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Biology Test

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Which of the following is NOT a secondary cause of hypertension?

  1. Addison's disease

  2. Cushing's disease

  3. Renal disease

  4. NSAIDs

  5. Coarctation of the aorta


Correct Option: A
Explanation:

Addison's disease causes postural hypotension. Other causes include phaeochromocytoma, Conn's disease and other drugs such as the oral contraceptive pill (OCP) and steroids.

A 32 year old man is suffering with a painful, red left eye. The pain has increased in intensity over 3 days and is worse looking at bright light. The eye is not sticky, watering or itchy and the vision is only slightly blurred. He must be suffering from

  1. conjunctivitis

  2. iritis

  3. corneal ulcer

  4. trachoma


Correct Option: B
Explanation:

There are characteristic features of iritis, however, including the stuck گdown pupil.

CA 125 is a/an

  1. antigen which is frequently expressed by mucinous ovarian carcinomas.

  2. useful for ovarian cancer screening in the general patient population.

  3. ganglioside

  4. mucin-type glycoprotein

  5. tumor specific transplantation antigen


Correct Option: D
Explanation:

CA 125 is a mucin-type glycoprotein which is usually not expressed by mucinous tumors. The antigen (CA 125) is expressed by fetal amniotic and coelomic epithelium.

When prescribing drugs, which of the following factors does not come into play?

  1. Renal impairment does not have a major effect on drugs which are excreted by the liver .

  2. Renal impairment generally decreases tubular drug secretion.

  3. Renal impairment can increase the half life of a drug.

  4. It is common to have to increase the dose of a drug when there is renal impairment.

  5. Dialysis can remove some drugs .


Correct Option: D
Explanation:

Commonly, the dose of a drug is reduced when there is renal impairment to prevent the accumulation of the drug. It is also common to reduce the frequency of the doses.

Amit is a patient with hyponatremia i.e. low plasma sodium concentration .Which of the following statements is NOT associated with hyponatremia?

  1. Plasma osmolality is likely to be low.

  2. Its symptoms are always present.

  3. Depression of neurological function is a recognised feature .

  4. If body volume is high, treatment is water restriction.

  5. If body volume is low, treatment is with sodium and water replacement.


Correct Option: B
Explanation:

Patients with hyponatremia commonly have no symptoms, but it is still important to treat the condition because if it is untreated, symptoms and serious problems can arise.

The majority of ovarian epithelial cancers occurring on a hereditary basis originates in a woman with germline mutations in which gene?

  1. BRCA 2

  2. BRCA 1

  3. p53

  4. MSH2

  5. pRb


Correct Option: B
Explanation:

Mutations in the BRCA 1 gene (located on chromosome 17) cause most of the ovarian epithelial cancers seen on a hereditary basis.

Mutation in the RET oncogene is associated with increased risk of

  1. PNET cancers

  2. Endometrial cancer

  3. Prostate cancer

  4. Adenocarcinoma

  5. Medullary thyroid cancer


Correct Option: D
Explanation:

Adenocarcinoma is a cancer arising from the mucosa of the rectum. Cancer cells can also spread from the rectum to the lymph nodes on their way to other parts of the body. RET mutation is responsible for adenocarcinoma RET mutation is responsible for increased risk of medullary thyroid cancer, as well as multiple endocrine neoplasia 2, in which pheochromocytoma and parathyroid adenoma also occur.

An young woman of 32 years is found to have a largely solid ovarian neoplasm. Tumor markers were obtained and demonstrated a markedly elevated LDH value. The hCG and a-Fetoprotein were negative. Which of the following tumors is the most likely histology for this neoplasm?

  1. Endodermal sinus tumor

  2. Choriocarcinoma

  3. Immature teratomas

  4. Gonadoblastoma

  5. Dysgerminomas


Correct Option: C
Explanation:

Immature teratomas of the ovary are rare germ cell malignancies. These are frequently diagnosed in girls and young women up to their early 20s. Dysgerminomas, the most frequent germ cell malignancy, are principally solid. Such tumors are most frequent in women with dysgenetic gonads. Pure ovarian dysgerminomas cause an elevated LDH with normal hCG and a-fetoprotein levels..

Which of the following statements is/are INCORRECT regarding the diuretics?

