1. What is the carrier that transports glucose into theβcells in the pancreas and hepatocytes depending on the glucose gradient?
2. In 2016, a student who went to see the Rio Olympic suffered from dyspnea and chest pain after a long time flight on his way home to Japan. what is most likely his diagnosis?
n Answer：Pulmonary thromboembolism
3. What is the substance produced by the liver, kidney and cartilage through the stimulation of GH, and facilitates body growth?
n Answer：IGF-1(Somatomedin C)
4. Deficiency of a certain hormone causes hypomagnesemia associated with hypocalcemia. What is the hormone?
n Answer：Parathyroid hormone(PTH)
5. What is the cell structure which exists on the free surface of proximal tubule and is composed of actin filament?
6. Which ketogenic amino acid is increases in the blood in patients with maple syrup urine disease?
n Comment：Defect of metabolizing enzymes of BCAA causes increase of concentration of BCAA in the blood. Ketogenic amino acid is only leucine in 3 types of BCAA.
7. Direct and indirect light reflex are both negative in the right eye and both positive in the left eye. In this case, which part of the visual pathway is the lesion?
n Answer：Right oculomotor nerve (Right or Left is necessary)
8. Cortisol is essential for the physiological action of adrenaline and glucagon. What is this physiological action of cortisol?
n Answer：Permissive effect
9. What is the medication that promotes the release of lipoprotein lipase from the endothelial cells?
n Comment：TG in VLDL is hydrolyzed by lipoprotein lipase (LPL) of vascular endothelial cells. Heparin, prescribed for patients with dyslipidemia, promotes the release of LPL from vascular endothelial cells.
10. Weight-loss related amenorrhea is caused by a decrease in a hormone produced by adipocyte. This hormone regulates secretion of GnRH from hypothalamus and regulates appetite. What is this hormone?
n Comment：Leptin is a hormone predominantly produced by adipocyte that helps to regulate hunger as well as promotes GnRH secretion from hypothalamus.
n Answer：Trophoblast cell or Syncytiotrophoblast
12. Sepsis causes an increased vascular permeability, resulting in hypodynamic state. What is the name of academically defined space in which the body water accumulates in the clinical states?
n Answer：Third space
n Comment：Third space or Third spacing is the abnormal accumulation of fluid into an extracellular and extravascular space due to the clinical state such as increase in vascular permeability. The fluid accumulated do not function as extracellular fluid.
1. When infusing 1200 ml of physiological saline, calculate the volume of physiological saline transfer to each of the following compartments. The body fluid should be distributed in plasma: interstitial fluid: intracellular fluid = 1: 3: 8.
② Interstitial fluid
③ intracellular fluid
n Answer：① 300 ml ② 900 ml ③ 0 ml
n Comment：Since the composition of physiological saline is almost equal to extracellular fluid, it is not distributed in intracellular fluid. Therefore, since plasma: interstitial fluid = 1: 3, 1,200 ml of physiological saline is distributed in 300 ml in plasma and 900 ml in stroma.
2. Answer which part of the ECG corresponds to the ejection period in the cardiac cycle.
【Picture is deleted】
3. Rearrange the physiological mechanism of inspiration correctly.
① Increase thoracic negative pressure
② Expansion of alveolus
③ Contraction of the diaphragm
④ Expansion of thoracic cavity
n Answer：③ ⇒ ④ ⇒ ① ⇒ ②
n Comment：Inhalation is done by pressure difference between the alveolar and atmospheric pressure. That is, the negative pressure in the thoracic cavity due to the contraction of the diaphragm causes the alveoli to expand, thereby setting the inside of the alveoli to a negative pressure comparing with the atmospheric pressure, whereby the air flows into the alveoli.
4. Choose 2 of the following that are seen in pyramidal tract disorder.
① muscle stiffness
④ spastic paralysis
⑤ Babinski reflex
⑥ Increased superficial reflex
n Comment：The upper motor neuron disorder (pyramidal tract disorder) recognizes "spastic paralysis", "tendon reflex", "decreased superficial reflex", "appearance of pathological reflex." In addition, the fibrillar contraction of ③ is due to lower motor neuron disorder.
