1. 1.

(Points: 10.0)
All of the following statements regarding a portal venous system are true except
for:

1. A portal venous system includes veins from the small intestine

2. A portal venous system includes veins to the anterior lobe of the pituitary
gland

3. A portal venous system begins and ends in a capillary bed

4. A portal venous system includes veins to the liver

5. A portal venous system includes veins from the liver

2.
2.
(Points: 10.0)
Which of the following statements about the gastrointestinal tract is incorrect?

1. The muscularis externa, with its outer longitudinal layer and its inner
circular layer, is responsible for peristalsis in the intestine

2. Glands formed from the epithelium in the small intestine secrete

acid to aid digestion

3. The structures that join the columnar epithelial cells of the intestine to
each other are likely to include tight junctions, zonula adherens and
desmosomes

4. The small intestine both completes the process of digestion and absorbs
the products of digestion

5. The mucosa of the gut consists of a layer of epithelial cells supported by a

layer of connective tissue (the lamina propria) and a layer of smooth muscle
(the muscularis mucosae)

3.
3.
(Points: 10.0)
All of the following statements regarding the X-rays are true except for:

1. They are used in production of computed tomography (CT) images

 2. They are electromagnetic waves of radiation of a very short wavelength

3. They are produced in an X-ray tube

4. As a result of their divergent nature, image of any object in their path will
be magnified

5. The X-ray beam does not lose intensity as it penetrates through

the body

4.
4.
(Points: 10.0)
All of the following statements regarding leukocytes are true except for:

1. Monocytes give rise to macrophages in connective tissue

2. Basophils, along with mast cells, can release histamine as part of an

inflammatory response

3. Lymphocytes are a key part of the adaptive immune response

4. Neutrophils are granulocytes that can phagocytose bacteria

5. Eosinophils produce antibodies in response to an antigen

5.
5.
(Points: 10.0)
Which one of the following statements regarding a penetrating injury in the right
loin is NOT CORRECT?

1. A penetrating injury in the right loin endangers the right kidney

2. A penetrating injury in the right loin endangers the right suprarenal gland

3. A penetrating injury in the right loin endangers the caecum

4. A penetrating injury in the right loin endangers the liver

5. A penetrating injury in the right loin endangers the right ureter

6.
6.
(Points: 10.0)
 Which one of the following statements regarding erosion from a peptic ulcer on
the posterior wall of the body of the stomach is NOT CORRECT?

1. Erosion from a peptic ulcer on the posterior wall of the body of the
stomach particularly endangers the lesser sac of the peritoneal cavity

2. Erosion from a peptic ulcer on the posterior wall of the body of

the stomach particularly endangers the splenic vein

3. Erosion from a peptic ulcer on the posterior wall of the body of the
stomach particularly endangers the pancreas

4. Erosion from a peptic ulcer on the posterior wall of the body of the
stomach particularly endangers peritoneum

5. Erosion from a peptic ulcer on the posterior wall of the body of the
stomach particularly endangers the splenic artery
7.
7.
(Points: 10.0)
Which one of the following statements regarding the gallbladder is NOT
CORRECT?

1. The gallbladder fundus lies adjacent to the transverse colon

2. The gallbladder is supplied by a branch derived from the coeliac artery

3. The gallbladder is partly covered by peritoneum

4. The gallbladder fundus lies adjacent to the caudate lobe of the

liver

5. The gallbladder fundus lies adjacent to the right 9th costal cartilage

8.
8.
(Points: 10.0)
A patient has infarction of the jejunum and ileum due to an embolus arising from
the left atrium of the heart. The vessel most likely occluded by this embolus is
the:

1. Superior mesenteric artery

2. Coeliac artery
 3. Portal vein

4. Inferior mesenteric artery

5. Aorta below the level of the renal arteries

9.
9.
(Points: 10.0)
A patient was stabbed in the left costovertebral angle (between the 12th rib and
the 1st lumbar vertebra). The organ most likely penetrated is the:

