CLINICAL & CHEMICAL PATHOLOGY MCQ                                                                               BODY FLUID...
CLINICAL & CHEMICAL PATHOLOGY MCQ                                                                   CHEMISTRY             ...
CLINICAL & CHEMICAL PATHOLOGY MCQ                                                                  CHEMISTRY              ...
CLINICAL & CHEMICAL PATHOLOGY MCQ                                                                        CHEMISTRY        ...
هام  Clinical & chemical pathology mc qs-1
هام  Clinical & chemical pathology mc qs-1
هام  Clinical & chemical pathology mc qs-1
هام  Clinical & chemical pathology mc qs-1
هام  Clinical & chemical pathology mc qs-1
هام  Clinical & chemical pathology mc qs-1
هام  Clinical & chemical pathology mc qs-1
هام  Clinical & chemical pathology mc qs-1
هام  Clinical & chemical pathology mc qs-1
هام  Clinical & chemical pathology mc qs-1
هام  Clinical & chemical pathology mc qs-1
هام  Clinical & chemical pathology mc qs-1
هام  Clinical & chemical pathology mc qs-1
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هام Clinical & chemical pathology mc qs-1

  1. 1. CLINICAL & CHEMICAL PATHOLOGY MCQ BODY FLUIDS Clinical & Chemical Pathology MCQs Classified, Reorganized And Updated To Shawual 1425 With Short Notes Body fluids By Dr Mohammad A. Emam 1. **Doctor sending a sample requesting for lecithin 1. (c) Amniotic fluid sample is used to measure spingomyelin ratio what is the sample? lecithin: sphingomyelin ratio (L/S). L/S > 2:1 a. Blood. (or 2.5:1) denotes acceptable lung maturity. Contents b. CSF Body fluids ................................................................................. 2 c. Amniotic fluid. d. Urine Clinical Chemistry .................................................................... 4 INSTRUMENTATION ...................................................................................................................4 2. ***Cytological examination of pleural effusion in a 60 yrs 2. (d) Lung cancer: 75% of malignant pulmonary BLOOD GASES, PH AND ELECTROLYTES. .............................................................................5 old man revealed the presence of malignant cells. The effusions are due to 3 causes; lung cancer GLUCOSE, HEMOGLOBIN, IRON AND BILIRUBIN. ...............................................................7 most likely primary tumor will be: (30%), breast cancer (25%) & lymphoma (20%). CALCULATIONS, QC AND STATISTICS ..................................................................................9 a. Lymphoma. Practically, cytological examination only CREATININE, UA, BUN AND AMMONIA ...............................................................................10 b. Mesothelioma. establishes the presence of malignant effusion, PROTEINS, ELECTROPHORESIS AND LIPIDS .......................................................................11 c. Cancer colon. however, in most cases it cannot identify the CLINICAL ENZYMOLOGY........................................................................................................13 d. lung cancer. primary site of the tumor. CLINICAL ENCOCRINOLOGY .................................................................................................14 Regarding mesothelioma, it is a rather a rare General ..................................................................................... 17 tumor of the pleura. Hematology .............................................................................. 19 3. *****Regarding Albustix: 3. (c) Commercial strips for detecting albumin BASIC HEMATOLOGY CONCEPTS / LABORATORY PROCEDURES ................................19 a. Useless if infected urine. (Albustix) use the following formula: NORMOCYTIC NORMOCHROMIC ANEMIAS .......................................................................20 b. Gives red color. Tetrabromophenol blue (yellow at 3.0) HYPOCHROMIC MICROCYTIC ANEMIAS .............................................................................24 c. Not useful if acid is added to urine. shades of green in the presence of protein at the MACROCYTIC NORMOCHROMIC ANEMIA .........................................................................25 d. Depends on acid precipitation of urinary proteins same pH. QUALITATIVE / QUANTITATIVE WBC DISOREDERS ........................................................26 This reaction is sensitive to 0.03g/L albumin. A LYMPHOPROLIFERATIVE / MYELOPROLIFERATIVE DISORDERS .................................29 false negative result occurs with acidification of COAGULATION AND PLATELETS ..........................................................................................35 urine. Also, a markedly alkaline urine (pH or Immunohematology ................................................................ 