BECOM 2 Exam 4 – 2018

 

  1. What tissue is found at the end of the arrow?

    1. Infundibulum
    2. Pars tuberalis
    3. Pars intermedius
    4. Pars nervosa
    5. Pars distalis


  2. Thyroglobulin is produced from which of the following types of cells?

    1. A
    2. B
    3. C
    4. D
    5. None of these cells secrete thyroglobulin.


  3. Which of the following hormones is produced by an acidophilic cell type?
    1. Prolactin (PRL)
    2. Follicle Stimulating Hormone (FSH)
    3. Luteinizing hormone (LH)
    4. Adrenal corticotropin (ACTH)
    5. Lipotropin (LPH)


  4. A pituitary adenoma secreting somatotropin in a child would cause which of the following conditions?
    1. Addisons’ Disease
    2. Congenital adrenal hyperplasia
    3. Type I DM
    4. Gigantism
    5. Acromegaly  


  5. Pitocin is a synthetic oxytocin injection often used to induce labour. Although it is man-made, the drug works identical to the naturally occurring hormone Oxytocin. Which of the following is a potential side effect of excessive Pitocin?
    1. Hypertension
    2. Increased frequency in urination
    3. Milk synthesis
    4. Postpartum depression
    5. Hyperkalemia


  6. After seeing a patient who has been complaining of diarrhea for several days, you decide to take a stool sample and evaluate the sample microscopically. After using an acid-fast stain, you see an abundance of a large organism in the range of 10 micrometers. What is the most likely organism for you to have found?
    1. Entamoeba histolytica
    2. Cyclospora
    3. Cryptosporidium
    4. Mycobacterium
    5. Toxoplasma gondii


  7. A patient with a history of AIDS presents to your clinic with a complaint of diarrhea for the last 3 days. Which of these would be most concerning in regards to your patient?
    1. Giardia lamblia
    2. Cryptosporidium
    3. Entamoeba histolytica
    4. Trypanosoma brucei
    5. Pediculus humanus


  8. A patient in the hospital has been experiencing a recurring fever and hematuria over the past week and imaging shows signs of cerebral hemorrhage. Blood analysis shows a protozoan infection affecting all RBCs. What is a likely specimen that could be causing these clinical presentations?
    1. P. falciparum
    2. P. malariae
    3. P. vivax
    4. P. ovale
    5. P. rotundum


  9. What is the invading organism in the blood smear shown below?

    1. Toxoplasma gondii
    2. Entamoeba histolytica
    3. Giardia lamblia
    4. Plasmodium falciparum
    5. Babesia microti


  10. Congenital adrenal hyperplasia is caused by a lack of which hormone?
    1. Aldosterone
    2. Cortisol
    3. Androstenedione
    4. DHEA
    5. ACTH


  11. A 23 year old female presents with severe hypotension, nausea, irregular heart rhythm, and exhaustion. Blood tests confirm hyperkalemia with low mineralocorticoid and glucocorticoid levels. Physical exam is otherwise unremarkable. Which adrenal enzyme would you expect to be low in a patient with this presentation?
    1. CYP21A2
    2. CYP17A1
    3. Aldosterone synthase
    4. HSD3B2
    5. CYP19A1


  12. A 57 year old caucasian male presents to the clinic with difficulty swallowing, enlarged lymph nodes, and a hoarse voice. Endoscopy reveals a mass in the distal esophagus. A biopsy is taken and is identified as esophageal adenocarcinoma. The patient has had a long history of gastroesophageal reflux. Which of the following correctly describes the metaplasia of the esophageal epithelium that most likely occurred prior to this patient’s diagnosis?
    1. Simple Columnar to stratified squamous
    2. Stratified squamous to simple columnar
    3. Stratified squamous to simple cuboidal
    4. Simple cuboidal to stratified squamous
    5. Stratified squamous to transitional epithelium


  13. A 32 year old female presents to the clinic 12 weeks pregnant. Upon further testing, you discover that her total T3/T4 levels are high. Which of the following is TRUE regarding this patient?
    1. She will have symptoms of hyperthyroidism brought about by the high levels of hCG during pregnancy
    2. She will have symptoms of hypothyroidism brought about by the high levels of hCG during pregnancy
    3. She most likely has Graves’ disease
    4. Iron deficiency anemia associated with pregnancy will cause hyperthyroidism
    5. If tested, her free levels of thyroid hormones would most likely be normal.