1. Pancreas

2. Spleen

3. Stomach

4. Liver

5. Left kidney

10 10.
. (Points: 10.0)
A patient has obstructive jaundice due to a cancer in the head of the pancreas.
The part of the biliary tract most likely compressed by the cancer at this site is
the:

1. Neck of the gallbladder

2. Cystic duct

3. Proximal part of the bile duct

4. Common hepatic duct

5. Distal part of the bile duct

11 11.
. (Points: 10.0)
A vertical incision, through all layers of the anterior abdominal wall, just lateral
to the margin of the rectus sheath and above the level of the arcuate line is
 contraindicated because:

1. External oblique muscle fibres are cut

2. Rectus abdominis muscle fibres are cut

3. The superior epigastric artery is endangered

4. The inferior epigastric artery is endangered

5. The nerve supply to rectus abdominis is endangered

12 12.
. (Points: 10.0)
With regard to enteric neurons which one of the following statements is
INCORRECT?

1. Enteric neurons control gut movement, secretion of water and

electrolytes and blood flow

2. Enteric neurons form complete functional circuits in the walls of the small
and large intestine

3. Enteric neurons are deficient in Hirschprung's disease

4. Enteric neurons are post-ganglionic parasympathetic neurons

5. Enteric neurons are deficient in Hirschprung's disease

13 13.
. (Points: 10.0)
With regard to the enteric nervous system indicate the one CORRECT statement
below

1. You could survive without an enteric nervous system

2. The major enteric neurotransmitters are glutamate, GABA and aspartate

3. The enteric nervous system plays an essential role in whole body

fluid and electrolyte homeostasis
 4. The ganglia of the enteric nervous system consist of parasympathetic
post-ganglionic neurons

5. The enteric nervous system is not present in the oesophagus

14 14.
. (Points: 10.0)
In order to create a muscle flap for reconstructive surgery, a plastic surgeon
dissects out the rectus abdominus muscle and identifies the posterior
compartment of the rectus sheath.

Above the level of the arcuate line the posterior layer of the rectus sheath is:

1. Absent

2. comprised of thoracolumbar fascia

3. comprised of the aponeurosis of external oblique and the anterior leaf of

the internal oblique aponeurosis

4. comprised of the aponeurosis of transverses abdominis and the

posterior leaf of the internal oblique aponeurosis

5. comprised of the aponeuroses of all 3 layers of the anterior abdominal

wall

15 15.
. (Points: 10.0)
Emergency surgery is performed on a night club patron who has been stabbed
and a large laceration in the liver is identified.

In order to stop the bleeding the portal vein and hepatic artery can be clamped
proximal to the porta hepatis where they:

1. are in contact with the anterior abdominal wall

2. are in contact with the posterior abdominal wall

3. are retroperitoneal

4. pass in the free edge of the lesser omentum

 5. pass anterior to the first part of the duodenum and head of pancreas

16 16.
. (Points: 10.0)
In portal hypertension alternative pathways for blood flow result in engorgement
of anastomotic channels at sites of porto-systemic overlap.

Which one of the following is NOT a site of porto-systemic anastomosis?

1. The retroperitoneal tissues

2. The anal canal

3. The anterior abdominal wall

4. The lower oesophagus

5. The porta hepatis

17 17.
. (Points: 10.0)
A 32-year-old man with severe left sided abdominal pain is suspected of having
a left ureteric calculus (stone lodged in the left ureter).

On plain abdominal X-ray the course of the left ureter can be traced along:

1. the lateral margins of the lumbar vertebral bodies

2. the tip of the 12th rib

3. the tips of the lumbar transverse processes

4. the lateral border of quadratus lumborum

5. the lateral border of psoas

18 18.
. (Points: 10.0)
A young motorcyclist sustains a fracture of his left 10th and 11th ribs in a fall
 from his bike.