40 higher can give false +ve. Immunology ............................................................................. 41 4. ****Which is not a reducing sugar in urine? 4. (c) A reducing substance is the one that reduces a. Glucose. alkaline cupric sulfate to red coprous oxide. Microbiology............................................................................ 43 b. Galactose. Most important are glucose, lactose, fructose, ANTIBIOTICS, ANTIMICROBIALS, STERILIZATION AND DISINFECTION .....................43 c. Sucrose. galactoses and pentoses (e.g. ribose, xylose and BASIC TECHNIQUES .................................................................................................................44 d. Fructose. arabinose) while sucrose will not reduce alkaline BASIC BACTERIOLOGY............................................................................................................46 cupric sulfate. GRAM POSITIVE COCCI ...........................................................................................................47 GRAM NEGATIVE COCCI .........................................................................................................49 b. Rifampicin is a well known drug to cause red 5. ***Red urine is due to? 5. GRAM POSITIVE BACILLI ........................................................................................................49 a. INH urine. ENTEROBACTERECIAE & PSEUDOMONAS .........................................................................50 b. Rifampicin RICHETTSIAE, CHLAMYDIA AND MYCOPLASMA .............................................................52 c. Pyrizinamide. SPIROCHETES .............................................................................................................................53 BORDETELLA & BORRELIA ....................................................................................................53 6. **Urine strips detect all except 6. Fat droplets. Occur with glomerulonephritis and ANEROBIC BACTERIA ..............................................................................................................54 nephritic syndrome but are not detected by the BRUCELLA ..................................................................................................................................55 routine urine strips. MYCOBACTERIA .......................................................................................................................55 MISCELLANEOUS ......................................................................................................................56 7. **If urine is left for long time which is affected more? 7. Urea. The most labile constituent of urine is MYCOLOGY ................................................................................................................................57 urea. Bacterial action decrease urea and increase VIROLOGY ..................................................................................................................................60 ammonia and pH. 26th Shawual 1425 .................................................................. 64 8. **Abnormal constituent of urine includes? 8. (c) Although also glucose and protein are a. Urea abnormal constituents of urine, yet they b. Glucose normally present in trace amounts below the c. Cholesterol. detection limit of ordinary methods. d. Uric acid e. Protein. mohammad_emam@hotmail.com 1 mohammad_emam@hotmail.com 2CLINICAL & CHEMICAL PATHOLOGY MCQ BODY FLUIDS CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY9. ****Calcium in urine stone is present in all of the 9. (b) In 2ry hyperparathyroidism, hypocalcemia following except: a. UTI due to e.g. chronic renal failure is the cause of increased parathormone. Stones due to Clinical Chemistry b. Secondary hyperparathyroidism. hyperparathyroidism only occur with the 1ry or 3ry disease. Calcium is precipitated in stones with oxalate (at INSTRUMENTATION acid or neutral pH), or less commonly with urate 1. ******Difference between ELISA & RIA is ? 1. (a) Both techniques apply almost the same (at acidic pH) or with phosphate (at normal urine a. ELISA technique uses an enzyme. methodology, .ELISA technique uses an enzyme pH). Causes of hypercalciurea include: b. ELISA is used by bacteriologists while RIA by label and RIA uses radioisotopic label. - intestinal calcium absorption ( P level virologists vit D Ca absorption Or in case of hypervitaminosis D. 2. The label in ELISA is? 2. - Lack of renal tubular reabsorption e.g. with a. Enzyme furosamide. b. Antibody - Loss of Ca from bone (due to mobilization c. Antigen. as in 1ry & 3ry hyperparathyroidism, due to bone destruction or due to Cushings and 3. ***Which of the following not seen in chemistry lab? 3. (d) Electron microscope. thyrotoxicosis) a. Analytic balance. Otherwise, UTI causes stones at alkaline pH b. Centrifuge where ammonium is high and mixed stones form c. Spectrophotometer due to obstructing Ca stone which favors d. Electron microscope, infection and precipitation of ammonia salts. e. Turbidimeter.10. If urine is kept for a long time: 10. See 7. 