction of anticoagulant effect of warfarin by an agent which accelerate its hepatic metabolism such as phenobarbitone an example for a) Functional antagonism b) Chemical antagonism c) Pharmacokinetic antagonism * d) No receptor antagonism

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MOD 4 : COHD Phenoxybenzamine and adrenoceptors give an example for : a) functional antagonism b) Chemical antagonism c) Antagonism by Receptor blockade * d) No receptor antagonism In competitive antagonism ........... is changed a) Efficacy b) Potency * c) Agonist d) Therapeutic index In non equilibrium antagonism .......... is changed a) Efficacy * b) Potency c) Agonist d) Therapeutic index Histamine and adrenaline ( OR cortisone and insulin ) give an example for a) functional antagonism * b) Chemical antagonism c) Antagonism by Receptor blockade d) No receptor antagonism Strong purgatives should be avoided during a) Labour b) Pregnancy * c) Menstruation d) Lactating .......... should be avoided during menstruation because it increase bleeding : a) Uterine stimulants b) Tetratomic drugs c) Salicylates * d) Chloramphenicol Drug should be avoided during lactation : a) uterine stimulants b) Tetratomic drugs c) Salicylates d) Chloramphenicol *

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MOD 4 : COHD Females usually require the same dose as males a) True * b) False The drugs that should be used cautiously in young age that : a) Suppress growth b) Affect brain or bone maturation c) Greatly bind to plasma protein d) All of the above * Morphine cause depression of fetal respiration so shouldnt use during a) Labour * b) Pregnancy c) Menstruation d) Lactating Circadian rhythms can affect how we respond to drugs a) True * b) False In liver diseases we increase the dose of drugs depend on hepatic metabolism a) True b) False * ....... is abnormal response to the therapeutic dose of the drug due to genetic difference in metabolism a) Idiosyncrasy * b) Hypersensitivity c) Tolerance d) In tolerance ....... is abnormal response to the therapeutic dose of the drug due to antigen -antibody reaction a) Idiosyncrasy b) Hypersensitivity * c) Tolerance d) In tolerance Decreased normal pharmacological response to the drug with its continued administration is called a) Idiosyncrasy b) Hypersensitivity c) Tolerance * d) In tolerance

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MOD 4 : COHD .......... occur when rate of drug administration exceeds the rate of its elimination a) Idiosyncrasy b) Hypersensitivity c) Tolerance d) Cummulation * Cigarette smoking is a psychological dependence a) True * b) False Addiction is physiologic dependence only a) True b) False * The effect of two drugs is the algebraic summation is called a) Antagonism b) Addition * c) Synergism d) Potentiation The effect of two drugs is more than their algebraic summation is called a) Antagonism b) Addition * c) Synergism d) Potentiation Caffeine and paracetamol give an example for : a) Antagonism b) Addition c) Synergism d) Potentiation * Paracetamol and aspirin give an example for : a) Antagonism b) Addition * c) Synergism d) Potentiation

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MOD 4 : COHD Barbiturate and alcohol give an example for : a) Antagonism b) Addition c) Synergism * d) Potentiation Morphine and naloxone give an example for : a) Functional antagonism b) Chemical antagonism c) Competitive antagonism * d) Non receptor antagonism Cimetidine is an enzyme inducer that lead to increase metabolism a) True b) False * Chloramphenicol is an enzyme inhibitor that lead to decrease metabolism a) True * b) False Barbiturates are enzyme inducer that lead to increase metabolism a) True * b) False .............is the passage of drugs from the site of administration to systemic circulation a) Metabolism b) Absorption * c) Distribution d) Elimination The drug concentration gradient is the driving force of the a) Lipid diffusion b) Endocytosis c) Aqueous diffusion * d) Exocytosis Lipid diffusion depends on : a) Degree of lipid solubility drug b) Degree of ionization c) Both a and b * d) None of the abov

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MOD 4 : COHD Facilitated diffusion is an energy requiring process a) True b) False * Very hydrophilic drugs are not well absorbed because cannot cross lipid cell membrane a) True * b) False Rectal route of administration always avoid 1st pass metabolism a) True b) False * All route of administration have bioavailability < 1 except : a) Oral b) Rectal c) I.V * d) Sublingual Major plasma protein important for drug binding include : a) Albumin b) Lipoprotein c) Glycoprotein d) All of the above * The ratio between the amount of the given drug and the concentration of the drug in blood or serum is called : a) Clearance b) Elimination c) Volume of distribution * d) bioavailability ........... is the volume of plasma cleared off the drug per unit time a) Clearance * b) Elimination c) Volume of distribution d) bioavailability the time required to decrease the amount of drug in body by during elimination is called a) Clearance b) Elimination half life * c) Volume of distribution d) Bioavailability