The abdominal viscus most likely to be injured is the:

1. spleen

2. liver

3. gallbladder

4. left kidney

5. stomach

19 19.
. (Points: 10.0)
The posterior wall of the inguinal canal is formed throughout by the:

1. Transversus abdominus muscle

2. Conjoint tendon

3. Fascia transversalis

4. Internal oblique muscle

5. External oblique muscle

20 20.
. (Points: 10.0)
The hilum of the spleen is directly related to the:

1. Left kidney

2. Duodenal-jejeunal flexure

3. Stomach
 4. Diaphragm

5. Tail of the pancreas

21 21.
. (Points: 10.0)
The accessory pancreatic duct drains into:

1. The second part of the duodenum distal to the ampulla of Vater

2. The duodenal-jejeunal flexure

3. None of the above

4. The second part of the duodenum proximal to the ampulla of

Vater

5. The main pancreatic duct

22 22.
. (Points: 10.0)
Below the arcuate line the posterior rectus sheath is:

1. Not present

2. Formed by all of the aponeuroses of the muscles of the anterior

abdominal wall

3. Formed by the aponeuroses of internal oblique and transversus

abdominus muscle

4. Formed by the aponeuroses of external oblique and internal oblique

muscle

5. Formed by the aponeuroses of internal oblique and transversus

abdominus muscle

23 23.
. (Points: 10.0)
Which of these statements concerning control of water and electrolyte secretion
through the Enteric Nervous System is NOT CORRECT?
 1. Enteric reflexes controlling transmucosal fluid exchange are
prominent in the stomach

2. Mucosal secretion and blood flow are locally co-ordinated

3. Enteric secretomotor reflexes are under central, sympathetic, inhibitory

control

4. Major secretomotor transmitters are Acetylcholine and Vasoactive

Intestinal Peptide

5. Enteric reflexes act to return fluid to the lumen of the small intestine

24 24.
. (Points: 10.0)
In normal anatomy which one of the following are observed on the posterior
abdominal wall?

1. Peritoneal reflections pass as mesenteries to surround

intraperitoneal viscera

2. The lumbar vessels run anterior to the psoas major

3. The thoracolumbar fascia gives origin to the rectus abdominus muscle

4. The psoas minor is a constant structure present in every individual

5. The kidneys are retroperitoneal viscera and lie on the psoas major

25 25.
. (Points: 10.0)
Which one of the following enzymes is not elevated in liver damage?

1. GGT (gamma glutamyl transferase)

2. CK (creatine kinase)

3. ALT (Alanine transaminase)

4. LD (Lactate dehydrogenase)
 5. AST (Asparatate transaminase)

26 26.
. (Points: 10.0)
Select the one statement about serum enzymes measured in pathology tests
that is INCORRECT.

1. Serum enzyme levels depend on the severity of organ damage

2. Serum enzyme levels depend on the clearance rate of enzymes from the
blood stream

3. Serum enzymes levels depend on the extent of organ damage

4. Serum enzymes levels depend on the enzyme levels in the cell

5. Serum enzymes may not be measured correctly when the

patient's blood lacks enzyme cofactors

27 27.
. (Points: 10.0)
Elevation of blood levels of which enzyme is most specific as an indicator of
hepatocyte damage?

1. Alanine aminotransferase (ALT)

2. Creatine phosphokinase (CK)

3. Gamma glutamyltransferase (GGT)

4. Lactate dehydrogenase (LD)

5. Aspartate aminotransferase (AST)

28 28.
. (Points: 10.0)
Which one of the following is a CORRECT characteristic common to all
cytochrome P450 enzymes involved in detoxification?
 1. An iron-sulphur complex in which the iron alternates between Fe2+ and
Fe3+ as electrons are donated to oxygen

2. An absorbance maximum of 450 nm when oxidised to the Fe3+ state

3. Expression at higher levels when substrates are persistently

present i.e cytochrome P450s are inducible

4. An active site which is specific for a unique substrate that becomes

hydroxylated, or otherwise oxygenated

5. A hydrophobic protein “foot” that anchors the P450 to the inner

mitochondrial membrane

29 29.
. (Points: 10.0)
The liver component designated CYP 2E1 is involved in which one of the
following ways with drug/metabolite metabolism?