5. Answer the changes in the following blood tests in primary hyperparathyroidism.
③ intact PTH
④ Bone type ALP
⑤ Blood pH
n Answer：① Increased ② Decreased ③ Increased ④ Increased ⑤ Decreased
n Comment：③ intact PTH refers to PTH secreted from the parathyroid gland. It is elevated in primary cases, whereas in cases where PTHrP is secreted by tumor-associated syndrome of squamous cell carcinoma, it is reduced by feedback inhibition.
④ PTH increases bone resorption, bone type ALP rises.
⑤ PTH may cause acidosis as it suppresses reabsorption of HCO3 - in the proximal renal tubule.
6. Choose 3 of the listed anatomical structures below which indicate embryologically correct combination.
① Jejunum --- Foregut(Pre-enteron)
② Pancreas --- Midgut(Mesenteron)
③ Urinary bladder --- Hindgut(Metenteron)
④ Thymus --- First pharyngeal pouch
⑤ Adrenal medulla --- Neural crest
⑥ Retina --- Surface ectoderm
⑦ Thyroid gland --- Endoderm
① Jejunum stems from midgut. Digestive tracts which stem from midgut are supplied by superior mesenteric artery.
② Pancreas stems from foregut. Organs which stems from foregut are supplied by celiac trunk.
④ Thymus stems from third pharyngeal pouch.
⑥ Retina stems from neurectoderm.
7. Answer the correct order of the development mechanism of fatty liver by drinking alcohol.
① Increased production of glycerol-3-phosphate
② Oxygen deprivation in the central region of the hepatic lobule
③ Hyperactivation of NADH production in glycolysis system
④ Reduced activity of TCA circuit
⑤ Alcohol oxidation with CYP2E1
n Answer：⑤ → ② → ④ → ③ → ①
n Comment：In addition to alcohol dehydrogenase (ADH), alcohol metabolizing enzymes also have a pathway that metabolize alcohol to acetaldehyde in cytochrome enzyme CYP2E1. Since oxygen is consumed in this system, oxygen consumption related to alcohol metabolism increases under heavy consumption of alcohol. Alcohol metabolizing enzymes are distributed in the central region of hepatic lobule so that the central part of hepatic lobule becomes hypoxic and the activity of the TCA circuit decreases. As a result, anaerobic glycolysis occurs, and the production of NADH by glyceraldehyde-3-phosphate dehydrogenase (GAPDH) is enhanced. This NADH is used to reduce dihydroxyacetone phosphate (DHAP) to glycerol-3-phosphate (G-3-P). Since G-3-P serves as a substrate for the biosynthesis, synthesis of TG in hepatocytes is enhanced.
8. In occlusive hypertrophic cardiomyopathy (HOCM), a pressure gradient occurs due to stenosis of the left ventricular outflow tract. Which of the following are effective pharmaceutical for this situation? Choose 2 of the following.
① β activator
② β blocker
③ Ca blocker
n Comment：The pressure difference can be corrected by suppression of myocardial contraction force, increase in preload and increase in afterload occurs.
1. Gastrin is secreted by G cells in pyloric gland.
2. Axon contains a number of ribosomes.
n Comment：Since axons do not contain ribosomes, necessary proteins need to be transported by axonal transport.
3. Inhibition of SGLT2 in proximal tubule increases volume of urine.
4. Atherosclerosis reduces diastolic blood pressure.
n Comment：Diastolic blood pressure is the pressure generated when the elastic fibers of the elastic artery are stretched and then return to their original state. This is called the Windkessel function, but in arteriosclerosis this physiological function collapses and it leads to a decrease.
5. Romberg’s sign is positive in subacute combined degeneration of the spinal cord.
6. The pancreatic acinar cells mainly secrete bicarbonate ions.
n Comment：Bicarbonate ions are produced by duct cells.
7. Which organ has the highest blood flow per tissue weight?
8. Which cell junction has connexins?
P) Synaptic junction
Q) Gap junction
R) Adherens junction
S) Tight junction
9. Which drug inhibits Na+/K+/2Cl- symport(NKCC2)?
10. Choose Th2 cytokine from the following
11. A 10-year-old girl is suffering from influenza and has 39℃ fever. Which antipyretic analgesic should she take?
n Comment：Prescribing diclofenac and aspirin to children under 15 who have influenza is contraindicated because they can induce Reye syndrome. Cyclophosphamide is an immunosuppressant so it has no relation to this question’s theme.
