EMRCS 2021

Physiology

Physiology
MRCS I.V.
1/1/2021
 MRCS I.V. Course

physiology

N. Question Ans.
Which of the following drugs increases the rate of gastric emptying in the
vagotomised stomach?
A. Ondansetron
1 B. Metoclopramide D
C. Cyclizine
D. Erythromycin
E. Chloramphenicoli
Which of the following is not secreted by the parietal cells?
A. Hydrochloric acid
B. Mucus
2 B
C. Magnesium
D. Intrinsic factor
E. Calcium
A 65 year old man is admitted for a below knee amputation. He is taking
digoxin. Clinically the patient has an irregularly irregular pulse. What
would you expect to see when you examine the jugular venous pressure?
A. Absent y waves
3 E
B. Slow y descent
C. Cannon waves
D. Steep y descent
E. Absent a waves
Deficiency of which vitamin is most likely to explain the presentation of a
3 year old child with Rickets?
A. Vitamin C
4 B. Vitamin B3 C
C. Vitamin D
D. Vitamin A
E. Vitamin E
Which of the following substances is released from the sympathetic
nervous system to stimulate the adrenal medulla?
a. Noradrenaline
5 b. Acetyl choline B
c. Substance P
d. Tyrosine
e. Arginine
von Willebrand factor is involved in the stabilization of which of the
6 B
clotting factors listed below?

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A. Factor VII
B. Factor VIII
C. Factor V
D. Anti thrombin III
E. Factor Xa
Which part of the ECG represents atrial depolarization?
A. P wave
B. Q wave
7 A
C. T wave
D. QRS complex
E. P-R interval
A 45 year old male has alcoholic cirrhosis and decompensated liver
failure, which of the following clotting factors is least likely to be
affected?
A. Factor V
8 D
B. Factor VII
C. Factor IX
D. Factor VIII
E. Factor XI
A patient has an arterial blood gas sample taken and the following result is obtained:
pH 7.48

pO2 10.1

Bicarbonate 30

pCO2 4.5
9 B
Chloride 10meq
What is the most likely cause?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Type 1 respiratory failure
D. Metabolic acidosis with normal anion gap
E. Metabolic acidosis with increased anion gap
Which of the blood gas results listed below is most likely to fit with a
patient who has acute respiratory acidosis?
A. pH 7.57, PaCO2 3.5, Pa O2 24.5 (FiO2 85%), Bicarbonate 23.5,
Base excess +1.8 mmol
B. pH 7.19, pCO2 10.2, pO2 16 (FiO2 85%), Bicarbonate 23.8, Base
10 B
excess -2.2 mmol
C. pH 7.14, PaCO2 7.4, PaO2 8.9 (FiO2 40%), Bicarbonate 14 mmol,
Base excess -10.6
D. pH 7.36, PaCO2 7.3, PO2 8.9 (FiO2 40%), Bicarbonate 30.2, Base
excess 5.3

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E. pH 7.32, PCO2 3.8, PaO2 22.2 (FiO2 40%), Bicarbonate 19.1, Base
excess -7.9
A 43 year old lady is recovering on the intensive care unit following a
Whipple procedure. She has a central venous line in situ. Which of the
following will lead to the y descent on the waveform trace?
A. Ventricular contraction
11 B
B. Emptying of the right atrium
C. Emptying of the right ventricle
D. Opening of the pulmonary valve
E. Cardiac tamponade
A 23 year old is stabbed in the groin and develops hypovolaemic shock.
What is the most likely finding on analysis of his urine?
A. Decreased specific gravity
12 B. Increased specific gravity B
C. Increased urinary glucose
D. Increased urinary protein
E. Increased red blood cells in the urine
A healthy man has a blood pressure of 120/80 mmHg and an intra cranial
pressure of 17 mmHg. What is the approximate cerebral perfusion
pressure?
A. 103 mmHg
13 E
B. 63 mmHg
C. 83 mmHg
D. 91 mmHg
E. 76 mmHg
The pressure within the pleural space is negative with respect to
atmospheric pressure, except for which of the following?
A. At the end of inspiration
14 B. When taking a deep breath D
C. If the patient is intubated with an endotracheal tube
D. During a Valsalva maneuver
E. At the end of expiration
There is decreased secretion of which one of the following hormones in
response to major surgery:
A. Insulin
15 B. Cortisol A
C. Renin
D. Anti-diuretic hormone
E. Prolactin
What is the main event involved in the neovascularization of the
immature wound bed following surgery?
16 A
A. Endothelial cell proliferation
B. Fibroblast proliferation

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C. Macrophage migration
D. Neutrophil accumulation
E. Granulocyte degradation
A 28 year old man undergoes an ileocaecal resection to treat terminal ileal
Crohns disease. Post operatively he attends the clinic and complains of
diarrhea. His CRP is within normal limits and small bowel shows no focal
changes. Which of the following interventions is most likely to be
beneficial?
17 E
A. 5 ASA drugs
B. Azathioprine
C. Pulsed methylprednisolone
D. Infliximab
E. Oral cholestyramine
Which of the following best accounts for the mechanism of action of
glucocorticoids?
A. Binding of cell wall receptors and intracellular tyrosine kinase
activation
B. Binding of intracellular receptors that migrate to the nucleus to then
18 B
affect gene transcription
C. Activation of transmembrane tyrosine kinase systems to affect
intranuclear gene transcription
D. Induces post translational modification of intracellular proteins
E. Direct binding of inflammatory cells inducing apoptosis
Which of the following statements related to the coagulation cascade is
true?
A. The intrinsic pathway is the main pathway in coagulation
B. Heparin inhibits the activation of Factor 8
19 C. The activation of factor 8 is the point when the intrinsic and the D
extrinsic pathways meet
D. Tissue factor released by damaged tissue initiates the extrinsic
pathway
E. Thrombin converts plasminogen to plasmin
A 34 year old man receives morphine following an appendicectomy. He
develops constipation as a result. Which of the following best accounts
for this process?
A. Stimulation of DOPA receptors
20 C
B. Inhibition of DOPA receptors
C. Stimulation of Mu receptors
D. Stimulation of serotonin release
E. Inhibition of serotonin release
Which of the following is not well absorbed following a gastrectomy?
21 A. Vitamin c C
B. Zinc

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C. Vitamin B12
D. Copper
E. Molybdenum
Which of the conditions listed below is most likely to account for the
following arterial blood gas result:
pH 7.49
pO2 8.5
Bicarbonate 22
22 pCO2 2.4 A

Chloride 12meq
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Type II respiratory failure
E. Metabolic acidosis with increased anion gap
Which of the following blood gas results would fit with metabolic
acidosis with a compensatory respiratory alkalosis?
A. pH 7.36, PaCO2 7.3, PO2 8.9 (FiO2 40%), Bicarbonate 30.2, Base
excess +5.3
B. pH 7.14, PaCO2 7.4, PaO2 8.9 (FiO2 40%), Bicarbonate 14 mmol,
Base excess -10.6
23 D
C. pH 7.57, PaCO2 3.5, Pa O2 24.5 (FiO2 85%), Bicarbonate 23.5,
Base excess +1.8 mmol
D. pH 7.32, PCO2 3.8, PaO2 22.2 (FiO2 40%), Bicarbonate 19.1, Base
excess -7.9
E. pH 7.19, pCO2 10.2, pO2 16 (FiO2 85%), Bicarbonate 23.8, Base
excess -2.2 mmol
Which vitamin is involved in the formation of collagen?
A. Vitamin A
B. Vitamin B
24 C
C. Vitamin C
D. Vitamin D
E. Vitamin E
A 56 year old man has long standing chronic pancreatitis and develops
pancreatic insufficiency. Which of the following will be absorbed
normally?
25 C
A. Fat
B. Protein
C. Folic acid

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D. Vitamin B12
E. None of the above
A 56 year old male presents to the acute surgical take with severe
abdominal pain. He is normally fit and well. He has no malignancy. The
biochemistry laboratory contacts the ward urgently, his corrected calcium
result is 3.6 mmol/l. What is the medication of choice to treat this
abnormality?
26 A
A. IV Pamidronate
B. Oral Alendronate
C. Dexamethasone
D. Vitamin D
E. Resonium salts
An over enthusiastic medical student decides to ask you questions about
ECGs. Rather than admitting your dwindling knowledge on this topic,
you bravely attempt to answer her questions! One question is what
component of the ECG represents ventricular repolarization?
27 A. QRS complex D
B. Q-T interval
C. P wave
D. T wave
E. S-T segment
The oxygen-haemoglobin dissociation curve is shifted to the right in
which of the following scenarios?
A. Hypothermia
28 B. Respiratory alkalosis E
C. Low altitude
D. Decreased 2,3-DPG in transfused red cells
E. Chronic iron deficiency anemia
A 45 year old man undergoes a sub total colectomy and formation of end
ileostomy. What is the most likely sodium content per liter of ileostomy
fluid?
A. 120 mmol
29 A
B. 60 mmol
C. 20 mmol
D. 210 mmol
E. 180 mmol
A 73 year old lady is admitted for a laparoscopic cholecystectomy.
During her pre-operative assessment, it is noted that she is receiving
furosemide for the treatment of hypertension. Where is the site of action
30 of this diuretic? C
A. Proximal convoluted tubule
B. Descending limb of the loop of Henle
C. Ascending limb of the loop of Henle