4. **The washing is must in all heterogenous ELISA 4. (b) In ELISA, the first washing is used to a. Becomes black. Urine becomes black on standing in cases of techniques because? remove the unbound (free) sample antigen. The b. Urea increases. alkaptonurea ( homogentesic acid) and a. It remove the excess binding second washing removes unreacted free label c. Urea decreases. methemoglobinurea. b. Increase the specificity (not excess binding in either of the 2 washings) d. Creatinine increases c. Increase the sensitivity. If washing is not complete, this will false high11. Myoglobinuria is seen in: 11. Muscle injury (also known as rhabdomyolysis) specificity. e.g. in cases of crush injuries and strenuous If the question comes as It avoids excess exercise. binding, then this will be the choice. 5. **The enzyme in ELISA is present in the? 5. (a) The conjugate is the second antibody a. Conjugate conjugated with the enzyme. b. Microplate c. Buffer. 6. **A standard microplate in an ELISA has? 6. (a) 96 wells are present in the microplate (8 a. 96 wells rows x 12 columns).of these, 1 is used for the b. 98 wells blank, 2 for the –ve controls, 2 for the +ve c. 92 wells. controls and 4 for the cutoff control (COC). The remaining 85 for tests. 7. Five ml of a colored solution has an absorbance of 0.500. 7. (b) According to Beers law, absorbance is The absorbance of 10ml of the same colored solution will proportional to the final concentration (whatever be: the volume is) a. 1.000 b. 0.500 c. 0.250 8. a dichromatic analysis is carried to increase: 8. (a) Di- (bi) chromatic photometry measures a. Specificity absorbance of the sample at 2 different b. Linearity wavelengths. This corrects for interfering c. Sensitivity. substances increasing specificity of the method. mohammad_emam@hotmail.com 3 mohammad_emam@hotmail.com 4
  2. 2. CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY BLOOD GASES, PH AND ELECTROLYTES. 19. H+ homeostasis is altered by; 19. In actively contracting muscle, 8% of the pyruvate New a. Excessive change of pyruvate to lactate. New is utilised by the citric acid cycle and the9. ******PO2 (or gases) is measure in which unit? 9. © mEq/L (mmol in SI) is used for electrolytes remaining molecules are reduced to latctate. This a. Mmol e.g. BE, bicarbonate and H+. While mmHg (or lactate is oxidized by the liver to pyruvate which b. umol kpa in SI) is used for gases e.g. pCO2 and pO2. ,through gluconeogenesis, becomes glucose. If c. mmHg lactate is not efficiently reutilized in such a way, it accumulates in the blood causing lactic acidosis.11. Acidemia is associated with 11. Acid in urine and increased HCO2-. 20, ***Main extracellular ions? 20, b. Na is the major ECF cation, Cl is the major ECF Increased hydrogen ion in the blood is termed 21, a. Na & K 21, anion, K is the major ICF cation and proteins academia. If the cause is metabolic, there will be 22, b. Na & Cl 22, followed by phosphates are the major anions. compensatory hyperventilation H+ back to 24, **Main electrolyte in blood is? 24, normal while HCO3- drops. Furthermore, if renal 25, ***Electrolytes in ECF 25, function is normal, H+ will be excreted. 26. a. Na is a major cation 26. If the cause is respiratory, renal compensation b. Cl is a major cation will cause H+ excretion and HCO3- retention and d. HCO3 is a major anion. generation lowering H+ back to normal. ***Main intracellular cation is; **In serum:12. ***To correct acidosis, the kidneys: 12. (c). See 11. a. Sodium is the main cation. a. secrete more H+ in urine. b. Bicarbonate. b. Synthesis bicarbonate to ECF ***Intracellular fluid contains: c. Both a and b a. More potassium less sodium than extracellular fluid.. b. Sodium and potassium in equal amount.13. **A buffer is made of ? 13. (c) A buffer system is made of a weak acid and a. Strong acid & strong salt its salt with a strong base of a weak base and its 23. **All causes renal damage except 23. Hypocalcaemia. b. Strong acid & weak salt salt with a strong acid. Causes of renal damage include; hypovolemia c. Weak acid & strong salt (hemorrhage or dehydration), myoglobulinurea, d. Weak acid & weak salt. hypercalciurea, uricosuria, and drugs e.g. aminoglycosides and ACE inhibitors.14. ****pH means: 14. Negative log H+ concentration 27. Renal tubular injury occurs in 27. See 23.15. ***What is the base: acid ratio at pH 7 for acid of pK6? 