  1. Loop diuretics can cause potassium depletion.

  2. Thiazide diuretics can cause potassium depletion.

  3. Amiloride can cause potassium depletion.

  4. A very high plasma glucose level can act as a diuretic.

  5. Diuretics are used to treat edema.


Correct Option: C
Explanation:

Amiloride inhibits the reabsorption of sodium in the collecting ducts and so also blocks the potassium secretion at this point in the nephron. The result is that amiloride can reduce overall potassium excretion and potassium depletion does not occur. 

Which of the following increases sodium excretion in the body?

  1. ADH

  2. ANP

  3. Angiotensin II

  4. Renin

  5. Aldosterone


Correct Option: B
Explanation:

ANP stands for atrial natriuretic peptide. It is made in the atrial cells in the heart and in some cells in the kidney. It can increase sodium excretion by inhibiting collecting duct sodium reabsorption. However, it probably does not play an important role in the normal regulation of sodium excretion.

The mutations in the Na-K-2Cl transporter in the Loop of Henle causes

  1. Liddle's syndrome

  2. Pseudohypoaldosteronism

  3. Nephrogenic diabetes insipidus

  4. Gitelman's syndrome

  5. Barrter's syndrome


Correct Option: C
Explanation:

This renal disorder arises from a mutation of the receptors for ADH (anti diuretic hormone or vasopressin) or the aquaporins which are water channels. In Barrter's syndrome, there is a mutation which inhibits the activity of the NaK2Cl cotransporter, which is the molecule normally inhibited by frusemide. The clinical effects of Barrter''s syndrome are therefore the same as excess frusemide and include loss of sodium, potassium and water. The body's response to this is to raise aldosterone levels in an attempt to conserve sodium.

Mr. Malhotra is suffering from Fanconi syndrome which is a proximal tubule dysfunction. Which of the following is NOT a characteristic feature of this syndrome?

  1. Glycosuria

  2. Phosphaturia

  3. Metabolic acidosis

  4. Excess bicarbonate reabsorption

  5. Hyperkalemia


Correct Option: D
Explanation:

In particular, there can be a failure of reabsorption of sodium in the proximal tubule. This results in excess sodium reaching the collecting ducts where some of it is exchanged for potassium, causing excess potassium loss and a low plasma potassium level. Hence, there is a loss of bicarbonate .

Which of the following statements regarding sodium and water regulation by kidney is NOT true?

  1. Body volume is regulated by changing body sodium content and maintaining a normal osmolality.

  2. Body osmolality is usually regulated by changing body water content by keeping body sodium content constant.

  3. Stretch receptors provide information about body volume .

  4. The receptors in the puituitary provide information about osmolality.

  5. Renal sodium excretion is the main influence on body volume.


Correct Option: D
Explanation:

Body osmolality is sensed in the hypothalamus by osmoreceptors which influence thirst (water intake) and ADH (anti-diuretic hormone or vasopressin) secretion (which influences water output by the kidneys). 

Which of the following statements does not characterise the disorders of sodium and water metabolism by the kidneys?

  1. Excess aldosterone can cause both excess sodium retention and potassium secretion.

  2. Addison's diseases can be associated with excessive potassium secretion.

  3. Psychogenic polydipsia typically causes a high plasma sodium concentration .

  4. Body volume is typically decreased in Addison's disease.

  5. Body volume is regulated by body sodium content.


Correct Option: C
Explanation:

In psychogenic polydipsia, prolonged excess water intake can lower plasma osmolality by a dilutional effect. Despite the kidneys efforts to produce a dilute urine, the patients intake of water may exceed the kidneys output of water and so dilute urine.

Which of the following is characterised by low plasma osmolality?

  1. SIADH

  2. Addison's disease

  3. Cranial diabetes insipidus

  4. Nephrogenic diabetes insipidus

  5. Central diabetes insipidus


Correct Option: D
Explanation:

In nephrogenic diabetes insipidus, there is adequate ADH, but the kidney is unable to respond to the ADH. Nephrogenic diabetes insipidus can arise as a side effect of certain drugs, especially lithium which is used to treat manic depression. Changes in plasma osmolality are poorly tolerated, especially by nerve cells, so plasma osmolality is tightly regulated. If renal water reabsorption is inadequate then there will be excess water loss in the urine and plasma osmolality will rise and vice versa. Central diabetes insipidus is characterised by low plasma osmolality.

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