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D. Distal convoluted tubule

E. Collecting ducts
Which of the following physiological changes do not occur following
tracheostomy?
A. Alveolar ventilation is increased.
31 B. Anatomical dead space is reduced by 50%. C
C. Work of breathing is increased.
D. Proportion of ciliated epithelial cells in the trachea may decrease.
E. Splinting of the larynx may lead to swallowing difficulties.
What is the substrate of renin?
A. Aldosterone
B. Angiotensinogen
32 B
C. Angiotensin converting enzyme
D. Angiotensin I
E. Angiotensin II
A 28 year old man is shot in the abdomen and hemorrhages. Which of the
following substances will produce vasoconstriction in response to this
process?
A. Renin
33 C
B. Angiotensin I
C. Angiotensin II
D. Aldosterone
E. None of the above
A 23 year old man has taken an opiate overdose. Of the following
structures, which will be most affected by opiates to produce a reduction
in respiratory rate?
A. Carotid chemoreceptors
34 C
B. Central chemoreceptors
C. Medullary respiratory center
D. Pneumotaxic center
E. Juxta capillary (J) receptors
A 32 year old man has a glomerular filtration rate of 110ml / minute at a
systolic blood pressure of 120/80. If his blood pressure were to fall to
100/70 what would glomerular filtration rate be?
A. 110ml / minute
35 A
B. 100ml/ minute
C. 55ml/ minute
D. 25ml/ minute
E. 75ml/ minute
Which of the following does not stimulate insulin release?
A. Gastrin
36 B
B. Atenolol
C. Protein

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D. Secretin
E. Vagal cholinergic action
A 63-year-old female is referred to the surgical clinic with an iron
deficiency anemia. Her past medical history includes a left hemi
colectomy but no other co-morbidities. At what site is most dietary iron
absorbed?
37 A. Stomach B
B. Duodenum
C. Proximal ileum
D. Distal ileum
E. Colon
Which of the following arterial blood gas results would fit with chronic
respiratory acidosis with a compensatory metabolic alkalosis?
A. pH 7.36, PaCO2 7.3, PO2 8.9 (FiO2 40%), Bicarbonate 30.2, Base
excess +5.3
B. pH 7.32, PCO2 3.8, PaO2 22.2 (FiO2 40%), Bicarbonate 19.1, Base
excess -7.9
38 A
C. pH 7.14, PaCO2 7.4, PaO2 8.9 (FiO2 40%), Bicarbonate 14 mmol,
Base excess -10.6
D. pH 7.57, PaCO2 3.5, Pa O2 24.5 (FiO2 85%), Bicarbonate 23.5,
Base excess +1.8 mmol
E. pH 7.19, pCO2 10.2, pO2 16 (FiO2 85%), Bicarbonate 23.8, Base
excess -2.2 mmol
Which of the following hemodynamic changes is not seen in hypovolemic
shock?
A. Decreased cardiac output
39 B. Increased heart rate E
C. Reduced left ventricle filling pressures
D. Reduced blood pressure
E. Reduced systemic vascular resistance
An otherwise fit 30-year-old male donates 500ml of blood. Which of the
processes outlined below is most likely to occur?
A. Oliguria
40 B. Activation of the renin angiotensin system B
C. Sweating
D. Fall in mean arterial pressure
E. Tachypnoea
A 25-year-old man is undergoing respiratory spirometry. He takes a
maximal inspiration and maximally exhales. Which of the following
measurements will best illustrate this process?
41 B
A. Functional residual capacity
B. Vital capacity
C. Inspiratory capacity

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D. Maximum voluntary ventilation

E. Tidal volume
Which of the following does not decrease the functional residual
capacity?
A. Obesity
42 B. Pulmonary fibrosis E
C. Muscle relaxants
D. Laparoscopic surgery
E. Upright position
Which of the following is the main site of dehydroepiandrosterone
release?
A. Posterior pituitary
43 B. Zona reticularis of the adrenal gland B
C. Zona glomerulosa of the adrenal gland
D. Juxtaglomerular apparatus of the kidney
E. Zona fasciculata of the adrenal gland
Secretions from which of the following will contain the highest levels of
potassium?
A. Rectum
44 B. Ileum A
C. Gallbladder
D. Pancreas
E. Stomach
What is the typical stroke volume in a resting 70 Kg man?
A. 10ml
B. 150ml
45 E
C. 125ml
D. 45ml
E. 70ml
A patient loses 1.6L of fresh blood from their abdominal drain. Which of
the following will not decrease?
A. Cardiac output
46 B. Renin secretion B
C. Firing of carotid baroreceptors
D. Firing of aortic baroreceptors
E. Blood pressure
What are the most likely effects of the release of vasopressin from the
pituitary?
A. Vasoconstriction of the afferent glomerular arteriole
47 B. Increased permeability of the mesangial cells to glucose E
C. Reduced permeability of the inner medullary portion of the
collecting duct to urea
D. Increased secretion of aldosterone from the macula densa

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E. Increased water permeability of the distal tubule cells of the kidney

Which of the following hormones is mainly responsible for sodium -
potassium exchange in the salivary ducts?
A. Vasopressin
48 B. Angiotensin I C
C. Aldosterone
D. Somatostatin
E. Cholecystokinin
In a 70 Kg male, what proportion of total body fluid will be contributed
by plasma?
A. 50%
49 B. 5% B
C. 35%
D. 65%
E. 25%
A 23 year old man is undergoing an inguinal hernia repair under local
anesthesia. The surgeon encounters a bleeding site which he manages
with diathermy. About a minute or so later the patient complains that he
can feel the burning pain of the heat at the operative site. Which of the
following nerve fibers is responsible for the transmission of this signal?
50 D
A. A α fibers
B. A β fibers
C. B fibers
D. C fibers
E. None of the above
What is the approximate volume of pancreatic secretions in a 24 hour
period?
A. 100ml
51 B. 200ml D
C. 500ml
D. 1500ml
E. 3000ml
A 34 year old lady has just undergone a parathyroidectomy for primary
hyperparathyroidism. The operation is difficult, and all 4 glands were
explored. The wound was clean and dry at the conclusion of the
procedure and a suction drain inserted. On the ward she becomes irritable
and develops stridor. On examination, her neck is soft and the drain
52 empty. Which of the following treatments should be tried initially? A
A. Administration of intravenous calcium gluconate
B. Administration of intravenous lorazepam
C. Removal of the skin closure on the ward
D. Direct laryngoscopy
E. Administration of calcichew D3 orally

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A 44 year old lady presents with jaundice. Following a minor ward based
surgical procedure she develops troublesome and persistent bleeding.
Deficiency of which of the vitamins listed below is responsible?
A. Vitamin C
53 B
B. Vitamin K
C. Vitamin D
D. Vitamin B
E. Vitamin A
A 23 year old man presents with blunt abdominal trauma and a splenic
bleed is suspected. He is commenced on an infusion of tranexamic acid.
Which of the following best describes its mechanism of action?
A. Inhibition of plasmin
54 A
B. Inhibition of thrombin
C. Inhibition of factor II
D. Inhibition of factor Xa
E. Activation of factor VIII
A 34 year old male donates a unit of blood. It is stored at 4 C. After 72
hours which of the following clotting factors will be most affected?
A. Factor IV
55 B. Factor II C
C. Factor VIII
D. Factor IX
E. Factor XI
Cortisol is predominantly produced by which of the following?
A. Zona fasciculata of the adrenal
B. Zona glomerulosa of the adrenal
56 A
C. Zona reticularis of the adrenal
D. Adrenal medulla
E. Posterior lobe of the pituitary
A 43 year old lady with a metallic heart valve has just undergone an elective
paraumbilical hernia repair. In view of her metallic valve, she is given
unfractionated heparin perioperatively. How should the therapeutic
efficacy be monitored, assuming her renal function is normal?
57 A. Therapeutic monitoring is not required B
B. Measurement of APTT
C. Measurement of INR
D. Measurement of Prothrombin time
E. None of the above
A 25 year old man undergoes an appendicectomy for appendicitis. The
58 appendix is submitted for histopathological evaluation. Which of the B
following is most likely to be identified microscopically?