15. (d) According to Henderson Hasselbalchs 28. Hypernatremia occurs with 28. (d) Hypernatremia occurs with: a. 0.01 equation, pH = pK + Log base/acid. By a. Cushing disease * body Na : due to extrarenal water loss or b. 0.1 compensation, Log (base / acid)= 1, thus base: b. Dehydration renal diuresis. c. 1.0 acid = 10:1.1 c. hypothalamic injury * Normal body Na: due to extrarenal loss e.g. d. 10 d. All of the above hyperthermia or renal loss e.g. DI. e. 100 * Na retention e.g. steroids or Na intake.16. ***Which is more serious? 16. (c) Critical K+ values are <2.5 or > 6.5 mEq/L 28. Regarding concentration of urine; 28. a. Approximately 80% of the water and NaCl a. Glucose 15mmol/l Critical glucose <40mg or >450mg (2.2 & New a. Proximal tubules return 75% of filtered water. New contenet together with glucose, phosphate, and b. pH 7.25 acidosis. 25mmol respectively), 1 b. Distal convoluted tubules deliver 40-60L of fluid to 1 amino acids are reabsorbed in the proximal tubule. c. Potassium 1.5 mmol/l critical pH <7.2 or >2.6 collecting tubules / day. About 20% of the tubular fluid enters the loop of d. Sodium 150 mmol/l critical Na+ <120 or > 160mEq/L c. Osmotic pressure in renal cortex is higher than in medulla. Henle where water is passively aborbed; 6ml per d. ADH acts on all parts of nephrone. minute of concentrated tubular fluid now enters17. ******Metabolic acidosis can result from: 17. (a) Ingestion of certain medicines or chemicals e. Aldosterone increase Na excretion. the distal tubule, where there is an active e.g. metformin.(glucophage). reabsorption of sodium. The fluid leaves the distal Metformin causes lactic acidosis. tubule at a rate of approximately 1ml per minute Generally, metabolic acidosis is due to either passing into the collecting ducts in the form of addition of H+ ( AG), excretion of H+ or urine. Aldosteron is relased due to ineffective loss of HCO3- arterial pressure in the kidney. It causes sodium reabsorption which raises plasma osmolality. ADH18. pH of the blood. 18. increases permeability of distal and collecting tubules to water urine concentration.19 Acid base balance. 19 mohammad_emam@hotmail.com 5 mohammad_emam@hotmail.com 6 CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY28. Regarding excretion of Na+ 28. b. Na+ excretion is influenced by 33. *****HBA1c (Glycosylated hemoglobin) is? 33. (b) GlycHb (RR 4-6%) is formed by nonNew a. Not dependent on aldosterone. New mineralocorticoids (mainly aldosterone): a. Not present in healthy normal individuals. enzymatic attachment of glucose to N-terminal2 b. Major share of GF osmolarity with associated ions. 2 valine of B-chain of Hb. Three types occur, HbA1a, reabsorption. The GF is isoosmolar with plasma b. in prolonged sustained hyperglycemia c. It passively diffuses in proximal tubules. i.e. Na is the major electrolyte. 90% of Na is HbA1b, HbA1c, Both total and HbA1a are used. d. In distal tubules it is exchanged for K+ actively (not passively) reabsorbed in the PCT. K Time averaged blood glucose = GlycHbx33.3-86 e. Coupled with K+ is excreted from DCT in exchange with Na (not (mg/dL) the reverse and not coupled with it). GlycHb reflects 8-12 weeks of blood glucose while fructosamine reflects 2-4 weeks.28. Regarding buffer systems; 28. b. Acids are substances that tare capable of 34. ***Glycogen differs from starch in: 34. It is a highly branched structureNew b. An acid is a substance that releases H+ New donating protons. When a strong acid is added to a3 3 35. **Cellulose is not metabolized in humans because of 35. Glucose units in cellulose are combined by c. Buffering involves change of strong acid to base. buffer, the salt reacts with the acid forming weak acid, and its salt (not base). absence of which enzyme? cellobiose bridges. These are hydrolyzed by cellobiase which is lacking in animal and human gut. GLUCOSE, HEMOGLOBIN, IRON AND BILIRUBIN. 