Block 6 Pace Quiz 2 Part 1
.JPG "Block 6 Pace Quiz 2 Part 1 - Quiz")
Pace quiz 5, march 15 2012 renal module
- 1.Stenosis of renal artery causes hypertension. The physician is interested to measure the renal blood flow (RBF) of a hypertensive patient to verify the significance of the stenosis of his renal artery. Which of the following clearances equals renal plasma flow (RPF), from which RBF can be estimated?
- A.
Glucose clearance
- B.
Inulin clearance
- C.
Creatinin clearance
- D.
Paraaminohipuric acid clearance
- E.
Urea clearance
- 2.Patients seen in a refugee camp after a famine would be expected to be in negative nitrogen balance because:
- A.
Dietary nitrogen drops below the recommended daily allowance
- B.
Fecal nitrogen excretion exceeds urinary nitrogen excretion
- C.
Dietary nitrogen intake exceeds nitrogen loss
- D.
Diet contains more nonessential amino acids than essential amino acids
- E.
Nitrogen loss exceeds dietary nitrogen intake
- 3.A 5mo old female was transferred to an emergency room in a rapidly deteriorating condition. She was born in Ville de Saguenay (Quebec), birth was uneventful. However, she failed to thrive. Lab: Glutamic:pyruvic transaminase (GPT), aspartate aminotransferase (AST), ammonia and creatinine levels in blood were elevated, attending physicians noticed a strong cabbage-like smell originating from her. The most likely diagnosis is
- A.
Hyperlysinemia
- B.
Tyrosinemia I
- C.
Cystinuria
- D.
Methylmalonic aciduria
- E.
Glycine cleavage enzyme deficiency
- 4.Dr Shams A substance that is filtered, but not secreted or reabsorbed (substance X), is infused into a volunteer until a steady state level of 0.1 mg/mL is achieved. The subject then empties his bladder and waits 1 hour, at which time he urinates again. The volume of urine in the second specimen is 60 mL, and the concentration of substance X is 10 mg/mL. What is the clearance of this substance and does the clearance measure glomerular filtration rate or renal plasma flow? Clearance (mL/min GFR RPF 1 30 X 2 30 X 3 100 X 4 100 X 5 300 X
- A.
1
- B.
2
- C.
3
- D.
4
- E.
5
- 5.
A 40 yo male comes to his physician because of nodules on hands, elbows and Achilles tendons (see fig.). His own medical history is unremarkable; however, both his father and paternal grandfather have died from AMI in their early 50s. Physical exam: weight 84 kg, size 1.80m, BP 125/70mm Hg, other findings normal. Lab investigations on an o/n fasting blood sample result in the following (in mg/dL): Cholesterol 370 (≤ 200), LDL 300 (100–130), HDL 32 (29–60), triglycerides 189 (35–150), glucose 90 (70–110). The most likely diagnosis is:- A.
Diabetes mellitus type I (DM-I)
- B.
Familial hypercholesterolemia (FH)
- C.
Maturity onset diabetes mellitus of the young (MODY)
- D.
Metabolic syndrome
- E.
Neurofibromatosis (NF)
- 6.
Which of the following structures is represented by the area labeled with an asterisk in the accompanying electron micrograph?
- A.
The lumen of a proximal convoluted tubule
- B.
Renal pelvis
- C.
The lumen of a glomerular capillary
- D.
Minor calyx
- E.
The urinary space
- 7.Dr Buxbaum The DRI of Vitamin A for an 18a old is: EAR 625 µg/d, RDA 900µg/d and UL 2800µg /d. A patient of that group taking on average 950µg/d will suffer from symptoms of:
- A.
Poisoning with a probability of about 50 %
- B.
Poisoning with a probability of about 2%
- C.
Deficiency with a probability of about 98%
- D.
Deficiency with a probability of about 2 %
- E.
Deficiency with a probability of about 50%
- 8.A 54-year-old male presents himself at an outpatient clinic complaining of weakness, lassitude and a weight loss of 20kg over the last 7mo. On Dr. E. Buxbaum examination pulse and respiratory rate, EKG and chest X-ray appeared normal. Blood pressure was 145/75 mm Hg, liver was firm and moderately enlarged (2 fingers below costal margin). Upon questioning the patient remarked that his skin had become darker over the last years, a change he attributed to working outdoors. He denied exposure to toxic chemicals or metal fumes. Lab results: Fasting blood glucose 7.6mM (3.9–6.1mM), Urine glucose(random) + (0), total serum bilirubin 20 µM (2.6–26µM), Haemoglobin 16.5 g/dl (14.0–18.0g/dl) Haematocrit 52% (40–54%), Methemoglobin 0 (0), Serum iron 43 µM (7.2–28.6µM), total iron binding capacity (TIBC) 56µM (47–77µM), aspartate aminotransferase (AST) 50U/l(5–34U/l), alanine aminotransferase (ALT) 45U/l(5–50U/l), Serum ferritin 463µg/l (20–250 µg/l). On the basis of these results a liver biopsy was performed. Microscopic examination revealed fatty vacuolisation of the hepatocytes and moderate deposits of hemosiderin in their cytoplasm. Your diagnosis would be
- A.