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A. Macrophages
B. Neutrophils
C. Fibroblasts
D. Lymphocytes
E. Stem cells
A 53-year-old man is on the intensive care unit following an emergency
abdominal aortic aneurysm repair. He develops abdominal pain and
diarrhea and is profoundly unwell. His abdomen has no features of
peritonism. Which of the following arterial blood gas pictures is most
likely to be present?
59 C
A. pH 7.45, pO2 10.1, pCO2 3.2, Base excess 0, Lactate 0
B. pH 7.35, pO2 8.0, pCO2 5.2, Base excess 2, Lactate 1
C. pH 7.20, pO2 9.0, pCO2 3.5, Base excess -10, Lactate 8
D. pH 7.29, pO2 8.9, pCO2 5.9, Base excess -4, Lactate 3
E. pH 7.30, pO2 9.2 pCO2 4.8, Base excess -2, lactate 1
The Cori cycle is important in lactate metabolism in the septic surgical
patient. It is used to describe a pathway in which glucose is metabolized
anaerobically to lactate in one tissue and the lactate is converted back to
glucose in another. Which one of the following relies on this cycle to
meet all its energy needs?
60 C
A. Hepatocyte
B. Leucocyte
C. Erythrocyte
D. Pneumocyte
E. Goblet cells
A 48 year old woman suffers blunt trauma to the head and develops
respiratory compromise. As a result, she develops hypercapnia. Which of
the following effects is most likely to ensue?
A. Cerebral vasoconstriction
61 B. Cerebral vasodilation B
C. Cerebral blood flow will remain unchanged
D. Shunting of blood to peripheral tissues will occur in preference to
CNS perfusion
E. None of the above
A patient is seen in clinic complaining of abdominal pain. Routine bloods
show:

62 Na+ 142 mmol/l E

K+ 4.0 mmol/l
Chloride 104 mmol/l

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Bicarbonate 19 mmol/l
Urea 7.0 mmol/l
Creatinine 112 µmol/l

What is the anion gap?

A. 4 mmol/L
B. 14 mmol/L
C. 20 mmol/L
D. 21 mmol/L
E. 23 mmol/L
A 73 year old man has an arterial line in situ. On studying the trace the
incisura can be seen. What is the physiological event which accounts for
this process?
A. Atrial repolarisation
63 D
B. Mitral valve closure
C. Ventricular repolarisation
D. Elastic recoil of the aorta
E. Tricuspid valve closure
A 38 year old lady presents with abdominal pain. On investigation, her
serum calcium is found to be 3.5mmol/L. What is the most appropriate
initial management?
A. Intravenous bisphosphonates
64 D
B. Oral bisphosphonates
C. Intravenous calcitonin
D. Intravenous 0.9% sodium chloride
E. Intravenous frusemide
Which of the substances below is derived primarily from the zona
reticularis of the adrenal gland?
A. Mineralocorticoid hormones
65 B. Glucocorticoid hormones C
C. Sex hormones
D. FSH
E. Vasopressin
A 70 year old man with a past history of angina undergoes an
uncomplicated operation, for a hydrocele. Postoperatively he is found to be
66 hypotensive, tachycardic, and has a raised jugular venous pressure. What B
is the most likely explanation for the hypotension?
A. Reduced stroke volume

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B. Reduced parasympathetic tone

C. Reduced preload
D. Reduced sympathetic tone
Reduced afterload
A 22 year old man suffers a blunt head injury. He is drowsy and has a
GCS of 7 on admission. Which of the following is the major determinant
of cerebral blood flow in this situation?
A. Systemic blood pressure
67 C
B. Mean arterial pressure
C. Intra cranial pressure
D. Hypoxemia
E. Acidosis
A 43 year old man has recurrent episodes of dyspepsia and treatment is
commenced with oral antacids. Which of the substances listed below is
released in response to increased serum gastrin levels and decreases intra
gastric pH?
68 A. Cholecystokinin B
B. Histamine
C. Somatostatin
D. Insulin
E. Vasoactive intestinal peptide
Which main group of receptors does dobutamine bind to?
A. α-1
B. α-2
69 C
C. ß-1
D. ß-2
E. D-1
Which of the following is responsible for the release and synthesis of
calcitonin?
A. Parathyroid glands
70 B. Anterior pituitary C
C. Thyroid gland
D. Posterior pituitary
E. Adrenal glands
What is the half-life of insulin in the circulation of a normal healthy
adult?
A. Less than 30 minutes
71 B. Between 1 and 2 hours A
C. Between 2 and 3 hours
D. Between 4 and 5 hours
E. Over 6 hours
72 Which of the following statements about blood clotting is untrue? E

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A. Platelet adhesion to disrupted endothelium is dependent upon von

Willebrand factor
B. Protein C is a vitamin K dependent substance
C. The bleeding time provides an assessment of platelet function
D. The prothrombin time tests the extrinsic system
E. Administration of aprotinin during liver transplantation surgery
prolongs survival
Which of the following drugs is not positively inotropic?
A. Dopamine
B. Glucagon
73 D
C. Theophylline
D. Sodium thiopentone
A. Dobutamine
The blood - brain barrier is not highly permeable to which of the
following?
A. Carbon dioxide
74 B. Barbiturates E
C. Glucose
D. Oxygen
E. Hydrogen ions
A 43 year old presents to the urology clinic complaining of impotence.
Which of the following will occur in response to increased penile
parasympathetic stimulation?
A. Detumescence
75 B. Ejaculation C
C. Erection
D. Vasospasm of the penile branches of the pudendal artery
E. Contraction of the smooth muscle in the epididymis and vas
deferens
Which of the following substances related to thyroid function has its
effects mediated by a nuclear receptor?
A. Triiodothyronine
76 B. Thyroxine A
C. Thyroglobulin
D. Thyroid stimulating hormone
E. Thyroxin binding globulin
Which of the following best accounts for the action of PTH in increasing
serum calcium levels?
A. Activation of vitamin D to increase absorption of calcium from the
77 A
small intestine.
B. Direct stimulation of osteoclasts to absorb bone with release of
calcium.

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C. Stimulation of phosphate absorption at the distal convoluted tubule

of the kidney.
D. Decreased porosity of the vessels at Bowman's capsule to calcium.
E. Vasospasm of the afferent renal arteriole thereby reducing GFR and
calcium urinary loss.
Which of the following drugs is least likely to cause syndrome of
inappropriate anti-diuretic hormone release?
A. Haloperidol
78 B. Carbamazepine E
C. Amitriptyline
D. Cyclophosphamide
E. Methotrexate
Which of the following changes are not typically seen in established
dehydration?
A. Rising hematocrit
79 B. Urinary sodium <20mmol/ liter D
C. Metabolic acidosis
D. Decreased serum urea to creatinine ratio
E. Hypernatremia
A 67 year old male is admitted to the surgical unit with acute abdominal
pain. He is found to have a right sided pneumonia. The nursing staff put
him onto 15L O2 via a non rebreathe mask. After 30 minutes the patient
is found moribund, sweaty and agitated by the nursing staff. An arterial
blood gas reveals:
pH 7.15

pCO2 10.2

pO2 8
80 B

Bicarbonate 32

Base excess - 5.2

What is the most likely cause for this patient's deterioration?

A. Acute respiratory alkalosis secondary to hyperventilation
B. Over administration of oxygen in a COPD patient
C. Metabolic acidosis secondary to severe pancreatitis

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D. Metabolic alkalosis secondary to hypokalemia

E. Acute respiratory acidosis secondary to pneumonia
Which of the following statements relating to the pharmacology of
warfarin is untrue?
A. Interferes with clotting factors 2,7,9 and 10
81 B. It may not be clinically effective for up to 72 hours D
C. The half-life of warfarin is 40 hours
D. Warfarin has a large volume of distribution
E. It is metabolized in the liver
Which of the following does not cause an increased anion gap acidosis?
A. Uremia
B. Paraldehyde
82 C. Diabetic ketoacidosis E
D. Ethylene glycol
E. Acetazolamide
Which one of the following is least associated with thrombocytopenia?
A. Heparin therapy
B. Rheumatoid arthritis
83 B
C. Infectious mononucleosis
D. Liver disease
E. Pregnancy
Which of the following will increase the volume of pancreatic exocrine
secretions?
A. Octreotide
84 B. Cholecystokinin B
C. Aldosterone
D. Adrenaline
E. None of the above
Where is most of the iron found in the body?
A. Bone
B. Hemoglobin
85 B
C. Ferritin and hemosiderin
D. Myoglobin
E. Plasma iron
A 44 year old man receives a large volume transfusion of whole blood.
The whole blood is two weeks old. Which of the following best describes
its handling of oxygen?
A. It will have a low affinity for oxygen
86 E
B. Its affinity for oxygen is unchanged
C. It will more readily release oxygen in metabolically active tissues
than fresh blood
D. The release of oxygen in metabolically active tissues will be the