36. **Xylose test is done to detect the function of: 36. c. Xylose is absorbed from proximal small10. Factors affecting glucose level in blood include: 10. Adrenaline, T4. These together with cortisol, GH a. Stomach. intestine independent on pancreas.. and glucagons are the hyperglycemic hormones b. Pancreas. causing 2ry diabetes in case of excessive secretion. c. Upper small intestine. d. Lower small intestine.29. **Glucose level to diagnose hypoglycemia in newborn is. 29. - 25-30 g/dl e. Large intestine In newborn babies, glucose tends to be lower than in adults. Critical low level in newborn is 30mg/dL 37. ****Von Gerkes disease is caused by deficiency of: 37. (a) See 32. a. Glucose 6 phosphatase30. ***About GTT, which is correct according to WHO 30. (c) WHO recommendations for GTT include: b. Glucose 6 phosphate dehydrogenase recommendations? a. Should not be done in pregnant women, 38. What happens if sucrose is given parentrally: 38. It will be secreted unchanged or metabolized b. Should not be done after giving heavy carbohydrate diet for 3 days. 39. ***Which of these is not a ketone body? 39. (c) Ketone bodies are formed by condensation of 2 c. Should be done after 4-6 hrs fasting. a. Acetone. acetyl Co A Acetoacetic acid which gives B b. Acetoacetic acid. hydroxyl butyric acid by reduction or acetone by31. **With age renal threshold for glucose? 31. (b) With age, the renal ability to reabsorb filtered c. Butyric acid. decarboxylation. a. Increased glucose is decreased leading to appearance of d. B-hydroxy butyric acid. Butyric acid is a fatty acid b. Decreased glucose in the urine at lower plasma levels. e. None of the above. c. Not changed 40. ***In Gauchers disease; 40. (b) Gauchers is a glucosylceramide lipidosis32. **All are inborn error of glycogen metabolism except? 32. (b) Essential fructosuria is due to aldolase B defect a. Glycoprotein is accumulated. (lysosomal storage disease). It is caused by a. Essential fructosuria leading to accumulation of fructose-1-P b. Glucocerebrosidase is deficient. glucocerebrosidase enzyme leading to b. Phenyl ketonuria Galactosemia (serious) is due to decreased accumulation of glucosylceramide HSM and c. Galactosemia Galactose-6-P uridyl transferase leading to pigmentation of exposed parts. d. Glycogen storage disease decreased glycogen synthesis. Types of glycogen storage diseases (GSD) include: 41. Bile duct obstruction can be diagnosed by: 41. (c) Cholestatic hyperbilirubinemia is characterized Type I (VonGierkes): G6P a. AST by conjugated hyperbilirubinemia and b. T. Bilirubin hyperbilirubinuria (only the conjugated fraction Type II (Pompes): lysosomal maltase c. Bilirubin in urine appears in urine). Type III (Coris) : debranching enzyme. d. Ester bilirubin Type IV (Andersons): Absent debranching enzyme 42. *** Increased jaundice is diagnosis by 42. (a) Estimation of jaundice depends on serum Type V (McArdles): muscles a. T. bilirubin bilirubin, other mentioned tests help to identify the phosphorylation. b. AST cause of jaundice. c. ALT d. ALP mohammad_emam@hotmail.com 7 mohammad_emam@hotmail.com 8
  3. 3. CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY CALCULATIONS, QC AND STATISTICS 50. Sensitivity and specificity are 50. (b) Sensitivity & specificity can be adjusted a. Directly related. according to cutoff level. Sensitivity can be43. **Most of the concentration are calculated using factor, 43. (b) For methods obeying Beers law, slope of the b. Inversely related. increased by choosing a higher cutoff to include this factor is? calibration curve (Cs/As) provides a constant to c. They mean the same. more TP, this meanwhile will include more FP a. Std absorbance / std value calculate the unknown concentration. Also thus specificity. However, this is not always b. Std value / std absorbance depending on the formula: the case as highly specific highly sensitive tests c. Std value x std absorbance At x Cs = As x Ct, thus, Ct=(Cs/As)x As as well as poorly specific poorly sensitive exist.44. **Ten microliters are? 44. (d) μL = 10-6L 10 μL = 10-5L = 0.00001L 51. A carryover in chemistry analyzer means a disturbance in 51. (b) Carryover is due to contamination by a a. 0.01 L readings because: previous sample. It is calculated by measuring a b., 0.001 L a. The analyzer was carried and placed at a different place. high standard and a low standard each 3 times c. 0.0001 L b. The previously measured solution was still in the cuvette then applying the following formula: d. 0.00001 L c. The current solution is overflowing in the cuvette. Carry over = (contaminated low – actual low) / e. non of these. contaminated high – actual high)45. **How much water should be added to 500ml of a solution 45. (c) Using the formula: 52. STAT test means: 52. (c) Stat refers to immediate or as initial dose. of 10% NaOH to bring it to 75%? C1 x V1 = C2 x V2 a. Start at. a. 666ml 10 x 500 = 7.5 x V2 b. Standardize and test. b. 125ml V2 = 666mL c. Short turn around time c. 166ml Thus, 166 mL of DW should be added. d. 250ml e. 375ml CREATININE, UA, BUN AND AMMONIA46. When calculated osmolarity can not be accounted as a 46. Calculated osmolarity = 2 X Na + Glu + Urea 53. ***Which of the following result shows renal impairment? 