15

A 23 year old carpenter was admitted to medical ward with pneumonia because CURB-65 score was 4.

A. Carbamoyl phosphate synthetase II activity rises
B. C-reactive protein is a marker of negative acute phase response
C. Hypoxia occurs due to reduced diffusion surface area
D. Respiratory acidosis may occur
E. COX is inhibited by bacterial toxins

Further reading
Marti C, Garin N, Grosgurin O, Poncet A, Combescure C, Carballo S, et al. (2012) Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis.Crit Care 16: R141 doi:10.1186/cc11447 [PMC free article][PubMed]

14

A 52 year old drinker complaints of abdominal swelling. Abdominal ultrasound scan comfirms cirrhosis of liver with ascitic fluid. Two days after admission, he became comatosed.

A. Cerebral glutaminase activity is favored
B. Cerebral glutamate dehydrogenase activity is inhibited
C. Decreased albumin level indicates impaired synthetic function in acute hepatotoxicity
D. Serum ferritin level must be typically low
E. Astrocyte swelling occurs due to excessive glutamate and glutamine in the brain

13

Regarding swimming

A. Mild respiratory alkalosis may arise
B. Cori-cycle transports alanine and glucose in opposite direction
C. Muscle glycogen phosphoylase becomes phosphorylated
D. Metabolic rate will increase by at least 75%
E. Intracelluar pH may rise

12

A 45 year old man presented with repeated vomiting for 3 days. He had a history of taking omeprazole prescribed by a family doctor. The upper GI endoscopic findings were consistent with gastric outlet obstruction due to duodenal ulcer with mucosal edema. Urease test also proved of Helicobacter pylori infection.

A. Chloride-resistant metabolic acidosis may be present
B. Chloride-responsive metabolic alkalosis may be present
C. The bacterial urease produces additional acid load
D. Omeprazole acts on H+-Na+ transporter
E. Hypotonic dehydration may result

11

A 14 year old driver came to the emergency unit with profuse watery diarrhea. He had a history of self-administration of ORS but the condition did not improve. Urgent rectal swab was taken and microbiologic analysis revealed Vibrio cholerae.

A. Cholera toxin binds to Globoside receptor of intestinal epithelium
B. cGMP level rises as a result of ADP-ribosylation of G protein
C. Hypotonic dehydration may be present
D. Chloride channels in epithelium are sensitive to intracelluar cAMP level
E. High anion gap metabolic acidosis may occur

10

A stroke patient was recommended to take citacholine by the neurophysican. Citacholine (Cytadine diphosphate choline) provides both choline and cytidine in the the brain.

A. Choline can be used for synthesis of phosphoglycerolipid

B. Acetyl choline formed from choline can be oxidized via Kreb's pathway

C. Acetyl choline formed from choline can be used to replenish glucose

D. Choline can be demethylated to form serine

E. Choline can be deaminated to form ethanolamine

9

A 9 month old baby was diagnosed as methemoglobinemia after having repeated diarrhea. Bottle feeding has been practiced since birth but there was no similar attack before. The water source was said to be from an old private well.

A. Oxygen hemoglobin dissociation curve shifts to right

B. The affinity of hemoglobin for oxygen declines

C. Methylene blue can be the cause

D. Cherry red appearance is the typical presentation

E. Enteric bacterial action on nitrate metabolism may have a role