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same as fresh blood

E. It will have an increased affinity for oxygen
A 43 year old lady undergoes a day case laparoscopic cholecystectomy.
The operation is more difficult than anticipated and a drain is placed to
the operative site. Whilst in recovery, the patient loses 1800ml of frank
blood into the drain. Which of the following will not occur?
87 A. Release of aldosterone via the Bainbridge reflex A
B. Reduced urinary sodium excretion
C. Increase in sympathetic discharge to ventricular muscle
D. Fall in parasympathetic discharge to the sino atrial node
E. Decreased stimulation from atrial pressure receptors
Approximately what proportion of basal salivary secretions are provided
by the submandibular glands?
A. 10%
88 B. 70% B
C. 40%
D. 90%
E. 20%
Which is the least likely to cause hyperuricemia?
A. Severe psoriasis
B. Lesch-Nyhan syndrome
89 C
C. Amiodarone
D. Diabetic ketoacidosis
E. Alcohol
Which of the following statements relating to low molecular weight
heparins is false?
A. They act via inhibition of Factor Xa
B. Large doses may be used prior to commencing cardiopulmonary
90 B
bypass
C. They have a highly predictable pharmacokinetic profile
D. They are derivatives of unfractionated heparin
E. They have a molecular mass in the range of 3000-10000Da
A 43-year-old lady presents with urinary incontinence. At which of the
following locations is Onufs nucleus likely to be found?
A. Medulla oblongata
91 B. Anterior horn of L5 nerve roots D
C. Micturition center in the Pons
D. Anterior horn of S2 nerve roots
E. None of the above
Which of the following is associated with reduced lung compliance?
A. Older age
92 E
B. Emphysematous type COPD
C. Decline in pulmonary blood flow

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 MRCS I.V. Course

D. Adopting a vertical posture

E. Adjusting a ventilator to maintain high lung volumes
Which of the following statements relating to alveolar ventilation is
untrue?
A. Anatomical dead space is measured by helium dilution
B. Physiological dead space is increased in PE
93 A
C. Alveolar ventilation is defined as the volume of fresh air entering
the alveoli per minute
D. Anatomical dead space is increased by adrenaline
E. Type 2 pneumocytes in the alveoli secrete surfactant
A 57-year-old man is coming off the cardiac bypass circuit following a
successful coronary artery bypass procedure. Which drug should be
administered to normalise the patients clotting prior to decannulation and
chest closure?
94 A. Intravenous vitamin K B
B. Protamine sulphate
C. Aprotinin
D. Fresh frozen plasma
E. None of the above
Which of the following inhibits the secretion of insulin?
A. Adrenaline
B. Lipids
95 A
C. Gastrin
D. Arginine
E. Vagal cholinergic activity
What is measured to obtain renal plasma flow?
A. Creatinine
B. Para-amino hippuric acid (PAH)
96 B
C. Inulin
D. Glucose
E. Protein
Which of the following surgical procedures will have the greatest long
term impact on a patients calcium metabolism?
A. Distal gastrectomy
97 B. Cholecystectomy C
C. Extensive small bowel resection
D. Sub total colectomy
E. Gastric banding for obesity
A 52-year-old woman with a history of gastrectomy reports lethargy and a
98 sore tongue. Blood tests are reported as follows: A

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 MRCS I.V. Course

Hb 10.7 g/dl
MCV 121 fl
Plt 177 * 10^9/l
WBC 5.4 * 10^9/l

What is the most likely cause?

A. Vitamin B12 deficiency
B. Vitamin C deficiency
C. Iron deficiency anaemia
D. Anaemia of chronic disease
E. Vitamin E deficiency
A 43 year old lady is diagnosed with primary hyperparathyroidism. Her
serum PTH levels are elevated. An endocrine surgeon performs a
parathyroidectomy. How long will it take for the serum PTH levels to fall
if the functioning adenoma has been successfully removed?
99 A. 6 hours E
B. 24 hours
C. 2 hours
D. 1 hour
E. 10 minutes
Which of the following statements relating to abnormal coagulation is
false?
A. Warfarin affects the synthesis of factor 2,7,9,10
B. The prothrombin time is prolonged in Haemophilia A
100 C. Cholestatic jaundice can cause vitamin K deficiency B
D. Disseminated intravascular coagulation is associated with
thrombocytopenia
E. Massive transfusion is associated with reduced levels of factor 5
and 8
A 34 year old man presents with a peptic ulcer. Which of the following is
responsible for the release of gastric acid?
A. Chief cells
101 B. Parietal cells B
C. Brunners Glands
D. G Cells
E. None of the above
Which of the following does not lead to relaxation of the lower
oesophageal sphincter?
102 A
A. Metoclopramide
B. Botulinum toxin type A

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 MRCS I.V. Course

C. Nicotine
D. Alcohol
E. Theophylline
Which of these substances is not released from the islets of Langerhans?
A. Pancreatic polypeptide
B. Glucagon
103 C
C. Secretin
D. Somatostatin
E. Insulin
Which of the following is not classically seen in coning resulting from
raised intra cranial pressure?
A. Coma
104 B. Hypotension B
C. Unreactive mid-sized pupils
D. Cheyne Stokes style respiratory efforts
E. Bradycardia
Control of ventilation. Which statement is false?
A. Peripheral chemoreceptors are located in the bifurcation of the
carotid arteries and arch of the aorta
105 B. Central chemoreceptors respond to changes in O2 B
C. The respiratory centers control the rate and depth of respiration
D. Involuntary control of respiration is from the medulla and pons
E. Irritant receptors cause bronchospasm
A 54 year old lady has her serum calcium measured. Assuming her renal
function is normal, what proportion of calcium filtered at the glomerulus
will be reabsorbed by the renal tubules?
A. 5%
106 E
B. 15%
C. 25%
D. 50%
E. 95%
Which of the following does not cause hyperkalaemia?
A. Haemolysis
B. Burns
107 E
C. Familial periodic paralysis
D. Type 4 renal tubular acidosis
E. Severe malnutrition
Which of the following statements is true of glucagon?
A. Glucagon is produced in response to hyperglycaemia
B. Released by beta cells
108 D
C. Inhibits gluconeogenesis
D. Produced in response to an increase of amino acids
E. Composed of 2 alpha polypeptide chains linked by hydrogen bonds

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 MRCS I.V. Course

A 52 year old man develops septic shock following a Hartmans procedure

for perforated diverticular disease. He is started on an adrenaline infusion.
Which of the following is least likely to occur?
A. Peripheral vasoconstriction
109 B
B. Coronary artery vasospasm
C. Gluconeogenesis
D. Lipolysis
E. Tachycardia
Intra cranial pressure is governed by the principles of the Monroe-Kellie
doctrine. To which of the following does this concept not apply?
A. A 2 month old child
110 B. A 2 year old child A
C. A 5 year old child
D. A 10 year old child
E. An adult
Which of the following is not caused by cortisol in the stress response?
A. Anti-inflammatory effects
B. Hypoglycaemia
111 B
C. Skeletal muscle protein breakdown
D. Stimulation of lipolysis
E. Mineralocorticoid effects
Which of the following features does not put a patient at risk of refeeding
syndrome?
A. BMI < 16 kg/m2
112 B. Alcohol abuse C
C. Thyrotoxicosis
D. Chemotherapy
E. Diuretics
Which of the following statements relating to the regulation of renal
blood flow is untrue?
A. In a healthy 70Kg male, the glomerular filtration rate will be the
same at a systolic blood pressure of 120mmHg as a systolic blood
pressure of 95 mmHg
B. Over 90% of the blood supply to the kidney is distributed to the
113 cortex E
C. Both kidneys receive approximately 25% of the total cardiac output
at rest
D. A decrease in renal perfusion pressure will cause the
juxtaglomerular cells to secrete renin
E. Systolic blood pressures of less than 65mmHg will cause the
mesangial cells to secrete aldosterone
A 39 year old lady undergoes a laparoscopic cholecystectomy as a day
114 B
case . The operation is more difficult than anticipated and the surgeon

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 MRCS I.V. Course

places a drain to the liver bed. In recovery 1.5 liters of blood is seen to
enter the drain. Which of the following substances is the first to be
released in this situation?
A. Angiotensinogen
B. Renin
C. Angiotensin I
D. Angiotensin II
E. Aldosterone
Which of the following drugs causes hyperkalaemia?
A. Heparin
B. Ciprofloxacin
115 A
C. Salbutamol
D. Levothyroxine
E. Codeine phosphate
A 25-year-old man who has been morbidly obese for the past five years is
reviewed in the surgical bariatric clinic. In this patient, release of which of
the following hormones would increase appetite?
A. Leptin
116 D
B. Thyroxine
C. Adiponectin
D. Ghrelin
E. Serotonin
Which of the following is not linked to excess glucocorticoids?
A. Osteonecrosis
B. Osteoporosis
117 D
C. Hypokalaemia
D. Hyponatraemia
E. Growth retardation in children
A 54-year-old woman is admitted to the Surgical Admissions Unit with
abdominal pain. Blood tests taken on admission show the following:

Magnesium 0.40 mmol/l (normal value 0.7-1.0 mmol/l)