53. (e) A urine osmolarity less than 800 after 12 hrs measurement for osmolarity? (All in mmol/L) a. urea 9 mmol of water deprivation denotes renal impairment. a. per 100gm/l When calculated osmolarity is less than b. creatinine 10 mmol/l Urea 9mmol is high normal (n: 2.9-8.2) and is b. Urea 20 mm/l measurement for osmolarity, this denotes c. urates not a very sensitive measure of GFR. increased osmolar gap (OG). This occurs with: d. cholesterol Creatinine, although a sensitive measure of GF, - Factitious hyponatremia (due to e. urine osmolarity less than 800 after 12 hrs of water 10umol is normal (n: 53-106) decreased water) deprivation. Cholesterol and urates are useless in this regard. - Unmeasured osmotically active compounds e.g. alcohols, sugars, and 54. **Low GFR occurs in all except: 54. (b) low GFR occurs with: ketones. a. Congestive heart failure. - Hemorrhage. b. Urethral obstruction. - Dehydration.47. **Calibrator sera are? 47. (b) Secondary std? - Renal loss of fluids e.g. diuretics. a. Primary std A primary Std is a reference standard. - Ineffective blood volume, e.g. CO, b. Secondary std Secondary Std is standardized depending on the systemic VD, renal vasoconstriction. c. Tertiary std primary standard. d. Internal std. 55. Diagnosis of RF 55. GFR is an index and a monitor of increased or decreased renal functions. It is practically48. **External QC program means? 48. (b) In EQC, participants receive QC material to estimated from serum creatinine and creatinine a. An external person come & does the QC test be tested inside their labs. Results are sent to clearance. b. A QC person goes to another lab & does the test.. supplier to be compared to other labs results. EQC will be most practically implemented 56. ****Nephrotic syndrome is characterized by all except: 56. (a) Nephrotic syndrome consists of: during the regular visit of the lab coordinator. a. Hypocholesterolemia. - Heavy proteinuria. This will give opportunity for errors to be b. Hypoalbuminemia. - Hypoalbuminemia. investigated on site and corrected rapidly c. Albuminuria. - Oedema. (Monica) d. Hypertriglyceridemia. - Hypercholesterolemia (Almost always49. **We select 2SD value to plot LJ curves because? 49. (c) QC results follow a Gaussian distribution, e. None of the above present). a. They are easy to calculate, thus 95% of these results normally fall within Hypertriglyceridemia is present in 50% of b. They cover 97.5% of normal population, ±5% of the mean. Therefore, 2.5 out of 100 cases. c. Patient value rarely go beyond these limits. (1:40) are acceptable to be above +2s and 2.5 our of 100 are acceptable below -2s. mohammad_emam@hotmail.com 9 mohammad_emam@hotmail.com 10 CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY57. ****Ureate excretion by the kidney is inhibited by: 57. (b) Thiazide diuretics cause relatively urate 65. **Lipoprotein related to hypertension? 65. . LDL a. Probenecid. retention, glucose intolerance and hypokalemia b. Thiazide diuretics. and interfere with water excretion and may 66. *****Which is important for atherosclerosis? 66. (b) cause hyponatremia. a. HDL Probenecid is a uricosuric agent like allopurinol. b. LDL c. Chylomicrons.58. Chronic glomerulonephritis is diagnosed by: 58. (d) In chronic glomerulonephritis, there is a. Blood urea. persistent deterioration of renal functions ending 67. ***In plasma protein electrophoresis, the protein that will 67. Albumin. b. Creatinine. with renal failure. go first is (moves furthest from application)? c. Proteinuria d. All of the above On electrophoresis; 68. ***Based on behavior of lipoproteins in 68. ultracentrifugation pre-B lipoprotein is? Chylomicrons and its remnants stay at the a. HDL origin. PROTEINS, ELECTROPHORESIS AND LIPIDS b. LDL. VLDL at preβ (=α2 globulin region)59. **The protein having molecular wt less then albumin is? 59. (b) B2-microglobulin has a MW 11,800. c. VLDL IDL at broad β a. Beta protein Betalipoprotein is 380,000. d. Chylomicron LDL at β (= β globulin region) b. B2-microglobulin. BJ protein is the light chains of HDL at α (= α1 globulin region)/ c. Lysozyme. immunoglobulins. Its MW is variable from d. Benze Jones protein. 11,000 for monomers, 22,0000 for dimmers or 69. **All of the following are lipoproteins except? 69. (d) Although phospholipids are not lipoproteins, tetramers. a. Phospholipid they are ingredients of lipoproteins, conferring Lysozyme is 14,000. It is used to differentiate b. VLDL the hydrophilic properties. AML M4 and M5 and appears as a far cathodal d. Sphingomylin band on serum or urine EP. e. LDL f. HDL60. ******In cystic fibrosis, which is deficient? 60. (d) Alpha 1 antitrypsin a. Beta globulin 70. What is the proposition of pulmonary surfactant? 