  14. Which of the following is a potential symptom of hypothyroidism?
    1. Heat intolerance
    2. Weight loss
    3. Hypercholesterolemia
    4. Tachycardia  
    5. Palpitations  

       
  15. A 6 month old female patient presents to the clinic with symptoms of iodine deficiency. Urinalysis reveals high levels of MIT and DIT. Which of the following is most likely deficient?
    1. Selenodeionidase
    2. TPO
    3. NIS
    4. Pendrin
    5. iodotyrosine deiodinase
  16. Selenium deficiency could result in which of the following symptoms?
    1. Water hammer pulse pressure
    2. Hyperreflexia
    3. Cardiomegaly
    4. Heat intolerance
    5. Weight loss


  17. You are on rotations in OB-GYN when a a 25 year old woman presents to the clinic 6 weeks pregnant. She reports having recent symptoms of slow reflexes, intolerance to cold, and goiter within the last 6 months. You learn that she has been only consuming himalayan pink salt because it’s “all natural.” What is your main concern regarding this patient?
    1. Deficient intrauterine T3 can result in mental and growth retardation in her fetus
    2. Her hCG levels may be low indicating a problem with the pregnancy
    3. Although her fetus won’t be affected, you recommend that the woman be treated for Iodine deficiency.
    4. This patient most likely has a congenital hypothyroidism and should be placed on a synthetic thyroid hormone  
      Overactive TSH from Iodine deficiency would lead to increase T3 and developmental delays in the fetus.


  18. The detection of increased levels of 24,25-hydroxycholecalciferol would be accompanied by which of the following?
    1. Elevated plasma concentration of calcium
    2. Elevated levels of parathyroid hormone
    3. Decreased plasma concentration of thyroid hormones
    4. Decreased plasma concentration of Vitamin D3
    5. Elevated levels of 25-hydroxycholecalciferol


  19. Stimulation of the endocrine function of pancreatic alpha cells can be inhibited by:
    1. Norepinephrine
    2. High plasma amino acid concentration
    3. Epinephrine
    4. Somatostatin
    5. Hypoglycemia


  20. Which of the following hormones is NOT considered to be ketogenic?
    1. Glucagon
    2. Cortisol
    3. Growth Hormone
    4. Insulin
    5. DHEA


  21. A common biomarker for pancreatic adenocarcinomas reduces gastric emptying time by binding to Y4 receptors. Which pancreatic cell type secretes this hormone?
    1. α cells
    2. β cells
    3. ε cells
    4. δ cells
    5. F cells


  22. In a male patient with epispadias, the urethral tract has improperly fused during development. At what point in male embryological development is the full urethral tract completed?
    1. 4th week
    2. 7th week
    3. 9th week
    4. 11th week
    5. 12th week


  23. During the development of the female reproductive system, it is possible for the superior portion of the paramesonephric ducts to fail to fuse. Which abnormality would arise in this scenario
    1. Double uterus with double vagina
    2. Double uterus with single vagina
    3. Bicornuate uterus
    4. Unicornuate uterus
    5. Divided uterus


  24. A male patient is born with an external urethral orifice on the ventral surface of the glans, a condition known as?
    1. Epispadias
    2. Hypospadias
    3. Hydrocele
    4. Cryptorchidism
    5. Peraspadias