118 Which one of the following factors is most likely to be responsible for C
this result?
A. Excessive resuscitation with intravenous saline
B. Digoxin therapy
C. Diarrhoea
D. Hypothermia
E. Rhabdomyolysis

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 MRCS I.V. Course

A 43 year old man has a nasogastric tube inserted. The nurse takes a small
aspirate of the fluid from the stomach and tests the pH of the aspirate.
What is the normal intragastric pH?
A. 0.5
119 B
B. 2
C. 4
D. 5
E. 6
A 33 year old female is admitted for varicose vein surgery. She is fit and
well. After the procedure she is persistently bleeding. She is known to
have menorrhagia. Investigations show a prolonged bleeding time and
increased APTT. She has a normal PT and platelet count. What is the
most likely cause?
120 D
A. Anti phospholipid syndrome
B. Haemophilia
C. Factor V Leiden deficiency
D. von Willebrands disease
E. Protein C and S deficiency
Which of the following is the equivalent of cardiac preload?
A. End diastolic volume
B. Stroke volume
121 A
C. Systemic vascular resistance
D. Mean arterial pressure
E. Peak systolic arterial pressure
A 48 year old man undergoes a right hemicolectomy for a large caecal
polyp. In the immediate post operative period which of the physiological
processes described below is least likely to occur?
A. Glycogenolysis
122 D
B. Increased production of acute phase proteins
C. Increased cortisol production
D. Bronchoconstriction
E. Release of nitric oxide by vessels
A 73 year old female is referred to the surgical clinic with an iron
deficiency anaemia. As part of the diagnostic work up the doctor requests
a serum ferritin level. Which of the conditions listed is most likely to lead
to a falsely elevated result?
123 A. Locally perforated sigmoid colonic adenocarcinoma A
B. Colonic angiodysplasia
C. Dieulafoy lesion of the stomach
D. Transitional cell carcinoma of the bladder
E. Endometrial adenocarcinoma
Which of the following is least likely to cause a prolonged prothrombin
124 E
time?

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 MRCS I.V. Course

A. Cholestatic jaundice
B. Disseminated intravascular coagulation
C. Prolonged antibiotic treatment
D. Liver disease
E. Acquired factor 12 deficiency
What is the main component of colloid in the thyroid gland?
A. T3
B. Thyroglobulin
125 B
C. T4
D. Thyroxin binding globulin
E. TSH
Which statement about peristalsis is true?
A. Longitudinal smooth muscle propels the food bolus through the
esophagus
B. Secondary peristalsis occurs when there is no food bolus in the
126 A
esophagus
C. Food transfer from the esophagus to the stomach is 4 seconds
D. Circular smooth muscle is not involved in peristalsis
E. Peristalsis only occurs in the esophagus
A 24 year old man is injured in a road traffic accident. He becomes
oliguric and his renal function deteriorates. Which of the options below
would favor acute tubular necrosis over prerenal uremia?
A. No response to intravenous fluids
127 A
B. Urinary sodium < 20mmol/L
C. Bland colored urinary sediment
D. Increased urine specific gravity
E. None of the above
Which of the following is not an effect of cholecystokinin?
A. It causes gallbladder contraction
B. It increases the rate of gastric emptying
128 B
C. It relaxes the sphincter of oddi
D. It stimulates pancreatic acinar cells
E. It has a trophic effect on pancreatic acinar cells
Which part of the jugular venous waveform is associated with the closure
of the tricuspid valve?
A. a wave
129 B. c wave B
C. x descent
D. y descent
E. v wave
Which one of the following serum proteins is most likely to increase in a
130 patient with severe sepsis? C
A. Transferrin

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 MRCS I.V. Course

B. Transthyretin
C. Ferritin
D. Albumin
E. Cortisol binding protein
A 23 year old man has a routine ECG performed. Which part of the
tracing obtained represents atrial repolarization?
A. P wave
131 B. T wave E
C. Q-T Interval
D. P-R interval
E. None of the above
A 72-year-old woman is admitted to the acute surgical unit with profuse
vomiting. Admission bloods show the following:

Na+ 131 mmol/l

K+ 2.2 mmol/l
Urea 3.1 mmol/l
Creatini 56 micro
132 ne mol/l E

Glucose 4.3 mmol/l

Which one of the following ECG features is most likely to be seen?

A. Short PR interval
B. Short QT interval
C. Flattened P waves
D. J waves
E. U waves
The oxygen-haemoglobin dissociation curve is shifted to the left in:
A. With decreased 2,3-DPG in transfused red cells
B. Respiratory acidosis
133 A
C. Sudden move to high altitude
D. Pyrexia
E. Haemolytic anaemia
A patient has an arterial blood gas sample which provides the following
result:
134 pH 7.20 A

pO2 7.5

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 MRCS I.V. Course

Bicarbonate 22
pCO2 8.1
Chloride 10meq
What is the most likely cause?
A. Type II respiratory failure
B. Metabolic acidosis with increased anion gap
C. Metabolic alkalosis
D. Type I respiratory failure
E. Respiratory alkalosis
A homeless 42 year old male had an emergency inguinal hernia repair 24
hours previously. He has a BMI of 15. He has been put on a feeding
regime of 35 kcal/kg/day with no additional medications. The nursing
staff contact you as he has become confused and unsteady. On
examination the patient is disorientated to place, has diplopia and
135 nystagmus. What is the most likely diagnosis? E
A. Cerebellar stroke
B. Acute dystonic reaction
C. Cerebrovascular accident
D. Parkinsonism
E. Wernickes encephalopathy
A 77 year old man presents to pre operative clinic for a total knee
replacement. He is on furosemide for hypertension. He is known to have
multiple myeloma. He is found to have the following test results:
Na 120
Serum 280
osmolality (normal)
Urine
136 normal A
osmolality
Urine Na normal
What is the most likely cause?
A. Pseudohyponatraemia
B. Syndrome of inappropriate ADH secretion (SIADH)
C. Hypotonic hypovolaemic hyponatraemia
D. Psychogenic polydipsia
E. Hypertonic hypovolaemic hyponatraemia
A 48 year old lady has a metallic heart valve and requires a paraumbilical
137 B
hernia repair. Perioperatively she is receiving intra venous unfractionated

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 MRCS I.V. Course

heparin. To perform the surgery safely a normal coagulation state is

required. Which of the following strategies is routine standard practice?
A. Administration of 10 mg of vitamin K the night prior to surgery and
stopping the heparin infusion 6 hours preoperatively
B. Stopping the heparin infusion 6 hours preoperatively
C. Stop the heparin infusion on induction of anesthesia
D. Stopping the heparin infusion 6 hours pre operatively and
administration of intravenous protamine sulphate on commencing
the operation
None of the above
Which one of the following reduces the secretion of renin?
A. Erect posture
B. Adrenaline
138 E
C. Hyponatraemia
D. Hypotension
E. Beta-blockers
Which of the following stimulates prolactin release or action?
A. Leutinising hormone
B. Dopamine
139 C
C. Thyrotropin releasing hormone
D. Oestrogen
E. Follicle stimulating hormone
A 55 year old man undergoes a laparotomy and repair of incisional
hernia. Which of the following hormones is least likely to be released in
increased quantities following the procedure?
A. Insulin
140 A
B. ACTH
C. Glucocorticoids
D. Aldosterone
E. Growth hormone
Which of the following is not a major function of the spleen in adults?
A. Iron reutilization
B. Storage of platelets
141 E
C. Storage of monocytes
D. Hematopoiesis in hematological disorders
E. Storage red blood cells
Which one of the following is associated with increased lung compliance?
A. Kyphosis
142 B. Pulmonary oedema C
C. Emphysema
D. Pulmonary fibrosis

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 MRCS I.V. Course

E. Pneumonectomy
A 30 year old male is admitted electively for a right inguinal hernia repair
under local anaesthesia. He is otherwise well but his grandfather died from
a pulmonary embolism. What is the most appropriate form of
thromboprophylaxis?
A. Administration of low dose low molecular weight heparin for 2
weeks
143 B. Administration of high dose low molecular weight heparin for 2 C
weeks
C. No prophylaxis
D. Low dose low molecular weight heparin and pneumatic compression
stockings
High dose low molecular weight heparin and pneumatic compression
stockings
Which of the following substances related to thyroid function has its
secretion inhibited by increased plasma T3 and T4?
A. T3
144 B. T4 E
C. Thyroglobulin
D. Thyroxin binding globulin
E. Thyroid stimulating hormone
A 55 year old male is diagnosed with carcinoma of the head of the
pancreas. He reports that his stool sticks to the commode and will not
flush away. Loss of which of the following enzymes is most likely to be
responsible for this problem?
145 A. Lipase A
B. Amylase
C. Trypsin
D. Elastase
E. None of the above
Which of the following drugs does not interfere with the laboratory
analysis of serum cortisol levels?
A. Dexamethasone
146 B. Prednisolone A
C. Hydrocortisone IV
D. Hydrocortisone PO
E. Hydrocortisone IM
An elderly lady who presented with weight loss and malabsorption was
found to have amyloid of the small bowel. On presentation she was found
147 A
to have osteomalacia and was hypocalcaemic. Over the past seven days
she has received total parenteral nutrition with adequate calcium