12. Which is not the risk factor of the osteoporosis?
P) Primary hyperparathyroidism
n Comment：Obesity causes pressure stress on bones. It is not the risk factor of osteoporosis.
13. In Goodpasture syndrome, alveolar diffusing capacity appears to be kept normal, even though the actual PaO2 is decreased. What is the cause of this situation?
Q) Alveolar hemorrhage
n Comment：In Goodpasture syndrome, diffusion disorder is caused by pulmonary alveolar bleeding. In this case, carbon monoxide, used for evaluating diffusion ability, binds to leaked hemoglobin. Therefore, it seems that diffusion capacity is kept normal at first glance.
14. What is the second messenger produced by activation of glucagon receptor?
15. What is the center of patellar tendon reflex?
n Answer：Spinal cord
16. What is the name of the anatomical structure that communicate lacrimal sac and inferior nasal meatus?
n Answer：nasolacrimal duct
17. Calculate the mean atrial pressure of 126/66mmHg.
n Comment：To calculate the mean atrial pressure, first calculate the pulse pressure (subtract the diastolic pressure from the systolic pressure ) and divide that by 3, then add the diastolic pressure.
18. What is the name of the hormone that cause hyperpigmentation in patients with 21-hydroxylase deficiency?
19. What substance transfers amino acid that corresponds to its anticodon to ribosomes?
20. What is the infectious disease to which the patient with heterozygous sickle cell anemia has resistance?
21. What is the substance which is secreted by ECL cell of stomach and promotes secretion of gastric acid from parietal cell?
22. In prenatal period, what differentiates into ductus deferens and seminal vesicle in the presence of testosterone?
n Answer：Wolf duct
23. This procedure checks what reflex?【Picture is deleted】
n Answer：Babinski reflex
24. Which anti-coagulation factor is strongly promoted by heparin?
25. What is the name of a chemical mediator that causes a side effect of ACE inhibitor increases vascular permeability?
n Comment：Bradykinin increases the vascular permeability and vasodilation.
1. Somatostatin has inhibitory effects on the alimentary duct.
2. The oxygen affinity of hemoglobin declines under alkalosis.
3. Activated Vitamin D is responsible for reabsorption of both calcium ion and phosphorus in renal tubules.
4. Nitroglycerin decreases the preload of ventricle.
n Comment：Nitroglycerin expands veins (volume vessels) and decreases venous return.
5. Moro reflex is observed in normal 1 year old child
6. The renin-angiotensin system is activated in a patient with SIADH.
n Comment：Temporary increase in circulating plasma volume due to excessive reabsorption of water suppresses the RAA system.
7. What nerve innervates the external urethral sphincter muscle?
P) Pelvic splanchnic nerve
Q) Hypogastric nerve
R) Obturator nerve
S) Pudendal nerve
8. Which one of the following is the exchange ratio of Na+/Ca2+exchanger?
P) Na+：Ca2+ = 3：1
Q) Na+：Ca2+ = 3：2
R) Na+：Ca2+ = 1：3
S) Na+：Ca2+ = 2：3
9. Which of the following substance has the largest difference in concentration between plasma and interstitial fluid?
10. Which of the following is the mechanism for resistance of MRSA?
P) Producing β-lactamase
Q) Active excretion of penicillin
R) Mutation of the penicillin-binding protein
S) Producing competing substrate of the penicillin
11. Which pathogen cannot be detected by sputum smear?
P) Streptococcus pneumonia
Q) Haemophilus influenzae
R) Legionella pneumoniae
S) Pseudomonas aetuginosa
n Comment：Legionella pneumoniae is obligate intracellular bacteria. Thus, it is difficult to detect this pathogen by sputum smear.
12. Which one of the following decreases in 21-hydroxylase deficiency?
R) Plasma renin activity(PRA)
13. Which of the following is NOT CORRECT as the pathophysiology in obstructive sleep apnea syndrome?
P) Activation of parasympathetic nerve
S) Increase of left ventricular afterload
n Comment：Hypoxemia occurs due to apnea, which in turn activates sympathetic nerves. Then, it increases ventricular afterload and results in hypertension. Therefore, B, C, D are correct.
14. Lactic acid produced in skeletal muscle during exercise is converted into glucose in the liver. How do you call this circuit?
n Answer：Coriolis circuit
15. What are the carrier proteins distributed mainly in muscle cells and adipocytes that uptake glucose insulin-dependently?