  25. Which of the following statements is true concerning the regulation of hormone secretion by GnRH neurons?
    1. GnRH neuronal activity is increased by activation of sex steroid hormone receptors on the GnRH neurons
    2. GnRH neuronal activity is decreased by activation of sex steroid hormone receptors on the GnRH neurons
    3. GnRH neuronal activity is increased by activation of kisspeptin receptors on the GnRH neurons
    4. GnRH neuronal activity is decreased by activation of neurokinin B receptors on the GnRH neurons
    5. GnRH neuronal activity is increased by activation of beta endorphin receptors on the GnRH neurons


  26. A person with a deficiency in 17βHSD type 3 would have a problem with which steroidal reaction?
    1. Activation of estrogens
    2. Deactivation of estrogens
    3. Activation of androgens
    4. Deactivation of androgens


  27. Which of the following is a function of the zona pellucida?
    1. Prevents polyspermy
    2. Facilitates fertilization
    3. Protects zygotes against immunologic rejection
    4. A & B
    5. A, B & C


  28. Which of the following hormones is DIRECTLY responsible for ovulation?
    1. LH
    2. Estradiol
    3. Progesterone
    4. FSH
    5. Estrone


  29. Which of the following mechanisms has been hypothesized to cause hormonal atresia?
    1. Lack of sufficient aromatase receptors in non-dominant follicles lead to a build up of androgens and production of Estrogen leading to atresia  
    2. Lack of sufficient aromatase receptors in non-dominant follicles leads to a build up of FSH causing the death signal associated with atresia
    3. The LH surge in the non-dominant follicles causes atresia
    4. Lack of progesterone in the non-dominant follicle causes atresia
    5. Lack of sufficient aromatase receptors in non-dominant follicles lead to a build up of androgens and production of DHT leading to atresia


  30. The menstrual phase of the uterine cycle is closely correlated with which of the following?
    1. Low progesterone and high estrogen
    2. Low progesterone and low estrogen
    3. High progesterone and low estrogen
    4. High progesterone and high estrogen
    5. Presence of the corpus luteum


  31. Which of the following hormones is responsible for the onset of the secretory phase of the uterine cycle?
    1. Estradiol
    2. Estrone
    3. Progesterone
    4. FSH
    5. LH


  32. Which of the following hormones is responsible for the slight increase in body temperature associated with early pregnancy?
    1. Estradiol
    2. Estrone
    3. Progesterone
    4. FSH
    5. LH


  33. It is not uncommon for women suffering from malnutrition to become infertile. Which of the following best explains the mechanisms for how this infertility arises?
    1. Hunger stimulates both CRH and ACTH which act to induce beta-endorphin and inhibit GnRH secretion
    2. Hunger stimulates CRH and ACTH which act on Arcuate Kisspeptin to inhibit GnRH secretion
    3. Increased cortisol directly inhibits GnRH secretion
    4. Increased cortisol directly inhibits LH secretion
    5. Increased cortisol directly inhibits FSH secretion


  34. Which of the following best describes the mechanism for progesterone-only contraceptive pills?
    1. It causes the cervical mucus to become thin and watery
    2. It causes a ferning effect on the cervical mucus
    3. Prevents the LH surge
    4. Increase the thickness of the cervical mucus
    5. Increase uterine contractions and causing miscarriage


  35. Which of the following is NOT associated with menopause?
    1. Higher risk for osteoporosis
    2. Higher risk for cardiovascular disease
    3. Low Estrogen
    4. Elevated Gonadotropins
    5. High progesterone


  36. Which of the following is TRUE regarding estrogen?
    1. E1 (estrone) is the most active form
    2. E2 (estradiol) is most closely associated with pregnancy
    3. Estrogens bind to albumin with high affinity
    4. More Estrogens are bound to albumin than SHBG
    5. E3 (estriol) is the main estrogen produced during menopause


  37. hCG is produced by which of the following?
    1. Chorionic villi
    2. Corpus luteum
    3. Corpus albicans
    4. Granulosa cells
    5. Theca interna cells


