MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES MODULE Ill EXAMINATIONS 17" FEB 2010 CLINICAL PHYSIOLOGY PG 2HRS CANDIDATE'S NUMBER: Prime pAe os course-t /werRuenoNe Multiple Choice Examinations: Attempt all questions Please answer the questions on the answer provided, Indicate your answer by filling in the bubble under *T” if the item is TRUE or under “F” if you think the item is FALSE. If you do not | _ know the answer to the item in question leave the item BLANK. | Incorrect responses will be penalised by a minus mark. NOTE: This form will be machine marked. You are advised to use | BLACK pen and fill the bubbles boldly and completely. If you change your mind erase your original answer cleanly and shade the appropriate bubble. | Fillin like this: ® and notlike this: ® ©1. Osteomalacia in CRF is a result of: a). excess secretion of PTH Tb) reduced I-alpha hydroxylase enzyme activity ©) impaired absorption of vitamin B12 in the GIT F 4) erythropoietin activity being Fe vity of 1-25 dihydroxycholececiferol 2. Total removal of the panerease would result into: “_a)_ hyperglycaemia 7'b)_ metabolic acidosis ©) vitamin E deficiency 4) reduced amino acid entry in muscle cells Fe) weight gain 3. Glucose uptake: “Ta)_ in muscles cells is fascillitated by thyroid hormone © b) inthe brain of patients with diabetes mellitus is impaired Te) imhepatocytes depends on the concentration of the glucose in the cells F 4) is enhanced by glucagon in liver cells F ©) inalpha cells of the pancrease depends on the presence of insulin in plasma 4, In an untreated diabetic patient: F a) The intracellular fluid has a higher osmolarity than the extracellular uid Fb) Energy for brain function is exclusively derived from ketone ___ bodies Te) Hyperventilation is a common finding +d) Plasma potassium is usually high lyperphagia results from inability of glucose to enter cell in glucostatic center h goiter due to iodine ‘may present with normal plasma thyroxine levels b) plasma TSH is usually elevated ©) radioactive iodine uptake ‘may found normal 4) signs of myxoedema are frequently observed ©) can be treated by partial removal of the swelling in the neck 6. An adult patient with primary thyroxine deficiency is likely to present a). Tow heart rate {'b) an increase in plasma cholesterol levels ©) heat intolerance 4d) raised plasma TSH levels €) increased tissue sensitivity to catecholamines 7. Features of cretins differ from those of pituitary dwarfs in that in the former: fa) subjects have mental retardation b)_ growth is proportionately impaired ) plasma Té level is reduced @) The BMR usually is low ©). Blood pressure is low 8. Patients with diabetic ketoacidosi a) will require a higher dose of insulin than non-ketotic patients with same level of plasma lucose )_are usually potassium depleted ©) are more likely to be in the ‘mature onset diabetic patients 4) do present with Kusmall’s type (Geep) of respiration ©) are usually volume depleted9, Mechanism of hyperglyeaemi sbetes mellitus include: decreased utilization of glucose in the brain increased glycogen breakdown in the muscles ©) relative increase in glucagon secretion @) increased production and utilization of FFA for energy’ «)_ increased hepatic glycogenolysis 10. The following may be beneficial in patients with mature onset diabetes mellitus: (a) Exercise b)_ drugs that stimulate insulin release 6) agents that slow down glucose absorption in the GIT high carbohydrate dict reduction of body weight in obese patients 6a T° 11. Patients with type I diahetes mellitus: {7 a). have beta cll of Islet of Langerhans destroyed fb) are usually mature 7 €) have absolute insulin deficiency ) have a tendency to developing keto- acidosis © e) are commonly treated with oral hypoglycaemic drugs 12, Features of hyperealeaemia include: a) diabetes insipidus ~~ Fb) increased neuromuscular byperexeitebility Fe) ectopic ealeificaton of soft tissues d) cardiac arrest 7 ¢)_ presence of renal stones 13. Causes of hypercalcaemia might be: inereased calcitonin secretion secondary hyperparathyroidism excess vitamin D administration prolonged immobilization reduction in I-alpha hydroxylase’ enzyme activity. Fa) Fb) £9 on) Fe 14, (b) Ee E@ = 45, (a) ) FO @ © 16. @ J (b) © (d) 5e i oy tb) © @ © 1 @® (>) © (@) “© we. Damage of the cerebellar system is, characterized by: Major movement abnormalities at ~ rest Lack of precision in voluntary ‘movements. Paralysis of muscles of lower limbs. Gross sensory deficits. In-coordination of movements. Brain stem lesions are characterized by: ty Hypoactive stretch reflex ~ Increased gamma efferent discharge. Hypotonia Rigidity Generalized body spasticity ‘Thrombosis of left posterior cerebral artery may eause either of the following: Loss of sensations from opposite of body. Ataxia Perceiving affective sensations of ‘extreme unpleasantness Tremors Loss of sweating on the affected side Acute lesion of spinal cord at T2 level would