16. Where in the eye does the light refraction occur most strongly?
n Comment：The cornea has the refractive power of 40 diopters (Approximately two thirds of the total refractive power of the eye) , whereas the lens has 20 diopters.
17. What is the effect that the strength of myocardial contraction increases with sympathetic stimulation called?
n Answer：positive inotropic effect
18. Which vitamin tends to be insufficient in neonate because of its small content in mother’s milk?
n Answer：Vitamin K
19. What is the enzyme whose activity is suppressed in a patient with chronic granulomatous disease?
n Answer：NADPH oxidase(NOX)
n Comment：The lack of this enzyme in neutrophilic leukocyte causes decrease of disinfection and susceptibility to infection.
20. What is the generic name of RNA virus which has reverse transcriptase?
21. What is the Vitamin which is likely to lack during intravenous hyperalimentation?
n Answer：Vitamin B₁
22. What is the name of the group which makes human’s vagina acidity?
n Answer：Doderlein bacillus
23. Frequent blood transfusion causes the excess of what ion?
n Comment：200 ml packed red blood cell includes 100mg iron so excess blood transfusion causes hemochromatosis.
24. Which vitamin prevents lipid peroxidation?
n Answer：Vitamin E
n Comment：Vitamin E supplies electrons to lipoperoxide radicals and stops the chain reaction of peroxidation. This mechanism is related to hemolytic anemia in patients with Vitamin E deficiency, in which the red blood cell membrane is weaken by peroxidation.
25. Which part of hypothalamus is related to maintaining circadian rhythm?
n Answer：suprachiasmatic nucleus
1. The diaphragm moves upward during inspiration.
2. Peripheral vascular resistance is inversely proportional to the viscosity of the blood.
n Comment：According to Poiseuille's law, vascular resistance is proportional to viscosity.
3. The respiratory quotient when catabolizing glucose is close to 0.7.
n Comment：The respiratory quotient when catabolizing carbohydrates is close to 1.
C6H12O6 ＋ 6O2 → 6CO2 + 6H2O
4. Coronary blood flow is higher in amount in diastole than in systole.
5. Clawhand appears when pressing on the carpal tunnel.
6. Estrogen elevates basal body temperature.
7. Which bone grows by endochondral ossification?
P) Frontal bone
S) Coxal bone
8. Which is not internal environment of the human?
P) Inside of the lymphatic vessel
Q) Inside of the vessel
R) Inside of the heart
S) Inside of the ureter
9. Uric acid is the final metabolites of which one of the following base?
n Comment：Uric acid is the final metabolites of Purine body, which is the cause of urinary stone and gout.
10. Calcineurin inhibitor blocks production of which cytokine?
11. There is no antiviral drug against which virus?
R) Influenza virus
12. Which ion increases in sarcoidosis?
13. The gestagen test causes withdrawal bleeding in which one of the following?
P) Sheehan syndrome
Q) Polycystic ovary syndrome
S) Turner syndrome
n Comment：Obesity is a background factor in polycystic ovary syndrome. Since aromatase in adipocytes produces estrogen, there is proliferation of the endometrium by estrogen, and the endometrium is detached by gestagen administration.
14. Cardiomyocytes function as functional syncytia by means of a cell adhesion device. What is that device?
n Answer：gap junction
15. What is the general term for valine, leucine, isoleucine which are actively metabolized in skeletal muscle?
n Answer：Branched chain amino acids (BCAA)
16. What is the name of the receptors for gustation?
n Answer：Taste buds
17. Where is the receptor for cortisol located in the cell?
n Comment：Unlike receptors for water soluble hormones, receptors for most lipid soluble hormones are located inside the cell because the lipid soluble hormones are able to pass through the cell membrane.
18. Which amino acid should be supplemented for patients with phenylketonuria?
n Comment：Phenylalanine hydroxylase converts phenylalanine to tyrosine. Patients with phenylalanine hydroxylase deficiency need to avoid phenylalanine intake and be supplemented with tyrosin.