  38. You are on rotations in the OB-GYN when a 24 year old female presents for her first prenatal appointment following a positive home pregnancy test. You are performing follow up bloodwork and urinalysis to confirm pregnancy. Assuming the patient is otherwise healthy, what would be a normal substance to find in excess in her urine?
    1. Potassium
    2. Bicarbonate
    3. Calcium
    4. Sodium
    5. Testosterone


  39. Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. It increase the risk of pre-eclampsia, depression, and requiring a Caesarean section. Which of the following hormones is most likely associated with gestational diabetes?
    1. Relaxin
    2. Human chorionic Gonadotropin
    3. Growth Hormone
    4. Progesterone
    5. Human chorionic somatomammotropin


  40. Organophosphates are toxic agents used in insecticides, medications, and nerve agents. The underlying mechanism involves the inhibition of acetylcholinesterase, leading to the buildup of acetylcholine (ACh) in the body. Which of the following is a likely effect of Organophosphate poisoning on the GI system?
    1. Increased excitability of smooth muscle and diarrhea
    2. Increased excitability of smooth muscle and constipation
    3. Decreased excitability of smooth muscle and diarrhea
    4. Decreased excitability of smooth muscle and constipation
    5. Increased excitability of skeletal muscle and diarrhea


  41. Diltiazem is a medication used to prevent chest pain by blocking L-type calcium channels Which of the following is a likely side effect of a patient taking Diltiazem?
    1. Hypertension
    2. Tachycardia
    3. Diarrhea
    4. Constipation
    5. Psychosis


  42. You are on rotations in the Emergency Department when a 19 year old male presents following a heroine overdose. Your attending administers Naloxone (Narcan) to reverse the overdose. When the patient finally becomes conscious, the attending asks you to inform the patient of the side effects of this drug. Which of the following is a potential GI side effect from Naloxone?
    1. Constipation
    2. Bloating
    3. Diarrhea
    4. Hematochezia
    5. Melena


  43. Vagotomy is a surgical procedure that involves removing part of the vagus nerve. This procedure is done typically to reduce the rate of gastric secretion (e.g. in treating peptic ulcers). Which of the following structures would NOT be affected in a patient that has undergone a vagotomy
    1. Small intestine
    2. Upper colon
    3. Pancreas
    4. Esophagus
    5. Sigmoid colon


  44. It has been hypothesized that irritable bowel syndrome (IBS) is caused by the overreaction of the colon stimulated by the act of eating or drinking. This can subsequently lead to abdominal pain, diarrhea, or constipation. Which GI reflex is most likely involved in this hypothesis concerning IBS?
    1. Peristalsis
    2. Vagovagal
    3. Gastrocolic
    4. Enterogastric
    5. Colonoileal


  45. A patient presents to the clinic 2 days post appendectomy complaining of constipation. The patient is a recovering alcoholic, and therefore declined use of narcotics to manage pain. Which of the following is a potential mechanism for this patient’s recent onset of constipation?
    1. Without opioids, the GI motility will be decreased
    2. Stress from surgery can increase sympathetic activation and decrease GI motility
    3. Stress from surgery can increase parasympathetic activation and decrease GI motility
    4. The patient is most likely using illicit drugs which has led to decreased GI motility
    5. Stress from surgery can decrease parasympathetic activation and decrease GI motility  

         
  46. Angel S. is a competitive eater. She can consume exactly 50 Chick-fil-a nuggets in 2 min. Which of the following reflexes is most likely responsible for her ability to consume this massive quantity of food?
    1. Enterocolic
    2. Gastrocolic
    3. Vagovagal
    4. Colonoileal
    5. Peristalsis