result into: Spastic paralysis of lower limbs. Paralysis of diaphragm Orthostatic postural hypotension An extensor plantar reflex Urinary retention, Thermoregulatory mechanism: Is impaired during fever. Is less effective in neonates Is seriously impaired in hyperthermia Require intact sympathetic nerves Is depressed during heat stroke. Lesions of the basal ganglia results in: Clow +i BEST WISHES! pe OBA . ~ jeMUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES MODULE II EXAMINATIONS 20" JAN 2010 CLINICAL PHYSIOLOGY PG ~ a CANDIDATE'S NUMBER: ; OR SIC COURSE} ) A -- SEMESTER=-=----- INSTRUCTIONS: Multiple Choice Examinations: Attempt all questions Please answer the questions on the answer provided. Indicate your answer by filling in the bubble under “T" if the item is TRUE or under “F” if you think the item is FALSE. If you do not know the answer to the item in question leave the item BLANK. ~~ = Incorrect responses will be penalised by a minus mark. NOTE: This form will be machine marked. You are advised to use BLACK pen and fill the bubbles boldly and completely. if you change your mind erase your original answer clearily and shade ; the appropriate bubble Fill in like this: ® — and not like this: ® OoIn the — diagnosis of obstructive lang disorder T@FVC is almost. the same like in restrictive lung disorder. Tie) FEV.%FVCis usually Tess than 40%, - (le) FEV, and FVC are proportionately reduced “{%@) "Residual volume is increased above normal T(©.—FEV, =is — markedly reduced than in restrictive lung disorder. 2. Im the clinical diagnosis of restrictive lung disorder the patient is likely to have: {@ Increased work of \ breathing, {() Reduced FEV, than in obstructive lung disorder TO) Relatively normal 9% |of FEVVFVC, (@)_ Relatively the same FVC as in obstructive lung disorder. T ©. The lung compliance is reduced, 3. _ Alveolar ventilation: “V@) Is lower at the apex atthe base. ‘Feb Thete is gis exchange ina lung that is perfused but not ventilated, © ViQ. ratio. is eghes of be ne Td) Is higher at the base = than atthe apex © Is wasted when pulmonary perfusion increases 4. Which of the following are likely consequences of _hypereapnoea? (a) Raised PVCO, {) Increased aneral blood . Ph FO A shin oF the exysen hagmoeiobin| dissociation curve 10 _ the left T@) More significant stimulation of central chemoreceptors than peripheral ones 6. @ o) © i@ © (e) Decreased P,O, With respect to lung capacities: (@) Inspiratory capacity is the sum of tidal volume and IRV. (>) FRC is the sum of, EVR and TY. (©) VC "is the volume that is expired after 8 maximal inspiration. ———— = V @) Vis the sum of TV, IRV and ERV. (©) Total fung capacity isthe sum of all lung volumes except residual volume, With respect of mechanics of breathing: (a) Diaphragm is most important for expiation E) During inspiration the ribs fre lifted upward and inward “Te Expiration is normally passive. “[(@) Compliance is inversely related to elastance, Te) Intrapleural pressure is normally subatmospheric, In system respiratory failure : Could be associated ‘with élevated P.CO: and low PaO, > Rarely associated with chronic pulmonary hypertention, VSD tends to cause hypoxic, rnormocapnie respiratory failure, Enriched oxygen correct hypoxemia, ‘due to hypoventilation, Breathing frequency is higher than normal With respect to the control of breathing: Dorsal respiratory group is primarily responsible for expiration. Ventral respiratory group is, primarily for inspiration Ventral respiratory group isnot active during normal, quiet breathing. Apneustic centre stimulates inspiration Preumotaxic centre inhibits inspiration,9. 10. UL. {A decrease in blood pressure ‘would cause: FU) An increase in impulses fiom baroreceptors tothe vasomotor cenve [.@) A shif of blood from intravascular compartment into the interstitial space. ©) A decrease in aldosterone secretion <(@) A decrease in ADH = seeretion = © An increase in angiotenst levels In patients with chronic «essential hypertension: (la) A large ORS at V6 isa commen finding {ib) Raised total peripheral resistance is usual finding in early stages “Y(@) Inhibition of eacium channels would reduce cardiac output “T@ Angiotension converting enzyme inhibitor reduces blood pressure. le) Baroreceptor sensitivity tend tobe raised. In congestive cardiae failure: F(a) Lowdoses of beta blockers may improve cardiac output J (b) Angiotension converts enzyme inhibitors reduces aftcrioad, ¥ (©) Digoxin administration improves cardiac output __ ~ by its inotropic effect. £(@) Pretoad is inereased by administration of diuretics F© Afterload is decreased by aortic valve stenosis. as. 15. a) b) +e) 4 ° 12, With respeet to tet ventricular failure: ‘C(a) Enlarged tender liver is an’ cariyl finding. (-{b) Pedal oedema tend to develop before pulmonary congestion, (©) Raised jugular venous pressure is diagnostic _ sign. “N@)-Raised renal sodium reabsorption is an early compensatory mechanism: (©) Orthopnoea is a common symptom. i 13. © Development of irreversible shock is associated with: G@) Decreased metabolic ‘enzymes, (b) Increased in vivo agglutination, (©) Generalised vasodilatation, T (d) Increased net filtration, =-(e) Marked acidosis, Aortic regurgitation causes: Y(a) An early diastolic ‘murmur, T (b) Low diastolic blood ___ pressure. Ve) An increase in left ~ ventricular dilatation. —* (@) Increased ventricular end, diastolic volume. le) Increased afterload, In the large intestines: Up to 3 litres of water is absorbed. daily. ‘Aldosterone enhances absorption of sodium. Vitamin K that enter the large intestine is reabsorbed. Defacation may be influenced by voluntary control Carbon dioxide forms part of the ccolonie gas (flats).16. Bi :) Secretion is enhanced by gastrin. Tb) Contains cholesterol in its molecule <0) Acids may be conjugated with taurine to form bile salts. “TW Salts are actively secreted into hepatic canaliculi “{@ Concentration in the gall bladder is enhanced by hepatic drainage around the gall bladder, ——— 17. Malabsorption: ‘Of proteins result in a compensatory decrease in transport of peptides. Of proteins result in increased intralumina poo! of proteins. Of carbohydrates may result in alkalinic stools, Of fats is associated with fat loss in stool of more than 796, Of fats is associated with decreased esterifying activity. po eb) FO 74) re) 1. Left ventricular hypertrophy: a cb) Fo TT) Te Is common in chronic hypertension. Can occur as a result of chronie pulmonary hypertension. Decreases cardiac contractility in early stages, ‘Causes some ECG ischaemie changes. ‘Causes large QRS ‘complex in V5 and V6. Compensatory mechanism in non progressive shock include increased: ae) Impulse from the ‘vasomotor centre tothe Arginine vasopressin secretion. Net reabsorption at the tissue level. Absorption of fluid from the GIT, Increased sympathetic discharge 0 the splanchnic organ, 20. 21, 2, In the regulation of gastrie “secretion: {@) Stimulation of gastrin secreting cells may be a” direct response to entry of food in the stomach {F©) CCK-PZ enhances gastric acid secretion © (©) Somatostatin i ‘gastric acid scertion F.© Increased gastric aid secretion ie arsocited ‘wih increased blood pH; T© Stimulation of sympatheticnerve resulted in increased acid secretion i Duodenal ulcers differ from gastre uleers in tha { (a) Pain sensation may be localized below the sternum () Pain is likely to be relieved by ameal TFLO Are less likely to develop ; t malignancy ~(@) The initiator is associated with H. pylori bacteria “Y(e) Are associated with high ~~ acid secreting cell mass > During the formation of HCL ac © (a) Chloride ions are secreted! : into the canaliculi slong | _ the concentration ‘ + (©) Creates a negative potential -0 to -70:mv in i __ canaliculi FO Nat is actively secreted into the canaliculi (© Gastrin is inhibited by vagal stimulation (©) CCK Pzinhibits its secretion23. _‘The entero-gastrie reflex: (@) Is mediated via enteric nerve plexus. {(@) Stimulate gastin release. ~{{©) Impair gastric contraction ~X(@) Impairs gastric secretion. YO Facilitate alkalinization of small intestine 24, Absorption of: ~[2)_Vitamin K would be impaired by + ~inhibition-of entero-hepatic circulation YB) Vitamin C is facilitated by diffusion. ye) Calcium occurs via a membrane ~_ carrer activated by vitamin D. J). Iron occurs more readily in the ferric state . = €) Iron would decrease when plasma \" ansfersin levels decreases. 25, The absorption of: ‘{E-a) Glucose in the small intestine is by diffusion across the membrane [®b) Amino acids is energy independent “[e) Bile salts is grossly affected by resection of the ileum {F-4) Vitamin Biz is likely to be impaired by gastric acid secretion Tre). Calcium from the gut is likely to be impaired by chronic malabsorption of protein +4, Describe the major functions: of- SHORT ANSWER QUESTIONS ‘5,1. Briefly discuss the transeapillary ‘luid exchange mechanism and possible oedema formation Briefly discuss the compensatory _ and decompensatory mechanism of heart failire. “3. Draw anormal "oxygen haemoglobin dissociation curve and briefly discuss the changes ‘that may affect the curve. the liver, sighting clearly their : relation with liver function tests. i ZS. Briefly discuss thé patho- i physiology of peptic uleer disease : ‘and the essence of triple therapy. BEST WISHES!0082 MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES 2 MODULE | CA ONE EXAMINATION MMED (SEMESTER I) CLINICAL PHYSIOLOGY. DATE: 18" November 2009 TIME: 10:30AM — 12:30 PM CANDIDATE'S NUMBER: PARP OLR oF stupy eV t© course-t: INSTRUCTIONS: Multiple Choice Examinations: Attempt all questions Please answer the questions on the answer provided. Indicate your answer by filling in the bubble under "T” if the item is TRUE or under “F” if you think the item is FALSE. If you do not know the answer to the item in question leave the item BLANK. Incorrect responses