Hemochromatosis
- B.
Wilson’s disease
- C.
Menke’s kinky hair syndrome
- D.
Keshan-disease
- E.
Kashin-Beck disease
- 9.Which of the following is the afferent limb of cremasteric reflex-?
- A.
Femoral branch of genitofemoral nerve
- B.
Lateral femoral cut. Nerve
- C.
Iliohypogastric nerve
- D.
Genital branch of genitofemoral nerve
- E.
Pudendal nerve
- 10.Dr Yin A 5-lb newborn is dead soon after birth and autopsy shows renal agenesis. Which of the following most likely happened during this baby’s development?
- A.
Urachus failed to obliterate
- B.
Kidneys fused into one and failed to ascend
- C.
Ureteric bud failed to appear bilaterally
- D.
Pronephros failed to regress
- E.
Cysts developed in all segments of renal tubules
- 11.
Which of the following structures is shown in the following Electron micrograph?
- A.
Distal convoluted tubule
- B.
Visceral layer of Bowman’s capsule
- C.
Parietal layer of Bowman’s capsule
- D.
Proximal convoluted tubule
- E.
Thin limb of loop of Henle
- 12.Dr Dhiman A newborn boy is brought to his physician’s office by his mother, who reports that the baby is constantly crying and that his scrotum seems much bigger than it was at birth just 2 days ago. The physician suspects that the child is suffering from a hernia. The baby’s scrotal swelling is most likely the result of which kind of hernia?
- A.
Indirect inguinal hernia
- B.
Diaphragmatic hernia
- C.
Direct inguinal hernia
- D.
Femoral hernia
- E.
Hernia through Hesselbach’s triangle
- 13.A 65-year-old man presents to your clinic complaining of abdominal pains. He notes that the pain normally starts 20 minutes after having a meal, and often lasts for about 90 minutes. He has also been having severe hematochezia (red blood in stool). Upon physical examination, the patient looks emaciated. Palpation of the abdomen reveals no evidence of peritonitis or bowel masses. Endoscopic survey shows he is suffering from ischemic colitis. To access the extent of the ischemia, an exploratory laparotomy is ordered and you observe an extensive damage in the hindgut region. You recommend a resection of the ischemic portion, and ligation of the Inferior Mesenteric Artery (IMA) at its origin. Which nerve is likely to be damaged and what function is likely to be compromised during the ligation of the IMA at its origin?
- A.
Greater splanchnic Transmit reflex sensation
- B.
Lesser splanchnic Promote digestion
- C.
Lumbar splanchnic Maintain tonus of internal sphincter muscles
- D.
Pelvic splanchnic Inhibit internal anal sphincter muscles
- E.
Sacral splanchnic Promote glandular secretion
- 14.Dr Barremkala Portal hypertension is defined by a hepatic venous pressure gradient (HVPG) greater than 5 mmHg. It is usually caused by an increase in resistance in the portal-hepatic vascular bed due to obstruction to flow, which is related to cirrhosis in the vast majority of patients. What veins would contribute for by passing this obstruction?
- A.
Right gastric and esophageal veins
- B.
Middle rectal and inferior rectal veins
- C.
Left gastric and esophageal veins
- D.
Superior rectal and sigmoidal veins
- E.
Left gastromental and Splenic vein
- 15.A 48-year-old female patient presented with loin pain hematuria syndrome. The history revealed that the initial pain was intermittent followed by organic obstruction pain and there was no history of injury. Supine standard and ancillary imaging was normal. Upright intravenous urography, however, showed pelvi-ureteric junction kink. What is the most likely cause of her condition?
- A.
Cystic kidney
- B.
Dropped kidney
- C.
Horse shoe kidney
- D.
Duplex kidney
- E.
Infracted kidney
- 16.Dr Kirera You decide to perform an endoscopic examination of a 50-year-old man who is complaining of generalized abdominal pain on left lower quadrant. Based on your endoscopic findings, which anatomical feature is most useful in distinguishing the ileum from the jejunum?
- A.
Ileum has smaller caliber compared to jejunum
- B.
Ileum has smaller circular folds compared to jejunum
- C.