  47. Which of the following is TRUE regarding the Enteric Nervous System?
    1. S-type neurons constitute the largest portion of auerbach’s plexus
    2. S-type neurons fulfill the role of interneurons
    3. AH-type neurons respond to tetrodotoxin (Na+ channel blocker)
    4. The Myenteric plexus is located in the submucosa
    5. The Meissner’s plexus is responsible for secretion


  48. Which of the following evokes a fast EPSP?
    1. Opioid peptides
    2. NE
    3. Galanin
    4. Adenosine
    5. Substance P


  49. You are taking the history of a 58 year old male patient during an annual health exam. Upon inquiring about bowel movements the patient states, “well, doc, I have a cup of coffee every morning and it seems to move right through me after that!” Which of the following most accurately describes the mechanism by how caffeine can lead to bowel movements?
    1. Caffeine binds to the NE receptor and prevents slow IPSPs
    2. Caffeine directly leads to fast EPSPs
    3. Caffeine directly induces slow EPSPs
    4. Caffeine binds the Adenosine receptor and prevents slow IPSPs
    5. Caffeine directly induced slow IPSPs


  50. Famotidine is a H2 receptor antagonist that is used to treat ulcers, gastroesophageal reflux disease (GERD), and conditions that cause excess stomach acid. Which of the following best explains the mechanisms of action through which this medication works?
    1. It prevents histamine from inducing a slow EPSP
    2. It prevents histamine from inducing a fast EPSP
    3. It prevents histamine from inducing a slow IPSP
    4. It prevents histamine from inducing presynaptic inhibition
    5. It prevents histamine from inducing presynaptic facilitation


  51. Which of the following is TRUE regarding the mechanism of peristalsis?
    1. The longitudinal layer contracts ahead of the bolus and relaxes behind the bolus
    2. The longitudinal layer relaxes ahead of the bolus and contracts behind the nolus
    3. The circular layer contracts ahead of the bolus and behind the bolus 
    4. The longitudinal layer contracts ahead and behind of the bolus
    5. The circular layer contracts behind the bolus and ahead of the bolus 


  52. A prokinetic agent, is a type of drug which enhances gastrointestinal motility by increasing the frequency or strength of contractions, but without disrupting their rhythm. Which of the following correctly describes the mechanisms by which these drugs work?
    1. The lead to presynaptic inhibition and decrease the probability of gate opening, enhancing propulsion
    2. They lead to presynaptic facilitation and increase the probability of gate opening, enhancing propulsion
    3. They lead to fast EPSPs and increase the probability of gate opening, enhancing propulsion
    4. They lead to slow EPSPs and increase the probability of gate opening, enhancing propulsion
    5. The lead to slow IPSPs and decrease the probability of gate opening, enhancing propulsion


  53. Which of the following is NOT associated with incompetence of the lower esophageal sphincter (LES)?
    1. GERD
    2. Acid reflux
    3. Esophageal achalasia    
    4. Barrett’s esophagus
    5. Esophageal Adenocarcinoma


  54. Which of the following is TRUE regarding the behavior of the antral (pyloric) pump?
    1. The pacemaker frequency is 11-12/min
    2. The leading contraction is responsible for contraction of the pyloric sphincter
    3. The trailing contraction is caused by the rapid uptroe of the AP
    4. Stomach emptying decreases at particles decrease in size
    5. The leading contraction is mainly responsible for the mechanical breakdown of food


  55. Which of the following is associated with bacterial overgrowth in the small intestine?
    1. Ileocecal sphincter incompetence
    2. Decreased MMC
    3. Vagotomy
    4. A & B
    5. A, B & C


  56. Which of the following correctly describes the purpose behind the production of haustration in the large intestine?
    1. Allows for the mixing of digestion enzymes
    2. Allows for the accommodation of large amounts of chyme
    3. Increases the surface area for the absorption of water
    4. Provide power propulsion
    5. Increases the surface area for the absorption of nutrients