70. (b) Dipalmityl lecithin (a lecithin phospholipid b. Macroglobulin a. Phospholipid acid with 2 palmetic acid residues) is the chemical c. Albumin b. Dipalmityl lecithin composition of pulmonary surfactant. d. Alpha 1 antitrypsin c. Phosphatidyl choline, e. Alpha 2 antitrypsin. 71. **HDL is good cholesterol because? 71. (a) HDL is composed of 20% cholesterol, 30%61. ***Diet rich in phenylalanine should be restricted in? 61. (a) In phenylketonuria, there is phenylalanine a. It has more protein & phospholipids in it phospholipids and 50% proteins. a. Phenyl ketonuria b. It has no cholesterol in it,. hydroxylase leading to accumulation of b. Tyrosinemia c. It has less TG in it. phenylpuruvate and its derivatives and their c. Maple syrup disease excretion in urine. Diet rich in phenylalanine should be restricted to prevent brain damage. 72. ***Which lipoprotein has highest concentration of 72. (b) VLDL are the TG rich lipoproteins cholesterol? HDL has 20% cholesterol. a. VLDL IDL has cholesterol and TG in equal amounts.62. ***In phenylketonuria, diet should be low in: 62. (a) Phenylalanine (see 61) b. LDL LDL is the richest lipoprotein in cholesterol a. Phenylalanine. c. IDL esters. b. Carbohydrate. d. HDL c. Lipids. 74. ****Which is not associated with abetalipoproteinemia: 74. (b) Hereditary spherocytosis is due to spectrin62. Hypoalbuminemia is associated with all except? 62. (a) Tetanus is clostridial infection caused be C. a. Acanthocytes in the peripheral blood. deficiency. a. Tetanus tetani has nothing to do with albumin. b. Hereditary spherocytosis. Abetalipoproteinemia is a lipoprotein b. hypocalcaemia c. Malabsorption and fatty stools abnormality of absent LDL due to autosomal c. oedema recessive abnormality in the synthesis of apoB + d. toxic effect of sulfonamide failure of chylomicron formation leading to malabsorption of fats + fat soluble vitamins +64. **Gluconic amino acids include: 64. (a) Ketogenic amino acids are: Leucine and adrenal dysfunction. 50-70% of RBCs have a. Alanine. lysine, spinal projections (acanthocytes) b. Methionine. Mixed amino acids are: Isoleucine, c. Valine. phenylalanine, threonine, tryptophan and 75. Chylomicrons: 75. (a) Chylomicrons dont confer an excess d. Glutamic acid. tyrosine. a. Can cause thrombosis. cardiovascular risk, however, in LpL deficiency e. All of the above. Gluconic amino acids are all the other amino b. Cannot cause thrombosis. and apoC II deficiency, the patient presents with acids. lipemia retinalis and retinal vein thrombosis. mohammad_emam@hotmail.com 11 mohammad_emam@hotmail.com 12
  4. 4. CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY76. Nature of apoproteins. 76. 5 major classes of proteins A to E 85. ***In MI, which is the last enzyme to be raised and lasts 85. (d) long? Onset (h) Peak (h) Duration Saturated Unsaturated a. CK (d)77. Saturated vs unsaturated fats (nutritional value) 77. e.g. Oleic a (50% of Linoleic a CK 6-12 20-30 2-6 b. CK-MB. CK-MB 3-10 12-24 1.5-3 body fat) Linolenic a Palmitic a (25% (both are c. AST. AST 6-12 20-30 2-6 of body fat) Essential) d. LDH LDH 6-12 24-72 7-14 Stearic a (5% of Arachidonic a. body fat) 86. **Isoenzymes: 86. © Isoenzymes have the same catalytic activities Acetic a. Butyric a. a. Are physical types of one enzyme. and differ in physicochemical properties. Presence Adipose Vegitable oils. b. Have different electrophoretic mobility. Suffix Anoic Enoic c. All of the above Significance Arachidonic acid is precursor of Pgs. 87. **MI is diagnosed by: 87. (a) CK-MB is specific for cardiac muscle, CK- Although not a. CKMB BB for brain and CK-MM for skeletal muscle. essential, it b. CKBB depends on c. CKMM essential FA d. LDH Chemistry No double Double bonds bonds78. Which is best for parentral alimentation? 78. (b) Parentral nutrition is composed essentially 88. **Elevation of LDH is caused by: 88. (d) LDH is present in the cells of the heart, liver, a. FFA. 79. of: a. Myocardial disease muscles, blood and malignancies. b. AA a) Nitrogen source: synthetic valuable amino b. Liver disease c. lipoproteins acids (9-17g/L N2) c. Prostatic disease b) Energy source: Glucose (mainly) and fat d. many organ disease because it has many distribution emulsion (additional source to avoid EFA deficiency). 89. ****Myoglobin in injury of: 89. (a) muscle whether cardiac or skeletal is the c) Electrolytes and trace elements. a. muscle. source of myoglobin.79. Protocol for IV nutrition? b. Liver80. **Regarding lipoprotein metabolism: 80. Although cholesterol can be synthesized by all nucleated cells, however, cholesterol in VLDL, CLINICAL ENCOCRINOLOGY IDL and LDL is of hepatic origin82. Treatment of familial hypercholesterolemia. 