Ileum has few lymphoid nodules compared to jejunum
- D.
Ileum has thinner walls compared to jejunum
- E.
Ileum mucosa has sparse vascular network compared to jejunum
- 17.
Numerous buffer systems are participating in buffering H+ during acid/base disturbances in the body. pK’ values of five buffer systems are listed below: Which one of the listed buffers would have the highest buffering capacity in ECF, if the concentrations of all buffers are equal?
- A.
Buffer 1
- B.
Buffer 2
- C.
Buffer 3
- D.
Buffer 4
- E.
Buffer 5
- 18.Dr White Which of the following responses to a fall in arterial pressure accounts for the ability of the kidneys to autoregulate GFR?
- A.
Decreased resistance of the efferent arteriole
- B.
Decreased resistance of the afferent arteriole
- C.
Increased delivery of fluid to the end of the proximal tubule
- D.
Increase resistance of the afferent arteriole
- E.
Increased [NaCl] in tubular fluid at the macula densa
- 19.
The graph below depicts the change in tubular fluid concentration of various substances along the length of the proximal tubule plotted as the tubular fluid-to-plasma concentration ratio (TF/P). Thus the TF/P = 1 for a substance that is at the same concentration in the tubular fluid and plasma (all substances that are freely filtered have a TF/P equal to 1 at the glomerulus). Which of the lines best depicts the TF/P ratio for Na+?
- A.
1
- B.
2
- C.
3
- D.
4
- 20.A 24-year-old male is being investigated for renal stone disease, estimation of his creatinin clearance gives a value of 75 mL/min (normal 125 mL/min). By what mechanism is the change in creatinine clearance likely to be occurring?
- A.
Dilation of the afferent arteriole
- B.
Decrease in renal nerve activity
- C.
Decrease in plasma oncotic pressure
- D.
Increase in renal blood flow
- E.
Increase in hydrostatic pressure in Bowman’s space
- 21.The transepithelial potential difference in the late part of the proximal tubule is orientated 1 – 2 mV lumen-positive. What is the mechanism that generates this voltage?
- A.
Secretory movement of potassium ions
- B.
Absorptive movement of bicarbonate ions
- C.
Secretory movement of hydrogen ions
- D.
Absorptive movement of phosphate ions
- E.
Absorptive movement of chloride ions
- 22.Dr Adebiyi A 29-year-old man who loved the sound of sea waves and regularly took long walks on the beach bare-footed complained of a pruritic and erythematous rash on his feet. He also experienced abdominal pain and diarrhea. Upon evaluation at the health clinic, it was found that he had a fever and was slightly anemic. Routine blood cultures were negative for bacteria but some parasite ova were found in his stool. What organism was most probably responsible for the disease?
- A.
Ascaris lumbicoides
- B.
Necator americanus
- C.
Enterobius vermicularis
- D.
Taenia saginata
- E.
Strongyloides stercoralis
- 23.A 29-year-old man is an avid diver and has taken part in several diving expeditions. He presented with a sudden onset of headache and stiff neck following a routine dive. Blood examination was negative for bacteria or parasites. However, examination of cerebrospinal fluid revealed the presence of actively motile amoebic trophozoites and a few neutrophils. What organism was most probably responsible for the disease?
- A.
Trypanosoma gambiense
- B.
Naegleria fowlerii
- C.
Entamoeba histolytica
- D.
Taenia solium
- E.
Balantidum coli
- 24.Dr LaVille A 16-year-old female is known to suffer from systemic lupus erythematosus. Blood analysis reveals autoantibodies which are produced against a membrane lipid in platelets, resulting in blood clotting disorders. This membrane lipid is most likely to be:
- A.
Phosphatidylserine
- B.
Phosphatidyl inositol
- C.
Dipalmitoylphosphatidylcholine
- D.
Cardiolipin
- E.
Platelet activating factor
.JPG "Which of the following structures is represented by the area labeled with an asterisk in the accompanying electron micrograph?")
.JPG "Which of the following structures is shown in the following Electron micrograph?")
.JPG "Numerous buffer systems are participating in buffering H+ during acid/base disturbances in the body. pK’ values of five buffer systems are listed below:
Which one of the listed buffers would have the highest buffering capacity in ECF, if the concentrations of all buffers are equal?")
.JPG "The graph below depicts the change in tubular fluid concentration of various substances along the length of the proximal tubule plotted as the tubular fluid-to-plasma concentration ratio (TF/P). Thus the TF/P = 1 for a substance that is at the same concentration in the tubular fluid and plasma (all substances that are freely filtered have a TF/P equal to 1 at the glomerulus). Which of the lines best depicts the TF/P ratio for Na+?")
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