  57. Sjögren syndrome is an autoimmune disease that affects the body’s moisture-producing glands. Primary symptoms are a dry mouth and dry eyes. Which of the following is likely an additional outcome from an individual with this disease?
    1. Hypertension
    2. Tooth Decay
    3. Bradycardia
    4. Hyperhidrosis


  58. Mineralocorticoids such as aldosterone act in various areas and their effects are not just limited to the kidney tubules. Which of the following best describes Aldosterone’s effect on
    1. Which of the following is TRUE regarding sympathetic and parasympathetic innervation to the salivary glands?
    2. Sympathetic inhibits salivary production while parasympathetic stimulates it
    3. Parasympathetic inhibits salivary production while sympathetic stimulates it
    4. Both parasympathetic and sympathetic will inhibit salivary production
    5. Both parasympathetic and sympathetic will stimulate salivary production
    6. Salivation is stimulated by the ENS and neither sympathetic or parasympathetic innervation have an effect on it


  59. The conversion of pepsinogen to pepsin is facilitated by which of the following?
    1. HCl
    2. Pepsin
    3. Intrinsic factor
    4. A & B
    5. A & C


  60. What is the most likely outcome for an individual who is deficiency in Antitrypsin enzyme?
    1. Gastritis
    2. Acid Reflux
    3. Pancreatitis
    4. Inability to digest proteins
    5. Paralytic ileus


  61. Some suggest that hypothyroidism can lead to increased chance of the formation of gallstones. Which of the following best explains the reasoning behind how hypothyroidism contributes to the formation of gallstones?
    1. Hypothyroidism can lead to hypercholesterolemia
    2. Hypothyroidism can lead to liver disease
    3. Hypothyroidism can lead to obesity
    4. Hypothyroidism leads to bile salt deficiency 
    5. None of the above 


  62. Crohn’s disease is an inflammatory bowel disease. It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. One of the treatment options for Crohn’s disease is the resection of the distal ileum. Which of the following would NOT likely be a potential consequence of this surgical procedure?
    1. Deficiency in fat soluble vitamins
    2. Scurvy
    3. Pernicious anemia
    4. Beri-beri
    5. Steatorrhea


  63. A 56 year old male patient presents to the clinic with hypercholesterolemia. Which of the following would be a potential treatment option for this individual?
    1. Suggest a low fiber diet to increase his excretion of cholesterol
    2. Prescribe Ezetimibe to decrease the intestinal absorption of cholesterol
    3. Prescribe Lipitor to decrease the intestinal absorption of cholesterol 
    4. Suggest a diet high in tannic acid to increase excretion of cholesterol 
    5. Suggest a distal ileum resection.  


  64. You are on a pediatrics rotation when a 3 month old female patient presents with failure to thrive, steatorrhea, and various developmental delays. Liver biopsy is performed and the histological specimen collected is shown below. A deficiency in which of the following is the most likely the cause of this infant’s symptoms?

    1. Intrinsic factor
    2. Sucrase
    3. Pancreatic cholesterol esterase
    4. Phospholipase A2
    5. Microsomal triglyceride transfer protein (MTTP)  


  65. In the small intestine, the absorption of various nutrients in dependent on the absorption of Na+ following its concentration gradient. Which of the following is NOT cotransported with Na+?
    1. Amino Acids
    2. Glucose
    3. Fructose
    4. Galactose


  66. A deficiency in which of the following would be most concerning an adult patient?
    1. Lingual lipase
    2. Salivary alpha-amylase
    3. Acid lipase
    4. Pancreatic lipase
    5. Pepsin
  67. Which of the following is an example of a pancreatic exopeptidase?
    1. Trypsin
    2. Chymotrypsin
    3. Elastase
    4. Pepsin
    5. Carboxypeptidase A

       
  68. Electrolyte modification in the salivary ducts takes place mainly in which structure?
    1. Acinus
    2. Intercalated duct
    3. Intercalated disc
    4. Striated duct
    5. Excretory duct
        

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