will be penalised by a minus mark. NOTE: This form will be machine marked. You are advised to use a PEN and fill the bubbles boldly and completely. If you change your mind, CROSS OFF your original answer and shade the appropriate bubble. Fill in like this: ® and not like this: ® /1. Coagulation of blood Fa) Is enhanced by adeition of calcium oxalate in blood =} Is inhibited by thromboxane A2 Tc) Inhibited by heparin Fd) Isenhanced by mechanical process such as stiring Fe {s enhanced by serotonin 2." intra-vascular haemolysis differs trom exira-vascular haemolysis that in the later: Ta} Methemalbinaemia is absent “[ Po) mere sno haemoglobinuria TEs} Body iron stores ore usually normal | (Fd) Folic acid deficiency may occur “Le) Methaemogiobinemia is usually absent 3. Bleeding tendency is likely to occur in a patient when: [P.a) Plasma levels of clofing factor Vill are higher than normal ‘b) Large quantities of lysokinases are found in circulaton “€)_ Body stores of vitamin K are depleted Fd) There is disseminated intra-vascular clot formation £2) Two litres of blood which has been stored for wo weeks Is transfused within 24 hours 4, Chronic Vitamin 812 deficiency is likely fo: Tra) Result from intrinsic factor deficiency x (2 FP) impair haemoglobin synthess * =) Cause peripheral neuritis 7d) Shorten the life span of red blood cells 78) Occur in association with achlorhydria ‘ste 5. The following are likely to be found in chronic iron deficiency anaemia: 7a) Higher than normal otal ron binding capacity *[6) Reduced ferritin deposit in the gut A) Reduced mean RBC volume Af) Reduced effective erythropoiesis {B'e) Reduced RBC lite span yl to 6. Compensatory mechanisms in anaemia include: Ja) Increased cardiac output Reduced venous retum ‘£E) Increased total peripheral resistance 77) Increased 2.3 DPG concentration in RBC Te] Increased production of erythropoietin 7. Manitastations of vitamin B 12 deficiency include: “[-a) Anemia that responds fo low dose of folic acid 7b) Peripheral neuropathy tC} Shortened red blood cell ife spanSo Ad) Decreased white blood cell series \ se — 4£€) Mactocytic nomochromic thin blood smeor 8 Disseminated intravasculor coagulopathy: Fo) Presents as spontenous bleeding from surgical wounds [8] May develop following bee sting Fe) Usually associated with embolus lodged in the pulmonary artery Ed) Is associated with high levels of thrombi if fibrinolysis dominates ) Decreased fibrin degradation products © 9." Extrinsic coagulation pathway: ° Fa) is impaired by fibrinogen (Fj deficiency =[-b) Unlike intrinsic pathway utitzes factor Il Wee “¢) Unlike intrinsic pathway utilizes factor X ) Require factor Vil Gh Fe) Does not require phospholipids 5 10. Prothrombin Time: Ta) Measures the rate at which plasma prothrombin is converted to thrombin “ -T'b) Measures the integrity of the extrinsic pathway Te) May be influenced by factor X deficieny TA) Sof value in jaundice due to hepatocytes diseases = 6) Is prolonged in bile salts deficiency 11. In disseminated intravascular coagulopathy: Ta) Marked tissue infarction is seen when hypercoaguiopathy dominates —b) Fibrinolysis is manifested by marked spontenous haemorharage {FA) Thrombosis is more associated with fibrinolysis than hypercoagulopathy ye J, 9) Fibrin degradation products enhances more bleeding 3/—AFa) Pesma plosminogen lever ere ralsed 12, Obstruction jaundice is associated with [Fa. Increased unconjugated bilirubin f ©. Gilberts disease ¢ c. Sickle Cell Disease d. Crigier Nojar Syndrome ) e. Decreased plasma albumin levels 13. With respect to body fluid content: | a. The intracellular fluid volume is 2/3 of total body water 77. Infants do have a greater body fluid content per kg body weight than adolescents €. Females have less water content than the males of the same weight d. The cerebral spinal fluid volume is greater than the synovial fluid The intracellulor fluid to extracellular fluid ratio is increased in patients with oedema ree “tee Iota14, Renal sodium reabsorption a. In the proximal tubules is exclusively active b. In the distal tubules is enhanced when the delivery load of sodium to macula densa is increased C. In the proximal tubule is impaired when glucose in the fitrate is deficient d. In the thin ascending limb of loop of Henle in passive @. Cannot occur in the absence of carbonic anhydrase enzyme The concept of Tubuloglomerviar feedback (TGFB) @. Is amechanism intended fo control the glomerular filtration b. Refers to the mechanism that leads to increase tubular reabsorption in the proximal tubules when the GFR is increased Involves the production of angiotensin i Activity is impaired if the socium chioricle passing at the macular clensa is increased @. And RAS are responsible for aldosterone secretion + 16. Patients with severe diarthea and vomiting, J ‘Ta. May present with hyperventilation Tb. Their hist centre is mainly simulated by an increase in plasma osmolarity Fc. The