1. CYP 2E1 is active in the microsomal ethanol oxidising system

2. CYP 2E1 is also known as aromatase and modifies steroid hormones

3. CYP 2E1 is induced to high levels by as little as a picogram of dioxin

4. CYP 2E1 initiates smooth endoplasmic reticulum proliferation

5. CYP 2E1 has codeine as a substrate and poor metabolisers of codeine lack
this activity

30 30.
. (Points: 10.0)
Select the one statement about thalassaemia that is INCORRECT.

1. In thalassaemia red cells resemble size and appearance of red cells in

iron deficiency

2. Thalassaemia is an inherited group of genetic defects that lead to

defective synthesis of one or other of the globin chains

3. Thalassaemia results in an increased amount of haemoglobin per

red cell
 4. In thalassaemia red cells are smaller and more pale than normal

5. The geographic distribution of thalasaemia fits the past and present

distribution of malaria

31 31.
. (Points: 10.0)
Anaemia due to iron deficiency is typically associated with four of the five
conditions listed.

Which one of the following is not an indicator of anaemia due to iron deficiency?

1. A subnormal serum iron level

2. Decreased haem production

3. A subnormal serum transferrin level

4. Microcytosis

5. A subnormal serum ferritin level

32 32.
. (Points: 10.0)
Beta thalassaemia minor is typically associated with which one of the following?

1. Mutations in both beta globin genes

2. Transfusion-dependent anaemia

3. A decreased percentage of haemoglobin A2 in red cells

4. An abnormal globin amino acid sequence

5. A subnormal mean red cell volume

33 33.
. (Points: 10.0)
The triad of subnormal serum iron, low normal serum transferrin, and high
normal serum ferritin best correlates with:
 1. Liver damage from iron overload

2. High dietary iron content

3. Low dietary iron content

4. Mild blood loss

5. Inflammation

34 34.
. (Points: 10.0)
All of the following statements regarding β-thalassaemia are true except for:

1. Frequent blood transfusions are used to treat someone who has a severe
phenotype

2. The carrier state confers some resistance to malaria

3. Unusual red blood cells called target cells can be seen in the blood of
someone who is homozygous

4. It is usually caused by deletions in the β (beta) globin genes

5. If left untreated, excessive breakdown of red blood cells leads to

hepatosplenomegaly

35 35.
. (Points: 10.0)
All of the following statements concerning dysplasia are true except for:

1. In dysplasia, the cell nuclei are often hyperchromatic

2. In dysplasia, mitotic figures are often more frequent

3. Dysplasia is a type of malignant neoplasia

4. In dysplasia, the cell nuclei are often pleomorphic

 5. In dysplasia, the cells often show an increased nuclear:cytoplasmic ratio

36 36.
. (Points: 10.0)
All of the following statements concerning neoplasia are true except for:

1. Cells of a malignant neoplasm invade and replace local tissues

2. The cells of a malignant neoplasm may metastasise (spread to distant

sites)

3. In a benign neoplasm, the cells are often well differentiated

4. A benign neoplasm has an expansile pattern of growth

5. Benign neoplasms often develop central areas of haemorrhage

and necrosis

37 37.
. (Points: 10.0)
All of the following statements concerning neoplasms are true except for:

1. Benign neoplasms may be fatal

2. The terms "benign" and "malignant" are defined in terms of the

appearance of neoplastic cells under the microscope

3. A neoplasm is a mass formed as a result of the progressive proliferation

of cells

4. Benign neoplasms are often encapsulated

5. All carcinomas are malignant neoplasms

38 38.
. (Points: 10.0)
Which one of the following statements concerning hepatic sinusoidal endothelial
cells is INCORRECT?