19. C3a and C5a of complement have strong chemotaxis. What is the complement with this effect called?
20. What is the phenomenon that gastric poorly differentiated carcinoma spreads to both ovary called?
n Answer：Krukenberg metastasis
21. What is the movement which causes mixing of food and digestive juices in small intestine?
n Answer：Segmental motion
22. Deficit of which hormone causes anovulatory cycle?
n Answer ：LH
n Comment：Ovulation occurs due to LH surge induced by high concentration estradiol. The deficit of this phenomenon causes anovulatory cycle
23. Drinking causes polyuria. What hormone production is inhibited by alcohol?
24. Which vitamin is related to the treatment of acute promyelocytic leukemia?
n Answer：Vitamin A
25. Hypoxia leads to a reduced radio sensitivity. This is caused by a decrease of what substance in the body?
n Answer：radical oxygen / reactive oxygen species(ROS)
n Comment：In a state of hypoxia, radical oxygen is poorly produced thereby cell injury is weaken.
1. Dopamine is used for the treatment of Parkinson’s Disease.
3. The serum γ-GTP is high for those who drink alcohol.
4. Standard limb lead of electrocardiogram is a method of observing the electrical activity of the heart on a horizontal plane.
5. Semantic memory and procedural memory are classified as declarative memory.
n Comment：There are semantic memory and episode memory
6. Feminization of men occurs in a patient with 21-hydroxylase deficiency.
7. Which muscle opens the glottis?
P) Cricothyroid muscle
Q) Posterior cricoarytenoid muscle
R) Aryepiglottic muscle
S) Lateral cricoarytenoid muscle
n Comment：Posterior cricoarytenoid muscle is the only muscle which opens the glottis.
8. Which receptor does atropine bind?
P) Muscarinic Acetylcholine receptor
Q) Nicotinic Acetylcholine receptor
S) Sodium channel
9. β blocker is contraindication for which one of the following?
P) Bronchial asthma
Q) Chronic heart failure
R) Paroxysmal supraventricular tachycardia(PSVT)
S) Effort angina pectoris
n Comment：The activation ofβ2 receptor relaxes bronchial smooth muscle.
10. Penicillin is effective in which of the following disease?
P) Scarlet fever
Q) Legionella pneumonia
R) Mycoplasma pneumonia
S) Herpes encephalitis
11. Which complement destructs target cell membrane?
n Comment：C5b6789 is called membrane attack complex(MAC)
12. Which disease does not create granuloma?
P) Crohn disease
S) Bechet disease
13. Which is the recommendable treatment strategy for a woman with first-degree amenorrhea who does not wish to have a baby?
P) Risk reduction of estrogen-dependent tumors
Q) Risk reduction of osteoporosis
R) Prevvention of infection
S) Development of brain function
n Comment：In the first degree amenorrhea, secretion of progesterone is lowered, so it is an estrogen dominant environment. This requires therapeutic intervention as high estrogen environments such as breast cancer and endometrial cancer are at risk of developing risk factors of malignancy.
14. What is the substance that is rich in type I muscle fibers, has heme, and has high oxygen affinity?
15. What is the site where the common bile duct and the main pancreatic duct join and open into the duodenum called?
n Answer：Vater papilla (large duodenal papilla)
16. What is the name of the knee ligament that is often injured by landing from a jump?
n Answer：Anterior Cruciate Ligament
17. What is the second messenger for β₁adrenergic stimulation?
n Comment：The beta-1 adrenergic receptors belong to the group of Gs-protein coupled receptors. Alpha domain of the Gs protein activates adenylyl Cyclase.
18. What is the name of the substance in TCA cycle that inhibits PFK-1？
n Answer：citric acid
n CommentWhen hungry, acetyl CoA is produced by the oxidation of fatty acids and PFK-1 is inhibited and therefore glycolysis would stops.
19. What is the gene which is independent of chromosomal DNA of bacterium?
20. If we lack a certain substance, we may suffer from Nyctalopia. What is the cell which stores the substance?
n Answer：Ito cell (hepatic stellate cell)
21. What cell produces testosterone in testis?
n Answer：Leydig cell
22. In Basedow disease, Merseburg triad indicates tachycardia, goiter and what?
23. In the human body, where is the most of iron located?
n Answer：Hemoglobin / erythrocyte / Red blood cell
24. What is the target receptor for autoantibody of Myasthenia gravis?
n Answer：Acetylcholine receptor
25. Which base is related to the cross linkage reaction of alkylators?