EMRCS, Physiology 29 MRCS I.V. Course

 MRCS I.V. Course

replacement. Despite this she remained hypocalcaemic. Deficiency of

which of the following electrolytes is most likely to account for this
process?
A. Magnesium
B. Potassium
C. Sodium
D. Phosphate
E. None of the above
A 19 year old man is attacked outside a club and beaten with a baseball
bat. He sustains a blow to the right side of his head. He is brought to the
emergency department and a policy of observation is adopted. His
glasgow coma score deteriorates and he becomes comatose. Which of the
following haemodynamic parameters is most likely to be present?
148 A
A. Hypertension and bradycardia
B. Hypotension and tachycardia
C. Hypotension and bradycardia
D. Hypertension and tachycardia
E. Normotension and bradycardia
Which of the following drugs does not cause pseudohaematuria?
A. Rifampicin
B. Quinine
149 C
C. Noradrenaline
D. Levodopa
E. Phenytoin
A 74-year-old woman with thyroid cancer is admitted due to shortness of
breath. What is the best investigation to assess for possible compression
of the upper airways?
A. Arterial blood gases
150 E
B. Forced vital capacity
C. Transfer factor
D. Peak expiratory flow rate
E. Flow volume loop
Which of the following statements relating to cerebrospinal fluid is
untrue?
A. The choroid plexus is only present in the lateral ventricles
B. Total CSF volume is 100-150ml
151 A
C. CSF pressure is usually 10-15mmHg
D. The cerebral aqueduct connects the third and fourth ventricles
E. The foramen of Luschka are paired and lie laterally in the fourth
ventricle
Which substance can be used to achieve the most accurate measurement
152 of the glomerular filtration rate? C
A. Glucose

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 MRCS I.V. Course

B. Protein
C. Inulin
D. Creatinine
E. Para-amino hippuric acid
A 45 year old man sustains a closed head injury. He is initially alert,
however, his level of consciousness deteriorates on arrival at hospital. An
intra cranial pressure monitor is inserted. What is the normal intracranial
pressure?
153 A. 35 - 45mm Hg C
B. 45 - 55mm Hg
C. <15mm Hg
D. 25 - 35mm Hg
E. 25 - 30 mm Hg
A 55-year-old man with a history of type 2 diabetes mellitus, bipolar
disorder and chronic obstructive pulmonary disease has bloods taken
during a pre-operative assessment of an inguinal hernia repair:

Na+ 125 mmol/l

K+ 3.8 mmol/l
Bicarbonate 24 mmol/l
Urea 3.7 mmol/l
154 C
Creatinine 92 µmol/l

Due to his smoking history a chest x-ray is ordered which is reported as

normal. The Consultant asks you what is the most likely cause for the
hyponatraemia?
A. Metformin
B. Lithium
C. Carbamazepine
D. Sodium valproate
E. Pioglitazone
A 24 year old man is involved in a road traffic accident. His right leg is
trapped for 6 hours whilst he is moved. On examination his foot is
insensate and a dorsalis pedis pulse is only weakly felt. Which of the
biochemical abnormalities listed below is most likely to be present?
155 D
A. Alkalosis
B. Hypercalcaemia
C. Hypocalcaemia
D. Hyperkalaemia

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E. Hyponatraemia
A 39-year-old lady has recurrent attacks of biliary colic. What is the
approximate volume of bile to enter the duodenum per 24 hours?
A. 500 mL
156 B. 50 mL A
C. 100 mL
D. 2000 mL
E. 150 mL
At which of the following sites is the most water absorbed?
A. Right colon
B. Left colon
157 D
C. Stomach
D. Jejunum
E. Duodenum
Which of the following is not a characteristic of the proximal convoluted
tubule in the kidney?
A. Up to 95% of filtered amino acids will be reabsorbed at this site
B. It is a risk of damage in a patient with compartment syndrome due
158 to a tibial fracture D
C. It is responsible for absorbing more than 50% of filtered water
D. Its secretory function is most effective at low systolic blood
pressures (typically less than 100mmHg)
E. Glucose is reabsorbed by a process of facilitated diffusion
An arterial blood gas sample is taken and the following results obtained;
PaO2 8kPa
PaCO2 4kPa
pH 7.4
159 D
With which of the following are these values most consistent?
A. Compensated metabolic alkalosis
B. Pulmonary atelectasis
C. Alveolar hypoventilation
D. Residing at 4500M for 48 hours
E. LAD occlusion
Which of the following does not cause a normal anion gap acidosis?
A. Pancreatic fistula
B. Acetazolamide
160 C
C. Uraemia
D. Ureteric diversion
E. Renal tubular acidosis

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Which one of the following would cause a rise in the carbon monoxide
transfer factor (TLCO)?
A. Emphysema
161 B. Pulmonary embolism C
C. Pulmonary haemorrhage
D. Pneumonia
E. Pulmonary fibrosis
Which of the following is least likely to be associated with
hypercalcaemia?
A. Thiazides
162 B. Antacids C
C. Coeliac disease
D. Sarcoidosis
E. Zolinger-Ellison syndrome
Release of somatostatin from the pancreas will result in which of the
following?
A. Decrease in pancreatic exocrine secretions
163 B. Contraction of the gallbladder A
C. Increase in the rate of gastric emptying
D. Increased synthesis of growth hormone
E. Increased insulin release
A 34 year old lady develops septic shock and features of the systemic
inflammatory response syndrome as a complication of cholangitis. Which
of the following is not a typical feature of this condition?
A. Body temperature less than 36oC or greater than 38oC
164 C
B. Respiratory rate >20
C. Lactate <4 mmol/L
D. High levels of tumour necrosis factor α
E. WCC >12,000 mm3
Which of the following stimulates gastric acid secretion?
A. Cholecystokinin
B. Gastric inhibitory peptide
165 D
C. Secretin
D. Histamine
E. Somatostatin
Which of the following statements relating to gastric acid secretions are
untrue?
A. In parietal cells carbonic anhydrase generates hydrogen ions which
are then actively secreted
166 C
B. The cephalic phase is abolished following truncal vagotomy
C. The intestinal phase accounts for 60% of gastric acid produced
D. Histamine acts in a paracrine manner on H2 receptors
E. H2 receptor antagonists will not completely abolish gastric acid

EMRCS, Physiology 33 MRCS I.V. Course

 MRCS I.V. Course

production
A 22 year old man is undergoing a daycase excision of a sebaceous cyst.
He is needle phobic and as the surgeon approaches with the needle the
patient begins to hyperventilate. He soon develops circumoral parasthesia
and muscular twitching. Which of the following is the most likely
explanation for this event?
167 B
A. Temporal lobe epilepsy
B. Reduction in ionised calcium levels
C. Increase in ionised calcium levels
D. Fall in serum PTH levels
E. Rise in serum PTH levels
Which of the following inhibits gastric acid secretion?
A. Histamine
B. Nausea
168 B
C. Calcium
D. Parasympathetic vagal stimulation
E. Gastrin
A 73 year old lady is diagnosed with hyperaldosteronism. From which of
the following structures is aldosterone released?
A. Zona fasciculata of the adrenal gland
169 B. Juxtaglomerular apparatus of the kidney E
C. Zona reticularis of the adrenal gland
D. Adrenal medulla
E. Zona glomerulosa of the adrenal cortex
Which of the following hormonal agents will increase secretions of water
and electrolytes in pancreatic juice?
A. Secretin
170 B. Aldosterone A
C. Somatostatin
D. Cholecystokinin
E. Adrenaline
A 43 year old lady is admitted with cholestasis secondary to a stone
impacted at the level of the ampulla of vater. Which of the following tests
is most likely to be predictive of bleeding diathesis at the time of ERCP in
this particular case?
171 A. Bleeding time B
B. Prothrombin time
C. APTT
D. Platelet count
E. Factor I levels
Which of the following mechanisms best accounts for the release of
172 adrenaline? D
A. Release from the adrenal medulla in response to increased

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 MRCS I.V. Course

angiotensin 1 levels
B. Release from the zona fasiculata from the adrenal gland in response
to increased sympathetic discharge
C. Release from the adrenal medulla in response to increased
noradrenaline levels
D. Release from the adrenal medulla in response to sympathetic
stimulation from the splanchnic nerves
E. None of the above
The acute phase response to injury does not typically include:
A. Pyrexia
B. Decreased albumin
173 D
C. Hepatic sequestration of cations
D. Increased transferrin
E. Increased serum amyloid A
A 73 year old man presents to pre operative clinic for an elective total hip
replacement. He is on furosemide for hypertension. His investigations
reveal to the following results:
Na 120
Urine Na 10 (low)