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MOD 4 : COHD To reach about 95% of a new steady state..... half-lives are required a) 8 b) 5 c) 4 * d) 2 .......... of drugs to more hydrophilic molecules is required for elimination from the body a) Clearance b) Elimination half life c) Volume of distribution d) Biotransformation * In phase I of biotransformation : a) Active metabolites directly excreted in the urine b) React with endogenous compound to form water soluble conjugates c) Both a and b * d) None of the above Example of phase I reactions in biotransformation : a) Oxidation b) Reduction c) Hydrolysis d) All of the above * In phase II of biotransformation parent drug or metabolite participate in reaction that form covalent linkage between a parent compound functional group and a) Acetate b) Glutathione c) Sulphate d) Amino acid e) All of the above * Nitric oxide synthetized in : a) Macrophages b) Endothelium c) CNS d) All of the above * Nitric oxide has many actions such as: a) Vasodilatation b) Immune regulation c) Neurotransmitter d) All of the above *

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MOD 4 : COHD

.......... may prevent excessive production of NO in septic shock a) Sildenafil b) NO donor c) NO synthesis inhibitor * d) Interferons Glucocorticoids block all the known pathways of eicosanoids a) True * b) False Lipo-oxygenase enzyme converts arachidonic acid to : a) Leukotrienes * b) Prostaglandins c) Thromboxane d) Both b and c Cyclooxygenase enzyme converts arachidonic acid to : a) Leukotrienes b) Prostaglandins c) Thromboxane d) Both b and c * ......... are oxygenated products of polyunsaturated long chain fatty acids a) NO b) Cytokines c) Eicosanoids * d) Amino acids ......... is the most abundant precursor of eicosanoids a) Cephalin b) Arachidonic * c) Lecithin d) Stearic ...... is a constitute iso-enzyme important for gastric cytoprotection a) COX I * b) COXII c) NSAIDs d) TXA2

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MOD 4 : COHD NSAIDs activate both Isoenzyme COXI and COXII a) True b) False * ........ are important mediators of inflammation and allergy a) Leukotrienes b) Prostaglandins c) Thromboxane d) Both a and b * ....,.... cause vasodilation a) PGI2, PGE2 * b) TXA2, PGF2 c) COXI a) COXII ........ cause vasoconstriction a) PGE2 b) TXA2, PGF2 alpha * c) COXI d) COXII ....... relax smooth muscles a) PGE1 * b) TXA2, PGF2 c) COXI d) COXII ...... have oxytocic effect a) PGI2 b) PGF2 * c) COXI d) COXII ....... inhibits gastric secretion A) PGI2 ,PGE1 * B) TXA2, PGF2 C) COXI D) COXII NOTE: PGI2 >>> vasodilatation, inhibit gastric secretion PGE1>>> relax smooth muscles, inhibit gastric secretion PGE2 >>> vasodilatation PGF2 >>>> have potent oxytocic effect

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MOD 4 : COHD Histamine stored bound to granules in a) Mast cells b) Brain c) Enterochromatin cells of GIT d) All of the above * ....... is a physiological antagonist of histamine a) Corticosteroids b) Adrenaline * c) Mast cells d) Cromolyn Mast cell stabilizers as ......... inhibit degranulation of mast cells a) Corticosteroids b) Adrenaline c) Mast cells d) Cromolyn * ............ suppress the effects antigen antibody reaction a) Corticosteroids * b) Adrenaline c) Mast cells d) Cromolyn Second generation of competitive inhibition of histamine at H1 receptors has short acting a) True b) False * First generation of competitive inhibition of histamine at H1 receptors cross blood brain barrier a) True * b) False Second generation of competitive inhibition of histamine at H1 receptors may cause cardiac arrhythmias a) True * b) False ............. are actions of kinins a) Arteriolar dilating effect b) Pain mediator c) Both a and b d) None of the above

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MOD 4 : COHD ............ is one of vasoconstrictor peptides a) Kinin b) Bardykinin c) VIP d) Angiotensin II * ......... is one of vasodilating peptides a) Kinin b) Bardykinin c) VIP d) CGRP e) All of the above * ......... are proteins or large peptide mediators released by the cells of the immune system a) Eicosanoides b) NSAIDs c) Cytokines * d) Prostaglandins The cytokines super family include a) Interleukins b) Interferons c) Growth factors d) Chemokines e) All of the above * Cytokines act in a complex interconnecting network on a) Leucocytes b) Mast cells c) Osteoclasts d) All of the above * ........ is important primary inflammatory cytokines a) Interleukin 1 b) TNF c) IFNs d) Both a and b * ..... has antiviral activity a) Interleukin 1 b) IFNs beta c) IFNs alpha d) Both b and c *

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MOD 4 : COHD ......... has significant immunoregulatory functions a) Interleukin 1 b) IFNs y * c) IFNs alpha d) Both b and c ....... is used in treatment of chronic hepatitis B and C a) Interleukin 1 b) IFNs beta * ( interferon ) c) IFNs alpha d) Both b and c Cytokines can act on haemopoietic stem cells a) True * b) False

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