1. Hepatic sinusoidal endothelial cells contain clusters of fenestrae forming

“sieve plates”
 2. Hepatic sinusoidal endothelial cells are located on a boundary of the
Space of Disse

3. Hepatic sinusoidal endothelial cells promote hepatic stellate cell activation

in response to injury

4. Hepatic sinusoidal endothelial cells do not rest on a basement membrane

5. Hepatic sinusoidal endothelial cells contain fenestrae covered by

a thin membrane

39 39.
. (Points: 10.0)
Which one of the following statements concerning hepatic regeneration is
INCORRECT?

1. Hepatic regeneration results in liver cell plates more than one cell-thick

2. Following hepatectomy, the hepatocytes are capable of replacing at least

twice their mass by proliferation

3. Hepatic regeneration results in increased numbers of binucleate

hepatocytes

4. Under normal circumstances, most hepatocytes are in the G0 phase of

the cell cycle

5. Following extensive liver injury, regeneration results from

stimulation of the division of hepatocyte stem cells

40 40.
. (Points: 10.0)
Which one of the following statements concerning hepatic stellate cells is
INCORRECT?

1. Hepatic stellate cells synthesise type 3 collagen

2. Hepatic stellate cells give rise to a myofibroblast phenotype when

activated

3. Hepatic stellate cells store vitamin A once activated by liver injury

4. Hepatic stellate cells have a role in regulating sinusoidal blood flow

 5. Hepatic stellate cells up-regulate cell surface PDGF receptors when
activated

41 41.
. (Points: 10.0)
Which one of the following statements concerning Kupffer cells is CORRECT?

1. Kupffer cells stretch across the sinusoidal lumen

2. Kupffer cells have cytoplasmic extensions called macropodia

3. Kupffer cells may be found within portal tracts in alcoholic hepatitis

4. Kupffer cells lack phagocytic activity

5. Kupffer cells lack cyclo-oxygenase activity and do not release

prostaglandins when activated

42 42.
. (Points: 10.0)
Which one of the following statements is CORRECT with respect to imaging of
the liver?

1. Ultrasound, computed tomography and magnetic resonance

imaging can all display images of blood vessels in the liver

2. Magnetic resonance imaging cannot display the bile ducts without the use
of intravascular contrast agents

3. Ionizing radiation is used in magnetic resonance imaging

4. Cholangiography refers to the imaging display of small hepatic arteries

5. The direction of blood flow cannot be determined with ultrasound

43 43.
. (Points: 10.0)
In regard to the blood supply of the liver which one of the following is
CORRECT?

1. The portal vein supplies about 25% of the volume of blood flow to the
liver
 2. The portal vein receives blood from the spleen

3. There are two main hepatic veins that drain into the inferior vena cava

4. Contrast agents administered in a forearm vein will reach the hepatic

artery after they reach the portal vein

5. The hepatic artery normally arises from the superior mesenteric artery

44 44.
. (Points: 10.0)
In regard to radiological imaging of the bile ducts which one of the following is
NOT able to display normal bile ducts?

1. CT scan

2. Ultrasound

3. Radioisotope imaging

4. Plain abdominal radiograph

5. Magnetic resonance imaging

45 45.
. (Points: 10.0)
In radiological imaging of the abdomen which one of the following is CORRECT?

1. The Doppler effect is used to measure the density of tissue

2. Magnetic resonance can be used in patients with cardiac pacemakers

because it does not use ionizing radiation

3. Radioisotope scanning relies on detection of electromagnetic

radiation using a gamma camera

4. Intravascular contrast agents contain calcium atoms to increase

absorption of X-rays

5. Ultrasound relies on absorption of the ultrasound beam to generate

images