baroreceptors wil be highly stimulated Fd, sympathetic discharge to the heart will be increased [= e. Plasma ADH levels will be raised 17. Edema in heart failure can resuit from TT a. Reduced venous return & b. Reduced plasma colloidal osmotic pressure © c. Anincrease in interstitial coloid osmotic pressure Td. Aninctease in capilary hydrostatic pressure T @, Increased rennin angiotensin aldosterone activity 18. A patient with ADH deficiency T a. May complain of severe headache F bb. The blood pressure is going to be severely reduced T ¢. May come complaining of persistent thirst Fe d. The RAS mechanism is highly stimulated, Te. Sodium reabsorption will be impaired 19. A patient who comes to the clinic in diuretic phase of Acute Rencl Failure T a. May present with normal blood urea Tb. The plasma ADH levels wil be raised Tc. May complain of thirst Td +e. 3) pagt4t ym ae May complain of imegulor heart beat te Will complain of frequent micturation20, Anemia in Chronic Renal failure may result rom | . Inadequate intoke Tb. Reduced eryihropoletin production > ¢, Hemolysis bd. Acidosis Fe. Renal tubules unresponsive to ADH 21, With respect fo plasma potassium ©, Arise in plasma of the ion may lead fo cardiac arrhythmias | b. Alowed pH increases plasma potassium concentration c. Administration of insulin to diabetic patients tends to lower plasma potassium production @. An increase in plasma aldosterone tends fo increase potassium excretion 20. Patients with hypokalaemia due to primary aldosteronism a, May complain of constipation b. May have diabetic like glucose folarence curve c. May complain of polyurea ifthe condition is chronic d. May be found to have raised plasma bicarbonate level (alkalosis) ©. Tendon jork reflexes will be exaggerated 23. Excessive bleeding following motor tectic accident may lead to Ta. Increased rennin production F b. Increased baroreceptor activity c. Hyperventiiation ) d. Activation of alpha adrenergic receptors. (ve e. low GFR ent with an ADH secreting tumor Ta. Will have CNS features of increased intracranial pressure Fb: The osmoreceptors wil highly stimulcted Fic. The reabsorption of sodium willbe impaired Td. Willbe passing scanty urine Te. May present with blood pressure not higher than 5 mmHg above normal 25, Acute renal failure differs from chronic renal felute in that in acute renal failure 7K 0. Hyperkalaemia is more common 7(b. Plasma urea concentration is much higher FA. The total GFR is reduced 774. Eythropoietin production remains normal “7 £2> Filration at the glomervis in all he nephrons impairedeb ay SHORT ANSWER QUESTIONS cee 1. Briefly describe the pathophysiology of nutritional anaemia and its diagnosis~ ~ 2, coxrbe boty meatbgensiiagy el tzemngie rover, Ei coagulopathy salto Tepe iy vi Sat ses 2” 3. Discuss belly the possible diagnosé of a mile oged man admitiedina “Sess! surgical ward with a deep jaundice and tender liver. 4, Describe briefly how oedema comes about in a patient with chronic renal foilure © 5. briefly describe an adequate GFR may be achieved in patients with hypovoloernia op EheET a awna iy erek t= Heels who ALLIHE Best 2 Ae yep filmes a yee BN Alok SS eenv ( Steet (Amp ole MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES CA I_EXAMINATION, JANUARY 2009 MMED SEMESTER I CLINICAL PHYSIOLOGY. DATE: 21° JANUARY, 2009 TIME 10:30AM — 01:30 PM CANDIDATE'S NUMBER: course--: YEAR OF STUDY INSTRUCTIONS: Multiple Choice Questions: Attempt all questions Please answer the questions on the answer provided. Indicate your answer by filling in the bubble under "T" if the item is TRUE or under “F” if you think the item is FALSE. If you do not know the answer to the item in question leave the item BLANK. Incorrect responses will be penalised by a minus mark. NOTE: This form will be machine marked. You are advised to use a PEN and fill the bubbles boldly and completely. If you change your mind, CROSS OFF your original entry cleanly and shade the appropriate bubble. Fill in like this: ® and not like this: @ = D Pc1) Glucag “T (a) Activates phosphorylase B kinase to effect its FEA) Catalyzes the conversion of pyruvate to ‘ihosphoenol pyruvate Feo) Hecretion le reduced by inereased circulating velo of tree fatty acids I" (dPnereases cell membrane pertncability to Protas, : J (e) neteases the uptake of amino iids by liver 2) The following are effects of e-AMP: [) Gheagenolyss in the liver T(b) Formation of T3 and T4 in the thyroid gland F () Decreases cardiac contractility in the Jd) Increases renal epithelium permeability (6) Proliferation of granulose cells in the ovary 2) ‘type 2 dinbetes mellitus te ha {God Lenn of abit of in f psluction i the liver T-{h) An increased postprandial ghucone () Increased glucokinase activity (@) Reduced GLUT-4 in the cytoplasm {¢(e) Reduced circulating levels of insulin, terized by: to suppress glucose scusedulilizition of glucose inthe bral vo sulin deficiency. “Fy Decrease glucose uptake by muscle