174 Serum 280 A

osmolality (normal)
What is the most likely cause?
A. Hypotonic hypovolaemic hyponatraemia
B. Hypertonic hypovolaemic hyponatraemia
C. Syndrome of inappropriate ADH secretion
D. Over administration of 5% dextrose
E. Glomerulonephritis
Which of the following statements relating to blood transfusions in
surgical patients is false?
A. Packed red cells typically have a hematocrit of between 55 and
75%
B. Clotting factor activity in whole blood decreases in samples stored
175 E
for longer than 7 days
C. After 3 weeks of storage blood has a pH of 6.9
D. Gamma irradiated blood products are not required routinely
E. Patients should be transfused to achieve a target haemoglobin of 10
g/dl and a haematocrit of 30%
Which of the following statements relating the fluid physiology of a
176 physiologically normal 70 Kg adult male is false? B
A. He will have more water per unit of body weight than a female of

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similar weight
B. Plasma will comprise 25% of his body weight
C. Interstitial fluid will account for up to 24% of body water
D. Approximately 65% of total body water is intracellular
E. 60% of his body weight is composed of water
A 69 year old man has been living in sheltered accommodation for many
months, with inadequate nutrition notices that his night vision is
becoming impaired. Deficiency of which vitamin is responsible?
A. Vitamin B3
177 B
B. Vitamin A
C. Vitamin C
D. Vitamin B12
E. Vitamin E
A 17 year old lady with long standing anorexia nervosa is due to undergo
excision of a lipoma. Which of the following nutritional deficiencies is
most likely to be implicated in poor collagen formation as the wound
heals?
178 A. Deficiency of copper C
B. Deficiency of iron
C. Deficiency of ascorbic acid
D. Deficiency of phosphate
E. None of the above
A 45 year old man is undergoing a small bowel resection. The
anaesthetist decides to administer an intravenous fluid which is electrolyte
rich. Which of the following most closely matches this requirement?
A. Dextrose / Saline
179 D
B. Pentastarch
C. Gelofusine
D. Hartmans
E. 5% Dextrose with added potassium 20mmol/ L
A 16 year old girl develops pyelonephritis and is admitted in a state of
septic shock. Which of the following is not typically seen in this
condition?
A. Increased cardiac output
180 B
B. Increased systemic vascular resistance
C. Oliguria may occur
D. Systemic cytokine release
E. Tachycardia
Which of the following statements are not typically true in hypokalaemia?
A. It may occur as a result of mechanical bowel preparation
181 B. Chronic vomiting may increase renal potassium losses E
C. It may be associated with aciduria
D. It may cause hyponatraemia

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E. It often accompanies acidosis

A man is admitted after a period of prolonged self, induced starvation.
Naso gastric feeding is planned. Which of the following is least likely to
occur?
A. Hypokalaemia
182 C
B. Increased risk of cardiac arrhythmias
C. His haemoglobin will have decreased affinity for oxygen
D. Hypophosphataemia
E. Hypoalbuminaemia
Where does spironolactone act in the kidney?
A. Glomerulus
B. Proximal convoluted tubule
183 E
C. Descending limb of the loop of Henle
D. Ascending limb of the loop of Henle
E. Distal convoluted tubule
Which receptor does noradrenaline mainly bind to?
A. α 1 receptors
B. α 2 receptors
184 A
C. β 1 receptors
D. β 2 receptors
E. G receptors
What is the most significant event to contribute to wound healing
immediately following injury?
A. Neutrophil activation
185 B. Platelet degranulation B
C. Endothelial cell proliferation
D. Migration of tissue macrophages
E. Proliferation of wound bed fibroblasts
Adult lung volumes. Which statement is false?
A. In restrictive lung disease the FEV1/FVC ratio is increased
B. Residual volume is increased in emphysema
186 E
C. Functional residual capacity is measured by helium dilution test
D. The tidal volume is approximately 340mls in females
E. The vital capacity is increased in Guillain Barre syndrome
A 47 year old lady is diagnosed as suffering from a pheochromocytoma.
From which of the following amino acids are catecholamines primarily
derived?
A. Aspartime
187 D
B. Glutamine
C. Arginine
D. Tyrosine
E. Alanine

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Where are the arterial baroreceptors located?

A. Carotid sinus and aortic arch
B. Carotid sinus only
188 A
C. Superior vena cava
D. External carotid artery
E. None of the above
Which one of the following cells secretes the majority of tumour necrosis
factor in humans?
A. Neutrophils
189 B. Macrophages B
C. Natural killer cells
D. Killer-T cells
E. Helper-T cells
Which of the following is responsible for the rapid depolarization phase
of the myocardial action potential?
A. Rapid sodium influx
190 B. Rapid sodium efflux A
C. Slow efflux of calcium
D. Efflux of potassium
E. Rapid calcium influx
Which of the following is not a feature of normal cerebrospinal fluid?
A. It has a pressure of between 10 and 15 mmHg.
B. It usually contains a small amount of glucose.
191 C
C. It may normally contain up to 5 red blood cells per mm3.
D. It may normally contain up to 3 white blood cells per mm3.
E. None of the above
Which of the following is not an effect of somatostatin?
A. It stimulates pancreatic acinar cells to release lipase
B. It decreases gastric acid secretion
192 A
C. It decreases gastrin release
D. It decreases pepsin secretion
E. It decreases glucagon release
193 A 73 year old man undergoes an emergency amputation for severe lower A
limb sepsis and gangrene. Post operatively he develops disseminated
intravascular coagulation. Which of the following clotting factors will be
most rapidly consumed in this process?
A. Factor V and VIII
B. Factor I
C. Factor I and III
D. Factor III and VII
E. Factor VI and VIII

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194 A 22 year old man is having a blood transfusion after losing blood from a D
peptic ulcer. He is normally fit and well. Four hours after the transfusion;
he complains of sudden onset shortness of breath and chest pain. On
examination his temperature is 37.2, saturations are 88% on air, blood
pressure 100/55 mmHg and HR 110 bpm. He has crepitations bilaterally
up to the midzones. He is given IV furosemide but deteriorates and is
admitted to ITU. Invasive monitoring shows normal right heart pressures.
What is the most likely underlying process?
A. Acute haemolytic transfusion reaction
B. Delayed haemolytic transfusion reaction
C. Fluid overload
D. Transfusion associated lung injury
E. Graft versus host disease
195 A woman is diagnosed as having pernicious anaemia. What is the most A
likely underlying explanation for this?
A. Autoimmune antibodies to parietal cells
B. Autoimmune antibodies to chief cells
C. Autoimmune antibodies to goblet cells
D. Autoimmune antibodies to Brunners glands
E. Autimmune antibodies to fundic cells
196 A pregnant women suddenly develops bilateral leg swelling. Her mother C
and aunt were troubled by the same problem. What is the most likely
underlying abnormality?
A. Anti endomysial antibodies
B. Anti nuclear antibodies
C. Anti cardiolipin antibodies
D. Anti thyroid antibodies
E. Anti mitochondrial antibodies
197 A 73 year old lady is admitted for a laparoscopic cholecystectomy. During A
her pre-operative assessment it is noted that she is receiving furosemide
for the treatment of hypertension. Approximately what proportion of
the sodium that is filtered at the glomerulus will be subsequently
excreted?
A. Up to 25%
B. Up to 75%
C. Between 3 and 5%
D. <2%
E. Between 1 and 2%
198 A 34 year old woman presents with recurrent peptic ulceration. She is on C
proton pump inhibitors and previously received Helicobacter pylori

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eradication therapy three months ago. Which of the following is likely to

be raised on venous blood testing?
A. Secretin
B. Cholecystokinin
C. Gastrin
D. Amylase
E. Histamine
199 Which of the following is least associated with thrombosis? D
A. Endothelial cell damage
B. Use of tourniquets in surgery
C. Formation of platelet aggregates
D. Thrombocytopenia
E. Carcinoma of the stomach
200 A 28 year old female attends the gynaecology unit for a D and C A
following an incomplete miscarriage. She has previously had recurrent
pulmonary embolic events. After the procedure she is persistently
bleeding. Her APTT is 52 (increased). What is the most likely cause?
A. Antiphospholipid syndrome
B. DIC
C. Haemophilia B
D. von Willebrand disease
E. Factor V Leiden deficiency
201 A 43 year old man presents with dyspepsia and undergoes an upper GI E
endoscopy. During the procedure diffuse gastric and duodenal ulcers are
identified. A Clo test confirms the presence of Helicobacter
pylori infection. What is the most likely explanation for the ulcers?
A. Decreased gastric motility
B. Increased urease activity
C. Decreased release of mucous and bicarbonate
D. Decreased gastrin levels
E. Increased acid production
202 What is the most likely electrolyte abnormality in a patient with B
diarrhoea and a soft mass felt on digital rectal examination?
A. Hyperkalaemia
B. Hypokalaemia
C. Hyponatraemia
D. Hypernatraemia
E. Hypocalcaemia
203 A 25 year old male pedestrian is involved in a road traffic accident. He B
sustains multiple injuries and is admitted to the intensive care unit,
intubated and ventilated. Over the next week he develops adult