82. These include general management of 90. *****ADH is? 90. (b) ADH is produced by the hypothalamus and hypercholesterolemia + cholesterol lowering a. Produced by posterior pituitary stored and secreted from the posterior pituitary. drugs + oestrogen replacement in b. Produced in the hypothalamus. postmenopausal women. 91. **The method used to estimating insulin is? 91. (d) Immunoassay (multiple labels) is used for a. Electrophoresis the measurement of insulin. b. Kinetic estimation. c. Spectrophotometer. CLINICAL ENZYMOLOGY d. Radioimmuno assay.83. ***The better for diagnosis of acute pancreatitis is? 83. (b) Lipase elevation is of a greater magnitude (2- a. Amylase 10 xN) and duration than amylase in acute 92. *****After the insulin dose, the patient soon comatozed 92. (b) Hypoglycemia (glucose <3mmol/l) b. Lipase pancreatitis. When lipase method is optimized, due to c. ALP the test is more sensitive and specific than a. Hyperglycemia d. ACP amylase for detection of acute pancreatitis. b. Hypoglycemia (glucose <3mmol/l) c. ketonuria84. **Activities of some enzyme increased in some disease 84. (b) That’s why enzymes are measured for the c. Ketoacidosis is the cause of coma conditions because they are? most part by their activity rather than d. Lactic acidosis, a. Non functional enzymes concentration. b. Functional enzymes c. Neither mohammad_emam@hotmail.com 13 mohammad_emam@hotmail.com 14 CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY CLINICAL & CHEMICAL PATHOLOGY MCQ CHEMISTRY93. **While using the pregnancy test we are measuring? 93. (b) α subunit of HCG is very similar to α 98. Carcinoid tumors secrete 98. 5HIAA. a. B-HCG subunit of TSH and FSH and identical to LH. New New Carcinoid tumors originate from the b. Total HCG Although β subunits of HCG and LH are very enterocromaffin cells (APUD cells) of the c. B-HCG & LH similar, antibodies can be made to the β subunit intestine and most commonly occurs in the d. B-HCG & FSH. of HCG that do not cross react with LH or other appendix, terminal ilium and rectum. pituitary hormones. Most EIA use 2 monoclonal Presentation may be asymptomatic until antibodies against different sites of HCG metastasis (most cases), appendicitis (10%) or molecule one for carboxyl terminal of β chain carcinoid syndrome (in5% when there is liver and the other to the α chain, i.e. react with intact metastasis) as spontaneous flushing on the face HCG. and neck, abdominal pain and water diarrhea, cardiac abnormalities and hepatomegally. The94. ****Water deprivation test is used in the diagnosis of: 94. (b) Water intake is restricted the patient loses 3- tumor secretes a wide variety of amines an a. Anterior pituitary disease. 5% of body weight or until 3 consecutive hourly peptides including serotonin (5- b. Posterior pituitary disease. determination of urine osmolarity are within hydroxytryptamine (5-HT) with its major c. Hypothyroidism. 10% of each other. Measure urine osmolality, metabolite 5-hydroxyindoleacetic acid (5- plasma vasopressin and increased urine HIAA)), bradykinin, histamine and tachykinins osmolality with exogenous vasopressin. and prostaglandins. Urine Pl. VP After VP osmol Normal >800 >2 DI <300 Undetectab Neeman Peck disease is due to deficiency of sphengomylinase le Cholesterol: In LDL, cell membrane, precursor of bile salts and steroid hormones. Nephrogeni <300 >5 No change c DI95. ****24 hours urine for VMA is used for diagnosis of 95. (b) Catecholamines are oxidized to VMA and diseases of: metanephrins. 24hour urinary metanephrins is a. Adrenal cortex. the best single test for pheochromocytoma. b. Adrenal medulla Specificity and sensitivity approach 100% when both VMA and metanephrines are measured.96. ***Hypertension is found in all of the following endocrinal 96. (d) Hypertension secondary to endocrinal causes diseases except: occurs in: a. Cushings syndrome. - Pheochromocytoma. b. Pheochromocytoma. - Crohns syndrome c. Adrenal medulla hyperplasia. - Cushings syndrome. d. Addissons disease. Addison is associated with hypos (hypotension, hypokalemia, hyponatremia and hypocortisol)97. Diabetic coma presents with: 97. All. a. Ketone bodies in urine In diabetes, 2 types of coma may occur, DKA b. Blood glucose may be 1000mg or more and nonDKA. Glucose levels in nonDKA are c. osmotic diuresis present typically <800 mg/dL. Once hyperglycemia is established, ketonurea & pH should be looked for to differentiate.98. **While anti-PSA is coated on to the well in total PSA 98. (a) different antibodies. estimation, the antibodies coated in free PSA is? a. The same antibodies that is coated for total PSA b. Same antibodies in large amount c. Same antibodies in very low amount d. Different antibodies. mohammad_emam@hotmail.com 15 mohammad_emam@hotmail.com 16

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