Fc) Increased glycogen breakdown in muscle. VW) Increased hepatic gluconeogen { (6) Aualisobite Ghneagon excens due 5) Type f diabetes mellitus fs characterized by: * | (ay Los of becom in alts of Langctban “7 (b) Usially an absolute insulin deficiency. {[(e) Increased cholesterol synthesis. (i) tendency t ketoacidosis -t (ey typovatemia (6) Bouluses of hypereaeenila Include Fo) Increased neurornuseula iritability -(b) Fetopie calcification, + (¢) Constipation. *(0) Hypertension { (e) Diabetes tnsipidas 7) Patient with diabetle ketoacidosis: 2) Need higher doses of insulin than non ketotic diabetics ‘T(b) Ace likely to be potassium depleted (©) Present with Kusmall’s respiration + (u) Are more likely 1 he type 2 than type 1 diabetic “{ (@) Are usually volume depleted 8)tmmutins gas? LH, { le) Abour 6oreor is degraded inthe kidoe 2b) Decreases amino acid uptake by cells. (©) Reduces the conversion of glucose to fat. 5 (@ Impairs renal absorption of glucose, ‘¥(e) Decreases rates of translation of mRNA in cells. 9) Absorptlon of Calelum from the gut: “| (@) Occurs along concensation gradient F-() Depends on Cat" ATPase activity F (6 Increases with increase tn fake ofcaliurn (0) Incteasen with high protein bitahe (6) Ht reduced by high levels of Catbinain 10) Actions of 1,25-(OM, Dy includes: T(@) Calbinin-Dss formation T() Bone mineralization & Te) reabsorption feom principal tive calcu cells (a) Reduced absorption of caleium from monocytes. (2) Increased wanslocation of ealeiuin from gut cplthelial cells ‘ 1/11) The following are features of duodenal uleers: Fo) Located dul pa T(t) Reliefanera meat “\(©) Tendency to over weight (0) Melaerastoot | (5) Diaithoea A2) Respiratory failure JEG) Usuaty mantles as eevated #460, but normal P.O. F() Is likely fo present with raised P,CO; equal crabove 29 mn I “Te Teassocited with a fat in P.O; AG) Due to failure of the system ie associated ‘with normal eontoller responce TO Bue to aie ofthe controller Is associated with decreased chest movements 1Hypoxte bypoeapnoste reepirataiy {allure may result from the followings ‘Motor nerve lesion to the muscles (poliomyelitis) Deformed respiratory cage (kyphoscoliosis) Pulmonary embolism Acute lef ventricular failure ‘Ventilation: perfusion imbalance Hype followings Ascent to high altitude, ‘Veniiation = perfusion Gihalence yperventlation Pulmonary oedema estrctive lung diseases joes Is Ilkely to result from the Obstructive lung disease differs from restrictive lung disease tn that: FBV, is usually increased above normal EVC may be reduced below normal below ‘ots +5 Cloning volume fs higher than normal ‘May deteriorate and eause in cyanosis Is Iikely to cause a highce than normal dah regulation of g ‘Stinatatton of gastrin secreting cells ay ‘be an indirect response to entry of food in the stomach CCK-PZ.reducce gastric acid secretion omatostatin inhibits gastric acid secretion Tcreascl gastric acid secretion is. ssswcluted with redived blood pl Stimulation of sympathetic nerve resulted in tlocrensed acid secretion lcors differ from gastric sin aehation may be localized Below the Pain is likely to be relieved by a meal ‘Ate less likely to develop malignancy The initlator is associated with Helicobacter pylori bacteria, ‘Are associated with high acid secreting cell Te to Fee 1) Fo Te EO To Lo 22 Te) To) 1) oO Fe) diffusion across the membrane ‘Amino acide is energy dependent Bile salt is prosely atfected by rescctioh of the fleum. Vitamin Bis likely to be impaired by gastric acid secretion Cleium from the gut is likely to be impaired I ehronie malabsorption of protein In a patient with chronic defielency Vitam Dy i ikely #0 develop megalobalsiosis Caleinsn is likely to develop tetany ‘Vitamin C is likely to develop collages: synthesis enormalies Protein may manifest with gross anemia Folic acid is likely to present with rmicrocytic anemia During pregnancy: Cardiac output increases by about 30% Inereases i Dl Folie Acid demand increase. Pibrinolytie activity is increased. Estrogen inhibits uterine contractility Follicle Stimulating Hormone: Levelt increases 6-10 times during, ovulation Ms effects wy be enlianced by LIL Involved in the formation of corpus luteum Initiates anteal eavity formation in the ovgny Causes proliferation of yranulose theca cell in the ovary A patient with raised radioiodine uptake night have Hyperactive adenoma af thyroid gland, Todine deficiency ‘Normal pregnancy Hypothyroidism Nephrotie syndrome25) Insulln Resistance: F (@) May be due to up-regulation of adiponectin. F (©) May be due to down-regulation of resistin E (©) ls associated with elevated PPAR- receptors Fy (@) Is feature of metabolic syndrome “(© Is associnted with normal GLUT, receptors STACIHL and Coitseh F (The incronte in the acrotion oF adrenal {AAS frou the Posterior Pituitary T (€) Low levels of Leptin delays the onset of puberty 1. Briefly discuss the physiological effects of Answer ALL Questions ¢ QN 10 marks) F (@) Sexual precocity is associated with inhibition of ‘he hypothalamic —pltultary ~ gonadal axis thyroid hormones and what are the manifestations of increased thyroid “T (©) Meal body weight is critical forthe attainment of hhortnones, puberty 2. Explain adaptive changes that take place during pregnancy. 