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respiratory distress syndrome. What is the main reason for hypoxaemia

in this condition?
A. Increased lung compliance
B. Reduced diffusion
C. Reduced surfactant
D. Reduced elastase
E. Left to right shunt
204 An enthusiastic medical student approaches you with a list of questions A
about blood transfusion reactions. Which of her following points is
incorrect?
A. Graft versus host disease involves neutrophil proliferation
B. Thrombocytopaenia may occur in women with a prior pregnancy
C. IgA antibodies may cause blood pressure compromise during
transfusion
D. Hypocalcaemia can occur
E. Iron overload can be avoided by chelation therapy
205 A 72 year old man has just undergone an emergency repair for a ruptured B
abdominal aortic aneurysm. Pre operatively he was taking aspirin,
clopidogrel and warfarin. Intra operatively he received 5000 units of
unfractionated heparin prior to application of the aortic cross clamp. His
blood results on admission to the critical care unit are as follows:
Full blood count
Hb 8 g/dl
Platelets 40 * 109/l
WBC 7.1 * 109/l
His fibrin degradation products are measured and found to be markedly
elevated. Which of the following accounts for these results?
A. Anastomotic leak
B. Disseminated intravascular coagulation
C. Heparin induced thrombocytopenia
D. Adverse effect of warfarin
E. Adverse effects of antiplatelet agents
206 Which of the arterial blood gas analyses shown below would most likely E
be seen with a patient who has a pulmonary embolus?
A. pH 7.64, pO2 10.0 kPa pCO2 2.8 kPa, HCO3 20
B. pH 7.25, pO2 8.9, pCO2 3.2, HCO3 10
C. pH 7.20, pO2 6.2, pCO2 8.2, HCO3 27
D. pH 7.60, pO2 8.2, pCO2 5.8, HCO3 40

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E. pH 7.50, pO2 7.2, pCO2 2.5, HCO3 24

207 Which of the following conditions is most likely to be associated with these
arterial blood gas sample results:
pH 7.48

pO2 10.1

HCO3 30

pCO2 4.5 C

Cl- 96mEq
A. Respiratory alkalosis
B. Metabolic acidosis with normal anion gap
C. Metabolic alkalosis
D. Metabolic acidosis with increased anion gap
E. Type 2 respiratory failure
208 Which of the agents listed below is a phosphodiesterase inhibitor?
A. Milrinone
B. Metaraminol A
C. Dopamine
D. Dobutamine
E. Adrenaline
209 A 22 year old lady is admitted to the intensive care unit following a
laparotomy. She has a central line, pulmonary artery catheter and arterial
lines inserted. The following results are obtained:

Pulmonary artery occlusion Cardiac Systemic vascular

pressure output resistance

Low High Low B

How may these findings be best interpreted?
A. Hypovolaemia
B. Septic shock
C. Normal
D. Fluid overload
E. Cardiogenic shock

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210 A 53 year old man has an arterial blood gas sample taken and the following
results are obtained, he is breathing room air.

pH 7.49

pO2 8.5

HCO3 22

pCO2 2.4
A
Cl- <10meq
Which of the conditions listed below is most likely to account for these
findings?
A. Respiratory alkalosis
B. Type 2 respiratory failure
C. Metabolic acidosis with increased anion gap
D. Metabolic alkalosis
E. Metabolic acidosis with normal anion gap
211 A 28 year old lady with known von Willebrand's disease is bleeding
following the excision of a sebaceous cyst. Administration of which of the
following agents is most likely to be beneficial?
A. Desmopressin A
B. Factor IX concentrate
C. Factor VII concentrate
D. Factor X concentrate
E. Vasopressin
212 A 45 year old man is admitted to the intensive care unit following a
laparotomy. He has a central line, pulmonary artery catheter and arterial
lines inserted. The following results are obtained:

Pulmonary
Systemic vascular
artery occlusion Cardiac output E
resistance
pressure

Low Low High

What is the most likely interpretation of this?
A. Normal

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B. Cardiogenic shock
C. Septic shock
D. Fluid overload
E. Hypovolemia
213 A patient with tachycardia and hypotension is to receive vasopressors.
Which of the following conditions are most likely to be treated with
vasopressors?
A. Hypovolaemic shock
B
B. Septic shock
C. Neurogenic shock
D. Cardiogenic shock
E. None of the above
214 Which of the arterial blood gas analyses would most likely be seen in a
patient with a high output ureterosigmoidostomy?
A. pH 7.64, pO2 10.0 kPa pCO2 2.8 kPa, HCO3 20
B. pH 7.25, pO2 8.9, pCO2 3.2, HCO3 10 B
C. pH 7.20, pO2 6.2, pCO2 8.2, HCO3 27
D. pH 7.60, pO2 8.2, pCO2 5.8, HCO3 40
E. pH 7.45, pO2 7.2, pCO2 2.5, HCO3 24
215 Which of the agents listed below can be administered via the peripheral
intra venous route in the non-cardiac arrest setting?
A. Milrinone
B. Noradrenaline D
C. Adrenaline
D. Metaraminol
E. Dobutamine
216 Which of the following agents is most likely to be helpful in controlling
refractory hypotension in a 23 year old female with severe pyelonephritis?
A. Noradrenaline
B. Adrenaline A
C. Dobutamine
D. Dopamine
E. Milrinone
217 Which arterial blood gas sample best represents widespread mesenteric
infarction?
B
A. pH 7.64, pO2 10.0 kPa pCO2 2.8 kPa, HCO3 20
B. pH 7.25, pO2 8.9, pCO2 3.2, HCO3 10

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C. pH 7.20, pO2 6.2, pCO2 8.2, HCO3 27

D. pH 7.60, pO2 8.2, pCO2 5.8, HCO3 40
E. pH 7.45, pO2 7.2, pCO2 2.5, HCO3 24
218 A 75 year old man is admitted to the intensive care unit following a
laparotomy. He has a central line, pulmonary artery catheter and arterial
lines inserted. The following results are obtained:
Pulmonary artery Systemic vascular
Cardiac output
occlusion pressure resistance

High Low High E

How may these findings be best interpreted?
A. Hypovolaemia
B. Normal
C. Neurogenic shock
D. Septic shock
E. Cardiogenic shock
219 You are the cardiothoracic surgical registrar reviewing a patient referred
for an aortic valve replacement. The 40-year-old man is being investigated
for progressive breathlessness in a previous respiratory clinic. The notes
show he has smoked for the past 25 years. Pulmonary function tests reveal
thefollowing:

FEV1 1.4 L

FVC 1.7 L
C
FEV1/FVC 82%

What is the most likely explanation?

A. Asthma
B. Bronchiectasis
C. Kyphoscoliosis
D. Chronic obstructive pulmonary disease
E. Laryngeal malignancy
220 A 78 year old man presents with a ruptured aortic aneurysm. This is
repaired but the operation is difficult as it has a juxtarenal location. A supra D
renal cross clamp is applied. Post operatively he is found to be oliguric and

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acute renal failure is suspected. Which of the following statements relating

to acute post-operative renal failure are untrue?
A. Intravenous dopamine does not prevent acute renal failure.
B. It is more common after emergency surgery.
C. Use of excessive amounts of intravenous fluids may lead to falsely
normal serum creatinine measurements.
D. Vasopressor drugs have a strong renoprotective effect
E. It is minimized by normalization of haemodynamic status.
221 A 50 year old man has an arterial blood gas sample taken and the following
results are obtained, he is breathing room air.
pH 7.20

pO2 7.5

HCO3 22

pCO2 8.1
E
Cl- 10meq
Which of the conditions listed below is most likely to account for these
findings?
A. Type 1 respiratory failure
B. Metabolic alkalosis
C. Metabolic acidosis with normal anion gap
D. Metabolic acidosis with increased anion gap
E. Type 2 respiratory failure
222 A 63 year old man undergoes a subtotal colectomy and iatrogenic injury to
both ureters is sustained. He develops renal failure and his serum potassium
is found to be elevated at 6.9 mmol/L. An ECG is performed, what is the
most likely finding?
A. Increased PR interval D
B. Prominent U waves
C. Narrow QRS complexes
D. Peaked T waves
E. Low ST segments
223 Which of the following is not directly affected by warfarin?
A. Protein C E
B. Factor II

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C. Factor VII
D. Factor IX
E. Factor VIII
224 A 63 year old man undergoes a laparotomy and small bowel resection.
Twelve hours post operatively he is noted to have a decreased urine output.
Which of the hormones listed below is most likely to be responsible?
A. Cortisol
C
B. Atrial natriuretic hormone
C. Vasopressin
D. Insulin
E. Glucagon

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