24) Mypothyroldism may be associated with: 13. Briefly describe how calcium jon T (a) Anioi "(by Peripheral vascular resistance ((c) Extensive coronary sclerosis 4a) Cerebeltar syndrom Fe) Mosese crouky voice icity ‘oneouleation in Llood is ulways kept with Sspyreciable levels wl what are the punifestations af hypercalcemi, Miietly describe the pathophysiology of neplle ulcers and physiolople basis of smuanagement 5, Tiriefly describe the compensatory rwechariisms in patient with respiratory failure. GOOD LUCK!MUHIMBIL! UNIVERSITY OF HEALTH AND ALLIED SCIENCES CAI EXAMINATIONS, NOVEMBER,2008 MMED SEMESTER | CLINICAL PHYSIOLOGY. DATE: 19" November,2008 TIME: 10:30AM - 01:30 PM d/o. CANDIDATE'S NUMBER: ~~ Gn INSTRUCTIONS: Multiple Choice Examinations: Attempt all questions Please answer the questions on the answer provid Indicate your answer by filling in the bubble under “T” if the item is TRUE or under “F” if you think the item is FALSE. If you do not know the answer to the item in question leave the item BLANK. Incorrect responses will be penalised by a minus mark. NOTE: This form will be machine marked. You are advised to use a PEN and fill the bubbles boldiy and completely. If you change your mind, CROSS OFF your orginal answer and shade the appropriate bubble. Fill in like this: ® and not ‘ike this: @ @1 In patients with inappropriate ADH secretion [ # Fluid tends to move from the ECF to the ICF ©. The thirst centre is inhibited 4c. Both the ECF and the ICF volumes are increased 4, The blood pressure is increased significantly is elevated above normal (b) F PaQy is lower than normal (©TImpulse from the appropriate (OT The response of the system to the controller is inappropriate | (AP Breathing frequency is ‘higher than normal brain are The following were made on a pat yeasurrements ‘Tidal volume = $00 mt Anatomical dead spac Breathing frequency ~ Cardiac output =7 litres/n 5 Vas eam MO) Be = im - 00 18 you x1 if @ a wo tae Be TY Koa 7.500 Which of the following are correct about the results? (3) [, Pulmonary ventilation is © about 7.5 litres/min (b) “TAlveolar ventilation is about 6 litres/min The patient is Tikely to be a hild (@) [The _ ventitation/perfusion _ ratio is about 0.86 (e) F Alveolar ventilation would if dead we increase space 5 of carbohy (@) FBlood glucose level, is higher than normal (b) “There is severe diarthoea (c) F There is tendency to form peripheral pitting oedema (@) Patients complain of night blindness (c) T° Loss of energy absorption of proteins: (a) Kasised red blood cell mass (o)F Increased haemoglobin (c)"T Pitting oedema (a) Reduced immunity (c) increased bone mineralization 7. Total removal ofthe stomach is likely to lead to: (a) (° Hemoditution after meals due to excessively rapid __ absorption of water (0) JR Mataboorption because of Week of pepein (c) ‘V Vitamin Brz malabsorption (3). Fe Impaires fat absorption de tovtbsence of gastric pase (| Slight reduction inthe absorption of ron pits ¢ es TVx BF pis (yw)| 8. In a jaundiced patient: (a) There's increased urobilinogen excretion if the jaundice is due to obstruction (b) _Feacobilinogen exeretion is increased if jaundice is obstructive Deficiency of glucrony! transferase results in excessive unconjugated bilirubin (@) Hepatocellular damage leads to excessive secretion of bilirubin in the kidney (©) There is always damage to the basal ganglia 9. A fall in blood pressure would cause: (@) Am increase in plasma rennin levels. (b) E A shift of blood from capillaries into the interstitial space. (©) P An increase in aldosterone secretion (@ f A decrease in ADH secretion (©) fF An increase in impulses FF ous te barat 10. Inpatients with chronic hypertension: “f° (#) Left ventricular hyperteophy is common finding TT (b) Raised total peripheral resistance is a usual findin, carly stages. (©) Inhibition of beta one recs would reduce cardiac output. (@ Angiotension converting T Ghrgme nhbirsredves blood pressure. T--() Resting plasma rennin levels tend to be raised 11 In cardine failure: )) Sympathetic stimulation improve cardiac output. (0) Angiotension converts enzyme inhibitors tend to improve cardiac output. ( G) Digoxin sdrainiarution improves eardiae output by stimulating cell membrane calcium __ ion pumps € (@) Preload is increased by administration of diuretics, F (©) Afterload is decreased by aortic, Mest es 12, With respect to right ventricular failure: (a) Enlarged tender liver is a usual finding. “V (b) Pedal eclema tend to develop before pulmonary congestion, F (©) Raised jugular venous pressure 1 isa diaynosti sign. F(a) Renal sodium reabsorption _ decreases. £6) Temore common dan left 15. Development of i shock is associated witl “[(a) Decreased metabolic enzymes. F (0) Increased high energy phosphate reserve F(c) Persistent raised total peripheral resistance TUG) Increased apillary permeability. j ©) Acidosis: 14. Aortic regurgitation causes: (a) A systolic murmur (b) Low diastolic blood pressure. 7 (c) Am increase in left ventricular end diastolic volume [(D Increased ventr J, (©) Ineteased afterload15, Left yentricnar hypertrophy: = () Iueammon nchronte T hypertension, £ () Cancer asa result of sonic pulmonary hypennaton £-() Decrenset cardiac contact. (@) Causes ef exi deviation P(e) Gaus lags QRS compli in Yeas In the measurement of 16. G Jung funetion> Ya) Lung volume is ‘underestimated by. dilution methods in an individual with large trapped gas voluine Phase T of the single breath test represents snatomical dead space volume flor Fase IV ofthe single breath test ( q is likely to be higher than normal jm a patient with premature > closure of the airways; / (a) Body plethysmograph reliably measures total ung volume (Of Residual volume’ is, higher in an individeal with small closing volume ~ 17, Alveolar ventilation: COT Is reduced ineroaued anatos al dead space volume (o)pAVhen critically reduced is anweiated with respiratory alkalosis (6}F'Is relatively higher than normal during hyperventilation (@}pis wasted when pulmonary perfusion decreases © Bis the amount of gos breathed into the lungs in one minute Ww 18, Which of the following are likely consequences of hyper eaphoca G)-PRaised mined vende PCO, Gy PeAngreased arterial blood pit (6) & Decreased cerebral blood flow Bs) increased asterial pulmonary vs pressure we eo Decreased P,O2 19, Hypoxemia due_—_to lation differs from that due to diffusion impairment in that: (a) [Arterial PCO isclevated. (o)pelypoxemia improves by increased alveolar partial ey THiyponemia Be a ssl: Gp chronie, administration of 100% oxygen results in increased aneral PCO, (erp Hpexemia docs not als 0 vey loge levels before deteotion 20. The following would increase impulse generation from peripheral chemo-receptors: T@)PMLow pH v F-(b) Increased temperature Fie) Increased PCO: Ga) Reduced perfusion Fe Tow POs 21. ‘The following would tend increase food intake: 1a)F Raised blood glucose () Reduced blood © ids . ()- Reduced body temperature (@f- Stimulation of the ventromedial nuclei of hypothalamus lating amino (ofp Stimulation of the — lateral hypothalamus 22. Development of peptle uleers is associated with: {aS Increased numberof parital cells (b) [Increased capacity to secrete acid & pepsin (©) T Increased parietal cells sensitivity to gastrin (7 Decreased acid-induced inhibition of acid secretion (©) T Impaired seeretion of pancreatic HCOx my uke23. In the digestion of carbohydrates: (a) “PLactose is broken down to yield glucose and galactose ) jucrose is broken down to Wis ‘glucose and fructose (©) -[Maltose.is broken to yield ~ luc (@)_C_Fructose is broken down to yield galactose (OT &Limit dextrins are broken to yield glucose 24. The absorption of carbohydrates differs from that of fats in that: (@) -F Absorption of glucose is Na’ dependent, (b) “Absorption of glucose require a protein carries (©) [-Mal-absorption of carbohydrates is associated with energy loss (&) -T Absomtion of fructose is by facilitated diffusion (©) FF Panereatie insufficiency may lead to reduced absorption ye bu 25, Mal ion of fats is associated with the following (OMAR Increased prothrombin time (6) [> Comeal opacity (a) “{ Increased bone resorption Increased loss of bile salts in stool . Essays: 1. Briefly deseribe the effects of raised arterial blood PCO “#2. Briefly discuss the pathogenesis ‘of peptie ulcers 3. Briefly discuss the possible diagnosis and the pathophysisology of a patient with a history of paroxysmal noctumal dyspnoea and bilateral pedal oedema, t uy 4. Briety discuss the pathophysiology and treatment of ‘ essential hypertension,_______MUHIMBILI UNIVERSITY OF __ HEALTH AND ALLIED SCIENCES MODULE ONE CONTINUOS EXAMINATION 7™ NOVEMBER 2007 SEMESTER ONE EXAMINATIONS FOR THE DEGREE OF MASTER OF MEDICINE (MMED). CLINICAL PHYSIOLOGY TIME: 10.30 - 12.30 NOON CANDIDATE’S REGISTRATION NUMBER: -- COURSE “INSTRUCTIONS: Multiple Choice Examinations: Attempt all questions Please answer the questions on the answer sheet provided. Indicate your answer by filling in the bubble under “T” if the item is TRUE or under “F” if you think the item is FALSE. If you do not know the answer to the item in question leave the item BLANK. Incorrect responses will be penalised by a minus mark. NOTE: This form will be machine marked. You are advised to use an HB pencil and fill the bubbles boldly and completely. If you change your mind erase your original answer cleanly and shade the appropriate bubble. Fill in like this: ® and not like this: @ @ FOR YOUR EXAM NUMBER USE THE FOUR DIGITS OF YOUR REGISTRATION NUMBER E.G. 21/2007 USE 2107